Posts Tagged ‘Vaccine’

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.

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.

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.

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.”

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.

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 can see is to the pharmaceutical company Roche,
and its member company Genentech.

Autism Review 2013

Sunday, December 29th, 2013

Here is this year’s crop of stories (listed in Medical News Today) that I consider to be the most informative, interesting, and likely to change the knowledge base concerning the epidemic of childhood signs and symptoms presently called Autism Spectrum Disorder.

Can Children Lose Their Autism Diagnosis? - Uh, yes. And, many more than this group reports.
New Gene Variants Linked To Autism Discovered - The perfect storm of environmental toxins and susceptible individuals (genetic variation).
Epilepsy Drug Linked To Increased Risk Of Autism - The perfect storm of environmental toxins (medication) and susceptible individuals.

Feeding Problems And Nutritional Deficits A Significant Risk For Children With Autism - Ya think?
Attention Deficits Picked Up In Babies Who Later Develop Autism - The ‘Spectrum’ diagnosis involves a combination of signs and symptoms, not just the ‘core’ deficits.
Help Needed For Youths With Autism Spectrum Disorder Transitioning To Adult Health Care - Transitioning in general, don’t you suppose?
Autism Study Finds Behavioral Therapy For Children Can Impact Brain Function - So, the autistic brain can exhibit plasticity. Just like every other human brain.
Brain Connections Differ In Kids With Autism - There were lots of brain connection articles this year. The problem is understanding WHY the brains work that way, since it’s pretty obvious that some circuits are crossed and/or missing.

Study By Kennedy Krieger’s Center For Autism And Related Disorders Reveals Key Predictors Of Speech Gains - This is why it’s so important for kids to play with others.
Suicide Ideation And Attempts A Greater Risk For Autistic Children - Why doctors shouldn’t put teenage patients on anti-psychotic medications.
Old Drug Offers Hope For New Autism Treatment - This article covers it all; inflammation, immunity, the environment, mitochondria, stress and recoverability. It’s just in a mouse model, but offers a unifying theory.
One In 50 Kids Has Autism In U.S., CDC - And, we’re still arguing the ‘E’ word (? epidemic ?)
Gaze Shifting Delay Has Potential To Diagnose Autism At 7 Months - Plenty of research about earliest diagnosis, not much about how to intervene.
Multiple Vaccines Not Linked To Autism Risk, CDC - So they keep telling us.

Link Between Autism And Increased Genetic Change In Regions Of Genome Instability - The perfect storm… you get it.
Minocycline Show Benefits In Children With Inherited Cause Of Intellectual Disability And Autism - Some assistance for patients with Fragile X syndrome, one of the known causes of ASD.
Study Shows Different Brains Have Similar Responses To Music - Love of music is universal.
Propranolol Could Improve Working Memory In Autism - Several of the older blood pressure medicines perform in some fashion to help affected individuals.
Taking Valproate While Pregnant Raises Autism Risk - Drugs taken during pregnancy may not be good for the developing brain. Well, at least it’s in print now.
A Newborn’s Placenta Can Predict Risk For Autism - Now, there’s an early predictor! Again, what to do about it?
Significant First Step In The Design Of A Multivalent Vaccine Against Several Autism-Related Gut Bacteria - Formal recognition that there is a gut-brain connection in autism.

Researchers Successfully Treat Autism In Infant - OK, so maybe you can do something about the earliest red flags.
Early Intervention Program For Children With Autism Found To Be Cost Effective Through School Years - More documentation such as this is needed so that governments, insurance companies, and the like will take notice.
Link Between Epilepsy And Autism Found - The literature reports that 40% – 80% of patients have seizures (much lower at The Child Development Center, however).

