Clark Avenue Connection

Dr. Jamila Fletcher

Weekend Notes

Written by Dr. Jamila Fletcher

It’s the Weekend, April 21 and 22, 2018

  • No Walk-In Appointments on the Weekend
  • Patients are seen by appointment only on all holidays and weekends.
  • If you think your child may need to be seen this weekend, call 919-781-7490 in the morning after 9 am and speak to the nurse working with the On Call Pediatrician.
  • Saturday and Sunday Clinic begins at 10am. Clinic ending time varies depending on how busy we are.
  • After clinic, we are available to speak by phone about any urgent concerns you may have.

The Weekend Lineup

After Hours Care

  • Our On Call Pediatrician manages our after hours care.
  • Urgent calls outside regular hours: 919-781-7490
  • After hours backup number: 919-831-5526
  • Poison Control: 1-800-222-1222

Dr. Jamila Fletcher

Friday Notes

Written by Dr. Jamila Fletcher

Today is Friday, April 20, 2018

  • This morning we sign off from our answering service at 8:00 am to take calls directly from our office.
  • We will be in the office until we finish our On Call Evening Clinic (typically around 7:00 pm).

Walk-Ins

  • 8:00 – 8:30 am: Today if you arrive at the Duraleigh office during that time your child will be seen by our pediatrician(s) covering walk-in patients.
  • Walk-In appointments are for acute sick visits only (symptoms of a short duration).
  • As always, all other visits today are scheduled by appointment only.

Today’s Lineup

  • On Call PediatricianDr. Jamila Fletcher will be rounding on our newborns at Rex Hospital and running our On Call Evening Clinic.
  • In our Duraleigh Office today:  Drs. Muff Carr, Jamila Fletcher, Lily Harris, Todd Harris, Jen Long and Tom Sena (AM)
  • In our Brier Creek Office today:  Drs. Rick Gessner, Ben Meares and Tom Sena (PM)

After Hours Care

  • Our On Call Pediatrician manages our after hours care.
  • Urgent calls outside regular hours: 919-781-7490
  • After hours backup number: 919-831-5526
  • Poison Control: 1-800-222-1222

Dr. Leigh Lehan

It’s Easter Weekend, March 30, 31 and April 1, 2018

  1. IMPORTANT NOTE: Our office will be closed for routine business on Friday in observance of the Good Friday holiday
  2. We will offer a morning clinic for urgent needs on Friday, Saturday and Sunday

 All patients seen at our Duraleigh office by appointment only

  • No walk-in appointments; be sure to call ahead
  • Try to call soon after 9am if you think your child may need to be seen to talk to the on call phone nurse
  • As always, we will be available for phone advice all day and every day

Your Easter Weekend Lineup

After Hours Care

  • Urgent calls outside regular hours: 919-781-7490
  • After hours backup number: 919-831-5526
  • Poison Control: 1-800-222-1222

Dr. Todd Harris

Banner Change: Spring 2018 Edition

Written by Dr. Todd Harris

March 26, 2018 – In case you hadn’t noticed – this past Tuesday – calendar winter gave way to calendar spring.

At that time, we also snuck in our new banner – the cold and solitary ‘boy making snow angel‘ was replaced by this colorful and congenial ‘two girls in a field of marigolds‘.

Since changing to a spring-themed banner, it has snowed twice so we now recognize that the banner change was nothing but wishful thinking.

Flu Season Winding Down

  • That was some February.
  • As you can see, there is some flu out there still but not very much.
  • Start planning for the 2018-2019 flu season. Mark your calendars: September and October are good months during which to get your flu vaccine so you can be protected throughout flu season.

Well Season Cranking Up

  • Call now to schedule your child’s camp or school physical.
  • If your child has already had their well visit / physical for this year, remember that we can complete school, athletic and camp forms based on information from that visit. There is no reason that you would have to go to an Urgent Care or a Pharmacy Clinic for your annual physical.

Holiday Week Coming Up

  • Our office will be closed for routine business on Friday, March 30th in observance of the Good Friday holiday.
  • Our holiday schedule is very similar to our weekend schedule and both are detailed here.
  • In short, we will offer a morning clinic at the Duraleigh office for urgent needs on Friday, Saturday and Sunday.
  • For predictable needs – like medication refills – try to call before Friday.

Dr. Todd Harris

March 20, 2018 – Some recommendations include so much common sense it almost feels silly to make the recommendation – until you are presented with the statistic listed below.

60,000 is a large number – particularly for something that should be close to 100% preventable.

Today is the day to put medications up and away – out of reach and out of sight.

