Dr. Stef On Call provides personalized pediatric care. From newborns to teens. Home visits and phone consultations for all your pediatric needs.
Dr. Stef On Call is a Direct Patient Care practice delivering personalized pediatric care to your home in the Dallas area.
Operating as usual
webmd.com According to the CDC, only 6.6% of all confirmed cases in the U.S. have been in children under 18 years old. Regionally, though, the numbers look different.
I’m getting asked this question every day..... Should we send our children back to school? There’s no quick answer, no easy answer, no “ right” answer.... but this is the best answer I’ve seen.....
vox.com Six questions about the safety of kids, teachers, and families, answered.
Any rambunctious kiddos stuck at home that end up bopping their heads and wind up with a cut like this - where a bandaid won’t suffice, but stitches are probably overkill - give me a call and I’ll come and fix it up for the cost of a home visit - I will waive the extra $50 fee for the wound repair (skin adhesive) so long as we are all still “sheltering in place”. 214-557-0877
Two drive-thru testing sites now available in Dallas to test for COVID19 in anyone who presents with cough (or shortness or breath or chest pain.... but don’t wait til symptoms progress that far....) & fever > 99.6. The criteria of who ‘qualifies’ for testing lessens as the capacity to run more tests increases, so more & more people will be able to get tested. Keep in mind, test results don’t change the treatment. Most people (particularly if they are in good health and have no underlying health conditions) will just experience a cold or flu-like illness. The treatment is to STAY AT HOME, strictly limit your contact with others, rest, drink plenty of fluids, and take OTC pain/fever relievers as needed to keep comfortable. Testing is still important so we have a more accurate picture of the extent of disease and to help us understand the various clinical courses it may have in different populations of people. Reasons for contacting your doctor or going to the ER would be chest pain, heavy sensation in chest, difficulty breathing, shortness of breath, etc. On the other hand, if you are > 65yo or have other underlying medical conditions (heart disease, diabetes, autoimmune disease (or on immunosuppressive therapy) history of smoking, COPD, etc) then I would advise you to contact your doctor immediately at the onset of any symptoms.
Several private labs are now able to test for COVID19 as well, but doctor’s offices may be limited in their ability to perform these tests due to lack of Personal Protective Equipment, and out of concern for the health & safety of their staff and other patients in the office, they may direct you to one of these drive-through testing sites.
Disclaimer: this is not intended to be medical advice. Call your doctor if you have any questions / concerns; see the CDC website for more comprehensive information about COVID19 or the Dallas Health & Human Services website for more local updates.
wfaa.com The drive-thru testing sites in Dallas are now open to more people. Here's what you need to know before visiting one.
nbcchicago.com Dr. Emily Landon is the chief infectious disease epidemiologist at the University of Chicago Medicine, who moments after Pritzker issued the ordinance to take effect Saturday evening, took to the stand with a 7-minute-long speech that went viral after striking a chord for many individuals.
Update on COVID-19 testing: Right now, testing capabilities for COVID-19 are still limited and most facilities are only able to run tests on patients who have a doctor’s order and meet the following criteria: fever + cough with a history of travel from high-risk area; OR fever + cough in an individual who is at greater risk for severe disease due to underlying illness (ex: elderly, immunocompromised, etc.); OR fever + cough and a history of exposure to a confirmed or suspected case; OR someone who is ill enough to require hospitalization for respiratory symptoms.
It would be helpful (for epidemiologic purposes - meaning to help get a true idea of how wide-spread the virus is, and how varied the spectrum of disease may be, etc.) to be able to test anyone and everyone with fever + cough (or perhaps just everyone, period...), but that is not feasible, at least not at this time.
That being said, there is a private lab in Dallas that is offering COVID-19 testing to anyone that wants it, without a doctors order. They will deliver the collection kit to your house - you collect the sample yourself - package it up - and they will retrieve it and deliver it to the lab. They claim that results will be available in 48 hours. The fee for this test is $299, up front. Anyone can go to the website to complete a request and submit payment: magnoliadiagnostics.com
I don’t recommend everyone try to get tested by this route, but if you have serious concerns (suffering with a flu-like illness, but have tested negative for the flu...) and really really want to know, as of today, this seems like your best option. And you don’t have to go to the doctor’s office or urgent care, and you don’t need me to come to your house....
I suspect testing capabilities will increase over the coming weeks, making COVID19 testing more widely available and less expensive. In addition to needing more supplies, the private labs also need more time to work out an agreement with insurance carriers on pricing and coverage.