A Third Of Autism Cases Also Have ADHD Symptoms - It’s not ALSO, it’s an integral part of the picture for some children.
Autism Discovery Offers Hope For Early Blood Test And Therapeutic Options - One of the reasons that I prescribe tryptophan (5-HTP) to address some ASD signs and symptoms.
Racial And Ethnic Disparities Found In Gastroenterology, Psychiatry Or Psychology Care For Children With Autism - Yeah, professionals need to get on the same page.
Air Pollution Raises Autism Risk - The environment. Again.
Single Mutation Can Destroy Critical ‘Window’ Of Early Brain Development - Genes. Again.
Autism In Children Affects Not Only Social Abilities, But Also A Broad Range Of Sensory And Motor Skills - Recognition of signs and symptoms that every parent of an ASD child observes. More such information was published subsequently.

The Gut May Offer Clues About Autism - By now, even pediatric gastroenterologists should be getting the message.
Autism Training Program For Pediatricians Meets ‘Critical Need’ For Earlier Identification - Until now, I don’t think that my fellow pediatricians are doing such a great job at early diagnosis.
First Full Genome Sequencing For Autism Released By Autism Speaks Collaborative - This kind of valuable information is why all of the parties in the autism community should work together, rather than criticize each other in public forums.
Early Intervention Benefits Young Children With Autism Regardless Of High-Quality Treatment Model - So, if early intervention helps, and we can make the diagnosis earlier, then the situation should be improving. Right?
Oxytocin not found to offer symptom relief in autism - A bunch of these articles this year, both pro and con. My experience is that it does help in a small percentage of affected individuals.
Fresh fuel reignites Asperger’s debate - Combining two conditions that we don’t understand – couldn’t that make us twice as ignorant?

Oxytocin, the ‘love hormone’ may have relevance in autism - This was one of the ‘pro’ articles.
New research sheds light on previously under-researched area of study – females with autism - We really need more information about the difference between boys and girls with ASD.
Induced labor linked to higher autism risk - Here is my advice (as a Board-Certified Neonatologist): Have the baby when the time comes. Sometimes, Mother Nature does know best.
Risk of autism in further children – study findings - This is the type of information that prospective parents frequently seek, and little is really known.

Young adults on the autism spectrum face tough prospects for jobs and independent living - This highlights why early diagnosis and intervention are so vital.
Genetic disorder 22q could be misdiagnosed as autism - Or, this could be just one of the causes of autism. No?

Improving understanding of brain anatomy and language in young children - This is the type of knowledge that needs to be elucidated as we try to solve this puzzle.
New cases of autism in UK have levelled off after five-fold surge during 1990s - Well, good for England (if it’s true). This is not the case in the U.S., or most other countries, however.
Autistic children look less friendly to peers - And, vice-versa, I would say.
Web-based autism intervention tool shows promise - Lots of tech stuff for autism appeared this year. I still like Proloquo2Go the most.
Link examined between pregnancy weight gain and autism spectrum disorders - An even EARLIER diagnosis. How about a fetal Speech and Language therapist?

Health-care changes needed to help adults with developmental disabilities - Much more information needs to become available to address the growing numbers of older individuals with autism.
Autism increases risk for synaesthesia - Maybe shedding some light on the sensory issues in ASD.
Relationship between bedroom media access and sleep problems among boys with autism - As if parents didn’t know this! Well, it’s official, now.
Gender differences in gene expression in male and female brains - I’ve described this clinical difference before. There’s the “girl kind”, and the “boy kind”.
Autistic children’s ability to perform everyday tasks improved by occupational therapy - This one should help with insurance reimbursement.

Genes and air pollution combine to increase autism risk - Circling back… genes and the environment.
Brain function in children with autism improved by a single spray of oxytocin - It works. It doesn’t work. Which is it?
Autism-like behaviors in mice alleviated by probiotic therapy - Human probiotics, by the way.
Research linking autism symptoms to gut microbes called ‘groundbreaking’ -  Well, it’s important, but groundbreaking? This association has been ‘documented’ since the “Refrigerator Mom” days.
Hospital infection in pregnancy tied to higher risk of autism - Perhaps it’s the antibiotics that are given, not the infection itself?

Hopefully, 2014 will bring more in-depth research with targeted treatments, so parents will have an increased number useful protocols to assist their developmentally challenged children.

