November 2019 Newsletter 
New Doc at Bambini!
Dr. Mukai Jaravaza joins us on Monday December 1st. "Dr. J" graduated from North Carolina A&T University in May 1999. From there, she obtained her MD from St. Georges University School of Medicine and completed an internship in Queensland, Australia.

For the last seven years, Dr. J had been a staff pediatrician at Cornerstone Health Center in Newburgh. During that time, she also served on the attending staff at Montefiore St. Luke's Cornwall and taught students as a clinical preceptor for Touro College of Medicine.

Read her full bio here.  With her help, we hope to open up again to new patients within the next few weeks. Thank you for your patience the last 8 months!
Vitamin D & UTIs
It seems like every month someone discovers another health benefit to vitamin D! Last year, three researchers from Egypt published their findings on the association of vitamin D deficiency with urinary tract infection in children.

The doctors tested the 25-OH vitamin D level in 50 children age 2 months to 6 years with their first febrile UTI. Their vitamin D levels were compared with age-matched sibling controls.  Their findings?

Children with UTIs had an average vitamin D level of 10.5 nmol/L, where as the control group averaged 25.9 - huge difference! They quoted authors of a related paper who stated:

In the light of the rapidly growing problem of resistance to common urinary tract antibiotics, vitamin D may be a potential complement in the prevention of UTI. Determining the vitamin D status of individuals with a history of UTI may be of importance to evaluate their ability to fend off intruding bacteria.
Bambini comments: You would think that kids that lived in Egypt would have really good vitamin D levels in general. These kids had extremely low levels! In this country, we measure vitamin D levels in ng/ml. In this study, the control group had 25-OH vit D levels of 10 ng/ml, and the kids with UTIs came in at .4 ng/ml. Our patients tend to run 30-40; with 50-80 being what we consider optimal.
How could these Egyptian tots be so low? Perhaps living mostly indoors within air-conditioned homes? Perhaps due to the culture, there is minimal skin exposure to the sun? Also of note, when we get sick, we tend to burn through vitamin D more quickly. 

Did low vitamin D levels lead to the fever in these kids - or did the fever lead to low vitamin D? We'll need a prospective study to say for sure.
Practical Rx of PANS / PANDAS
In reviewing info about the 400 or so children currently on our waiting list, we noted that the parents of almost two dozen have concerns about PANS / PANDAS.  What are these conditions?  How are they diagnosed?  What about office treatment?  And finally, what can parents do at home?

We will never forgot our first case.  Back in April 2011, we received a frantic call from the mother of a 17 year-old boy that had been an inpatient at Four Winds Hospital in Saratoga for two weeks.  Despite anti-psychotic and anti-depressant medication, he was languishing.

His trouble had begun four months earlier when obsessive thoughts and compulsions, coupled with severe anxiety abruptly developed -- not long after a febrile illness.  He was an honor roll student.  His father was an anesthesiologist physician.

He withdrew from school.  The anxiety gave way to depression, and the psych admission.  In the meantime, his parents had been doing research and came upon information about PANDAS -- which at the time was greeted with extreme skepticism by many in the medical community.  Even though his blood tests showed high levels of antibodies to strep, the treating physicians were reluctant to change course.

After taking a brief history over the phone, we agreed to see him.  His parents signed him out of the hospital (AMA -- against medical advice) and drove straight to Bambini.  Fortunately, his mood improved markedly upon release, and he was stable in our office.  We started amoxicillin.  After 10 days, there was no response.  His mom asked about going to Augmentin.  A few days after the switch, he symptoms began to fade.  Phew!

Since that first case, we have seen dozens and dozens of kids, some as young as age two years, with PANS / PANDAS.  Based on our research, the experience of other experts like Drs. Susan Swedo and Nancy O'hara, and our own time in the trenches, we put together a quick reference sheet that can be downloaded here.

Over the last several years, it has become increasingly clear that neuro-inflammation plays a big role in these conditions, and that's where our treatment options tend to focus.  We have also found that by combining various practical, affordable options, we can avoid "the big guns" (IVIG, plasmapheresis) and months of antibiotics.

For instance, after running a battery of screening labs, we might recommend a trial off gluten, enough vitamin D3 to reach a therapeutic blood level, plus twice daily dose of CBD oil, curcumin, and reishi -- along with a 30 day course of an appropriate antibiotic.  Each case to us is unique.  We do not take a one-size-fits all approach.  
What Are Exosomes?
Almost all of us have heard about stem cell therapy by now.  Again back in 2011, a little one year-old girl came to our office for integrative care.  She was a twin that had been born prematurely and was beginning to show signs of cerebral palsy.

Among the suggestions we made was stem cell therapy, which at the time was very cutting edge.  The family took the recommendation to heart and went to Panama where she was treated at the Stem Cell Institute with marked improvement!
Why haven't more Bambini patients been treated since?  For one, the cost -- which can run over $10,000 for a single treatment.  Moreover, in recent months, the FDA has cracked down on domestic stem cell clinics -- where the cells are typically obtained from adipose tissue and grown in culture for several weeks before they are re-infused.  

It turns out that research now indicates that the mechanism by which stem cells exert their regenerative effects is through exosomes -- tiny virus-like lipid-coated particles of protein and RNA.  The younger the donor tissue, the more anti-inflammatory and regenerative the exosomes produced. 

An order of magnitude more affordable than stem cells, exosomes are also relatively unencumbered by the FDA.  What are they being studied (and in some cases used) to treat?
-- burns
-- cancer
The sky is almost the limit as almost any injury or inflammatory condition may be fair game.
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