Martian Death Flu

Some years the Influenza virus gets a special name for it’s strain, like Swine Flu or H1N1.  When he had his bout with flu, humorist Dave Barry made up his own: Martian Death Flu. He and his wife spent days in bed achy and feverish. “There has been a mound of blankets on my wife’s side of the bed,” he wrote, “I think it might be my wife…the only way to tell for sure would be to prod it, which I wouldn’t do” for fear that poking her could be fatal. Dave, leading a more active lifestyle, attempted to crawl to the bathroom.

Flu season is coming, that winter scourge that lays millions of kids and adults out on beds and couches.  They cough, ache in head, throat and body, and occasionally vomit or have diarrhea. This misery can last 7 days, and medications like ibuprofen, Tylenol, and Tamiflu, only somewhat alleviate symptoms. It’s highly contagious, like Coronavirus. It can be life-threatening for medically vulnerable kids, those with asthma or heart conditions.

Last winter when Coronavirus started in China, many kids admitted to the hospital had combinations of viral infections, like Corona and Flu, or Corona and RSV.  Normally we see children with two contagious infections together in a season, like strep throat and flu or RSV and flu.  Put one of those together with Coronavirus, and it’s a whole new, awful, ball game.

Perhaps this’ll be a better-than-usual flu season, since we’ll be wearing masks, washing our hands more often, and staying distant from each other. However, these aren’t easy for kids, who fidget and horse around, and thus don’t follow the rules. Parents also forget to wear masks or keep their kids apart. We worry about parents organizing birthday parties and sleep-overs, potential Coronavirus and flu spreading events.

When hurricane Katrina was approaching, officials warned that “this is the one” to evacuate from.  Likewise, this year is “the one” to get you and your kids flu shots. Like masks, hand-washing, and distancing, flu shots are one more way to protect children; maybe the most reliable way given kids’ potential difficulty with hygiene measures. Because some kids will get both Influenza and Corona at the same time, a real Martian Death Flu combination.

Bronchiolitis is another winter scourge besides Influenza virus. It also needs a better name, like Dave Barry calling Influenza “Martian Death Flu.” For one, it sounds too much like Bronchitis, an adult respiratory illness. For another, “bronchiolitis” doesn’t really convey the misery infants and toddlers go through. Maybe call it Baby Snot Virus From Hell (BSVH)?  Gunk Hacking Infant Whopper (GHIW)? Slime Scourge?  Phlegm Factory? I could go on for days.

Many people know bronchiolitis by the virus that often causes it: RSV.  Respiratory Syncytial Virus is just one of the viruses causing this syndrome, but it’s the most common, and is highly contagious.  While most kids just get runny noses and fevers,  some babies and toddlers have trouble breathing and need hospitalization for oxygen and observation.  They can also get so congested that they can’t breathe and drink at the same time, thus needing IV fluids for hydration.

Bronchiolitis care is frustrating because there’s no effective treatment to ease symptoms or shorten the course. Nebulizers and steroids used for asthma don’t work for RSV.  We’re left with “supportive care:” riding it out with oxygen, IV fluids, and sometimes more intensive life support.

Like we surmised above with flu, maybe this winter’s “RSV season” will be better than usual. Adults and older kids carry RSV, and with masks, hand-hygiene, and distancing, maybe RSV won’t spread as much. However, the kids who get bronchiolitis- infants and toddlers- won’t be wearing masks much.  Daycares have stayed open, and are notorious places for RSV to pass from toddler to toddler, crib to crib. Not every daycare worker washes hands like he/she should, and toddlers certainly don’t. Even the most obsessive caregivers occasionally let their guard down. They’re only human.

Also like we discussed above, during last winter’s Coronavirus outbreak in China many hospitalized kids were co-infected with Coronavirus and RSV.  Both viruses are highly contagious, and every winter we see several kids who are likewise co-infected with contagions- RSV plus Influenza, Influenza plus Strep throat.  Thus we can expect to see babies and toddlers with both RSV and Coronavirus.  Baby Snot Virus From Hell indeed!  Wash your hands, wear your masks, and for goodness’ sake stay away!

That’s Not A Piggy Bank!

This week’s guest columnist is Dr. Christopher Clark, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

The saying “Find a penny, pick it up; all day long you’ll have good luck” doesn’t always apply, especially for one 5 year-old girl in the Pediatric Emergency Department. She was playing with some coins, inspecting them closely, even putting them in her mouth to taste them.  Then one hard swallow, and she felt something wrong, besides being “short changed.”  Uh-oh!

