Archive for the ‘Vaccines’ Category

A Vaccination Booster?

Friday, August 29th, 2014

Regarding any association between ‘shots’ and the occurrence of ASD, the vast majority of accepted scientific evidence supports vaccine safety. Yet, for a great number of families, the term ‘vaccine safety’ is an oxymoron.

When childhood inoculation schedules light up the social media radar screen, there is often an increasing demand for my professional assessment.

"My child has made alot of progress.
 I have learned to pick my battles. So we have won some battles...
 What is your opinion on the current Vaccine CDC Controversy?...
 I feel soooo let down by my government!
 I need to hear from a Professional that is honest and caring...
 What would Dr. Udell Do? (Please say hello to Karen)"

The issue:
A now unavailable, already discredited, (formerly) published ‘study’ in the journal Translational Neurodegeneration, made claims about an increased risk of autism after MMR vaccinations in African-American males. Assertions surfaced about the validity of data collection and evaluation, implicating a government cover-up. That fueled online finger pointing.

The press loves a fight, especially when it involves those anti-vaccination kooks.

The light:
Well, there really was no light. The 10-year-old study in question was appropriately explained. Given design and outcome measures, the conclusions in that paper seem valid.

Solid evidence is lacking about whether autism may be triggered by certain vaccinations, various dosages, schedules, in susceptible individuals, in the presence of certain physical findings, and depending on previous medical or family history, sex, age, etc. Then, there are external difficulties, such as the quality of storage and labeling, which have been brought into question.

NEVER? Impossible?
The government notes that ‘shots’ are responsible for fevers (up to 25%), seizures and neurologic disruption.
But not autism.

The heat:
CNN dredged up The Wakefield Effect; stories concerning any non-conventional point-of-view regarding autism should be assumed as false, and they could be dangerous.

Talking heads derided “those zealots” who are despoiling herd immunity with ignorant, self-centered beliefs. Still, in a highlighted measles vignette, the group-in-question was Amish! Such issues are extant in other religious organizations, as well. Autism outcome is not their primary concern, and that isn’t going to change with any CDC proclamation.

Admonishment from detached media ‘pundits’ further marginalizes affected families who are so baffled by what happened to their perfectly developing infant or toddler.

Conclusion:
We don’t even know what autism is, what causes it, or what has led to the increasing number of patients. Yet, the powers-that-be seem so sure about what doesn’t cause the problem. And often, about what doesn’t help, either.

Nothing has changed. I cannot get my head around the disconnect between public and medical opinion.
Two people get the ebola virus and we’re all running for the hills.
Autism as an epidemic? Not sure about that one.

This story is a tempest-in-a-teapot based on a decades-old study when the incidence of autism was 1/110. The rate has nearly doubled since that time. Rather than deriding those who question the gods of medical science, it’s time to delve even deeper into the factor(s) producing this modern epidemic.

Miracle Mineral Solution Treatment for Autism

Saturday, May 24th, 2014

I hadn’t really expected MMS to gain any traction as a viable autism treatment. It seems complicated and scary, and the FDA first issued a warning about it four years ago. Perhaps there is no measurable re-emergence, but it seemed so when I attended the Autism Today Second Conference in Miami this week.

I sat among eighty mostly-bewildered parents, representing children who are so affected that they are attracted to outlier theories and treatments. This is largely because the information supplied by the conventional medical community is so woefully inaccurate, incomplete, and unproductive for many patients.

Due to some scheduling glitches, this conference ended up focusing on the very controversial topic of MMS. The treatment was explained by Ms. Kerri Rivera, “a biomedical consultant for an autism clinic in Puerto Vallarta,” and mother of recovered child. Her experience was then authenticated by Dr. Andreas Ludwig Kalcker, inventor of “The Parasite Protocol,” which is an essential element in the therapy.

The Chlorine Dioxide Protocol is not about bleaching your kid. That was the first message. Well, it’s not about making your intestines white, but the word does mean “to sterilize.” Anyway, that refers to sodium hypochlorite, according to Ms. Rivera, not the chemical that MMS is utilizing. In that sense, it’s not about dipping your child in Clorox. Except that Chlorine dioxide is used in “stripping textiles and industrial water treatment,” and it does involve purging and cleaning the “excess of pathogens.”

  • The diet – organic vegetables and meats. GF/CF/SF/sugar free (especially fruits).
  • Supplements – Stay away from all anti-oxidants.
  • Main Ingredient – Ocean water and acid (lemon juice, e.g.), to make a dilute solution of Chlorine Dioxide.
  • How it is administered – Doses and administration depending on a pre-established protocol, plus alterations depending on symptoms and response to treatment. In the gut, it is supposed to remove the biofilm and so expose organisms that get flushed through the G-I tract. Breathed into the lungs, it addresses asthma and bronchitis. The cutaneous route helps eliminate bad skin cooties and detoxify. Enemas and rectal suppositories to directly address lower intestinal issues. There is also and Eye and Ear spray form.
  • What happens – The elimination of bad bacteria (and, admittedly some good ones – but they have a product to fix that), viruses, fungi, and worms. Lots of worms. Plenty of worm pics. Worms that no laboratory in the world, apparently, can document.
  • Acceptable additional treatments listed as HBOT, chemical chelation and GcMAF, probiotics, l-carnosine, carnitine, plant fatty acids, GABA, digestive enzymes, tryptophan, DMG and TMG (the last 2 are anti-oxidant precursors).
  • She claims to have helped over 6000 families, and 131 cases of patients losing the diagnosis.