The Different Kinds of Autism

Sunday, August 11th, 2013

When medical science finally settles on more precise terms for the epidemic that is presently called ASD, we should also be able to recognize and appropriately treat the various expressions of the disorder. This is important as it relates to interventions that address specific problems, such as in the G-I tract, and their downstream consequences, such as disruptive behaviors. The categories are not exclusive, the list is far from complete, and I hope to expand on this topic in the future.

1. ‘Typical’ (present from the earliest stages of development) and Regressive types. I’m not so sure that the only difference isn’t timing; i.e., when the patient became affected. Parents may be more likely to identify the latter type in association with childhood vaccinations. Otherwise, there aren’t big differences in presentation or the ability to diagnose underlying problems that are amenable to treatment.

2. Girls and Boys. There is a difference because of the amount of aggression in many boys, and the relative lack thereof in the majority of girls. This was previously discussed here.

3. Major system involvement, including:

The G-I system is the most glaring problem. This has been written about at length, and throughout this website.

The CNS shows significant involvement. There could be seizures, staring spells, or other unexplained motor episodes. Treatment may involve anticonvulsants and often becomes fairly complicated.

The immune system is the presenting problem. Some patients have eczema covering their entire body, others may have asthma and many have frequent infections. Laboratory tests may identify an over- or under-functioning ability to clear inflammation. Enabling the patient to achieve better health often helps lessen or even ameliorate behavioral and other ‘autistic’ disturbances. The disorders known as PANS/PANDAS appears to be consistent with such impairment.

The muscular system functions inefficiently; as evidenced by low tone, poor chewing, clumsiness, extremely flat feet and/or poor posture. When patients can tolerate oral glutathione and subcutaneous methyl B12, there is often significant improvement in not only OT, but S&L as well.

4. Variations due to age at diagnosis and intervention. Evaluation and treatment is different for toddlers, adolescents or adults. As patients get older, more patience is required and the coping skills of the individual become more important in addressing and assessing therapies. The age at which children continue to suffer apraxia is especially important. Imagine the difference in outcome for children who have no speech even by 3rd grade as opposed to youngsters who only experience a 1- or 2-year delay.

5. ‘High-’ and ‘low-’ functioning individuals. I object to these terms because they are pejorative, judgmental and inaccurate. After all, there are plenty of ‘low-functioning’ neuro-typical people! Many patients have a great deal more awareness and skill than is apparent. More correct designations would be disruptive, aggressive, “extremely sensory” or “prone to wander.” Understanding and treating any identifiable underlying abnormalities often leads to significant functional improvement.

6. Patients who present with genetic variations. There are major problems, such as children who have Fragile X (males) or Rett’s (females) syndrome. Less obvious are copy number variations that may confer an inability to detoxify. Very small changes in genetic information magnify in importance as our environment becomes more polluted. This has been discussed in more detail here. Most of the time, there are no identifiable abnormalities.

7. Significant metabolic abnormalities, evidenced by under-functioning mitochondria, or out-of-range fat, vitamin or mineral levels. Such variations require investigation, and are often amenable to supplemental intervention.

8. Those who look as if they escaped traditional ASD. There is a small percentage of patients presenting to the Child Development Center of America who are brought in by the parents because of behaviors that, “You just can’t put your finger on.” Although these children may not have the traditional criteria of social isolation, repetitive behaviors and speech and language delay, they have other associated difficulties with hypotonia, poor sleep or frequent infections that have resulted in developmental challenges that are often characterized as either anxiety, focus or both.

It is neither fair nor accurate to state “‘DAN!’ doctors all do the same thing for the patients.” Any professional will have a starting point based on the chief complaint that is specialty-specific and subsequent treatments and labs depend on the response to the first line of treatment. Based on just these categories described above, and the doctor’s experience, there are a number of routes and variations that the workup and ensuing interventions might follow.

Families need an experienced practitioner to recognize the different presentations of autism in order to make sense of the complex matrix of signs and symptoms and to offer appropriate, effective, reasonable, reproducible and verifiable results.