Kids put foreign objects (as we call them) in any place they can- ears, noses, and mouths. Infants and toddlers particularly like to explore with their mouths, being the most sensitive part of their bodies. And sometimes, they swallow stuff.  Luckily, about 80% of foreign objects pass through the gastrointestinal system without difficulty.  The one place they get can stuck is the esophagus, that tube that brings food from your mouth to your stomach.  When this happens, kids have to go to surgery to have the object removed.

Parents usually know when something gets stuck.  School-age kids can report the feeling of the coin lodged in the esophagus.  Parents usually witness the ingestion in infants, but occasionally toddlers aren’t in the room when they swallow something. Even then, a sudden onset of coughing, gagging, and crying alerts parents to what’s happened.  However, twice in the past year in our ER, we’ve seen babies with weeks of coughing and vomiting, and order a chest x-ray to look for pneumonia.  Surprise, what’s that coin doing in there!?

Coins are the most commonly swallowed objects in children.  However, anything they can get down, they will- pen caps, wedding rings, Legos.  Again, most of these pass without difficulty.  In a few days they’ll come out the other end.  However, some things that get stuck are an emergency.  The most common of these is disc or button batteries.  If these stop in the esophagus, mucus moistens them, setting up a current between the + and – sides, and they get hot. If left long enough, they’ll burn through the esophagus, letting contamination into the neck and chest cavities, in turn causing life- threatening infection. The same goes for sharp objects like needles and pins.

When I was 11 years-old, I remember playing with 12 game tokens from the arcade at a local pizza joint.  My 4 year-old sister watched as I counted them over and over.  Something distracted me and as my sister walked away, I now counted 11.  “Mom, someone took my coin!” I shouted.  She answered, “You just counted wrong!”  Then my sister began coughing and drooling.

Like we said above, we don’t always see when a kid ingests a foreign object.  Often though, we get clues like coughing and gagging after something goes missing.  In the Emergency Department, we first do an x-ray.  Most things that get stuck in the esophagus are metallic, like coins or batteries, easily seen by x-ray.. However, x-rays don’t always show softer materials like plastic toys or fish bones. If we suspect those, CT scans are necessary.

Also as we discussed above, most objects pass the esophagus.  They’ll come out the other end in a few days.  Whether you want to confirm it’s passed by “inspection,” that’s up to you. If you don’t see it in your child’s effluence, a repeat x-ray can confirm it’s gone. However, if the thing’s stuck in the esophagus, it needs to be removed.  The child is taken to the OR and a scope is passed down the throat. The object is visualized,  grasped with calipers, and pulled out.  Swallowed objects that need to come out right away- batteries and magnets.  These can cause internal injuries, and even if the child looks okay, need immediate evaluation in the ER.

The best treatment of swallowed objects, of course, is prevention. Infants and toddlers should always be seated when eating.  When they eat while walking, they can stumble and choke on incompletely chewed food.  Houses should also be toddler-proofed for choking hazards.  This means crawling around the entire floor plan on hands and knees, seeing everything at their eye level.  Go anywhere they can go- under beds, into closets, behind doors. You need to do this periodically, not just once, since everyone occasionally drops stuff.  Finally, take a CPR class.  Practicing the Heimlich maneuver with a CPR mannequin makes it a lot easier to do if your child starts choking.

Who Let The Dogs Out?

In 2014 I reported on a 22 pound cat named Lux who attacked his family. The family’s seven-month old baby pulled Lux’s tail, so he clawed baby’s forehead. Dad kicked the cat, who went ballistic and trapped the parents in a bedroom, prompting them to call 911. Yet they decided to keep the cat, getting it “therapy.”  When therapy failed, Lux’s veterinarian diagnosed him with Feline Hyperesthesia Syndrome, which apparently means “cat goes nuts for no apparent reason.”  On medication and in an “experienced” cat-foster-home, he’s apparently doing somewhat better.

It’s been said that while dogs are man’s best friend, cats are, well, cats’ best friend. Dogs, as animals that live in packs, are natural fits in their “pack” families.  Cats, as solitary predators, are less so. What is the best pet “fit” for families?  A spate of animal bites recently in the Pediatric Emergency Department has made me think more about this.

Most cases recently have been dogs biting toddlers.  Many attacks are unwitnessed by the parents, as the dog and child are in another room when the confrontation occurs.  Often, pets and toddlers don’t mix.  Infants and toddlers don’t know how to behave with pets: they’ll pull tails, get between pets’ mouths and their food, and lean in to kiss pets on the nose, unmindful that they’re making them nervous. I waited until our youngest was 5 years-old before getting our first puppy, and trained both how to treat each other.