The ‘Parasite protocol’ was presented by Dr. Andreas Ludwig Kalcker, who recommends Chlorine Dioxide treatment.  He lists his credentials as, “… first licensed in economics and later in biophysics and alternative health (Ph.D)
Although his German accent is compelling, the science that he presented was not. He listed the symptoms of parasites and noted similarities to many autistic behaviors (?cause and effect?). He claims that his key discovery was that regressive autism is due to “Parasitological Vaccinosis“. That term describes toxins that are later released by parasites in susceptible children who become vaccinated.
He made many grand overstatements, using real research papers that only prove the one point, frequently mixing apples and oranges. Slides such as “Larval migraines induced by vaccine,” not only lack a scientific citation, I couldn’t find any match over the entire Internet.

In the Q&A session, I asked a simple question, “131 ‘cured’ is the numerator, what is the denominator?” This resulted in Ms. Rivera and Dr. Kalcker blustering about how that number couldn’t be documented, and how it wasn’t really important. That begs the comment, “Well, if you don’t know how many have been treated in this manner, you also wouldn’t really know how many have experienced significant negative reactions.”

As expressed by top autism researcher, Dr. Martha Herbert, I do not believe that parents who attend these conferences are “gullible, dangerous, and/or don’t love their children, and the people who pass them off are snake oil salesmen.” I was there to learn about new ways to approach our most resistant patients, not to simply criticize. Avertising MMS in this manner is not the way to go about proposing innovative and controversial treatments. It promotes The Wakefield Effect.

Dismissing conventional medicine as being completely ignorant and challenging treatments from all sides takes strong scientific proof. Proof of concept in animal models and proof of efficacy and safety in appropriate human treatment trials. To be specific: no, I would not recommend this treatment for my patients. There is simply too much missing information. A few pictures of recovered children and parental testimonials should not sway a prudent professional.

At The Child Development Center, we have improved the lives of many of our patients by addressing and treating G-I health with a proven, safe, well-tolerated protocol. Nutritional status must be evaluated, treated and monitored. With appropriate behavioral therapies, child development gets on the right track.

For successful autism treatment, each piece in the puzzle has to fit into the bigger picture.

Autism Wars II: The Wakefield Effect

Tuesday, May 13th, 2014

This month, Pediatrics published a paper indicating that there was, in fact, a “greater prevalence of GI symptoms among children with ASD compared with control children.” 
OK, so far.
Not really groundbreaking information, but it did appear in a mainstream, well-respected, scientific journal.

Somehow, the authors felt compelled to include an opinion that the medical profession has been delayed in studying this gut-autism association. The Discussion section includes, “Previous controversy surrounding the MMR vaccine and proposed causal link between ASD and infection of the GI tract probably deterred investigators from dedicating resources to examine GI functioning in this population while fostering uncertainty in the ASD community regarding the validity of this line of inquiry.
Not OK.
Investigators are not prevented from pursuing certain lines of thinking. In fact, there are several follow-up studies challenging the original postulation. That’s science, right?

Shortly thereafter, Forbes autism blogger, Emily Willingham, followed with a piece actually naming the culprit. She tattled that it was the nefarious Dr. Andrew Wakefield. He is the British pediatric-surgeon-gastroenterologist-fallen-from-grace who has been accused of concocting the measles-vaccine-autism association in order to gain riches and international fame. Thanks, Em, otherwise we wouldn’t have known who they meant.
Really not OK.
The science writer penned another less-than-illuminating piece. She posited her somewhat unconventional point of view that anxiety is the cause of many G-I disturbances, rather than the other way ’round. What has that got to do with “Blame Wakefield For Missed Autism-Gut Connection”? Has that delayed ‘Dr.’ W’s research, as well?

Yikes.
Can we get some facts straight here?

Fact: The title of the original article in question was, Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.
It began as a series of case reports, which has been totally blown out of proportion. Some of the patients had an autism diagnosis, assigned by other specialists.

Fact: The conclusion of that paper, We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.”
Does that sound like science or sedition?

Fact: Dr. Leo Kanner, father of modern child psychiatry and inventor of the “autism” classification in the 1940′s, first reported on 11 patients, 8 of whom had G-I signs and symptoms. He called the problem a psychiatric disorder. That delayed correct diagnosis and treatment for about 50 years (and continues to slow the process because of the ASD inclusion in the Diagnostic and Statistical Manual of Mental Disorders).
Anyone angry about that?

Fact: Bruno Bettelheim helped prolong the ‘Refrigerator mom’ theory throughout the 60′s and beyond.
With a thick Austrian accent and faked credentials, he appeared on talk shows and became famous with that stupidity, not infamous.

The Wakefield Effect
Why is there such an emotional connection with this condition? It’s the Wakefield Effect. Because of this debacle, anything having to do with autism that is not sanctioned by the mainstream is considered an aberration; including special diets, yeast in the G-I system, vitamins, and toxins in the environment. Regarding certain establishment fixtures, such as vaccination, anyone who pursues a course of action other than the teachings of the Church (Big Pharma+ Conventional Medicine) is to be expelled from the religion and sent packing to other ports of call. With the availability of the Internet and Social Media, innuendo turns into truth.