More Vaccine Issues

Sunday, July 21st, 2013

This website is written to assist parents in making sense of the millions of ‘informational’ pages advising about the epidemic of ASD and ADHD. At The Child Development Center, childhood vaccinations only play a small part in the chief concern for the vast majority of our parents, and in the rest of the world it seems to present a major issue, so I write about this subject occasionally. However, just after my previous post on this topic, a research paper was published that begs my further attention. It appeared in the respected medical journal, Pediatrics, and is entitled Sick-Visit Immunizations and Delayed Well-Baby Visits.

The point of the article is that, when parents fail to follow the recommended immunization schedule because of a child’s illness, they are less likely to complete the full series (and so, be more vulnerable to preventable diseases). The implication is that, perhaps the ‘shots’ should be given anyway. “The substantial risk that infants will not return for a timely makeup well-baby visit after a sick visit should be included in any consideration of whether to delay immunizations.”

Nowhere in the discussion and conclusions that followed were the issues of fever, febrile seizures, or any developmental followup covered. The is no mention of how high a fever might be tolerable, whether the child was exhibiting other symptoms such as vomiting or diarrhea, the presence of fevers with previous vaccines, or what to do if there were any complications. Even in the full text, there is no advice to signify to parents that ‘vaccination anyway’ is not a recommended course. That isn’t necessary, I guess, since the lack of association between these toxins and autism is already a given for this vaccine Program Director (not a physician), who recommends AGAINST the AAP. Where are the ‘Champions of the Pediatric Way’ standing up to proclaim, “Wait, there is no research about safety and outcome to support your position!”

Such lopsided opinions by professionals are insensitive at best and ignorant at worst, and only serve to enhance the polarization of pro-vs.-con vaccination discussions. Here is some helpful advice to a family / physician who is trying to make sense of the immunization quagmire:

  1. ‘We could get ‘titers’ (levels of antibodies to diseases that the person already possesses) to see which shots are necessary.”
  2. “We could get a blood count and some blood studies to make you feel more comfortable about your decisions.”
  3. “We could take a more detailed history, including sleep, bowel function, eating problems incl GERD, frequent formula changes, other information that the modern mom knows and consider risk in this individual child vs. chance of significant exposure/disease in this child and try to let the present improvement play itself out.”
  4. “We could be part of a medical team that considers other experts, including the parents, in the decision about individuals.”
  5. “We could try to give as few at one time as possible (and, btw, MMR=3, not 1).”
  6. “Let’s talk about your particular child and your concerns and see which vaccinations are most important at this time and try to give the rest in as timely manner as possible.”

Here is my proposal regarding this piece of research:
Let’s do a randomized, controlled, prospective study of babies who get get treated with vaccinations while they are sick (no matter how sick), versus children who wait until they are well, and see if there are any side effects, such as high fever, seizures, other allergic disorders, or ASD. Who wants to be in the ‘vaccine anyway’ group?

The Vaccination Issue

Saturday, July 13th, 2013

I write this essay with great care and some trepidation, lest readers believe it to be either specific medical advice to patients, or sedition by the minions who worship Big Pharma. Any professional involved in this ASD epidemic can’t help but notice the number of parents who are certain that their beautiful child became harmed shortly after exposure to some vaccination. Traditional medicine remains convinced that any association with delayed childhood development is purely coincidental.

The twentieth century ushered a truly successful attack on feared diseases that had gripped previous generations of parents. Most of the well-accepted literature apparently supports the vaccinations, the present schedule, and most importantly, the lack of association with childhood developmental delays such as ASD.

However, I have become increasingly concerned about the quality of the information that the public is served by our government agencies. In giving advice to a national organization, CDC Committee member Dr. Mark Sawyer advised, ““We run the risk of contributing to the already present lack of full immunization if we stress too much on adverse events.”