It’s also important to pick the right breed.  Guard dogs (Dobermans and Rottweilers), fighting breeds (pit bulls), and shepherds aren’t the safest with children. The first two can be aggressive, and shepherds often want to herd children, nipping at them like they were sheep or cows.  Yet while farm animals have tough hides that withstand dogs’ teeth, toddlers’ skin is much softer. Finally, while everyone wants to rescue a dog from a shelter, rescues’ temperaments are less knowable than those of dogs from breeders.  Finally, dogs neutered or spayed are less aggressive, and thus safer with kids.

Finally, don’t let that dog out!  Dogs wandering from unfenced yards is a recipe for trouble.  A big batch of bites we see is neighbors’ dogs straying into others’ yards, or children going into the dog’s “territory.”

Unlike dogs and cats, horses don’t usually bite kids.  One of few I’ve seen was the time a boy was feeding his horse sugar cubes, and his fingers got chomped. When children are bitten, we worry that the offending animal could have rabies.  If kids get rabies, they die. Always. Thus we call Animal Control to inspect the animal, and quarantine it for 10 days to see if it develops rabies.

Though I’d seen few horse bites before, I knew rabid horses are rare.  I called Animal Control about what to do, who called the Office of Public Health, who called their veterinarian consultant.  This advice came down: while probably safe, the horse could have been bitten and infected by rabid skunks or raccoons unnoticed.  Lacking a corral at their facility to quarantine the horse, Animal Control settled on visiting it at home every few days to assess it’s status.

Bites from dogs, cats, and other animals carry infection risks for kids.  First, tetanus is a concern, so it behooves parents to vaccinate their children, since tetanus is also quite deadly.  Second, animals carry bacteria in their mouths, so bites that break the skin require antibiotics. That goes for bites from horses, dogs, cats, turtles, and humans. Finally, we worry about rabies.

Sometimes when we tell parents we’re calling Animal Control, they get defensive.  They’re afraid their pet will be taken away, or killed.  However, the animal is simply watched for 10 days, either at home or at Animal Control’s facility.  If taken there, Rover returns home after 10 days. This protocol is for the child’s (and family’s!) safety.  Again, rabies kills 100% of it’s victims.  If we can’t watch the animal, like if it’s a stray or a wild animal that can’t be found, or parents hide their pet, then the child needs the rabies vaccine series.  This consists of 4 shots, on the day of the bite and days 3, 7, and 14 after that.  Also, the child needs Rabies Immunoglobin injected into the wound to prevent infection while waiting for the vaccine to trigger immunity. Getting shots into a wound and then 4 more in the arm is no fun for kids, and we usually convince families to give up Fido: he’ll come home soon enough.

Who Let The Seals Out?

This week’s guest columnist is Dr. Tyler Hebert, Family Practice resident at the University Hospital and Clinics here in Lafayette.

The child wakes up in the middle of the night with a weird-sounding cough, struggling to breathe, a panicked look on her face. When she breathes in, she makes a honking sound. The parents jump in the car and race for the Emergency Department.  Upon arriving, the child is miraculously better.  She sits there cooing and gurgling, breathing just fine, looking between parents and doctor and nurse.  What’s all the fuss about, her expression says. “I swear she was in real trouble!” intones the mom. Rest assured mom, we believe you.  This is croup.

Croup is a condition brought on by regular winter cold viruses.  While most kids just have a cough and runny nose, a few get irritation in their airway below their vocal cords. The airway starts to swell closed, causing the characteristic “seal bark” cough. If you’ve never heard a seal bark at the aquarium, see it on Youtube. Instead of a dog’s “arf-arf” sound, seals make a much deeper “Orf-Orf” sound, as will your croup-afflicted child. When kids have bad attacks, they also have a sound when they breathe in called “stridor.”  Stridor is an inspiratory honking from even more narrowed airways.  When a child wakes up with this “Honk-Orf-Orf-Orf, Honk-Orf-Orf-Orf”, they’re working to get air through that narrowed passage.  They sound terrible and look panicked.

Daycare is a great thing.  At daycare, children get to socialize with other kids, receive important education, and parents can tend to their jobs and other responsibilities. Daycare plays a major role in many parents’ and children’s lives.  Daycares are also great places for kids to pass around cold viruses.

For the first 18 months of her life, our oldest daughter never got sick.  When she started daycare, she got her first runny nose. Then every other week she contracted yet another cold virus that her classmates passed around.  My youngest daughter got croup from these colds. Fortunately, we were able to settle her down at home and not need an ER visit. Remember how our girl above got better so fast?  There’s reasons for that we’ll go into below.