I have met Dr. W and heard him speak several times. He is good-looking, articulate, charismatic, and tells a compelling tale. He probably could have continued his research, and even received funding, if he had followed his original work with more humility and sense of uncertainty. If this was a hoax or part of some grander plan, it has certainly failed as he (and his work) falls into obscurity.

Rather than discuss biology, genetics, objective research strategies and prospective trials that could assure safety and effectiveness, the public is fed dogma and discord. The wrong line of reasoning is being followed and now appears in more diverse venues, including popular, financial and even scientific publications.

Perhaps it is less interesting and more complicated, but the best antidote to the Wakefield Effect is for medicine to drop this non-issue and move on. The media wants controversy, but parents want answers.

A Mother’s Intuition About Autism

Saturday, May 10th, 2014
Mother's Day 2014

Mother’s Day 2014

Every new patient at The Child Development Center has a unique history and physical presentation. Often, however, the children share the experience that their mother:
a. Already knew, or highly suspected, ASD, and
b. Heard the doctors proclaim that they were “reluctant to make a diagnosis, at this time, because the child is so young.”

Is there any other serious medical condition that carries this ‘wait and see’ attitude? “It’s probably not cancer, so let’s wait a few months and see what grows.” “The eardrum looks red and is bulging, if the fever gets any higher we will consider antibiotics.” “I hear wheezing, call us in a day or two.” And vaccinations? The first one is foisted upon newborns, with many more to follow, in order to prevent disease.

Study after study documents important gains that come from early intervention for developmental delays. Despite that, there are neurologists and psychiatrists who continue to claim that “You can’t make the autism diagnosis before the age of 2 or 3.” That imposes a waiting period, postponing intervention at the most critical juncture of development.

In order to assign an accurate diagnosis, both the DSM IV, and the present iteration of the Diagnostic and Statistical Manual of Mental Disorders 5.0, contain the stipulation that delays should be noted in early childhood. The previous manual stated, “Delays or abnormal functioning… with onset prior to age 3 years… ” The present DSM 5.0 describes, “Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).” There is no mention of a waiting period.

Yet, in the midst of this epidemic, and with all of the press coverage about the rise in autism, mother is usually the one who makes the diagnosis. Is it any wonder that the parents go to the Internet to get their information or seek alternative treatments when the doctors weren’t even willing to assign a diagnosis, let alone suggest any therapy?

At our Clinic, there are now many younger siblings of children who carry a ‘Spectrum’ diagnosis. Some demonstrate developmental red flags. A 2 year-old male who doesn’t speak and walks on hs toes but shows good eye contact. A 1 year-old female who turns to her name, but doesn’t stand or vocalize. A six month-old boy who suffers from GERD, eczema and chronic diarrhea.

The youngsters were all high-risk and the mom couldn’t sleep, worrying about the future. What is wrong with offering immediate action targeted to specific symptoms? The youngest children can use a probiotic, stop using PPIs and stay away from antibiotics. The older ones need speech and language, OT, ABA and/or PT. STAT.

These are real examples of some brothers and sisters who have gone on to neuro-typical development. Did earlier intervention prevent autism? Bottom line – who cares?

Try this analogy: It is the Middle Ages and The Plague has struck several neighboring cities. The first sign is a flu-like illness that rapidly advances, ending in death. So, when a local sufferer visits the doctor because of a runny nose and sore throat, the physician should be thinking “The Black Death,” not a cold.

Twentieth century poet Helen Steiner Rice wrote, “A mother’s love is patient and forgiving when all others are forsaking, it never fails or falters, even though the heart is breaking.”  When Mom thinks that something is wrong and the doctor dismisses it, saying “It will probably will go away,” families should run, not walk, to a professional who will listen.

Happy Mother’s Day
f
rom Dr. Udell
and the staff at the Child Development Center

The Autism Wars: Frank Bruni vs. Jenny McCarthy

Friday, May 2nd, 2014

Perhaps to mark the end of Autism Awareness month, but seemingly out of the blue, New York Times op-ed contributor, Frank Bruni, decided to weigh in on the vaccination-autism non-connection issue with this April 21, 2014 article. He accused Jenny McCarthy of being an “agitator… the intemperate voice of a movement that posits a link between autism and childhood vaccinations and that badmouths vaccines in general, saying that they have toxins in them and that children get too many of them at once.”

In this corner – Foodie Frank
Who is Foodie Frank to attack Gorgeous Jenny? His bio in the Times describes, “Over his years… he has worn a wide variety of hats, including chief restaurant critic… Rome bureau chief…  also written two New York Times best sellers: Born Round (“as in as in stout, chubby, and always hungry”), and Ambling Into History, (about George Bush)… coauthor of A Gospel of Shame: Children, Sexual Abuse and the Catholic Church.” Wikipedia adds that he “… became the first openly gay op-ed columnist…” of the Times.