Querying problems related to childhood vaccinations yields numbers as high as 18% “adverse events” in literature that supports the MMR. Further exploration about the presence of a febrile seizures (fevers are a frequent complication of vaccinations) as it relates to the risk of autism leads to more confusing information. How can pediatricians counsel that we know what we are talking about following the ‘Swine Flu’ Fiasco?

I don’t have a website. I believe that, in today’s toxic world, it is possible that some vaccines have led to, or triggered, behavioral diagnoses in susceptible fetuses and infants. In my skewed population, only 1/20 parents who harbor that impression. The majority of our families either aren’t sure, or do not feel that it was the cause of their child’s (children’s) condition.

Our approach is to evaluate the family and the individual child upon whom the traditional vaccine schedule is about to be foisted, and make decisions based on present health, risk of illness, and risk of interfering with recovery. What are the child’s red flags? How old is the child and when did symptoms begin? How severely affected is this patient? What are the present primary behaviors and is the child improving? What other conditions does the patient exhibit? Are there any affected siblings or cousins? Has the child had any recent illnesses, and were there any unusual reactions to previous ‘shots’?

Let’s take the poor parents, who have no idea about the correct vaccine course for their precious offspring’s present and future health, out of the debate, and ask your doctor’s opinion:

Little Johnny is 39 months old. He had loss of eye contact and disappearance of some late babbling in the month following a 15 month set of vaccinations including an MMR. Recently, he has been doing well in therapies, especially S&L, OT, and ABA. The child also happens to be followed by a holistic pediatrician, using a unique workup and simple medical interventions to address his autistic signs and symptoms – those same concerns that, last year, you dismissed.
Anyway, lately, Little Johnny has woken up from the fog, started to exhibit an increased level of speech, is interested in toys and other children, and shows genuine signs of improvement for the first time in what seems like years (well, it is a lifetime).

Should he get his booster shots now? Don’t try to argue with the professionals who would have you belittled, even by their staff, for being so ignorant as to question Medical Science. Just present this case (or explain your child’s particular issues) and ask god what he would do if this were his child. Better yet, ask god’s spouse.

Chelation Therapy for Autism

Saturday, July 6th, 2013

I routinely check autism websites and chat groups to gauge the landscape and better understand the community of families seeking relief from this devastating epidemic (and if you don’t think that autism is an epidemic, you have been living on Mars). On one listserv, a parent recently wrote, “I’m looking to start chelation on my daughter. Can anyone recommend a good DAN dr?” This request and the several responses that followed have led me to want to further explain my position about this popular autism treatment.

The first issue that I wish to comment upon is the precarious position that families are facing when THEY are the ones asking for specific treatment regimes, rather than seeking knowledgeable physicians who can offer various options their children. This is entirely the fault of the medical community who have been so slow to recognize and respond to the condition. When the only explanation for the child’s condition is that “It’s genetic” and the only treatment is “Find some good therapists,” desperate caregivers are sure to explore other options.

What parent of a child who has leukemia, for example, seeks out doctors for radiation treatment, even though the experts may counsel that chemotherapy is preferable? Sure, a sufferer of prostate cancer may choose microsurgery over radioactive seeds. But that is because there is an abundance of choices in a well-known condition, with documented evidence of outcomes in the various treatment alternatives. The patient in that case may wish to choose preservation of function over decreased risk of recurrence. Given so few choices for ASD, and so much information appearing on Internet websites, chelation will surely seem to be a reasonable treatment. The fact that the conventional scientific community is either ignorant or dismissive about removal of poisons only serves to steer the concerned family toward a different medical option.

We live in a toxic world. There are 85,000+ substances in the air, food and water that were not present (or only present in small amounts) in previous centuries. Unnatural material gets into fetuses as they develop, and the fragile infants and children have become the ‘canaries in the coal mine‘. On one hand is the growing number of children with ASD and ADHD and on the other hand is our poisoned environment – and medical professionals don’t see the relationship? Exposure to pollution and increased risk are reported over and over. There shouldn’t be an argument about this any longer. Which poisons, various combinations, at what levels, and the timing of the exposure(s) upon which susceptible individuals should be the subjects of intense study and treatment options.