As we mentioned above, daycare can be a wonderful thing.  Kids get to play with other kids; and parents can go to work, earn money, and tend to other responsibilities.  Note how even during the worst of the pandemic this past spring, many daycares stayed open. They’re that important for families’ function.

Daycares are also great places for kids to get sick. Infants and toddlers are virus-breeding and virus-spreading factories. A child catches a cold virus, brews it in his body, and then begins sharing it with his environment: coughing, sneezing, and running mucus out his little nose. Put that kid in a room with several other active, exploring toddlers, and soon they’re inhaling virus-laden aerosol.  They also get virus-contaminated mucus smeared on them by their pestilent playmate, their hands go in their mouths, and bingo: several more virus-manufacturers-and-spreaders are recruited.

Like we said above, a few of those infected kids develop croup. Croup is a side-effect of cold viruses, wherein the afflicted child gets narrowing in her airway right below the vocal cords. Then she wakes up with that seal-bark cough and inspiratory honking called stridor. Often these kids struggle to breathe.

Fortunately, most kids get better within minutes of their attack. One reason for the noise is that they’re sucking in dry, night-time air, which is “sticky” in a narrowed airway.  Also, when they’re lying flat while sleeping, fluid in their body contributes to the swelling. When the child sits up, waking in her panic, the swelling drains away. Then when the parents drive to the Emergency Department, the moist outdoor air lubricates the kid’s airway, and upon arrival she looks fine.

Thus the basics of croup treatment.  When parents call the doctor for croup attacks, they’re advised to hold kids upright and take them outdoors, or into the bathroom with all the hot faucets on to steam it up.  If that doesn’t work, then get seen.  We often prescribe steroids to decrease the airway inflammation, and occasionally use a special breathing treatment called racemic epinephrine for bad cases.  Your usual home breathing treatment, albuterol, doesn’t help with croup, except for the mist coming out of the pipe. Easy enough to turn your little seals back into kids.

Screamin’ Down The Road- Part III

In previous installments of Traveling With Children, I’ve discussed avoiding disasters  like plane crashes or hotel fires.  Traveling With Children now has a new dimension: avoiding getting COVID on road trip potty stops.  Yesterday our cousins with three little girls sent us pictures of their driving supplies while they head out west.  They included a five-gallon bucket with a toilet seat, filled with kitty litter. The picture’s caption: “This helped us avoid at least 24 interactions in public spaces.”

When little kids use the potty, they touch everything: the toilet seat, the walls, you, their own mouths. Gas station bathrooms are nightmares keeping track of their hands and staying sanitary. Now add the risk of breathing in COVID-laden aerosol from fellow travelers. The Centers for Disease Control (CDC) recommends not traveling at all during the pandemic. Traveling means increased interactions with other people, at gas stations, restaurants, and the vacation destination itself.

However, many are craving their summer vacation and like our cousins above, heading out. The great outdoors is a popular destination this summer.  Open air seems to greatly decrease your risk of breathing in someone else’s Coronavirus, as opposed to being indoors and breathing other people’s recirculated air. Hiking is good exercise, and a welcome change of scenery from your home’s yard and four walls. And being outdoors lets you avoid crowds.

I find giving advice about vacationing is like giving advice to ATV riders.  People put kids on ATVs no matter what I say, so likewise here’s how to minimize your risk if you must go on vacation. First, don’t travel to COVID hot spots, like California or Florida, where your odds of catching it are increased. Second, minimize interactions enroute to your destination.  This means not eating inside restaurants. Using drive-thrus is safer, but three drive-thru visits per day still increases your interactions with potentially infectious strangers.  Best to pack your own food, which is also less expensive and can be healthier.

As far as that potty stop, good luck!  One friend mentions that she and her kids will go “over the side of the road,” but her kids are teenagers.  With three little girls, our cousins went with the home-made port-o-potty.  Maybe just stay home?

While many are hitting the road for summer vacation, those lucky enough to have boats are hitting the water. NPR recently reported on boaters in Washington State sneaking across Canada’s closed borders to visit. Locals at one coastal town complained about an American yacht with teens and adults “wandering the dock…no social distancing, no masks, and went through the store as if…shopping at Walmart.”  To avoid detection, US boaters switch off their transponders, which are required by international law to avoid collisions, particularly at night or in fog. With so many American boats “going dark” when they cross the border, the Canadians know they’re not all sinking.

For places that rely on tourist dollars, allowing vacationers in is a two-edged sword.  While their livelihoods depend on visitors’ lodging and eating, those visitors also bring disease. Canada decided that American dollars aren’t worth the risk of more Coronavirus.  Our National Park system decided the opposite.