Nothing in Mr. Bruni’s curriculum vitae points to any learned knowledge of science, biology, immunology, ecology or child development. The only extant association between Mr. Bruni and autism is this vacuous article that he penned. There is no evidence that he possesses any special information. Oh, that’s right, he did say that Yale’s autism expert, Dr. Fred Volkmar, told HIM that the vaccination controversy “diverts people from what’s really important, which is to focus on the science of really helping kids with autism.” A diversion from the important stuff, huh? As in, this bullshit op-ed story.

And, in this corner – Gorgeous Jenny
And what role does Jenny McCarthy play in this complicated, emotional and misunderstood quagmire that is the present autism epidemic? Her pediatricians didn’t even know what she was talking about when her child was diagnosed with autism. The conventional medical community says that, “Autism is what it is… you got what you got… deal with the situation and get (really expensive and difficult-to-find) therapies. Good luck.”

Parents are admonished not to listen to anyone who says that they can help with medical treatment, other than the standard psycho-stimulant meds. Even if Mom witnesses a change (from a GF/CF diet, e.g.), professionals warn that “It’s probably just a coincidence, like that disproven vaccination theory.”

Ms. McCarthy warned the country and the world that a storm was coming. Regarding ASD, doctors have displayed ignorance at best, and have even caused harm, due to delays and misdiagnosis. And, while we’re on the subject, if it turns out that her son, Evan, has one particular version of autism, that hardly constitutes some sort of fraud for the purpose of gaining visibility. Smack of bullying, Frank?

The child’s complicated diagnosis – made by the doctors -  doesn’t make McCarthy someone “who sows misinformation, stokes fear, abets behavior that endangers people’s health.”
Only the CDC, FDA, and AMA are allowed to do that.

I have been witness to the miraculous improvements served by childhood vaccinations. I recommend them to our patients; perhaps more diligently than might serve the ‘herd’, however, in susceptible individuals, doctors need to be very conservative. It shouldn’t be so complicated for the medical community to produce independent, prospective studies about the present vaccine schedule with 3 year follow-up aimed at developmental outcome, especially as it applies to higher risk infants.

No Winner is Declared
My advice is for Mr. Bruni to go back to his core competencies, Ms. McCathy to continue to fight for her child and help raise money for autism awareness-treatment-and-prevention, and for medical science to work on a better explanation(s) for this epidemic.

An agitator produces lots of heat with little light.
What a desperate mother does, is search for answers why her perfect, beautiful toddler became non-responsive and stopped talking.

Worried About Autism – Where to Begin?

Saturday, April 19th, 2014

Not uncommonly, The Child Development Center receives emails such as this one:
Stumbled upon your website, and I have found it to be very informative. My 3 year old has just been diagnosed with Autism, although I do not really believe that he is autistic, because in some rare moments, I find he displays “normal” for lack of a better word, tedencies. He makes eye contact, he tries to express himself, he doesn’t point, but shows me where he wants to go and what he wants. Although, at the same time, many of the other signs are obviously there. Anyways, my reason for emailing you is that we live <<outside the US>>, and I wanted to know if there are any practitioners that you could recommend that we see in our neck of the woods?

In the past, parents would seek assistance and counsel from their child’s pediatrician or family physician.
Doctors take note: this is a serious shortcoming on our part if we do not understand how to diagnose, work up, treat and counsel families about the most important childhood epidemic of the 21st century.
Specialists take note: giving a parent a ticket for various therapies will not stop the family from seeking other opinions and treatments.

Step 1: Use an online tool, such as the M-CHAT, to learn if the child fits criteria for autism. The diagnosis is imprecise, at best, and misleading, at worst, because families may feel hopeless and believe that Rain Man is their child’s future. The behaviors that rule the diagnosis IN are the important ones, not the activities that do not fit the general perception of this disorder. In the case above, the child is starting to develop more typically by pointing and making eye contact, which is a positive sign toward recovery. What should concern any family (and the doctors) is lack of speech (or loss, even worse), and the “other signs that are obviously there.”

Step 2: If you can, find a knowledgeable practitioner with proven results. At the last meeting of Special Needs Pediatric doctors, there were fewer than 150 participants. Admittedly, there are simply not enough specialists for a condition that affects 1/68 children. The best place to start is the clinician directory at www.medmaps.org. Choosing one of the MAPS members will assure you that the clinician has studied (and been tested on) multiple courses in the most basic and advanced science of ASD.

Step 3: List all of the child’s other medical conditions and work with your pediatrician to address them. Diarrhea, constipation, reflux, asthma, eczema, allergies, recurrent infections may be the primary reasons for behaviors, such as aggression and fog, assigned to the ASD diagnosis. Ask the doctor to check the complete blood count, vitamin D levels, liver, kidney and thyroid function. Get an audiology examination. For the extremely restless, melatonin is a great anti-oxidant and sleep aid.

Step 4: Don’t give your child PPIs for GERD (smaller, frequent feedings and proper positioning), or Miralax for constipation (try probiotics and fiber). Refuse to give antibiotics with every fever elevation or ‘cold’, and question ALL medication advice, such as pre-treatment with Tylenol, or giving vaccinations while the child is ill.

