PEDI DOSING CHART 

If your child is less than 4 years old, do not give any cough/congestion/runny nose medicines without consulting your child’s doctor.

When your child is sick:

•  Increase fluids
•  Use a cool mist humidifier to relieve congestion
•  Use saline nasal spray and a bulb syringe to clear the nose of an infant
•  Use saline nasal rinse for older children to help loosen mucous.
•  Wash hands frequently

FAMILY MEDICAL CENTER                                          

190 BUTTERCUP CREEK BLVD, CEDAR PARK, TX 78630

512-336-5824                                                                                                                                                                      updated 2/21/2012 clc

Losing an immunization record can result in a child receiving multiple doses of their vaccinations, something most children would rather avoid! When you provide us with a copy of previous vaccines, we can enter it into your child’s electronic medical record as well, insuring that your child receives the appropriate vaccines.

It’s a good idea to keep a copy of the shot record in a safe place with all your important paperwork, such as birth certificates, passports, marriage licenses, and insurance policy information. For additional security, keep another copy in a safe place outside of your home, ie. the grandparent’s house or a bank safe deposit box, in case of fire or other disaster. Most people don’t want to think about disasters and emergency preparedness, but there is a very useful document from FEMA called the Emergency Financial First Aid Kit, which can help you organize your important paperwork. Just in case.

http://www.citizencorps.gov/downloads/pdf/ready/EFFAK_2010_FEMA.pdf

Stressed-Out Kids

By Cheryl Coldwater, MD

Stress is much more common in children and adolescents than most people imagine. Everyone experiences stress at some time, but some kids have a lot more trouble dealing with it. It can also be a cumulative effect- one thing after another until it is overwhelming. The “final straw” can be a simple thing, but it can be combined with other stresses until it is no longer manageable.

For many kids and teens, school can be a stressful environment. There is more pressure to succeed at an earlier age. Kindergartners are expected to have skills previously expected in first and second graders. Students can become very anxious about TAKS testing and may present with stress-related symptoms, including headaches, stomach aches, sleep and appetite changes, school avoidance behavior, and other psychological concerns. Pressure from teachers or parents regarding grades, sports activities and other extracurricular activities may leave some students with little chance to relax. Bullying at school has become a serious source of stress in children and they frequently hesitate to talk with anyone about it.

Children and teens may also have stress due to family situations, such as recent moves, change of school, new siblings or divorce. Kids may notice more than you think when there are household changes due to financial difficulties or illnesses, and feel stress when they don’t understand what is happening. Children with a family history for mental illness may be more prone to having severe depression or anxiety issues which may require mental health treatment.

Everybody has stress; it’s what you do with it that’s important. Children may handle stress differently than adults. Frequently, children hold anxieties inside, and actually become sick from it. It can affect their sleep, appetite, enjoyment of other activities, school performance, as well as cause frequent headaches and stomach problems. Children may act out when they are stressed- hitting, yelling, crying frequently, calling names, or testing their school or home rules with inappropriate behavior. Adolescents may develop self-destructive behaviors such as drinking alcohol, smoking, experimenting with drugs, or self- harm (such as cutting or even attempted suicide).

Helping your child learn to deal with stress starts early.

• Teach your child to deal with frustrations by taking deep breaths, and then trying something a different way or asking for assistance.
• Help them understand that no one is perfect, and you don’t expect them to be. Remind them that you love them, no matter what.
• Acknowledge their mistakes and help them learn from them rather than feeling that they have failed.
• Demonstrate a positive attitude- show your child that being optimistic can change their outlook. Point out the good in a situation rather than focus on the negative aspects.
• Teach your child to have healthy habits- eat nutritious food, drink plenty of water, get a good night’s sleep, avoid alcohol, smoking, and drugs, and exercise regularly.
• Help your child or teen find activities which they enjoy for stress relief.
• Physical exercise is a great way to burn off stress- a walk, riding a bicycle, going to a gym, take a yoga class, playing a sport for fun, or just playing outdoors.
• Help your child or adolescent explore their creativity- art, music, dance, writing, building, cooking, yarn-work- anything that allows your child to express their individuality can be great for the self-esteem. When you praise their work, show your child that you notice their efforts and the specific details which are unique to them, such as “I love how you use purple in this painting. It really makes me happy to look at it”. Overpraising a child by telling them they are the “best artist in the world” can backfire and cause the child to be afraid of not being able to live up to your expectation.
• Don’t over-schedule your child. Allow some down-time for your child to play, relax, and spend time alone or with friends.