The citizens of Jackson Hole, Wyoming, were expecting a quieter-than-usual summer, with the warnings against traveling. Jackson Hole is near Yellowstone and Grand Tetons National Parks, and has the region’s airport.  Instead, Jackson Hole is experiencing even more visitors than previous years, particularly at campgrounds and RV parks. People figure that camping and wilderness vacations are “safe-cations,” where they can breathe free of COVID-laden crowds. I’m sure the staff of the town’s only hospital, St. Johns Health, have eyes bugging out like deer in the headlights.

As we discussed above, the CDC recommends not traveling during the Pandemic, since this increases your odds of catching the virus.  Even the great outdoors’s wide-open spaces, with record visitors, is now less wide open.  If you must vacation, staying away from National Parks, sadly, is a smart move. Also stay away from any COVID hot spots like California or Florida.  Avoid crowds, where even outdoor air may not dilute all the aerosolized virus that’s exhaled.

Again like above, if you’re driving, minimize stops for gas, food, and the bathroom.  Sanitize your hands after using gas pumps, and wear those masks.  While flying is much safer than driving as far as avoiding crashes, personal interactions in the airport or airplane may increase your risk of catching Coronavirus. Maybe stay home, or at least stay south of Canada.

No Titanics Here

This week’s guest columnists are Drs. Dylan Poche and Brandon Saucier, Family Practice residents at the University Hospital and Clinics here in Lafayette.

As a kid, I spent summer weekends at the family fishing camp.  Lots of time we were tubing, being towed on an inner tube behind by our roaring boat, slaloming, occasionally bouncing off when we hit big waves.  One bad time I’ll never forget: another boat, driven by someone who’d been drinking, cut between our tube and boat.  Hitting the tow rope, they yanked my girfriend, who was on the tube, toward the stern of our boat.  She hit the propeller, sustaining deep lacerations.  Worse, she spent a long time in the hospital when they got infected.

Many South Louisiana families are now on the water tubing, fishing, boating, or zipping around on Jet-skis. Since this time is often for recreation, they couple it with another South Louisiana good time tradition- drinking. This leads to boat-driving like above: carelessness about where the boat’s going, how fast, and what it runs into. Impaired boaters are also more likely to drown if they fall overboard. They’re knocked out or pass out more easily, and are much less likely to be wearing lifejackets.

Boating isn’t like driving a car.  Boats don’t have the built-in safety features of cars, like seatbelts or enclosed cabins so passengers don’t fly out.  There’s also no brake pedal- stopping requires much more foresight. In cars the safe road is clearly marked with painted lines, warning signs, and guard rails to keep you on the straight and narrow.  Boat “roads” aren’t obvious- maybe a channel marker here and there, and you need a chart to know where the underwater hazards are, like sandbars and rocks. The rules of the road, particularly who has the right of way when boats approach, are more complicated. Many boaters skip a driving course,

Fun fact: the Louisiana Department of Wildlife and Fisheries requires everyone born after 1983 to complete an approved Boater Education Course, even to operate a Jet-ski!  This goes for kids and adults.  However, LDWF doesn’t have the personnel to enforce this rule like police ashore.  Ever see a Jet-skier get pulled over?

My father was strict about water safety, particularly enforcing wearing lifejackets in boats.  I wondered why he was like that, more than my friends’ parents, until one day he told me.  I had had an uncle who owned a racing boat.  He was a very experienced driver, and would always wear his lifejacket.  One day he was heading to a nearby camp, and didn’t wear it.  Going 30 miles per hour a freak accident happened- his steering cable broke and the boat jinked. He was thrown out, apparently knocked out by the impact on the water, and never came up.

According to the CDC, there’s over 3000 deaths each year due to accidental drowning.  About one in five of these victims are under age 14.  While many of these drown in pools, many also die in boating accidents.  Thus lifejackets should be worn by people of all ages, in all circumstances, near any kind of water.  Kids particularly should wear them, since they’re inherently less careful than adults about falling off docks, out of boats, or into pools.  Kids are also less capable swimmers, and thus more at risk when they tumble in.

As we mentioned above, adults are less attentive when drinking.  Alcohol and water seem to mix, at pool parties and on boats.  Imbibing adults are careless boat operators- driving recklessly and being more lax about kids wearing lifejackets. They run into things- docks, rocks, other boats; and everyone gets thrown in.  At pool parties drinkers are more distracted, and thus less observant of kids in the water.  Nighttime parties are the worst, where in the hubbub and dark a kid will fall in the water, no one sees it, until too late.