Step 4: In the absence of any other assistance, at least try the gluten free-casein free diet for a few months. What have you got to lose? And, while we’re on the subject of diet, the fewer toxins the better. Try not to cater to the child’s favorite foods, if they are full of sugar or artificial coloring and flavors. Children do not know what is best for them. Especially if outdoor play is minimal, supplement with multivitamins, including C and D3, and fish oil.

Step 5: There is no magic pill, so far. Start appropriate therapies, such as speech and language, OT or behavioral intervention as soon as possible. Your healthier child will progress much faster when proper behaviors are emphasized. Rethinkautism.com can be a valuable tool, particularly when a therapist is not available.

Parents who seek opinions about their child’s unusual development are probably thinking autism, somewhere in the back of their minds. However, after experiencing the denial that is part of the grieving process, the reality of actually believing the diagnosis has to motivate parents to research, ask other parents and take action.

Even for families living in the remotest locale, something can be done to help your developmentally high-risk child.

Autism Un-Awareness

Saturday, April 12th, 2014

March 27-March 29, 2014. The MedMaps.org meeting of Special Needs Pediatricians in California.

Friday, March 28, 2014. The CDC announcement that “about 1 in 68 children has been identified with autism spectrum disorder (ASD)…”

Wednesday, April 2, 2014. Autism Awareness Day (and Month).

Pretty much, such news should have set off a call to action, don’t you think? Yet, there seems to be very little traction. We’re already into the 3rd week of the month, and it doesn’t seem that publicized questions go beyond, “So, do you really think that there is more autism, or have we just changed the criteria?” And, as always, the vaccination issue… Or, nothing.

With deference to those with autism who are pleased with their life and lifestyle, what other childhood epidemic has gotten so little attention? In my youth, polio created summertime panic for our mothers and we were often kept indoors (and that was pre-ac, where I lived). In 1952, at its highest incidence, combined cases (paralytic and non-paralyzing) occurred in ~58,000 out of a population of 158 million people, with approximately 37 million susceptible youth. That was a risk of 1 per 2000 children.

Some may argue that, “Polio carried the risks of death or paralysis, this is just autism.” “Just autism,” is not a term that I have heard any parent express. Ergo, we need to erase Autism Un-Awareness.

Knowledge and experience will get us beyond this rhetoric. The first part is expanding daily. The associations between autism and inflammation, G-I heath, environmental toxins and genetic susceptibility continue to be re-confirmed in the conventional scientific literature.

Parents now request much more information about pre-pregnancy and maternal health. Families bring younger and younger children for evaluation. Developmental delays that were previously considered as ‘minor,’ or ‘normal’ may get evaluated and addressed. Sadly, the pediatric community continues to follow a more traditional course in the diagnosis and treatment of this epidemic. Children, nowadays, don’t appear to simply ‘outgrow’ slow language development in the presence of some repetitive or unusual movements. Medical evaluation and intervention does not appear to be consistent with their version.

With so few practitioners willing to learn about and tackle this condition in an aggressive and non-traditional manner, experience is evolving at a slower-than-expected pace. Technological tools, such as relational databases, can play a significant role as conventional medicine catches up with the explosion of cases in such a disparate group of patients and practitioners. Autism360.org is a great example. (Thank you, Dr. Baker)

I’m not quite certain what percentage increase it will take to sway the general population that we have a real problem on our hands. Maybe it won’t be a percentage at all. President Roosevelt’s story warned a previous generation about polio. In 1963, the plight of President Kennedy’s premie spurred the development of NICUs with trained specialists to solve the problems of prematurity, while preserving healthy development. It took Magic Johnson to get the public riled up about HIV and the risk to the entire community. Angelina Jolie exposed the BRCA gene, etc.

Real autism awareness will come when we stop asking the old questions and start considering the condition(s), as it (they) is (are). Autism was around and has been creeping up on us. What we call ASD is a new disorder in a new century. Speaking of polio, epidemics were virtually unknown in the US until the 20th century.

New shit happens.

Is Tamiflu for You?

Friday, February 7th, 2014

As a physician who cares for at-risk infants and children, I am frequently asked to weigh in on the topic of flu vaccine and the medication, Tamiflu.

Ever since the introduction of Oseltamivir Phosphate, an anti-viral preparation to ‘cure’ influenza, controversy has ensued. There are a number of websites that discuss the issue in detail, pro and con.

Forbes magazine, which generally takes fairly conservative positions, recently published “The Myth of Tamiflu“. The FDA doesn’t seem to have a problem with it; even recommending Tamiflu for infants as young as two weeks.

Consumer Reports, recently concluded, “Not unless you’re very sick with the flu or … are otherwise at high risk.” That respected medical journal’s opinion was to administer Tamiflu to the group that might get ‘sickest’ from the disease.

Cost(s):
A typical course has been reported to cost $120, more or less. For an entire family of 4 or more, it becomes fairly pricey.
Does Medicaid or insurance pay? If they are willing to cover (call, push buttons, and argue at your own peril), you may have to wait until the prescription is authorized; thus, mitigating the “at the earliest sign of the flu” advice. Co-pays can be more expensive as well, e.g. $25 or more. Keep your Tamiflu coupons handy.