There is more than one way to get rid of heavy metals. Chemicals are how we got here, so perhaps using chemicals such as DMPS, DMSA, or EDTA may not be the best method of detoxification. The body has a better way. It’s called glutathione, which is a natural protein that detoxifies – and not only metals, but all of the products that enter our body and cause tissue damage or prevent recovery. I have been using an oral glutathione preparation for years that is both safe and effective. There are various discussions about the ineffectiveness of the oral form, but The Child Development Center has seen over 1,000 children improve both signs and symptoms of their autism. Likewise, there is debate about increased yeast growth with such a preparation. However, antibiotic overuse is one of the most suspicious roads to the present epidemic, and anti-fungal treatment is often a successful method to treat that unnatural imbalance of gut flora.

The bottom line is not whether or not I am a fan of chemical chelation. What is most important is whether there are safer, less expensive, less invasive and more effective means to arrive at the same goal of detoxification to decrease the disorders and maladaptive behaviors that we call autism.

MAPS Spring 2013 Conference

Sunday, March 24th, 2013

This past weekend marked the third Medical Academy of Pediatric Special Needs Conference, which was held in Costa Mesa, CA. I have made sure to attend every one. This time, I had the added challenge of traveling on my damaged and recently repaired left foot. But, thanks to the help of my beautiful and patient wife, Jackie, I managed to fly, hop, crutch and wheel across the country.

What started out as the “Defeat Autism Now!”(DAN!) movement, then morphed into the Autism Research Institute (which continues to support autism research and provide needed information and support for families and individuals with autism spectrum disorders), has finally become a full-fledged medical society “for the treatment of children with autism spectrum disorders and chronic special needs.”

These courses provide the required CME credits to attain a MAPS fellowship certification. This educational experience prepares practitioners from all over the world to deliver state-of-the-art care. Qualified and experienced doctors and other professionals offer detailed scientific evidence and clinical information in order to further understanding and treatment. We review older therapies, some of which may still have value, the most common protocols that the participants presently utilize, and the emerging technologies that could lead to better treatment.

The advanced courses that I attended included the following discussions:
(Day 1): Hormones & Neurodevelopmental Disorders, led by Dr. Anju Usman. Covered subjects included the CNS, HBOT and treatments such as galantamine, phosphatidyl serene, propanolol, cortisol, oxytocin, secretin, the endocrine system, calcium, the adrenals, and hormones. We also learned about remedies from plants, foods and other cultures.
Evaluation & Treatment of Older Children was presented by Dr. Dan Rossignol, who gave one of his stellar presentations thoroughly reviewing the scientific literature that helps support our various treatment protocols. Case presentations with enthusiastic audience participation rounded out the afternoon.

(Day 2): Gastrointestinal & Nutrition. Dana Laake (Dietician-Nutritionist) reviewed Advanced Nutritional Assessment including labs, signs and symptoms, and special diets (all of them, I think). Dr. Elizabeth Mumper immersed us in G-I testing and discussed “clinical pearls” – what practitioners should look for to help patients with symptoms due to an unhealthy gut. Dr. Rossignol reviewed the pertinent literature and more clinical cases. Dr. Jeffrey Bradstreet taught us about testing and treatment options for autistic gastrointestinal disturbances. He concluded his talk with a thorough discourse about fecal transplants. No shit.

(Day 3): Cutting Edge & Novel Treatments. There were lots of experts, lots of treatment possibilities, and lots of opinions. Need I write more?

The MAPS conferences are no boondoggle. Classes go from 8-to-6 for three days, with formal testing at the end of those long sessions. The most important functions include networking with doctors from all over and discussing cases – just like your children – from the youngest, to the most challenging and complicated. This information adds immeasurably to our individual clinical experience.

What’s new is that your children – young and old, disruptive or spaced, apraxia or echolalic, unfocused and anxious, suffering from seizures or repeated infections – are being discussed, reviewed and considered as patients who deserve appropriate medical attention.