All that being said, if you DON”T think your child has COVID-19, but you have other health concerns and would like to have them evaluated, whether it be for Strep, an ear ache, asthma/allergies, pink eye, a rash, etc., I am available for house calls. Text me with your request: 214-557-0877, and be sure to let me know where you live (my geographic area is generally south and west of 635, east of the Tollway,
North of downtown).
Easier said than done..... especially the part about managing your own screen habits.... but oh so important to limit time, access & content on media devices, constantly supervise, be a good role model, and promote more active, creative & social past-times. Don't approach limiting screen time as a punishment - approach it as an opportunity to learn by experiencing real life. If we want kids to know how to act in social interactions, how to converse with adults, how to behave in a restaurant, to develop a sense of direction, and to understand & appreciate some of the simple but mundane tasks of everyday life - so that one day they will be able to do such tasks for themselves - we need to get them off their screens and get them to pay attention to what's going on around them.
activeforlife.com From planning a media strategy to limiting screen time for both you and your kids
Planning your summer get-away?
Thought this was a timely article to post regarding treatment and prevention of motion sickness. Note that, due to increased risk of side effects in children and the inability to adjust the dosage, the scopolamine patch - commonly used to prevent motion sickness in adults - is not recommended in children. Benadryl and Dramamine are OTC antihistamines that are most commonly used to prevent motion sickness in children, as mentioned in the article below. However, if your child has reacted adversely to these drugs in the past (most common side effect = sedation, though some folks may experience restlessness, anxiety & agitation), another OTC option for prevention of motion sickness, not mentioned in the article below, is Bonine for Kids (active ingredient = cyclizine), which tends to be much less sedating.
Lots of other good tips in the article to help you prepare for your trip and enjoy the ride. Bon Voyage!
childrensmd.org Nothing makes travel miserable like a vomiting child, but the good news is that even the worst motion sickness is treatable. If your child is car sick, air sick, or sea sick, the right drugs combined with tried-and-true home remedies can stop the nauseated misery and help your whole family enjoy tra...
No joke.... warn your kids to stay away from these drinks....
healthyandnaturalworld.com Some of the foods sold in North America aren't really food. They are imitations, imposters. Here are the top ten posers to strictly avoid.
This is terrible news! This is the dental floss I use - No more! I know it seems these chemicals are everywhere (our drinking water.... our carpets, our furniture...) and just impossible to avoid - but if I can decrease my serum levels by 25% by simply using another dental floss I most definitely will! So many chemicals we have created that are destroying our bodies and our world.... so sad, so disturbing.... but, on a positive note, at least people are starting to become more aware of this problem and more research is being done to identify and address the problem.....
medscape.com Flossing teeth with Oral-B Glide and similar brands could inadvertently increase exposure to PFAS chemicals, a number of which have been linked to cancer and thyroid disease, a US study indicates.
A few weeks ago there wasn’t much flu activity to talk about, at least not in Texas. But with people traveling all over the country the past couple weeks, it didn’t take long to spread. As you can see from the chart, flu activity has spiked in the past couple weeks, and likely will continue to do so for the next several weeks. If you haven’t gotten your flu shot yet, get it asap. The more people who are vaccinated for the flu and are able to defend themselves against this virus rather than play a host to it, the less efficiently it will spread.
Symptoms of the flu typically come on abruptly. Early symptoms may include headache, fatigue, malaise, body aches, fever & chills. Respiratory symptoms often develop over the following days, including sore throat, cough, congestion & runny nose. Some folks also experience GI symptoms, such as nausea, upset stomach, loss of appetite, vomiting and/or diarrhea.
If you experience any flu-like symptoms - especially fever, headache, fatigue - by all means STAY HOME. Don’t just take ibuprofen and “push through it”. Don’t go to work or send your child to school. Don’t go to the grocery store or run errands. Limit your exposure to everyone and anyone. Cover your mouth & nose when you cough or sneeze, and wash your hands frequently - rub them together vigorously under running water to flush away all those little flu germs.
The latter advice applies to everyone - cover your cough/sneeze and wash your hands frequently. Try not to touch your eyes, nose, mouth while out & about, as you never know what kind of germs you may have come into contact with.
To you the flu might just mean a couple days of feeling lousy, being unproductive and missing work, to others it can truly be life-threatening.
Let’s all do our part to limit the spread of the flu.
”Stay healthy my friends.” :)
Avoid an overdose - check your medicine cabinet for these bottles of liquid ibuprofen.
medscape.com Tris Pharma Inc. has voluntarily recalled three lots of infants liquid ibuprofen sold at Walmart, CVS, and Family Dollar, because they may contain too much ibuprofen.
lakewood.bubblelife.com Although flu activity has been relatively low in Texas so far, we all know that diseases spread when we spend more time in airports and group gatherings. If you...