Benefit(s):
Symptomatic relief occurring 1-2 days (out of 1-2 weeks of influenza) sooner is possible, but that is no certainty. The condition may not be the ‘flu’, the virus strain may not show responsiveness, or the patient waited too long to initiate treatment.
Additionally, I am sure that Roche has a ‘Days of Reduced Productivity From the Influenza Virus’ PowerPoint slide to persuade beaurocratic personnel that their concoction is worthwhile.

Risk(s):
Warnings listed in the Physician’s Desk Reference include:
• Severe allergic reactions.
• Serious skin reactions.
• Neuropsychiatric events, signs of abnormal behavior – how can you tell about this in your ASD affected child?
• Dyspepsia (upset stomach), with increased rates of vomiting - which is a common symptom in children, and many with autism.
• Diarrhea – another frequent physical sign in our high-risk patient population.
• “Caution in nursing” -  but it’s recommended if you’re pregnant? Also, most babies should be nursing; so, it’s OK as a liquid, but not OK in breast milk?

The Genentech website cautions:
“People with the flu, particularly children and adolescents, may be at an increased risk of seizure, confusion, or abnormal behavior early during their illness.”
“The most common side effects are mild to moderate nausea and vomiting, diarrhea and stomach pain.”

Conclusions:
So far, the risks appear to outweigh the benefits of Tamiflu. The cost seems high, considering that the drug only results in a possible, slightly shortened course of the flu. There are important lingering questions; including, whether there are fewer complications and deaths.

Long-term outcomes will have to wait until Tamiflu is used long term. This medicine was not available in the last century, begging the question of how there could be truly valid safety information when this antiviral is administered to a 2 week-old infant.

Recommendation:
Healthy older children and adults who exhibit the onset and suffering, or wish to prevent the flu in their virus-ridden environment, and can afford it, might give it a try.

My preference is to prescribe Tamiflu to those who are not pregnant, breast feeding, or very young children, in the hopes of preventing infectious transmission to those who are at increased risk for complications, without incurring the risks of the drug.

The greatest benefit that I see, is to the pharmaceutical company Roche,
and its member company, Genentech.

Emails from a Parent Concerned about Autism

Monday, January 13th, 2014

We get emails galore at The Child Development Center. The following exchanges (which took place over 7 months) are from one insightful, articulate and appropriately concerned mother.

Such correspondence is representative of the majority of questions that accompany this complicated process of improving health so that therapies can take hold and reverse the signs and symptoms of the epidemic that is presently called ASD. This Mom covered it all!

Mom: Hi doctor… I’m just scared that my son won’t play like other kids.  I get depressed sometimes about this but do you think my son will be normal again. Do you think my son will be ok ? Will he talk soon?

Dr U: We will do our best… we are quite successful, so let’s see how the first couple of months go, and you will know much better.

Mom: He still he has not said a word yet.  Still in a bit if his world. I know you told me baby steps, but how long? A month, two months?  I’m anxious. Thank you for listening to me.

Dr U: Is he babbling any more, pointing, using signs… other signs of increased communication?

Mom: He moves his lips. On Saturday he said more. He doesn’t babble like a baby. He tries, but not that much comes out. He does point a lot.
Mom: Hi doctor I’m sorry again, but do you think my son will be ok like the other kids playing with them talking? I’m just worried. No words are coming out of his mouth.

Dr. U: That is what we are working towards. It is months that matter, not days or weeks.

Mom: What is asd tympanostubi is that something bad what?

Dr U: Huh? I think that you mean tympanostomy tubes… surgical placement of venting ducts in the ears for children who suffer repeated ear infections. In the past several years, I have become more comfortable with the procedure, especially since it decreases the intake of antibiotics.

Mom: It has been two going three weeks and nothing yet… Do they get more aggressive when taking that probiotic, like… crying, or wanting to talk but can’t. You know what I mean, right? When should I expect him to talk? Do you think he will talk before he turns 3 or after? He’s a very intelligent boy. He knows his alphabet, numbers for his age. He’s intelligent but the thing is, he has to talk and play more – run, jump – more activities outside, so he exercises. Is he lazy? He wants to be sitting all the time.

Dr U: Yes, the change in behaviors could be due to the probiotics, and his new development. So, I can’t guarantee or predict the speech, I can only promise that we can make him healthier and that should lead to typical development.

Mom: Thank you for responding fast, but, what did you mean when you said that you can’t guarantee speech? That he won’t talk at all or he will? Will he be running like other kids do?

Dr U: You worry a lot… that’s what a mom should do. Please keep doing the protocol and we’ll talk at the visits in more depth.

Mom: Yes I worried a lot…But you are not answering my question. Will my son talk soon or not? What did you mean by “I can’t guarantee or predict speech”?

Dr U: I want to be honest and reasonable. No one can predict those things with certainty. Again, let’s wait until the next visit and see the progress and we will be able to tell you more.

Mom: I was reading about vaccines – do they cause autism? Do they contain Thimerosal? What About MMR? When he turns 3 years what should I do? With the blood work will you tell me if it was the vaccine that caused autism? Or was it genetic ? I read so many stories of autism that everyone tells you different stuff about it that makes me scared.

Dr U: Since you are on the ‘net already, please read my blog(s) about this complicated issue.

