John T. Rowe, MD, Author at Health Matters

Diphtheria, Pertussis and Tetanus

John T. Rowe, MD / May 18, 2011

Three Preventable Infections

The diphtheria, pertussis, tetanus vaccine (known generally as DPT) in its various forms is a combination of three vaccines which protect against the following three, serious, infectious diseases, all caused by toxin (poison) producing bacteria:

Diphtheria

Diphtheria is caused by the bacterium, Corynebacterium diphtheriae, which produces a toxin that can affect the heart, kidneys and nervous system. It starts as a severe sore throat and fever and is characterized by a thick coating on the back of the throat which makes it difficult to breathe and swallow. Diphtheria is extremely contagious and is transmitted by sneezing or coughing.

Tetanus

Tetanus is caused by the bacterium, Clostridium tetani, which is commonly found in the soil. It is also known as lockjaw, because it causes painful muscle spasms particularly noticeable in the facial muscles. Tetanus cannot be transmitted from one person to another. Many other injuries besides stepping on the proverbial ‘rusty nail’ can cause tetanus, including burn injuries. Because this bacterium requires an environment without oxygen to reproduce, any deep penetrating wound, such as might be caused by a rusty nail, could potentially cause tetanus.

Pertussis

The toxin produced by the bacteria, Bordetella pertussis, primarily causes damage to the lungs, along with painful spasms of coughing. Initial symptoms start as a common cold and the infection can last up to six weeks. It is also known as whooping cough, because of the noise made when a patient tries to take a deep breath. It is particularly dangerous in infants because the airway or windpipe is smaller than in older children and adults. Pertussis is also extremely contagious and is transmitted by sneezing or coughing.

Recommended Immunization Schedule

The DTaP vaccine is a safer version of the older vaccine called DPT. Unless there is a reason a child should not receive this vaccine, such as an allergic reaction, the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend that DTaP immunizations be given as a series of five injections at ages 2 months, 4 months, 6 months, 15 to 18 months and 4 to 6 years. After the initial series of immunizations, a modified vaccine called Tdap is be given as a booster shot at ages 11 to 12, or to older teens and adults who have not yet received a booster with pertussis coverage. Thereafter, a Td booster to prevent tetanus and diphtheria is recommended every 10 years. It is important to discuss any questions you have about the immunizations for diphtheria, pertussis and tetanus with your private physician. For further information about immunizations, follow the link at the top left side of this page (Vaccines).

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Child Passenger Safety Recommendations

John T. Rowe, MD / April 28, 2011

Rear View Until Age Two

Automobile accidents are one of the top causes of morbidity and mortality for children. In fact, automobile crashes continue to be the leading cause of death for children ages 4 and older. The American Academy of Pediatrics has issued a new policy statement recommending that ‘all children be restrained in a rear-facing position in the back seat of the vehicle until they reach age 2 or the highest weight or height allowed by the care safety seat manufacturer’. Other recommendations cited in the policy for keeping children safe while riding in passenger vehicles include:

1) Children ages 2 and older or those who have outgrown the rear-facing weight or height limit should remain in a forward-facing car safety seat with a harness for as long as possible, up to the limits allowed by the seat manufacturer.

2) All children whose weight or height is above the forward-facing limit for their car safety seat should use a belt-positioning booster seat until the vehicle lap-and-shoulder seat belt fits properly, typically when they have reached 4 feet 9 inches tall and are between 8 and 12 years of age.

3) When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap-and-shoulder seat belts for optimal protection.

4) All children under age 13 should be restrained in the rear seats of vehicles for optimal protection.

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Alzheimer’s Disease

John T. Rowe, MD / April 19, 2011

Ten Warning Signs

Alzheimer’s (AHLZ-high-merz) disease is the most common form of dementia, which is a slow decline in memory, thinking and reasoning skills. It is a fatal disorder that results in the loss of brain cells and function and which currently affects 5.4 million Americans. Most people diagnosed with Alzheimer’s disease are 65 years of age or older, but undetectable changes in the brain may begin five to ten years earlier. Some people can have milder memory problems, known as mild cognitive impairment, years before manifesting full blown Alzheimer’s disease.