Today is the day to go to the Up and Away website and review practical tips for taking control of this significant safety concern in your home.


Dr. Todd Harris

March 12, 2018 – Above you’ll see the most recent North Carolina state flu numbers – 3 straight weeks showing a steady drop in likely cases of influenza.

That’s good news. How about more good news?

A Big Drop in Flu Cases at Raleigh Children & Adolescents Medicine Too

And at our office, we’ve seen a similar trend of fewer cases of flu.

Only seven (7) positive flu tests last week – that is only one per day which is a lot less than most weeks during the month of February.

Yeah March! That is more good news.

Sports and Summer Camp Physicals

The sudden drop in flu cases has created an unexpected and atypical wellness opportunity in March.

If your child needs a physical for summer camp or for school next year, don’t go to Urgent Care or (ugh) Minute Clinic.

Give your pediatrician a call.

Why see your regular pediatrician?

  • This is the doctor who is an expert in pediatrics who already knows your child
  • This is the doctor who has all your child’s medical records and who knows which vaccines they’ve had and which vaccines they need
  • The doctor who has seen them before with illness and will be there to see them if they get sick later

Whenever possible, keep your child’s healthcare in one place –  at your pediatric medical home – Raleigh Children & Adolescents Medicine

Give us a call 919-781-7490 and get that taken care of now.

 


Dr. Todd Harris

Sometimes Happiness is a Good Swaddle

Written by Dr. Todd Harris

March 9, 2018 – [NOTE FROM EDITOR: In this post, I am desperate to avoid use of the 3-letter word that is associated a seasonal illness beginning with “F” and ending with “LU” – there’s been enough of that!]

In the first week of life, a good swaddle can be a really good thing.

As someone who works with newborn infants, I can appreciate a good swaddle. This swaddle has some things going for it:

A post shared by Puppy (@puppystagrams) on

What they did right:

  1. Blanket prep – If you don’t get this right, you have lost before you begin. An excellent example of the classic diamond layout with a folded corner at the head.
  2. Organization – this is a well-organized wrap; every move has purpose: from the prep noted above to the lower corner taking care of the legs, right corner taking the right upper leg (arm) and left corner taking the left upper leg (arm)
  3. Outside the box thinking – applying the swaddle to your puppy is a genius move – and that puppy is way more cooperative than the average newborn

What I would do different (with a human baby):

  1. Order of corner fold over – this may seem picky but I feel like I get a better ‘tight burrito’ swaddle with an infant if I do one of the arms first, the legs second (PRO TIP: make sure the legs are bent at the knees – if baby is crying and has them straight out, wait for them to bend their knees and bring them up toward their belly before you complete the bottom fold), and then the other arm last
  2. You can’t roll an infant – well – you probably could – but then you would likely be cleaning their stomach contents off your white (?!) bedspread
  3. Foundational concern – last and most obvious critique – baby on white bedspread? Can you say, “Set up to fail”?

Happy Friday!


Dr. Todd Harris

February 27, 2018 – At the end of last week, the North Carolina Department of Health and Human Services updated this years Influenza Surveillance reports.

Picture is Worth a Thousand Words

We’ve been watching this graph for a few weeks, and the most recent trend deserves more focus – how about a crop with some enlargement:

The report shows that there were fewer flu-like cases reported last week when compared to the previous week. That’s good news.

A Welcomed Downward Trend But Still Lots of Flu

Keep in mind – we are still seeing a lot of cases of flu – a significant drop in the number of cases is a good thing but it doesn’t mean flu season is over.

Is It Too Late to Get My Child a Flu Vaccine?

This question still comes up and here are a few points about flu vaccine:

  • I have to begin with this: The best time to get the flu vaccine is before flu season (duh) but not so early that it loses its effectiveness before the end of flu season. October is an ideal month for getting your flu vaccine (I always think holidays are a good way to remember so try to get your flu vaccine before Halloween).
  • We seem to be on the other side of the peak but there are still weeks to months left of this flu season – if you can find someone who still has flu vaccine – there is little downside and still some potential upside to getting a flu vaccine even though its almost March.
  • Note: RCAM still has flu vaccine for all children 6 months to under 3 years old.

How Effective is This Year’s Flu Vaccine?

  • There has been much talk of the effectiveness of this year’s flu vaccine and this is what the CDC is reporting as of February 3, 2018: “overall the seasonal flu vaccine [given for the 2017-2018 flu season] reduced the risk of getting sick and having to go to the doctor from flu by about one third.”
  • The flu vaccine experts try to shoot higher than one third, but when the choice is depending on one’s own natural immunity vs. that natural immunity plus 33% – most would take the latter.
  • So there you go: 1 in 3 people helped by the flu vaccine – not a great year but still a significant tangible benefit.