Lastly, teach your child or teen that it is good to ask for help when they are over-stressed, having physical concerns, or feeling overwhelmed. Help your child understand that requesting help from you, a teacher, a doctor, or other trusted adult is a healthy choice, not a sign that they have failed in any way. If you are worried about your child’s stress, check with your child’s health care provider about appropriate treatment. She may be able to recommend a therapist, discuss ways to reduce stressful triggers and handle everyday stresses in a more healthy manner, prescribe medication if necessary, or refer you to a specialist.

Dr. Cheryl Coldwater is a pediatrician at Family Medical Center in Cedar Park.

www.familymed-cedarpark.com

http://abcnews.go.com/Health/Wellness/surge-total-knee-replacements-boomer-women/story?id=15208520#.TvNkvlYlSdk

When I had my Total Knee Replacement Surgery in 2007, I wrote this article which may be helpful for those who are considering this surgery.

MY TOTAL KNEE REPLACEMENT: LESSONS LEARNED

By Cheryl Coldwater, MD

I had a total knee replacement of my right knee in September, 2007. As I had a birth defect which resulted in me having an amputation of my left leg during my childhood, I had spent my whole life using a prosthetic leg or crutches to get around. This eventually caused increased wear and tear on my “good” right knee which caused almost complete erosion of the cartilage and frequent inflammation of the knee joint. After consultation with orthopedic surgeons, I had surgery and received a rotating platform knee. These are some of the lessons I learned along the way.

1. Avoid injury and damage to your knees. Many of us are active in sports and exercise and the trend is to find “life sports” that we can keep doing as we age. Take care of your knees. When taking up a new sport or activity, condition yourself gradually so your muscles and joints can adapt to the new activity. Start early with strengthening exercise to prevent damage to your knee- such as quadriceps strengthening and flexibility training to allow balanced muscle groups to work together- and continue them throughout your entire life.  Keep your weight under control- excess weight puts more strain on your knee. Take glucosamine/chondroitin to help protect your cartilage. If you have an injury, take care of it properly and allow it to heal before gradually restarting your activity.

2. If you have knee pain that is persistent in spite of adequate rest and physical therapy, see your doctor. Don’t wait until the pain is preventing you from doing your usual activities. Many people who have total knee replacement surgery say afterwards that they wished they had done it 2 years/5 years/10 years before they actually did.

3. If it is time to see an orthopedic surgeon, find the best. Orthopedic surgery is becoming more and more specialized. There are some who only operate on knees, others only do shoulders, etc. Some only do arthroscopic surgery and some do primarily knee replacement surgery. You really want to find someone who does this surgery regularly because they will have the most experience. Experience absolutely counts in this case since there is great surgical skill involved in getting a good result. Don’t hesitate to get more than one opinion from orthopedic surgeons.  Orthopedic surgeons are people, too, and they have different ways of doing things and different ways of relating to patients. Find someone with whom you feel comfortable and make sure the surgeon listens to you and answers your questions.

4. Do your own research. Read information your doctor may give you. Talk to other people you know who have already had knee replacement surgery. Read reputable information on-line- www.webmd.com is a good source and there is a great up-to-date article on www.wikipedia.com which also has a link to www.edheads.org/activities/knee where you can view and participate in a virtual knee replacement surgery.  If the surgery is recommended, on subsequent visits, prepare a list of your questions before you see the doctor. Make sure you know what will be involved before, during, and after surgery. Ask questions about the time required for recovery, what you will and won’t be able to do, what arrangements you must make in your home, and even what the costs will be.

5. Talk to your insurance company early. You will probably need prior authorization for the office visits and the surgery. If possible, request a case manager. This is a person employed by the insurance company who can help coordinate your care, preferably in advance of your surgery. They can help arrange DME (durable medical equipment), such as crutches, a walker, a wheelchair, a continuous passive motion machine, or a Polarcare (circulating ice water pad to reduce swelling and relieve pain). They can also arrange for your rehabilitation, either in a rehab hospital or at home depending on your situation. They can help you find out what your financial responsibilities will be based on what your insurance coverage is.  Having a specific contact makes all of this easier.