Many older individuals wonder if they might be experiencing some of the signs of Alzheimer’s disease, but since our memories change as we grow older, how do we know if these changes may just be a part of normal aging? According to the Alzheimer’s Association, ‘memory loss that disrupts daily life is not a typical part of aging’ and they have prepared a list of ten warning signs that can help you recognize when you might be experiencing signs that warrant a visit to the doctor.

1) Memory changes that disrupt daily life

2) Challenges in planning or solving problems

3) Difficulty completing familiar tasks

4) Confusion with time or place

5) Trouble understanding visual images and spatial relationships

6) New problems with words in speaking or writing

7) Misplacing things and losing the ability to retrace steps

8) Decreased or poor judgment

9) Withdrawal from work or social activities

10) Changes in mood and personality

Even when armed with information such as this it can sometimes be difficult to distinguish between the early signs of Alzheimer’s disease and the normal changes associated with aging. The important thing to consider is whether the problem you are concerned about is something new. If you have always had difficulty balancing a checkbook, then struggling with this task is probably not a warning sign. One of the most common early signs is forgetting recently learned information. Whether an individual recognizes the warning signs in themselves or others are the first to notice changes in memory, behavior or abilities, it is important to see a doctor to find out the cause. The sooner the diagnosis of Alzheimer’s disease is made, the better chance one has to receive treatment and plan for the future.

For additional information visit the Alzheimer’s Association website at:

www.alz.org

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Energy Drinks

1 Comment / John T. Rowe, MD / March 27, 2011

Reporting in the March 2011 issue of the journal Pediatrics, S. M. Siefert et al concluded that energy drinks have no therapeutic benefit and that many of the ingredients of these unregulated products have not been sufficiently studied to determine the potential toxicity and serious adverse affects associated with them. Surveys have shown that 30% to 50% of adolescents and young adults consume energy drinks, which may contain high levels of caffeine, taurine and guarana, all of which have stimulant properties. Some energy drinks contain other ingredients such as vitamins, herbal supplements and sugar or other sweeteners. Energy drinks are a $9 billion industry in the United States, where more than half of the consumers are children, adolescents and young adults who use these products to “improve energy, weight loss, stamina, athletic performance and concentration”.

Adverse Effects

Caffeine is the main ingredient in energy drinks, which are different from sports drinks used for rehydration. Consuming large amounts of caffeine, such as may be found in some energy drinks, has been associated with serious adverse effects, including seizures, mania, stroke and sudden death. Those most vulnerable to these consequences include children with cardiovascular, renal or liver disease, seizures, diabetes, mood and behavioral disorders (including ADHD and eating disorders), hyperthyroidism or those who take certain medications.

Caffeine is the most commonly used psychoactive drug worldwide, a drug that is legally available over the counter to children. Some of the physiologic effects of caffeine include coronary and cerebral vasoconstriction (narrowing of the arteries that supply the heart and brain), stimulation of the heart, increased urination and increased blood pressure. Undesirable side effects also include anxiety, headache, irritability, tremor, sleep disturbances and withdrawal symptoms on cessation.

Editorially Speaking

At one time, coffee and caffeine were privileges of adulthood. It was an unspoken rule that for the most part children did not drink coffee. For centuries, adults have consumed coffee to improve mental alertness, concentration and stamina, usually without apparent adverse consequences when used in moderation. Unlike the amount of caffeine in sodas or soft drinks, which are regulated by the Food and Drug Administration as a food, energy drinks are considered dietary supplements and, therefore, the amount of caffeine is not regulated. We know that individuals with certain medical conditions are at risk of adverse side effects from the ingredients of energy drinks and should avoid them. Much more study, however, is needed to determine their overall safety for children, adolescents and young adults. Until that time, it makes sense that the developing child’s brain would be better off without exposure to caffeine and the other ingredients found in energy drinks.

