Tag Archives: symptoms

Rotavirus: Symptoms and Prevention

October 26, 2013 by

Rotavirus gastroenteritis is the most common cause of severe diarrhea in children less than 5 years of age. By age 3, most children have been infected by at least one strain of this virus.

Transmission

Rotavirus infection outbreaks occur most often during winter and spring months. The common mode of transmission is through the fecal-oral route. The virus is transmitted from hands or inanimate objects to the mouth after contact with infected feces.

Rotavirus Symptoms

Once a child has been exposed to the virus it takes about two days for symptoms to appear. Rotavirus symptoms may include:

  • Vomiting
  • Fever
  • Diarrhea
  • Lethargy
  • Abdominal pain

Typically, children will experience 24-48 hours of vomiting followed by three to nine days of diarrhea. This virus is extremely contagious with an incubation period of two to four days.

Managing Hydration

There is no specific treatment for rotavirus gastroenteritis. Because severe diarrhea and vomiting can cause dehydration, Boys Town Pediatrics stresses the importance of maintaining proper hydration.

Parents are encouraged to watch for signs of dehydration, which may include decreased urination (less than three times per 24 hours), lack of tears, and/or dry lips and mouth. If you notice these signs, seek medical attention.

Prevention

The best way to prevent rotavirus is to get vaccinated. This vaccine is given orally to infants at the two- and four-month or the two-, four-, and six-month well-check visits, depending on which vaccine is used. This vaccine can significantly reduce the severity of the rotaviral infection. Make sure to discuss this vaccine with your pediatrician.

Boys Town Pediatrics offers access to care 24 hours a day, seven days a week through extended evening and Saturday hours, Same Day Pediatrics clinics, and a 24-hour nurse helpline to answer your questions when your child is ill—any time of day or night. Call 402-498-1234 to schedule an appointment at any one of our convenient locations.

ADHD

September 24, 2013 by

One of the most common neurobehavioral disorders found among children is Attention-Deficit/Hyperactivity Disorder (ADHD), according to the Centers for Disease Control and Prevention (CDC). And rates are on the rise.

Dr. Ashley Harlow, psychologist at Children’s Hospital & Medical Center, believes that this spike in diagnoses is due to a combination of factors. “Parents, teachers, and [health care] providers are more aware of the signs and symptoms and, therefore, are investigating this diagnosis as a possibility,” he says.

Because ADHD is so prevalent, there is concern that children are being misdiagnosed.

Misdiagnosis can go many ways, explains Dr. Harlow. “I think misdiagnosis is a problem, although I think it is important to consider misdiagnosis as both diagnosing another condition as ADHD and diagnosing ADHD as another condition.

“I see kids who have been diagnosed with ADHD because they do not like their teacher, they do not listen to their parents, or they do not follow through on what their parents tell them to do,” says Dr. Harlow. “These behaviors do not necessarily indicate ADHD.”

Also complicating the issue are instances where children have ADHD and are instead diagnosed with another disorder, like Autism Spectrum Disorder, or when high-school and college students use ADHD medication to support studying. “In these cases of students seeking study aids, misdiagnosis might occur because of misrepresentation of the symptoms by the patient,” adds Dr. Harlow.

Dr. Harlow says that visible signs of ADHD can include behaviors like “difficulty sitting still in the classroom, disorganization in completing homework or turning it in, making careless mistakes, staring off into space, interacting with peers in immature ways, or starting chores but not finishing them.”

Many children may demonstrate these behaviors, so Dr. Harlow advises careful consideration before jumping to conclusions. “[Health care] providers, in consultation with families, work to determine if enough symptoms are present and impairment is at a level to warrant a clinical diagnosis.”

The CDC states that “children with ADHD do not grow out of these behaviors. The symptoms continue and can cause difficulty at school, at home, or with friends.” Therefore, it is important to treat children who are afflicted with ADHD.