Mom: Is Asperger’s the same as autism? When you said << my child >> has mild-to-moderate autism what does it mean autism spectrum or Asperger?  I was reading on google…

Dr U: Autism is one of the reasons for delayed development in childhood. Asperger’s may be one kind of autism. Mild to moderate means that there are behaviors that are good, and some that need to get corrected. If you want to read the Internet, www.theautismdoctor.com is very accurate.

Mom: When do I have to stop the probiotic? When he gets constipated he is acting very alert and hyper – it’s that ok?

Dr U: Please, don’t stop the probiotic… If things are ok we will move forward with this protocol.

Mom: How did the blood work come out? Can you tell me something?
Mom: I have some questions about the vitiams b12 injections; will that hurt, will it burn when the liquid is going in? Will my son be safe ??? I’m scared if I have to inject him. How will I do? Are those injection inside his skin like a vaccination – please tell me more about it??? My son will start school but won’t be able to talk. Also, he will be getting his tubes next week, what should I do?
Mom: I want to ask you if hepatitis A vaccination is ok – that’s what he’s going to be getting. He will start School pretty soon. One more thing is the b12 subcutaneous – will that hurt if we don’t inject the right way? I’m afraid to inject my son – it is going to be my responsibility, if something happens to him. I don’t want anything to happen to him. Is that safe? I know I asked you that already, but my son is in your hands and I still don’t see any talking yet – no mouth movement. So, hopefully, with the school and the b12, there will be more improvement. He will also be getting his tubes in his ears next week.

Dr U: Hepatitis A vaccine seems to be important – there was recently a HepA outbreak from some frozen berries in the western US. The mB12 shots shouldn’t hurt – think about a diabetic child who has to get 3 or 4 shots per DAY!

Mom: I’m a little bit concerned. My son has been bleeding  from his nose for two days. Could that be ’cause he is taking too much vitamins, or what could that? He bleeds, but not too much just from one nostril and that’s it. 

Dr U: It is normal, your son’s blood count is OK, and it isn’t the vitamins.

Mom: My son had his ear tubes put in already and everything went great. But I’m still concerned that he’s still bleeding from one nostril. I’m going to make a doctor appt. That is not normal for him to be bleeding and it started when we gave him all that vitamins. I’m not to sure about giving him to much vitamins. What do you think?

Dr U: I think that, if his development is moving along in a good way, you should stay that course.

Mom: But the thing is he’s not talking yet. No mouth movement yet.
Mom: I was given my son the medicine melatonin with yogurt but he threw up. What should I do?

Dr U: Some patients have even put it on pizza (not too hot though), so it should work in anything – not sure why he vomited, but maybe try it in something else and let me know.

Mom: I got the injections already. Should I start on Monday or wait another week with melatonin? What do you think?
Mom: I need a letter from you with the diagnosis, so he can get more therapy. Please, if you can fax it to me… Anther thing I wanted to ask you is how long does it take for the vitamin b12 injections get effective for my son to talk or say at something? I’m very disappointed ’cause it still hasn’t worked yet. He has gotten two injections already on Monday it will be his third one. Please let me know if I’m doing something wrong.

Dr U: Letter created and sent, 3 days later.

Mom: We have a problem. The last injection he had, he got so tight that that fluid was coming out again. What should I do? The nurse does not want to inject him any more. If you tell one of your employees to come to my house in the morning to inject my son,  please, I will pay them. We can’t – he’s to strong he gets very tight muscle contraction and the fluid comes out help please… I hope you got my message earlier. I need to know what to do so my son doesn’t get so tight that his muscle contracts and so the fluid starts coming out… I’m very depressed and anxious and it is to hard for me to stick him. Please call.
Mom: Thanks. I saw some videos, but my concern is how long will it take him to talk? There have been 3 shots already and still nothing is coming out from his mouth. How long after do I have to wait? Sorry I’m being annoying. The thing is, I’m concerned that my son is not talking yet. What else does he need for him to start talking? 1. B12 shots 2. Therapy 3. ——– I don’t know please tell me?

Dr U: You are not annoying… you are an appropriately concerned mom. I just can’t guarantee what/when is going to be the key to helping speech and language. My experience is that it can take up to 8 shots (1 month), but improvements happen before that (more verbal, singing, eye contact). So far, we’ve been doing OK. This is difficult, but if you and the family are seeing some progress, that should help you get the support that you need to see this through.

Mom: I wanted to know if I should do an MRI? I just want to know how much he has and everything. What does a MRI tell you about autism? I made an appt for the MRI. They said it will take up to two hours for the MRI ’cause they order the BAER. What do you think  - can he be put to sleep for two hours? She said first they give him something liquid to calm him down, then either IV and the mask. What do you think? I’m just scared?

Dr U: The MRI will probably show no abnormalities – if the child has never had any seizures, this would be even more likely to be negative. With that in mind, I do not see the need for an MRI at this time if you are concerned about the anesthesia.

Mom: Hi doctor I have few concerns. I want to enroll my son in ABA, but they don’t take my son’s insurance. So I have to pay out of my pocket and you know that program is expense. But my concern is, when they asked me who was the doctor who diagnosed my son with autism, when I said your name, no one has heard about you. They asked me if you are a psychologist or a neurologist. When I say a DAN doctor, they don’t know…What am I supposed to show those people?