MAPS participation grew by a third this meeting, but that is still not enough personnel to address the burgeoning patient load. It’s a great feeling to know that each year we are getting closer to the causes and cures for this ever-increasing epidemic.

Pregnancy, the Flu, and Autism

Sunday, November 25th, 2012

This blog is about what we don’t know about pregnancy and the flu as it relates to the epidemic of ASD. The popular press recently re-reported one specific finding from an article in the medical journal Pediatrics, entitled Autism after Infection, Febrile Episodes, and Antibiotic Use During Pregnancy: An Exploratory Study. Does that title make it look like the flu during pregnancy increases the risk of autism in the offspring?

ABC News, ABC News, Reuters, The Huffington Post, and just about every other news agency loudly declared this small, incidental finding as if it were some solid medical fact. I doubt that most readers went farther than the title, and so now there is another confusing piece of information in the quagmire of ignorance that presently surrounds this enigmatic condition.

What article really said:
The Danish researchers looked at the records of ~100,000 8-14 year-olds who were in the national registry from 1996-2002, of which < 100 fit the ASD diagnosis. The key variables – ASD, Fever, and Antibiotic use – were reported by (very non-specific) telephone interviews during the pregnancy or shortly thereafter.

1. Mild common infections and fevers were not associated with autism
2. Evidence “suggested” that there was a 2X increase in ASD when there was a maternal influenza infection
3. Prolonged fever “caused” a 3X increase of ASD
4. The use of various antibiotics during pregnancy was potential risk factors for ASD (BTW, did any of the popular press report this one?)
5. The final conclusion was “the few positive findings are potential chance findings.” (I didn’t see this reported, either.)

What is known about this situation:
There is surprisingly little information about the flu and autism. An earlier study (1990) questioned viral-type illness during gestation as a possible cause of ASD. Also, there are models which seem to correlate brain abnormalities in the offspring of infected pregnant animals. The evidence is not strong in humans, however, so more studies are required.

Maternal fever from other causes has also been implicated as leading to ASD in children. There are even concerns about whether fever-reducing medications are a culprit in this epidemic.

The CDC continues to recommend flu shots during pregnancy. There is very little information about which part of the pregnancy is more important or risky (that should matter), or specifically searching for ASD as an outcome measure.

What should your family do about this latest information:
Well, some good consequences of this VERY WEAK science is that it does tie autism to inflammation, highlights the epidemic, and gives readers pause about whether the flu shots could be related to autism as well. As in most of the other studies which show increases in ASD tied to other common occurrences such as the use of oxytocin for delivery, increased maternal weight, increased paternal and maternal age, smoking, drinking alcohol, hot tubs, and women who attend sporting events (that’s just a joke), it doesn’t really explain anything.

In the blurb where the Pediatrics journal documents “What this study adds“, the editors should have written “Very Little“.

Vaccine Awareness

Friday, June 8th, 2012

I can’t make this stuff up. One day after I pointed out that the CDC caused/found a ‘pseudo-epidemic‘, this report popped up on my Pediatric Radar Screen:

CDC vaccines for children might have been improperly stored

The Office of the Inspector General analyzed a sample of programs with the highest volume of vaccines ordered in 2010 and found that vaccines stored by 76% of providers were exposed to inappropriate temperatures for at least 5 cumulative hours over the 2 weeks. (No word on how many OVER that number of hours).

Medical News reporter Kristina Fiori story wrote, “Childhood vaccines administered via a free federal program may be inappropriately stored, which could affect their potency and efficacy, according to government inspectors… The American Academy of Pediatrics, which wasn’t involved in the study, said in a statement that it ‘encourages all practices to continue monitoring vaccine storage and handling… The AAP noted that despite these issues, the vaccines “were not found to be unsafe, and revaccination of children is not needed.”

