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:
What they did right:
- 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.
- 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)
- 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):
- 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
- You can’t roll an infant – well – you probably could – but then you would likely be cleaning their stomach contents off your white (?!) bedspread
- Foundational concern – last and most obvious critique – baby on white bedspread? Can you say, “Set up to fail”?
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.
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
- 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.
- 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.
- 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.
- Call our office with questions: 919-781-7490
- 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.
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
- 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).
- 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).
- 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.
January 26, 2018 – Some Influenza updates:
Flu Vaccine availability at RCAM:
State-supplied flu vaccine (Medicaid insurance):
- 6 months old to under 3 years old – in stock and available
- 3 years and up – in stock and available
Privately-supplied flu vaccine (Private insurance):
- 6 months old to under 3 years old – in stock and available
- 3 years and up – NO LONGER AVAILABLE AT RCAM
Flu Vaccine Elsewhere:
It is unlikely that we will be able to acquire any more privately-supplied flu vaccine. If you would still like to get it – we would still recommend it – and – if you can’t get it at RCAM – here are some places that may still offer flu vaccine.
Influenza at RCAM so far:
You can see – we are seeing more cases of influenza in our office – and we are expecting that number of “Positive [Flu] Tests” to continue to rise.
January 18, 2018 – Yesterday’s snow – one of the most beautiful snows here ever.
This picture of Crabtree Creek really captures some of that. Wow.
Tomorrow we will open both offices on a 2-hour delay:
- We’ll open at 10:00 am
- Both the Duraleigh and Brier Creek offices will open tomorrow
- Walk-Ins will occur at the Duraleigh office. If you show up between 10:00-10:30 am, we will see your sick child.
January 18, 2018 – Announcement:
The Duraleigh Office will open today (see below).
- Duraleigh office only (Brier Creek office will remain closed)
- 1:00pm to 3:00pm only
- WALK INS ARE WELCOME! You don’t need an appointment to be seen today.
- No well visits – only sick patients today
Photo Courtesy of RCAM Office Manager Debbie Maness
January 17, 2018 – They said it was coming.
And as I write it is still coming.
I am so sorry for those of you at home with sick children during such a beautiful snow.
Having access to your pediatrician is a big deal to us, and – at RCAM – we agonize about any decision that limits your access.
When it comes to winter weather we have to balance access with concern for the safety of our staff. Staff – who at one time typically lived close to our office but today live throughout the triangle – their commute has become more of a challenge and so has decisions about inclement weather.
Thursday’s Plan? Stay Tuned:
- Obviously, both the Duraleigh and Brier Creek offices will be closed tomorrow morning
- Our nurses will continue to be available for phone advice
- Stay tuned – we will monitor road conditions throughout the morning to see if we can open in the afternoon