"Were all of my previous physicians excellent? Yes. Did they have the extra time to have a personalized health conversation? No."
If you desire more personalized attention from your doctor & more individualized treatment plans - not just a protocol-driven checklist of Qs & As - you need to go with a DPC provider. Only DPC providers have the time and the motivation to listen to all your concerns, evaluate the "whole picture", talk through various treatment options - both the conventional and the non-conventional, and collaborate with you in a meaningful & effective doctor-patient relationship. DPC providers are not as quick to refer you to a specialist if a puzzling condition presents itself - instead they will take the time to research it themselves, consult with colleagues and specialists, and perhaps save you from unnecessary testing, procedures or specialty evaluations. DPC providers are available to take your phone calls & return your emails and they encourage you to reach out to them if you have questions or concerns. They want to know what's going on and they want to help and be involved. At least that's been my experience, and that's why I became a DPC provider.
opmed.doximity.com A collection of posts by and for Doximity members. Opinions expressed are those of the writers and do not necessarily represent the views of Doximity. The information here does not substitute for clinical advice.
“Should I get a FLU SHOT?”
I get asked this question all the time, especially this time of year. According to most health professionals & medical organizations ( including The World Health Organization, The Centers for Disease Control, The Advisory Committee on Immunization Practices), the answer is a resounding YES: any one over the age of 6 months (who has no specific contraindications) should get a flu shot every year. So, that’s the “short answer”. Most people are aware of this recommendation, yet still question whether or not it’s really worth it..... Afterall, everyone knows that the flu vaccine isn’t all that effective. Every year you hear of people who got the vaccine but still got sick with the flu.... not to mention all those stories of people who got sick from the vaccine itself.... and all those people who’ve never had the flu shot and have never had the flu..... so how do you make sense of it all? How do you determine if the flu shot is really “worth it”?
To determine “worth” we will have to delve into the pros & the cons of getting the flu vaccine and weigh those factors against the risk of getting the flu, and how that risk is mitigated by getting the flu shot. The biggest “con” for some people may simply be the idea of “getting a shot”. The needlephobia or shot-o-phobia is difficult to really take into account: the degree of fear that is evoked by the idea of getting a shot is an individual preconception and will be unpredictably effected by a number of variables. Efforts can be made to help minimize these fears, but even so, such phobias can be a real deterrent for some folks.
Cost & inconvenience are not generally big deterrents these days as the flu vaccine is widely available and often 100% covered by insurance. For those that don’t have insurance that covers the cost of the flu vaccine, the fees are typically $40 at the pharmacies or $20/adult and $10/child at state-funded health clinics, both of which offer flu shots to walk-ins, no appointment necessary.
If we can get beyond the needlephobia, cost & convenience factors, the next “con” to consider is the side effects - or, perhaps more appropriately referred to as your body’s reaction to the flu vaccine. The most common “side effect”, which should be of no surprise, is pain at the injection site. Less frequently, but still fairly common, there may be some redness and/or swelling at the injection site. This local reaction does not usually interfere with activity and generally resolves after 1-2 days. Experiencing fever after a flu vaccine is more common in younger children (12% in children < 5yo; 5% in children 6-16yo). Headaches (13%), myalgias (11%) and malaise (10%) are also not uncommon reactions to the flu shot, though on the flip side there’s an 85-90% chance you won’t experience any of these symptom. If they are to occur, such symptoms typically start within 6-12 hours of getting the vaccine and resolve in 24-48 hours.
Other less common side effects include syncope, allergic reaction and Guillain-Barre Syndrome, though these are not necessarily specific to the flu shot. Syncope, or fainting, may occur after any shot - it is not harmful or dangerous (other than the danger of hurting yourself if you suddenly collapse & fall) and is brought on by an emotional/ hormonal reaction to pain and/or anxiety. The greatest risk for fainting is within the first 5-10” after receiving a shot and is preceded by a feeling of light-headedness, weakness & tunnel vision. Recovery is almost immediate and without sequelae.
“Risk of a severe allergic reaction” is listed as a potential side effect with every medication, every supplement, and every kind of vaccine. The actual risk is estimated to be about 1.5 per million.
Guillain Barre Syndrome (GBS) is a rare auto-immune neuropathy that can be triggered by any one of a number of viral infections, bacterial infections or vaccines (even “surgery” has been implicated as a potential trigger) - basically, anything that stimulates your immune system has the potential to trigger this rare syndrome. In fact, being sick with the flu is actually a greater risk factor for developing GBS than getting immunized with a flu vaccine.