Treatment of ADHD focuses on reducing the impact of the symptoms, not eliminating them. “It is important to remember that ADHD is a neurologically based disorder, and so improving behavior likely means learning to manage symptoms rather than removing the symptoms entirely,” explains Dr. Harlow.

He recommends a combination of medical and behavioral health interventions, including setting up the environment (classroom or home) to be predictable and organized for the child and to make consequences immediate and consistent.

Children’s Hospital & Medical Center offers free parent education sessions related to topics surrounding ADHD. For more information, visit ChildrensOmaha.org/BehavioralHealth.

Food Allergies Abundant in a Purell Society

August 16, 2013 by

Food allergies are on the rise, and there are many theories as to why.

“We are too clean,” says Carlos Prendes, M.D., family medicine physician with Alegent Creighton Clinic. “We do not let our immune system do its job. Anything that comes in that is not a part of our routine, our body will attack and protect us against.

“Food allergies were very rare in the 1900s (and Purell did not exist). As we have developed a more antiseptic society, we are also developing more allergies. There is something to be said for a bit of dirt in your life.”

There are eight foods that are responsible for 90 percent of food allergies. The “big eight” are milk, eggs, peanuts, tree nuts, soy, wheat, fish, and shellfish.

“Many common food allergies for kids (milk, soy, wheat, and eggs) are not major allergens for adults. Adult food allergies tend to be lifelong and potentially severe. Many childhood allergies can be ‘grown out of,’ but adult allergies tend to stick,” says Dr. Prendes. “Most kids outgrow an allergy to milk and eggs by age six (this is different than being lactose intolerant).” However, he adds, this is not the case for peanuts.

“We are too clean. We do not let our immune system do its job.” – Carlos Prendes, M.D., family medicine physician with Alegent Creighton Clinic

Think you have a food allergy? “Symptoms usually begin within two hours after eating. If you develop symptoms shortly after eating a certain food, you may have a food allergy,” says Dr. Prendes. “Key symptoms of a food allergy include hives, a hoarse voice, and wheezing.” Other symptoms may include abdominal pain, diarrhea, difficulty swallowing, nausea, and stomach cramps.

“Any food allergies can be very serious,” says Dr. Prendes. “And mild reactions in the past do not always mean mild reactions in the future. If you are allergic to something, you cannot eat it; subsequent exposures can make the allergic reaction worse.”

There is a lot being done to make life with food allergies a little easier. The FDA requires by law that “the big eight” allergens are labeled on packages, even if the food does not contain any of “the big eight” but is produced in a factory that also produces any of these common allergens.

Schools and daycares are working to maintain peanut-free and milk-free zones or lunch tables, and to notify other parents that there is an allergy in the classroom.

Dr. Prendes recommends that the child takes responsibility for his or her allergy. “It is very important that the child is aware of their food allergy and cannot take a break from it. If you are at a birthday party and you are allergic to milk, you cannot have the ice cream. The sooner that they are aware of this allergy and that it is part of their life, the better off they will be.”

There are a lot of emerging ideas on how to reduce your risk of developing a food allergy. Some of the recommendations from the American Academy of Pediatrics—no cow’s milk until age 1 or peanuts until age 3—may be changing. “It is hard to tell parents to get their kids dirty more often,” says Dr. Prendes. “We have to figure out a balance to avoid developing these allergies and keeping people healthy.”

Concussions and Young Athletes

Here’s a question for parents—Can you describe a concussion? It’s more than a headache or a momentary blackout. Doctors consider it a traumatic brain injury, ranging from mild to severe, caused by a blow or jolt to the head. With young athletes back on the field, Kody Moffatt, M.D., a pediatrician and sports medicine specialist at Children’s Hospital & Medical Center, wants parents, coaches, and trainers to know the signs.

“We know much more about concussions today than we did even a year or two ago. A concussion in a child or teenager is different than in an adult. The impact on the developing brain can be a real problem,” says Dr. Moffatt.

Football poses a risk, particularly when players tackle with their heads down.