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Pregnancy and Alcohol

1 Comment / John T. Rowe, MD / March 17, 2011

American Academy of Pediatrics Confirms ‘There is No Safe Amount’

Reporting in the March 2011 issue of AAP News, Janet F. Williams, MD, FAAP reviewed the recommendations concerning consumption of alcohol during pregnancy and confirmed the Academy’s stance that “there is no safe amount, not a single drop”! Some recent reports in the mainstream media have claimed that moderate consumption of alcohol in pregnancy may be ok. Dr. Williams revealed the flaws in several of these studies and concluded that ‘all pregnant women should abstain from any alcohol consumption to eliminate the risk of alcohol’s damaging effects to the developing fetus”.

Alcohol and the Fetus

When the mother drinks alcohol, so does the baby. Alcohol passes through the placenta to the baby through the umbilical cord and because the fetus metabolizes alcohol more slowly than an adult, the developing baby’s blood alcohol concentration is higher. Alcohol interferes with delivery of oxygen and nutrients to the baby’s developing tissues, organs and brain. Because many women do not know that they are pregnant until several weeks or more after conception, it is important to abstain from alcohol if pregnancy is a possibility.

Fetal Alcohol Spectrum Disorders

The term Fetal Alcohol Spectrum Disorders (FASD) refers to a range of harmful effects to children whose mothers drank alcohol during pregnancy. They include growth delay, abnormal facial features, small head size and other physical malformations. In addition, neurological problems, such as poor coordination, speech and language delays and vision and hearing problems are common in this disorder. Finally, FADS can be manifested as mental and behavioral problems, including hyperactive behavior and learning disabilities. Fetal Alcohol Spectrum Disorders are thought to be the leading known preventable cause of mental and physical birth defects in the United States. There are approximately 40,000 infants born in this country each year with some form of alcohol related damage.

The Bottom Line

Taking it a step further, scientists at the Centers for Disease Control and Prevention (CDC) state that not only should pregnant women not drink alcohol during pregnancy, but that there is no safe time during pregnancy and there is no safe type of alcohol during pregnancy. If a woman is drinking alcohol during pregnancy, it is never too late to stop. The sooner she stops the better it will be for both the baby and herself. The results of drinking alcohol during pregnancy can have life long consequences for which there is no cure. The good news is that they are completely preventable by abstaining from alcohol consumption during pregnancy.

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The Importance of Nutrition and Physical Activity in Cancer Prevention

2 Comments / John T. Rowe, MD / March 6, 2011

The American Cancer Society guidelines state that in addition to not smoking, consuming a mostly plant-based diet (including five or more servings of vegetables and fruit daily), being physically active, and maintaining a healthy weight are the most important means to reduce cancer risk. They point out that about one-third of cancer deaths are due to nutrition and physical activity factors, including excess weight. Almost two-thirds of adults in the United States are overweight and obesity rates in children have doubled in the last two decades, making this a significant health concern.

Physical activity has been shown to reduce the risk of breast, colon and possibly endometrial and prostate cancers. A diet high in fruits and vegetables is associated with a lower risk of acquiring cancers of the mouth, pharynx, esophagus, lung, stomach, colon and rectum. Beginning a healthy diet and physically active lifestyle at any stage of life can reduce cancer risk. It is important to consult your doctor before beginning a vigorous exercise program.

Summary of American Cancer Society Guidelines

1) Don’t smoke or use any tobacco products!

2) Maintain a healthful weight throughout life

3) Adopt a physically active lifestyle

Adults: 30 to 60 minutes of moderate to vigorous physical activity five or more days a week

Children and Teens: 60 minutes of moderate to vigorous physical activity five or more days a week

4) Talk to you doctor about cancer screening tests

5) Consume a healthful diet

Eat five or more servings of fruits and vegetables a day

Choose whole grains instead of refined grains and sugars

Limit processed and red meats

6) Limit consumption if you drink alcoholic beverages

Women should have no more than one drink per day

Men should have no more than two drinks per day

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