 

 


Dr. Todd Harris

February 21, 2018 – For those interested, here are some updates about influenza:

Flu Peaking? (Fingers Crossed)

Above is a graphic showing North Carolina Flu Statistics up to the week of February 10, 2018. It includes the current flu season (red line), last year (dark gray line) and two years ago (light gray line).

Interestingly, both of the previous flu seasons per this graphic peaked on the same week – the week of February 24th.

That thick, ever-growing, red line shows how this flu season has surpassed the previous two. Some recent national reports suggest that the number of new influenza cases are slowing down (leveling off). It is hard to conclude that from the above information but keep in mind that is North Carolina data only and includes numbers only through February 10th.

RCAM Flu Numbers Leveling Off? (Two Conflicting Opinions)

Our information is a bit limited – however, flu numbers from our Duraleigh office presented above show that both the number of flu tests RCAM performed and the number of tests positive for influenza have remained similar for the last two weeks.

  • Glass-half-full analysis: Flu is leveling off and soon should begin to decline. You may make plans now to come out of your house.
  • Glass-half-empty analysis: The Pediatricians at RCAM have been made aware that we have a limited number of flu test kits and so the “leveling off” is simply not testing the more obvious cases or situations where a positive test wouldn’t change what you would do (a viewpoint that justifies the actions of those who continue to “double wipe down” your shopping carts).

Either way you look at it – you probably don’t want to share a glass – half-full or half-empty – with anyone just yet.

Influenza Summary as of February 21, 2018

  1. There is still a lot of flu active nationally as well as here in our community. This pediatrician is not smart enough to know if it is slowing down but there are some signs to suggest it could be.
  2. Most people are doing very well, but stay on the lookout for signs of complications from the flu. Here is a good summary about what to look for from The New York Times.
  3. RCAM is being careful to follow the CDC recommendations for the use of Tamiflu. In short, Tamiflu is not recommended for everyone who gets the flu – only those at high risk for complications from the flu – like the very young (under 2), the elderly, or patients with underlying conditions like asthma and diabetes.
  4. Call our office with questions: 919-781-7490
  5. Get your child seen if they seem particularly sick – both those who fall into a high risk group as described here by the CDC as well as anyone – both healthy children and children considered high risk – who are showing signs that their illness could be getting severe.

Dr. Todd Harris

More RCAM Influenza Updates

Written by Dr. Todd Harris

February 2, 2018 – Some important updates about flu season this year:

There is a lot of influenza out there

I am tired of writing about flu. I am sure you are tired of reading about.

But – for visual learners – I present the graph above that shows new cases of flu over time for the past 3 flu seasons. This year’s flu season is the brightly colored red line that stops at the week ending 1/27. You can see there are more cases of flu than at the same time compared to the previous two years.

What this means to me is we likely haven’t reached this flu season’s peak yet.

What is being reported nationally and statewide also fits what we are seeing at RCAM

Here is a snapshot of the rise in positive flu tests in our Duraleigh office so far for this flu season:

With lots of flu cases we are starting to see some shortages

  1. We have already run out of privately-supplied flu vaccine for patients 3 years old and up (our current supply is described here). We are hearing reports of pharmacies running low with flu vaccine as well. Here are other places you can call to check on their availability of flu vaccine. At this late juncture in the flu season, it is pretty unlikely that more flu vaccine will become available. (NOTE: put it in your calendar for next year – flu vaccine is generally plentiful every October).
  2. We anticipate running out of tests for influenza. At this point in time, we are testing for flu only when necessary (a patient doesn’t have to be tested to be diagnosed with flu; at the end of the day, the doctor seeing you makes a clinical judgement).
  3. We anticipate shortages of Tamiflu – one antiviral medicine that can in some cases lighten the symptoms and / or duration of flu illness

A few things about Tamiflu

Tamiflu is essentially the only medicine (Tamiflu) that might help in the fight against flu (other than the flu vaccine – which again is plentiful in the fall). Compare that number to the choices we have for something like ear infections where we can choose from 6-8 different antibiotics.

Having just one option for flu sets up the potential for problems with supply as well as increases the likelihood of resistance.

Therefore, the Centers for Disease Control (CDC) has come out with recommendations for physicians regarding the use of Tamiflu.

In short, they recommend using Tamiflu only with patients who are at high risk for complications from the flu. High risk tends to mean the very young (under 2 years old), the very old and those with underlying conditions (like asthma or diabetes).

As pediatricians, we feel it is our responsibility to follow the CDC recommendations as closely as possible.