“I tell parents that football, in general, is a safe sport as long as young people don’t lead with the head,” he explains. “Coaches in our area have been really good about teaching young, developing players to use the shoulder or chest as the first point of contact.”

Symptoms of a concussion are as individual as children themselves. Visible signs of a suspected concussion are:

  • Loss of consciousness
  • Slow to get up
  • Unsteady on feet, falling over, or trouble balancing
  • Dazed or blank look
  • Confused, not able to remember plays or events

Dr. Moffatt says athletes with a suspected concussion should not return to the field. They need to see a doctor. Immediate emergency care should be provided when the player is vomiting, has a seizure, experiences neck pain, is increasingly confused, or is unable to stay awake.

Nationally and across all levels of play, from professional to recreational leagues, the emphasis has been on “return to play.” This focus surrounds the safe return to the game following diagnosis and treatment. This fall, “return to learn” will receive increased attention, too.

“Before young athletes are returning to play, we need to get them back in the classroom symptom-free and able to learn like they did before the concussion,” says Dr. Moffatt. “We have to keep in mind that we’re dealing with a brain injury. This can result in learning problems that impact a student athlete’s academic performance.”

The new Sports Medicine Clinic at Children’s Hospital & Medical Center will work with student athletes, their families, and teachers to customize a “return to learn” plan. Dr. Moffatt considers it to be an important part of the recovery process.

“Return to learn is a significant step, in my mind. We’re considering cognitive function and how we help the brain heal,” he says. “We’ll work with schools to help kids get back on track in the classroom.”

The Sports Medicine Clinic at Children’s Hospital & Medical Center is open to families by appointment. No physician referral is needed. To make an appointment, call 402-955-PLAY (7529). For more information, visit ChildrensOmaha.org/SportsMedicine.

Passionate about pediatric sports medicine, Dr. Kody Moffatt is a highly regarded, well-known expert in the field. An athletic trainer turned pediatrician, he holds a Master of Science degree in orthopaedic surgery and is a Fellow in the American College of Sports Medicine. Dr. Moffatt helps shape sports medicine policy on a state and national level as an advisor to the American Academy of Pediatrics and the Nebraska High School Activities Association.

Watch Out for Heat Stroke

June 20, 2013 by

Most people—especially those of us who know how muggy and hot Nebraska summers can be—have suffered from heat exhaustion at least once. It usually hits us after we’ve spent too much time outdoors in the blazing sun and haven’t been drinking enough fluids to keep us properly hydrated.

Heat exhaustion is pretty easy to recognize. Muscles cramp up, fatigue sets in, and sometimes lightheadedness or fainting can occur. But never write off heat exhaustion as “not that big of a deal” because it can be a precursor to a more serious heat injury called heat stroke.

Robert Muelleman, M.D., Chair of Emergency Medicine in the Department of Emergency Medicine at UNMC, explains that heat stroke usually causes alteration or damage to a person’s mental state. “It could be as mild as confusion or as severe as seizures,” he says. “Heat stroke damages a lot of different organs—brain, heart, liver, kidneys. That’s why it can be so deadly.”

Dr. Muelleman categorizes heat stroke into two types: classic heat stroke and exertion heat stroke. “Classic heat stroke is the one you read about during a heat wave in the summer. It typically affects elderly people with chronic medical conditions, like diabetes, hypertension, or emphysema. The issue there isn’t necessarily the daytime highs but rather the nighttime lows. If the temperature doesn’t drop below 80° for 72 hours, that’s when we’ll see classic heat stroke. The body doesn’t have a chance to cool down.”

“Heat stroke damages a lot of different organs—brain, heart, liver, kidneys. That’s why it can be so deadly.” – Robert Muelleman, M.D., UNMC

Exertion heat stroke, however, can happen to anybody, and it doesn’t even have to be that hot outside. It’s more about the heat index, explains Dr. Muelleman. “Heat index takes into account the humidity. If the heat index rises above 105°, then everyone is at risk. If it rises above 115°, then athletic and outdoor events really should be canceled.” With exertion heat stroke, it’s a matter of whether or not your body is unable to dissipate the heat or is generating too much heat.