Dr U: This spawned a flurry of email and faxes to demonstrate that I am a medical doctor, Board Certified in Pediatrics and Neonatal Perinatal Medicine, with my most recent special training provided by the Medical Academy of Pediatric Special Needs.

Mom: The ABA therapist came over and did and evaluation… The reason why I’m writing you is cause she also mentioned to me about speech apraxiaShe asked me to tell you if you can diagnose him with that so I can give it to CMS Title 21 to the insurance company, so they can approve more hours in speech.

Dr. U: Speech is one of the earliest communication skills. Next, comes understanding. Sometimes, understanding comes first, and then the child can become very agitated, and display other behaviors. Yes, speech apraxia - the inability to speak – is a concern. I have documented this diagnosis in your child, already. I think that the course that we are pursuing gives children the safest and most reliable choice, and I am glad to review other options with you. Of course, S&L therapy is indicated.

Mom: But do you think that he will not talk at all ever? What do you think ? What else should I do? Put him in more speech therapy, like I was told by a speech pathologist ? Like you said, this is a major concern. Will he talk ever?

Dr U: Well, that is why we are giving any protocol that is reasonable and successful the best chance. Speech and language therapy, in addition to the biomedical, is ‘what the doctor ordered’.

Mom: I was reading your article on autism and apraxia was is the difference between those two? Is that something that autism kids have also ? Or is that a different diagnose ? Can my son get worse or better in the future? Will the Aba, plus speech and Ot therapy help him get better or will he need something else?

Dr U: Speech apraxia – the inability to speak when you want to – is one of the symptoms of autism. The biomedical protocols that we are doing, plus ABA and Speech and Language therapy is the most likely to have success. All of the other protocols that are out there are VERY EXPENSIVE (> $4000 up to $20,000) and have not been documented to work. There are no pills for this and you can’t buy your way out of autism/apraxia.

Mom: What else can I do for my son? Speech aphasia is that something to worried about?

Dr U: Yes, speech apraxia – the difficulty with your child’s delayed speech – is something to be concerned about. We are doing our best.

These are the exact thoughts and letters of every one of our families. Autism, especially when there is speech apraxia, is one of the most difficult diagnosis I have ever encountered, as far as 1) the reason for the problem and 2) the treatment(s).
Parents, I understand your worries.

The Polarized World of Autism Diagnosis and Treatments

Monday, November 4th, 2013

Last week, Forbes’ science writer, Emily Willingham, decided to spice up Halloween with one of her usual autism-themed stories. How timely. The 5 Scariest Autism ‘Treatments’ warned readers that there are money hungry snake oil salespeople posing as caring practitioners, who are scheming to steal your money without a shred of scientific proof that their protocol is either safe or effective.

The story might have actually been newsworthy had she been more up-to-date by including such controversial protocols as Fecal Transplantation or Worm Therapy. Anyway, I felt the need to write that we can’t merely dismiss families with overwhelming problems as misguided idiots who can’t figure out that dipping a kid in chlorine is probably not a good idea. Don’t worry Emily (and the other “pro-science commenters”), MMS never had any real traction.

I replied that her ‘Scary Story’ was missing the point. Autism leads to desperation, born of mis- and missing information, about everything ASD; from diagnosis, to incidence and prevalence, to DSM IV vs. DSM-5, to… What the hell, when are you doctors gonna get your act together and help us?

The re-replies displayed a surprising degree of vitriol. All or none, black or white. Do I support Dr. W’s position or not? TheAutismDoctor.com is an entire website consisting of hundreds of pages of hyperlink-supported information about all of my experience over a 36-year medical career. I address as many of the controversial and cutting-edge protocols as I can research. I figure that castrating your child is going to be pretty extreme to any parent, so I don’t cover it unless queried.

I wrote that the conventional medications are not only ineffective for correcting core signs and symptoms, they may be harmful and even deadly. That leaves families concerned about believing the ‘regular’ doctors who suggest giving potent CNS drugs to their young child. Many feel that exploring alternative treatments is their only alternative.

How many patients have I listened to, who have complained that, “We have been doing ABA, S&L, PT, OT, etc., and we hoped to see more progress”? That’s it? No fighting for your kid. No trying to figure out why your beautiful child isn’t keeping up. That’s what one of the commenters commented. “As a doctor you should know that conventional, evidence based medicine has no interventions that address the core symptoms of autism. Parents do not “turn to unconventional therapies.” They are persuaded that conventional medicine is wrong about autism by purveyors of therapies.” Even if he actually believes what he wrote, if he had an affected child, his spouse (or vice versa) would seek further information.

Shortly, the comments turned to a discussion about vaccinations. I was accused of “pandering to my base” and “shamelessly trying to steal readers” from the Forbes blog. Parents of special-needs children will continue to search for answers and help. Pedantic warnings from non-practitioners and ESPECIALLY the non-involved are not welcomed advice. Working with a trusted professional is their best hope.

I thought that my reply was completely noncontroversial. Who could argue with the dilemma faced by today’s affected families? The Home page of this website states “I hope that my essays and our discussions breathe a breath of fresh air into the polarized world of autism diagnosis and treatment.”

It seems that there is still more work to be done in order to bring all interested parties toward a more reasonable and compassionate position.

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Brian D. Udell MD
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