6. Talk to your anesthesiologist before the surgery date. The anesthesiologist needs to know all about your medical history and current medical treatment in order to provide the safest and most effective anesthesia. Since you will have done your research (as above), you will know that there are different ways to provide anesthesia during surgery. I chose to have spinal anesthesia with a femoral nerve block. I was also given Versed (midazolam) to allow me to be calm and provide a little amnesia about the surgery, but to be able to wake up with a fairly clear head and few side effects. The femoral nerve block was administered with a in-dwelling catheter which allowed on-going pain control for the first few days of post-operative hospitalization. For me, this was a much better choice than general anesthesia. Your anesthesiologist can help you decide the best choice for you. Of course, you should also inform your anesthesiologist if there are any changes in your health on the date of surgery. Also, discuss with your anesthesiologist how you will control your pain after surgery.

7. After your surgery, you will probably be in the hospital for 3-7 days. Use pain control when needed. Use the pain chart to help your nurses, doctors, and therapists understand how you feel. Waiting until your pain is more severe will make it more difficult to decrease the pain. You need rest to heal properly and pain can significantly interfere with adequate rest. Take care not to be overwhelmed with visitors. Although it is nice for them to visit, either encourage them to keep visits short or ask one of your own family members to pass the word around. The exception is that you may want someone (a spouse, parent, close friend) to stay with you during your first post-op night. You will not be at your best, you may not even be able to move easily in the bed on your own, you may not be able to get out of the bed for bathroom needs, and you may be connected to all types of tubes or equipment. Having an advocate there means that they can help get you medical help when necessary, take care of some of your basic needs when the staff is busy, such as bringing you fresh water or snacks, and keeping you from feeling alone in an unfamiliar environment.

8. Be courteous and kind to the hospital staff. Yes, they are there to help you, but they are also trying to help several other patients. It is a fact that in almost all hospitals, nurses and nursing aides are understaffed and overworked. If possible, anticipate your needs and ask for them when your nurse or aide is checking on your condition. As mentioned, you should actively monitor and control your pain. I had a PCA (Patient Controlled Analgesia) on my IV which allowed me to have controlled doses of pain medication into my IV when I pressed a button. Actually, my femoral nerve block catheter was also connected to a PCA which allowed pain control of the front of my knee while the other one allowed more general pain relief. The PolarCare also gave good pain relief by pumping ice water through a pad allowing continuous cooling of the surgery site which reduced swelling and pain dramatically. I also had a CPM which appears to be a medieval torture device, but is in fact a machine to continuously slowly move your knee, straightening and bending it within the preset limits. This increases flexibility and reduces the risks for blood clots and swelling in your leg by slowly moving the muscles. Whatever treatment is given to you, whether it be one of the machines just mentioned or a medication, ask the nurse or other staff member what it is, what it is for, what do you need to know about it, what side effects you should be aware of, etc. Although I was very polite to the staff, I did ask about every single pill or IV medication before it was given to me. It’s not being rude-it’s being safe. The hospital staff are humans and humans can make mistakes. If you think you are being given the wrong medication, or it is the wrong time for a dosage, don’t hesitate to ask. A good nurse will go and double- check and find out if it is correct.

9. Don’t go home or to the rehabilitation facility too soon. The amount of care available to you will be very different than in the hospital. To go home (or to a rehab hospital), you need to be able to adequately control your own pain with the prescribed pain pills your doctor gives you. You will need to be able to take care of your most basic needs. You will need to be able to get around on crutches, with a walker, or with a wheelchair at least semi-independently. You will need to have already (before surgery) prepared your home- moving area rugs out of the way so you won’t slip on them, having hand rails for your toilet and shower or bath, having a shower seat, having an area set up near your bed or sofa (wherever you will be resting on the first floor of your house) with necessary items (such as water bottle, books, telephone and phone numbers, medications [out of reach of children, of course], and snacks). Check to see if your doorways and hallways will allow the passage of a wheelchair. You may have to take off the door to the bedroom or bathroom in order for the wheelchair to go through.  I went home with a CPM machine which I continued to use for about 2 weeks. I also had a PolarCare at home which my husband kept stocked with ice as needed. Since I had a lot of experience on crutches, I had a wheelchair and crutches to get around the house.

10. Do your physical therapy. Whether you have physical therapy in a rehab   hospital or at home, listen to the therapist and do the recommended exercises. You really will get better quicker and you will prevent injuries or falls (which you absolutely need to avoid while you are healing). If an exercise causes pain, tell the therapist. They really are not there to torture you; they are trying to help you get stronger and more independent as quickly as possible.