When the body’s temperature control is overwhelmed, it can’t effectively cool down the body. Sweating is the normal response to overheating, but several factors can inhibit the body’s ability to cool itself—things like high humidity, obesity, fever, mental illness, poor circulation, heart disease, sunburn, and prescription drug or alcohol use.

Healthy children and adults are susceptible to heat stroke exertion in the summer because working in the heat or participating in summer sports can put them at risk. Babies, too—especially those left in cars when it’s hot. “Car temperatures rise so fast,” Dr. Muelleman says. “It’s extremely dangerous to leave a baby in the car during the summer.”

As for the symptoms of heat stroke, the Mayo Clinic recognizes the following:

  • High body temperature—usually 104°F (40°C) or higher
  • Lack of sweat
  • Nausea and vomiting
  • Flushed skin
  • Rapid breathing
  • Racing heart rate
  • Headache
  • Confusion
  • Seizures
  • Unconsciousness
  • Muscle cramps or weakness

If you suspect someone is suffering from heat stroke, immediately call 911 or transport them to the hospital. Any delay seeking medical help can be fatal. While waiting for aid, move the person to an air-conditioned environment and attempt to cool them down by removing unnecessary clothing, fanning air over them, wetting skin with cool water from a cloth or sponge, or applying ice packs.

From Patients to Caregivers

February 25, 2013 by
Photography by Bill Sitzmann

Margaret Ludwick spends her days sitting in a wheelchair at a senior care center in Elkhorn. She never speaks. The only expressive motion involves her hands—she constantly puts her long, tapered fingers together like a church steeple. Her big blue eyes stare straight ahead but focus on nothing. No one can reach her anymore, not her daughters, not her husband.

Alzheimer’s, the most common form of dementia in adults 65 and over, robs even the most intelligent people of their brain and eventually destroys their body. There is no cure. There is no pill to prevent it. There’s not even a test to definitively diagnose it. Effective treatments have proven as elusive as the disease, itself.

“We do have medications that may help with symptoms in some patients, especially in the early stages of Alzheimer’s,” says Dr. Daniel Murman, a specialist in geriatric neurology at The Nebraska Medical Center. “But they don’t truly slow down the disease process.”

According to researchers, the number of Americans living with Alzheimer’s will triple in the next 40 years, which means 13.8 million will have the disease by 2050 (Chicago Health and Aging Project research as reported by nbcnews.com).

Awareness of symptoms is crucial for early intervention.

“Memory loss and changes in behavior are not a normal part of aging,” stresses Deborah Conley, a clinical nurse specialist in gerontology at Methodist Health Systems who teaches other nurses and caregivers about Alzheimer’s. “I would urge family members to take [their loved one] to a family physician first, seek as much information as possible, and start making your plans.” An assessment that includes the person’s medical history, brain imaging, and a neurological exam can result in a diagnosis that’s about 85 percent accurate for Alzheimer’s.

Ludwick, a registered nurse, who worked at Immanuel Hospital for years, never received an extensive workup.

 “I would urge family members to take [their loved one] to a family physician first, seek as much information as possible, and start making your plans.” – Deborah Conley, clinical nurse specialist in gerontology at Methodist Health Systems

“I first noticed something was wrong about 15 years ago, when Mom was 70,” explains Ludwick’s daughter, Jean Jetter of Omaha. “It was the day I moved into my new house. Mom put things in odd places, like a box labeled ‘kitchen’ would wind up in the bedroom. And she stood smack in the middle of the doorway as the movers tried to carry large pieces of furniture inside, and she just stared at them.”

As Ludwick’s behavior grew worse, Jetter begged her father, Thomas, to get her mother help.