Often people don’t perceive the risk of being near water.  It’s a sunny day and everyone’s happy to be out. The water’s surface seems calm and, well, solid.  Being next to water is not like standing on a cliff.  Our brains understand the risk of falling off that cliff- you’ll die!  That same protective perception doesn’t seem to apply to water.  Thus people need to be conscious of the risk, for themselves and their kids.  At pool parties or in boats, have a designated sober adult to assure everyone’s safety.  And put those jackets on!

Guns Or Dogs?

The dog had bitten the child in the face, and the dog’s owner was angry.  The child’s parents thought the owner was going to shoot the dog.  This worried me because we needed the dog alive to see if it developed rabies.  I called the Sheriff’s department, who patched me through to the deputy on scene. “Did he shoot the dog?” I asked.  “Yes, in the head,” replied the deputy.  Oh no, I thought, shooting in the head is the worst, because second best to a live dog is having enough brain tissue to test for the rabies virus.

“How’s the dog then?” I asked tentatively.  “Well, when I pulled up,” the deputy replied, “he ran out, jumped up, and started licking me!”  Turns out the dog had been shot with a pellet gun, not the shotgun I imagined, and the pellet didn’t penetrate his thick skull.

This dog was lucky, because 9 times out of 10 dogs are shot with bigger weapons than pellet guns, and firearms are everywhere.  People are afraid of police because every cop carries a gun, and police are afraid because there’s so many guns among their constituents, who sometimes brandish them during routine traffic stops or domestic disputes.

Firearms are inherently dangerous.  They’re designed to kill. They’re present in at least half of all Louisiana homes, and our state is one of the top states with gun-related deaths in adults, and children. In fact, guns in the home are far more likely to injure or kill a family member than an intruder.  Exploring toddlers and children can accidentally shoot themselves.  Despondent teenagers use them to commit suicide. Angry spouses, in the heat of an argument, shoot each other. Guns stolen out of houses and cars are used in further crimes.

I have a shotgun for duck hunting (or more usually, given my aim, “duck scaring”).  However, when my kids were growing up, my gun was stored at my father-in-laws’. Like swimming pools, when there’s kids around, it’s best just not to have them at the house.  If you feel you must have a firearm, keep it locked up, unloaded, with ammunition stored separately.  For home protection, barking dogs are much more effective, and (mostly) safer.  Get one that doesn’t bite!

While pellet guns aren’t great at dispatching larger animals like our dog above, they’re effective against smaller pests.  When rats infest our yard, eating from the bird feeders and freaking out my wife, I’ll phone my brother-in-law.  “Hey, ‘Murder Incorporated,’” I’ll say, “come over with your pellet pistol.”  We’ll swagger around the yard like mafia hit men, and then “cap” the offending rodents.

While in my wife’s book the dirty rats have it coming, firearm threats to humans are another story.  As we mentioned above, guns’ sole design is to kill.  Having one in the house with kids is unsafe.  Depressed teenagers are one high-risk group. Teens are impulsive, one minute rational, the next minute ready to end their misery permanently.  Gun suicide is too easy, too quick, to give teens time for second thoughts.  When in the Emergency Department we see despondent teenagers, we advise removing guns from the home.

Toddlers and school-age children are also high-risk.  These kids are explorers.  When they find a new “toy,” (which they will, no matter how well you hid it) they’ll play with it. My worst encounter was when a DEA agent came home from an overnight stake-out.  Exhausted, he tossed his pistol on the kitchen table and fell in bed.  His five-year-old son woke up soon after, and you can guess the rest.

Regardless how you feel about the National Rifle Association, the NRA has good safety advice for gun owners.  First, if you must have a gun in the house, keep it locked up, unloaded, with the ammunition locked up separately.  When children are old enough, teach them about guns to take away the mystery, and so they learn safety rules.  The NRA advises teaching children that if they come across a stray firearm, they shouldn’t touch it. Instead, they should run away from it and tell a responsible adult.

Some argue that, if my gun is unloaded and locked up, how can I get it out in time if someone invades my home?  The answer: that gun is statistically much more likely to kill the owner or another family member than an intruder.  If you want real home protection, get a dog.  Dogs are much more effective stranger deterrence, and are cuter too.

Heavy Sleepers

This week’s guest columnist is Dr. Dylan Poche, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

I had the same dream every time I wet the bed: I’d be at summer camp, walking out to the camp flagpole, and I’d urinate on it.  When I woke up, the bed was wet.  As I got older, I realized the connection between the dream and wetting, and in the dream would struggle to awaken before peeing on the pole.  About age 9 I I’d wake up as I was peeing on the pole, and go finish in the toilet.  Finally, by 10 years-old, I’d wake up as soon as the dream started and keep dry.