11. Listen to your doctor. When you go back for your follow-up appointment after surgery, your doctor will probably give you more information about what you are and are not allowed to do. You will need to know when you can drive, when you can return to work, when you can return to sports and other exercise, etc. I have to confess that I did not do most of this according to the usual instructions, but that doesn’t mean you shouldn’t. Although you may be walking, either with crutches, walker or cane, the healing process continues for about 3 months. It takes time for your muscle strength to recover (or exceed your pre-operative level). It takes time for you to build up your endurance and not be so tired (fatigue is an important factor after surgery because it tells you to slow down and take it easy- don’t ignore it). It takes time for your ankle, hip, back, etc to adjust to you walking differently, especially if you have been walking with pain for some time. If you want the best result, you need to be patient.

12. Enjoy your new knee. Take care of it and it will work well for you for probably 20 years. Stay healthy and active. If it wears out (usually the cartilage replacement component which is polyethylene), there are newer and better ways to replace that component without having to redo the components which are attached to the bones. By that time, they may even come up with something better.

http://www.hillcountrynews.com/opinion/article_18f29c62-21ba-11e1-b1a8-0019bb2963f4.html
Have a safe and enjoyable holiday season!

http://abcnews.go.com/Health/top-flu-myths/story?id=14972658#

We will be closed from December 24th through December 26th for the Christmas holiday. If you have an urgent medical need during that time, please contact the doctor on call through our voice mail or go to the Emergency Room.

We will have regular office hours of 8:30 to 4:30 on December 27th through December 29th.

We will also be open on December 30th in the morning, and will be closing in the early afternoon. Please call early for an appointment if you need to be seen.

We will be closed from December 31st through January 2nd for the New Year’s holiday. Please call the doctor on call or go to the Emergency if you have an urgent medical need.

Due to the shortened work weeks, please call your pharmacy early for any medication refill requests.

FDA Warning: Hyland’s Teething Tablets May Harm Children

Both colds and the flu are caused by viruses, so there is no medication which will cure them. Your child’s own immune system fights these off and antibiotics are not needed or recommended. Taking antibiotics unnecessarily may make it more difficult for your doctor to treat other types of infections. Medications are available to treat the flu in certain circumstances, but these medicines only shorten the course of the flu by a day or so in most cases. The best medicine is time and comforting. Give your child plenty of fluids- water, Pedialyte, diluted Gatorade, clear soup. Allow him to rest as much as possible, and avoid contact with other friends and schoolmates while he is running a fever. You may use a cool mist humidifier to help with the congestion (the steam vaporizers can be very dangerous around children and are not recommended). Using saline drops or spray in the nose can loosen the mucous, and you may use a nasal bulb to suction your child’s nose. Honey in warm water or warm decaffeinated tea may be given to children over 1 year of age to help with coughing and throat pain.

Fever due to cold viruses and influenza may be treated with Acetaminophen or Ibuprofen. Check with your child’s doctor to be sure you are giving the correct dose for your child’s weight. Low-grade fevers are not dangerous and may help your child’s immune system, so it is not necessary to treat all fevers under 102ºF unless your child is very uncomfortable. After recent studies, many cough and cold medications are no longer recommended for children under 4 years old. For older children, an antihistamine (such as Benadryl, Claritin, or Zyrtec) may be helpful for the runny nose and congestion. It is best to avoid “multi-symptom” medications for children as they may contain unnecessary medicines with additional side effects. If you have questions about medication for your child, check with your child’s doctor.

If your child has a high fever (over  102ºF) for more than 2 days, has new symptoms such as vomiting, has worsening symptoms or is not getting better within a few days, is under 2 months of age, or seems to be very ill, please call your child’s doctor for appropriate care.

Good handwashing is the key to preventing the common cold and the flu. Wash hands with soap and water before eating, after coughing, sneezing, blowing her nose, using the bathroom, or contact with others with cold and flu symptoms. The Flu Vaccine is recommended for EVERYONE from 6 months old up. Getting a Flu Vaccine early is the most important way to prevent influenza. It may take nearly a month for immunity to build, so your child should get a Flu Vaccine NOW.

By Cheryl L. Coldwater, MD

Pediatrics

Published in the Hill Country News, 12/1/2011