“He didn’t want to hear it. He kept saying, ‘This will get better.’ He had medical and financial Power of Attorney. Dad worked full-time, and she was home alone. This went on for eight years.”

Ludwick’s steady decline rendered her unable to fix a meal or even peel a banana. She lost control of bodily functions. After she was found wandering the neighborhood on several occasions, Jetter was finally able to call Adult Protective Services and get her mother into an adult daycare program. After breaking a hip two years ago, Ludwick arrived at the Life Care Center of Elkhorn.

“This is such a sad, but not unfamiliar case,” says Conley, who began working with Alzheimer’s patients in the mid-’70s. “Even in 2013, people do not know what to do, where to turn.”

Dr. Murman adds, “There is still a stigma attached to Alzheimer’s. People don’t like to hear the ‘A’ word. But it’s much better to be open and specific about it.”

A specific diagnosis may rule out Alzheimer’s.

“Depression can mimic the symptoms of Alzheimer’s…symptoms like mistrust, hallucinations, apathy, social isolation,” explains Dr. Arun Sharma, a geriatric psychiatrist with Alegent Creighton Health. “But we can treat that. We can treat depression.”

Dr. Sharma helped establish a 22-bed, short-term residential facility called Heritage Center at Immanuel Hospital to better diagnose the reasons for a person’s memory loss. Once a patient is stabilized and receives a proper care plan, they can return home. The more doctors learn, the faster a cure will come.

“I see something exciting in the next five to 10 years,” says Dr. Sharma. “If we identify and isolate the protein believed responsible for Alzheimer’s, perhaps we can do a blood test to catch the disease early.”

 “There is still a stigma attached to Alzheimer’s. People don’t like to hear the ‘A’ word. But it’s much better to be open and specific about it.” – Dr. Daniel Murman, specialist in geriatric neurology at The Nebraska Medical Center

But what about a cure? With 78 million Baby Boomers coming down the pike—10,000 of them turning 65 each day—this country faces an epidemic. And what about the psychological, financial, and emotional toll on the caregivers, who are very often family members? They, too, feel isolated.

“It was an impossible situation for me. I couldn’t get her the help she needed,” says Jetter, who bore the brunt of the family crisis since her married sister lives in Dallas. “Now that Mom is at [the nursing home], I can take a breather and concentrate on Dad, who also has mental issues.”

In recent weeks, her father, Thomas, has been admitted as a permanent resident of Life Care Center of Elkhorn as well.

What about her own family?

“I have no one. No husband, no boyfriend. I mean, what boyfriend would put up with all this?” asks Jean, who’s been shuttling between one parent and the other for years, all the while trying to run her own business. The situation has obviously taken a huge personal toll.

Conley has two words for anyone facing similar circumstances: Alzheimer’s Association. The Midlands chapter has support groups, tons of information, and can gently guide the adult child or spouse. They even have a 24/7 hotline: 800-272-3900.

For anyone dealing with Alzheimer’s, that number could become a lifeline.

Bipolar Disease

November 25, 2012 by

“My husband didn’t know if he was going to come home to Cruella Deville or Dolly Levi from Hello Dolly.” That’s how Jane Pauley, broadcast journalist and former co-host of the TV morning show Today, described her battle with bi-polar disease in a interview on Healthy Minds, produced by New York Public Radio. “Who knows what provokes it, but it was like a swarm of bees that wants a target,” she says.

Being diagnosed with bipolar disease was a shock, recalls Pauley, but getting a diagnosis and subsequent treatment, however, allowed her to regain some normalcy in her life again.

Bipolar disease is a serious mental illness that is associated with extreme mood swings from mania to depression. “It is one of the most serious illnesses we deal with because of the disruptive nature of the disease,” says Sharon Hammer, M.D., psychiatrist at the University of Nebraska Medical Center (UNMC). “It is more serous than depression or schizophrenia because it can lead to risky behaviors, such as drug and alcohol abuse, damaged relationships, and suicide. And because of the impulsive nature of the disease, there is often no time to intervene.”