Bedwetting, “nocturnal enuresis” in doctor-talk, is common, and troubling for both children and their families.  It’s defined as involuntary bedwetting in kids otherwise potty-trained by age 5.  Up to a quarter of kids wet at age 5. These kids seem to be deep sleepers, not awakened by the urge to pee. There’s a genetic component, possibly involving maturation of the nerve pathway from bladder to brain.  When I was in medical school and learned this, I asked my parents about it.  Sure enough, dad wet the bed until he was 10, as did my grandfather!

The good news is that it usually resolves on it’s own, but can be alleviated sooner with  treatment.  However, kids who wet after having been dry for awhile might have something else, like urinary tract infections (UTI).  In other words, children who’ve been dry for months or years, and then wet, could be getting sick.  Sometimes it’s something like a stomach virus.  If your child has burning or belly pain with urination, it could be a UTI.  Other signs of infection are fever, foul-smelling urine, or extra frequent urination.  See your doctor for a urine test, since UTIs require antibiotics.

If it’s simple bedwetting, there’s lots of ways to approach this problem.  The easiest thing is restrict your child’s fluid intake in the evening.  This means not drinking a lot with dinner, certainly nothing sugary that kids will chug because it tastes good.  After dinner, minimal water, and have them pee just before bed.

I know of an old Cajun, Uncle Jim, who wet the bed as a child.  He grew up in the 1930s, sharing the attic bedroom, and beds, with six brothers.  When a brother pulled “Jim duty” and shared Jim’s bed, he also shared getting wet.  Finally the brothers, being clever Cajun-types, solved the problem: they propped up their side of the bed with bricks, so that the bed angled down towards Jim.  The high brother stayed dry.

Nowadays there’s better solutions to bedwetting.  Like we mentioned above, the vast majority of kids outgrow bedwetting, usually by around age 7.  A few kids wet into their teen years, but eventually stop.  In Uncle Jim’s day, it was sometimes seen as a psychological problem (Uncle Jim was mean, after all), but now is recognized as a benign issue.  These kids are simply heavy sleepers who aren’t awakened by the urge to go.

There’s things you can do to alleviate this issue sooner.  Like we said above, limiting fluid intake in the evening can make bladders less full.  Often the child needs to drink more during the day, so at night they aren’t drinking to catch up on hydration.  Also, making the child urinate just before bed, and even waking him up to pee soon after he falls asleep, can help make dry nights.  You can buy bedwetting alarms that have a sensor in the child’s pants.  When the sensor gets wet, the alarm wakes the child.  It takes time, but eventually he’s trained to wake up when he’s about to urinate, so he can use the bathroom.

Wetting the bed is of course embarrassing.  Punishing the child for wetting the bed only makes things worse.  It’s best to de-stigmatize the situation by calmly telling the child it’s normal, and decrease his guilt by having him help wash the bedclothes. Encase the mattress in a water-proof cover to prevent permanent urine smell.  Enforce a strict no-teasing policy with siblings.

Occasionally, doctors prescribe medicines to prevent bedwetting, like desmopressin or imipramine.  First the doctor needs to see the child to ensure there aren’t other medical reasons for the bedwetting, like urinary tract infections or constipation; and that the more benign interventions haven’t worked.  Including bricks under the bed.

Kids Don’t Float

My cousin has three daughters, and a pool.  He and his wife knew the drowning risks, so when they had kids they made this rule: no going in the backyard without a life jacket on, whether the girls were going in the pool or not.  So to tell their parents they wanted to go play outside, they’d chant “Jacket? Jacket?” with their arms held up, looking like chicks in the nest peeping for worms, waiting to have it slipped over their arms and buckled up.

This time of year beaches, lakes, and bayous become populated by vacationing families.  Home pools get big use: kids swim and splash around, and teens and parents host parties there.  Pools are also drowning hazards, a leading cause of death in children.

Toddlers are at particular risk.  They’re explorers, often escaping parents’ attention, scooting out into the yard.  If there’s a pool, they’ll bend down to touch the water, and tumble in.  Toddlers don’t know how to get their head above water; security videos invariably show that they don’t thrash about and get attention; they just sink quietly.  Pool parties are notorious for child drownings. The adults are drinking and distracted by conversation, it’s dark, and multiple kids are horsing around.  The toddler or older child slips under unnoticed.  Even for a designated watcher, the temptations to look at more interesting party events, or at the phone, are great.  In Germany, their Lifeguard Association noted more child drownings due to parents watching their phones rather than their kids.

The best drowning prevention is not to have a pool.  If you must have one, or live by a lake or river, fence the pool on all 4 sides, or fence your kids in from the bayou.  Pools  accessible by the patio door are particular trouble.  Pool alarms and covers also aren’t fail-safe.  Swimming lessons may buy your child time to shout for help or get out, but statistics haven’t proven their benefit.

