Bambini October 2016 Newsletter 
Vaccine Vexations
In an interview with High Intensity Healthy this summer, Paul Thomas MD, a pediatrician from Portland, OR, reported that in his large practice he found a zero percent autism rate when immunizations are given slowly and stopped at the first sign of developmental lag. He wrote a book about his experience.
A few hundred miles to the south, the California state medical board is going after one of the best known pediatricians in the country, Dr. Bob Sears - who has also written a book that promoted a gentler approach to immunization.
This epitomizes the growing contention between groups like the CDC, AAP, and FDA that see no association of vaccines with autism and the many parents, including the district attorney of San Antonio, interviewed by the producers of VaxXed - who have seen a causal effect in their family.
Last month, the American Academy of Pediatrics, came out with an even stronger position on "firing" families that will not follow the CDC vaccine schedule. They encourage pediatricians to have parents that will not follow the schedule sign a document that says they are knowingly endangering their child. HMOs have also begun to levy significant financial penalties at doctors whose immunization rates do not meet their benchmarks.
Closer to home, the commissioner of the NY State Department of Health has sent a letter to physicians advising that we must adhere to the CDC criteria for medical exemption. Not wanting to go the route of Dr. Sears, our practice adheres to this strict policy.
How is this affecting patients? Earlier in the week, we received a call from a school nurse for a six year-old little girl who developed nystagmus and staring spells after her four month vaccinations. She now has spastic cerebral palsy and developmental delay. Her parents opted not to have her received any more vaccines. She became a patient in our practice last year. Her mother pleaded with us to write a medical exemption, but her daughter did not meet CDC criteria we explained. The school nurse told us the little girl has only been to school for a week and is missing out on all her therapies over the vaccines. We asked if the school doctor could overrule us and allow her to attend. She advised that he would not.
Yesterday, another parent of a kindergartner contacted us because the school nurse has given an ultimatum. The child, who also came to our practice last year, has received all the required vaccines for entrance, but had gotten some of them too early. This child was apparently by mistake given 5 DPTs and 5 polio vaccines by only 19 months of age (the child now has Asperger's). According to the NY state guidelines, if the vaccines were given at a slower rate (the fourth DPT and polio were given after age 4), only four shots of each would be required. The nurse now wants him to have six of each. Last case of polio in the US occurred in 1979. We are hoping that the school physician, who is a cardiologist, may allow the child to attend.
Changes at Bambini
1. If you have been in for a visit since the beginning of September, you may have noticed that we don't spend as much time as we had been in the exam room. Sad to say, we are back to using 10 min slots for appointments. For a typical URI visit, this means a 3 minute history, 2 minute exam - with the remainder for e-prescribing and typing up a note. Crazy, isn't it?
We have begun to explore the possibility of a hybrid practice in which, for example, part of the day, we would see families at a much slower rate but would not accept insurance. If you have strong interest in this option, let us know. Post a comment on our Facebook page below this newsletter. 
In the meantime, you can help us a lot by letting us know when you call to schedule your visit if your child needs additional time. For instance, if you call to request a visit for your daughter for an earache but you want her warts looked at too, that will take a longer visit.
2. Somer DelSignore C-PNP will be leaving our practice at the end of December. Somer will be joining Kenneth Bock MD in Red Hook, NY. Somer was recently recognized by Hudson Valley Parent magazine and we wish her the best.
As some of you are already aware, Dawn Prati C-PNP has taken an unplanned leave of absence. We all miss her very much as are hopeful that her circumstances will allow a return to the office in the near future.
3. We've noticed that subscription to our e-newsletter is plateauing a bit. There simply aren't enough minutes in the month to take in the zillions of newsletters, podcasts, and online summits out there! We're scaling back to about every 3 months going forward. We will continue to post items of urgent interest to Facebook.

We are also, on a trial basis, holding a monthly meetup in the office for regional integrative health professionals called the Functional Forum. We hope that some good comes to the community from this networking opportunity.
4. Finally, we have begun to beta-test e-visits. As many know, there has been a growing buzz about telemedicine. It seems like we are getting approached by a new vendor every week. However, although NY state allegedly mandated third party coverage of video consultations, the HMOs do not appear to be following through. One large payor appears to be contracting with a number of telemedicine vendors that will actually compete against practices like ours. Good grief!
Earache Option
How did we miss this one?  We see tots with painful earaches everyday year 'round.  We've backed away from Tylenol a bit as it may promote asthma.  Too much Advil can be tough on the gut.

And the FDA recently pulled Auralgan and AB Otic (mild topical numbing ear drops) off the market.  True to form, however, the FDA recently approved Oxycontin for kids -- go figure!

What does that leave a parent at 2 AM when an earache strikes?  Well, according to physicians in the Department of Emergency Medicine at Royal Children's Hospital in Melbourne, Australia -- there's hope.  They randomized 63 children to receive either placebo or lignocaine (the British term for lidocaine) as an ear drop.  Their 2008 findings?  A 50% drop in pain at both 10 and 30 minutes compared to placebo.  Not bad!

That likely beats out garlic in mullein oil -- a traditional home remedy.  Moreover, because lidocaine is in an aqueous base, it would be safe to use even if the ear drum is ruptured.  That's not the case with oil-based remedies.

Lidocaine has to be prescribed and should not be used for teething.  Most pharmacists, however, are not going to be willing to take the time to transfer lidocaine from an injectable vial to an ear dropper.  We may have to improvise.  Almost all pharmacies stock lidocaine in viscous (jelly) form.  Squirting a little into the ear canal using a bulb syringe or eye dropper might mean an extra four hours of sleep for both child and parent.   
B12 for Bedwetting?
Last year, naturopathic physician Dr. Ben Lynch posted an interesting blog entitled "Bedwetting and MTHFR?" The gist was that a school-age child with enuresis might respond to methylation support such as methyl-cobalamin (a preferred form of vitamin B12) and L5-methyl folate (a preferred version of vitamin B9).
Moreover, he suggested that children that were vegetarian or had certain methylation pathway SNPs (mutations) may be at higher risk of bedwetting. He suggests a biochemical work up for these kids, including homocysteine, organic acid, and key vitamin levels.
About 10% of first grade boys and 5% of girls in our practice have enuresis. Rather than immediately recommending a dry bed alarm or attention to bowel habits as we have to this point, we are going to start taking a closer look at Dr. Ben's suggestions!
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