Bambini December 2017 Newsletter 
Practice Updates:  New Doc Coming & More
We recently learned that Rafiu Ariganjoye MD ("Dr. A" to most of us) has accepted a position with Blue Cross as a medical director. He will be leaving Bambini at the end of February. We wish him and his family the best.
On a positive note, Sarah Sercombe DNP will be joining Bambini in March! Dr. Sarah, a Connecticut native, worked six years with the oncology unit of Wolfson Children's Hospital. Soon after obtaining her nurse practitioner degree, she joined an integrative pediatric practice in Orlando. We will have her full biography posted on our website later next month.
Practice growth in 2017 has been off the charts. Some months we had over 130 new patients. We are in awe of this influx. As many of you have noted, however, the parking lot, our waiting room, and phone queue have been substantially impacted. Thus, effective January 1, 2018, there will be a hold on new patients. A waiting list will be added to the website in January. We hope that the freeze will be lifted in the spring.
Flu Season Forecast
Although across the country, reports indicate that the flu season started early, we have not seen signs of substantial activity yet. But with the exceptionally poor match of the current vaccine with circulating strains, it could be a long winter for us all!
A new technology that we have recently added to the office may, however, offer some help. For years, we have diagnosed strep, flu, and RSV using "rapid antigen" testing.
About three months ago, we switched to the new cobas Strep A assay. Using DNA methodology called polymerase chain reaction, this test takes about 15 min for results (unlike the old test which only took 5) but is so accurate that we no longer have to send a second swab out for culture.
Cobas also can test for influenza A & B as well as RSV. This will allow us to write for Tamiflu -- if parents wish to go with that option.
Black Belly Buttons
We see a fair number of infants and even toddlers with dark navels. Since we've never come across a great online discussion of this topic, we decided to start one here...
Probably the most common situation is the infant with "post-inflammatory hyper-pigmentation" in their umbilicus. These are kids, many of whom have a darker complexion, that have had some irritation of the umbilicus during the first week or two of life as the cord was detaching. This extra pigment tends to fade by a year or two of age.
The second group of "black belly buttons" arise from hormonal stimulation. The clue here is the linea nigra - something 75% of pregnant women develop from placental melanocyte stimulating hormone (MSH). Again, more common with African American or Hispanic heritage. The line typically fades by six months, and the darkened belly button follows not far behind.
The last group of "black belly button babies" seem to have umbilical vessel remnants that darken a few weeks after birth. They're definitely less common than the first two groups. We see them in all skin types. These little patches of dark pigment may be slightly raised and can last well past the first birthday.
Have you had experience with black belly buttons? Share your story on our Facebook page where this newsletter is posted.
Probiotics for Weight Loss?
Clinical data on the efficacy of probiotics for a broad range of maladies continues to pour in.

In 2013, for instance, Korean researchers published a randomized, double-blind, placebo-controlled study of 62 patients -- half of whom were treated with Lactobacillus gasseri BNR17.  At week 12, a modest drop in waist and hip size was noted.

Similarly, in 2016, a report from Finland found that in a study population of 225 obese adults, those given Bifidobacterium lactis B-420 along with a fiber supplement had a 1.4 kg (3 lbs) drop in weight over the course of six months.  No significant side effects were noted in either study.  This strain is now marketed as Ultraflora Control by Metagenics.

At last glance, there is ample supply of both Swanson's L. gasseri ($16) and Ultraflora Control ($27) on sale in the Bambini apothecary.  These prices are hard to beat.
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