So, those are pretty much all the “cons” to take into consideration. The list of “cons” from getting sick with the flu is a much longer list. The symptoms brought on by the flu include fever, chills, headache, malaise, fatigue, myalgias - similar to the side effects of the vaccine but occurring at a much higher frequency, greater severity and longer duration. Other common symptoms include congestion, runny nose, sore throat, coughing, abdominal pain, nausea, vomiting & diarrhea. The flu can also trigger croup, severe asthma exacerbations and febrile seizures. Not uncommonly it can lead to ear infections, sinus infections and pneumonia. More rare but serious complications include myocarditis, Guillain Barre Syndrome, encephalitis, sepsis, respiratory failure, heart failure, shock and death.
Then there’s the cost & inconvenience of having the flu.... a lot more costly & inconvenient than getting the vaccine. It’s not unusual to miss several days if not an entire week of work or school when you are sick with the flu. Billions of consumer dollars are spent each year on doctor visits, ER visits and anti-viral medications, as well as over-the-counter remedies for the alleviation of flu symptoms. Simply taking 2 children to the doctor’s office for an influenza-like illness could easily cost a family over $300, and then if Tamiflu is prescribed the pharmacy bill could easily exceed $500 (average cost of liquid medicine is $230-$280, average cost of pills are $110-$150).
Okay, okay, so everyone knows that having the flu can be really miserable as well as costly, but not every unvaccinated person gets the flu, and being vaccinated is certainly no guarantee of protection. In fact, most estimates suggest the flu vaccine is only 50-70% effective (some years even less!). So, again, is getting the flu shot really “worth it”?
Let’s look at the risks of getting the flu with or without the flu vaccine.... Every flu season, about 10-20% of the entire U.S. population will get sick with the flu. This number would be more like 30% if no one was vaccinated (or if a new, never-seen- before flu strain emerged that no one was protected against - like the “swine flu” in 2009). So, let’s start in a world where no one is vaccinated and say your personal risk of getting the flu this season is 30% - which means there’s a 70% chance that you won’t get it.... not too bad, right? But, now introduce the flu vaccine that could decrease this 30% risk to as little as 10-15%. That means there’s now an 85-90% chance that you won’t get sick from the flu this year - even better! You see, even though the flu vaccine may only be 50-70% effective, if your baseline risk is 30%, you’ve now reduced your risk to 10-15%, so you’ve essentially provided yourself with an 85-90% protection rate.
Not only that, but even if you are one of the 10-15% of vaccinated individuals who still gets the flu, having had the flu vaccine significantly decreases the likelihood that you will require medical care - from doctor visit to ER visit to hospitalization to ICU care - your risk of needing any type of medical care is greatly reduced. That’s because your symptoms will likely be less severe, decreasing your risk of secondary infections and other complications. Of course, that’s not always the case, but statistically speaking, getting a flu vaccine significantly reduces your chances of experiencing a severe flu illness with complications that might require hospitalization, ICU care, or result in death. Sadly, of the 171 pediatric deaths from the flu during the 2017-18 flu season, 78% of the children were unvaccinated or under-vaccinated.
Lastly, getting a flu shot also protects those around you - including those that were not able to get a flu shot as well as those that did get vaccinated but maybe did not have an adequate immune response to the vaccine for some reason. On the other hand, not getting a flu shot puts those around you at increased risk since the flu is highly contagious and easily spread. The more people who get a flu shot, the better the chance of limiting the flu outbreak in the whole community, potentially saving billions of dollars, preventing tens-hundreds of thousands of hospitalizations and thousands of deaths.
So, there you have it. That’s “the long story”, summarizing all of the pros & cons of getting a flu shot, and hopefully helping those of you who question the utility of the flu shot to better understand why we (doctors & other health professionals) do think it’s “worth it” and why we continue to recommend it for everyone year after year, despite it’s not always impressive track record. It’s not an easy computation, but the odds are definitely in favor a getting vaccinated. Even the insurance companies agree - they would never shell out millions of dollars a year to cover the cost of flu shots if they didn’t recognize that it was financially in their best interest to do so. Aside from isolating yourself from all human contact from December through March, getting a flu vaccine every year is the number one thing you can do to protect yourself - and those around you - from the flu. So, if you haven’t gotten one yet, then YES, I’d recommend you get one - now.
cdc.gov Everything you need to know about the flu illness, including symptoms, treatment and prevention
Dr. Stef On Call is a Direct Patient Care practice delivering personalized pediatric care to your home in the Dallas area. Dr. Stef treats children from newborns to teens. Home visits starting at $100. Mon - Thur 7am - 7pm, Friday 7am - 5pm, Saturday & Sunday 9am - 5pm. Call or text for same-day appointment: 214-557-0877. More info at www.drstefoncall.com
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