So, the Academy, which wasn’t involved in the study, knows that the vaccines are safe. How do they know that?! The story went on to explain that although the potency could have been affected, the poor kids who got the stuff won’t have to get an extra shot. Hooray for those children. I wonder, though, if the shots were incorrectly stored and administered to a more affluent community, if the CDC would have made the same recommendations. I mean, they said the inoculation might not work. If the children need them so much, why wouldn’t they need the missing dose? Maybe it’s the $3.6 billion that is paid to those public programs.

Then, there is this statement: “The report also revealed that 13 providers stored expired vaccines together with unexpired ones, increasing the risk of handing out the wrong vaccine.” Are you kidding me? Has anyone gone out and looked at the outcome of those children who received the expired or incorrect products? We’re in the middle of an autism epidemic now, and this could be very important information. Does anyone think that the “studies that have shown vaccine safety” used old or incorrect product?

I won’t belabor this point any longer other than to officially complain that, as a pediatrician and as a citizen, I find this stuff appalling. As an advocate of sensible vaccination protocols, these kinds of revelations make it really difficult to convince the public that they are protected or safe.

Why Autism Families Feel Isolated

Tuesday, June 5th, 2012

Having a special child requires more patience, time and love than most people can imagine. With ASD, it’s not just the grandparents who don’t understand, or the neighbors’ kids who taunt, or the schools that don’t seem to have the services, it even extends to the ignorance and insensitivity of doctors and medicine in general. Parents are told “your kid’s got PDD-NOS – you’re going to need OT, PT, S&L, ABA, ESEs… so you need to go get tested at the CDTC.”  The child neurologist makes a diagnosis, but offers little hope and no medical intervention. Allergists, gastroenterologists and dermatologists only consult about their area of concern. Even pediatricians are rarely knowledgeable enough to give advice and counsel. Worse, many physicians warn that you are wasting your time and money if you even consider an alternative treatment. So, families seek information and community on the web.

As a physician taking care of so many patients with autism, I often feel the same lonliness, isolation and even scorn as the parents whom I help. I became prompted to write this when I read an article in this month’s AAP newsletter, which is published by my professional Society, and paid for by the self-serving pharma, formula and other companies who wish to appear official by advertising in this supposedly impartial scientific periodical.

Pseudo-outbreak of pertussis linked to specimen contamination

That’s the headline of a small story tucked inside the second page of our obscure pediatric newsletter. Ummm… where did this appear in the mainstream media??? I mean, when the outbreak was considered to be due to those irresponsible, horrible parents that won’t vaccinate their kids, it was all over the news. But, you know what they found out? They found that the germ was coming from the people at CDC who were trying to grow the specimen. THEY created the problem! It wasn’t a ‘pseudo” anything, because there was NO outbreak. Isn’t this important enough to have appeared on TV? Yo, Anderson, Drs. Gupta & Oz  - where were you on this story?

“Staff reported not wearing gloves routinely when collecting specimens or preparing vaccines, which were done in the same rooms.” I’m sorry, I have to comment here; they were testing the “cases” of whooping cough in the same place they were making the pertussis product. “In addition, sinks were not always available in exam rooms, and surfaces were not cleaned regularly with bleach… <the whooping cough germ they were using to make vaccine> was detected on many surfaces, including nurses’ laptops and exam room areas. “

It is not merely the observation that such shoddy practices could take place in our so-called state-of-the-art, highly evolved public health infrastructure that should make the reader less-than-confident that we are all protected and safe from bad cooties. It is not only that there seems to be a disconnect when such a finding comes to light and the general public is not really informed about such a grievous error. The greatest problem that I have with this information is in the concluding statement, “The investigation and other data prompted the CDC to publish best practices for the use of PCR for pertussis diagnosis.”

That’s it? No one was fired, no managers were reprimanded? There was no retraction put out in the general media, that’s for sure. Who would that help? Then, vaccine makers and testers might be required to have unnecessary scrutiny from possible outside sources who couldn’t really understand the gravity of a real epidemic. Heaven forbid, people might not trust the system.

There are roosters guarding us chickens and explaining their actions using ‘newspeak’. Where are the right people to take notice? That’s why we feel so alone. 

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Brian D. Udell MD
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