The average onset of bipolar disease tends to occur in older teenagers and young adults ages 20 to 25 years old. “Many women may start to experience symptoms of depression in their teenage years followed by their first manic episode in college,” says Hammer. “This is a very risky time because the college years are often mixed with stress, sleep deprivation, and alcohol use, which are all triggers for episodes.”

“It is one of the most serious illnesses we deal with because of the disruptive nature of the disease.” – Sharon Hammer, M.D., psychiatrist at UNMC

Women with bipolar disease typically spend about 80 percent of the time in depression and 20 percent in mania. Episodes of mania are characterized by abnormal elevated moods that include irritability, being easily agitated, impulsivity, racing thoughts, and insomnia.

Many women tend to be in denial and don’t start taking it seriously until they have children, notes Hammer. Even then, it is often misdiagnosed as depression or anxiety due to the extended depressive states associated with the condition, and the fact that women are twice as likely to have depression than men. In fact, bipolar disease is the most under-diagnosed mental illness and the most challenging to diagnose, notes Hammer.

Misdiagnosis can create more problems because medications used for depression and anxiety are different than those used to treat bipolar disease and can make the condition worse.

In addition, untreated bipolar disease tends to gain momentum and become more malignant with time, says P.J. Malin, M.D., a psychiatrist with Alegent Creighton Clinic and an associate professor of psychiatry at Creighton University School of Medicine. “It can be very disruptive to other parts of your life. Approximately 60 percent of people with bipolar disease will develop substance abuse problems, and it carries a 15 to 20 percent suicide rate.

“Early treatment of the disease can help prevent the disease from getting more aggressive. Untreated bipolar disease, on the other hand, lowers one’s life expectancy by 10 years.”

If you are being treated for depression and are not responding to depression medications or you are experiencing negative or an unusual response, it is important to communicate this with your provider, adds Malin.

“Early treatment of the disease can help prevent the disease from getting more aggressive.” – P.J. Malin, M.D., psychiatrist with Alegent Creighton Clinic

You can also do your own test by taking the Mood Disorders Questionnaire (MDQ) online, which provides fairly accurate results and can help you and your clinician determine whether you are bipolar, notes Hammer.

Environmental factors and heredity appear to be the major risk factors for bipolar disease, says Malin. “There are different theories as to how the environment plays a role, but they include: obstetric complications, intra-utero viral infections, use of hallucinogenic drugs, and traumatic life events, such as the death of family or friends or abuse.”

Treatment typically involves a combination of medications and counseling that may be necessary over a person’s lifetime. “Counseling is huge for long-term success and stabilization,” says Robin Houser, a counselor for Nebraska Methodist Hospital’s employee assistance program, Bestcare EAP. “Bipolar disease is a lifetime problem, and counseling can help people learn coping techniques and avoid unhealthy thinking and unhealthy patterns of behavior. A lot of people think that once they have become stabilized that they don’t need medications or counseling anymore, but that’s when we’ll start seeing imbalances and manic episodes occur again.”

Women with bipolar disease are very sensitive to stress, lack of sleep, and environmental and seasonal changes, all of which can trigger an episode, notes Hammer. Practicing healthy lifestyle habits like getting regular exercise, adequate sleep, managing stress, and light therapy during the winter months can help keep the disease stabilized.

 “Counseling is huge for long-term success and stabilization.” – Robin Houser, counselor for Nebraska Methodist Hospital

Postpartum is also a common time to experience recurrences, probably because of sleep deprivation, says Hammer. There are medications that are safe to use during pregnancy, which are important to take to prevent a relapse. If a woman stops her medications during pregnancy, it can take up to six months to get the symptoms under control again, says Hammer.

“Newer medications as a whole have fewer side effects,” she says, “but it’s important that you are matched with the medication that works best for you and has the fewest side effects.

“Patients who are being followed and treated by a trained health care professional can function vey well and live a normal life.”