Thus my cousin’s solution to having toddlers and a pool- jackets all the time.  Also, one time he visited Alaska and noted that all boat docks have a rack with child life jackets for anyone to borrow.  The sign above the rack: Kids Don’t Float.

In 2017 I almost drowned at Grand Isle.  I was swimming out to an inflatable island anchored off shore.  The waves were up and slapping me around, and I wasn’t a strong swimmer- “suck” best described my aquatic prowess.  Fortunately, already lounging on the island was my friend Dayle, a former lifeguard and collegiate swimmer.  As I began to flounder and panic, I called out to Dayle, who in seconds was buoying me up and towing me to the float.  Since then I’ve taken lessons, and added swimming to my work-outs.

Grand Isle is Louisiana’s only beach resort island.  If you like your water and your beach brown, Grand Isle is your vacation destination!  Seriously, it’s quite nice there, but they’ve had a spate of recent drownings.  The town had constructed some rock breakwaters off the beach.  These prevent beach erosion and attract fish, making them great for anglers.  Unfortunately, breakwaters also make riptides, dangerous currents that sweep unsuspecting swimmers out to sea.  If swimmers panic or aren’t strong, they drown.  Two of the drownings involved kids who were fishing from the rocks and fell in.  Parents who jumped into save them likewise were lost.  Then most recently a family  was swimming by the breakwaters, and several of them drowned.

When a swimmer is in a riptide, he’ll try to swim back to the beach.  After several strokes, he looks up and notes he’s farther away.  Instinctually, he will paddle harder to get to safety.  He burns energy swimming harder, only to look up and be even farther. Time is running out.

After the first drowning, Grand Isle installed life rings and rope on posts by each breakwater.  Thus if someone falls in, you throw them the ring so they can float, and haul them back in.  But this must happen immediately, before the victim gets too far.  The posts are 20 yards behind the breakwaters.  How long does it take to climb off the rocks, run to the post, run back with the ring, climb back up?  And what if you miss on the throw?

Thus kids on these breakwaters should be wearing lifejackets.  They should wear them in boats, around pools during parties where everyone is drinking and attention wavers,   or anytime they’re in a backyard with a pool.  After all, kids don’t float.

Blood Suckers

Lately I’ve focused this column on consequences of all that time we’re spending outdoors. In the Pediatric Emergency Department we’ve seen lots of related injuries and skin problems.  Now let’s talk about wild beasts your kids might encounter, especially the deadliest animal known to man.  Causing the most fatalities world-wide every year, this animal kills far more people than sharks, snakes, hippos, crocodiles, lions, tigers, or bears.  Way more than murder hornets or killer bees.  This vicious scourge is that blood sucker, the mosquito.

The mosquito kills so many people by transmitting disease when it bites.  Fortunately for us in the United States, it’s bloated world-wide death toll is mostly from malaria, a tropical illness in Africa, Asia, and Latin America.  However, mosquitoes are beginning to spread other tropical diseases from the southern hemisphere to us, like Zika, Dengue fever, and Chikungunya.  Then there’s diseases that mosquitoes already carry locally, like Eastern Equine Encephalitis and West Nile virus.

Mosquitoes often hit and run before you know they’ve come.  They land, stab you with their needle-like nose, suck up blood while simultaneously injecting anticoagulant to prevent clotting in their nose, and lift off with a belly full of your blood, all within a minute.  Only after your body reacts to the anticoagulant, causing that ferocious itch, do you realize you’ve been a victim.

In my practice, that itch does the most damage to kids.  They scratch those bites with dirty fingernails and cause localized skin infections.  I see West Nile or other encephalitises maybe once every five years.  I see infected mosquito bites daily.

In spring I like a beer on my patio as the sun goes down, the temperature’s the nicest, and unfortunately when mosquitoes are most active.  I spray repellent on myself and clothes and put out citronella candles.  I also keep my grass mowed, because long grass hides water that mosquitoes like to breed in.  I also make sure there’s no standing water, like in gutters or buckets.  The one water feature in our yard, the birdbath, has a dripper fountain- mosquitoes don’t lay eggs in rippling water.  Do the same with your yard and your kids.  And keep those nails clean and clipped.

Another of nature’s blood suckers is a hitchhiker, grabbing onto unwitting passersby.  This vampire doesn’t have pale skin, slick hair, and pointy canines, or get rides with it’s thumb out (who’d pick up that guy anyway?).  This horror movie happens on a tinier scale: the tick.

To get out of the home, get some exercise, and get kids away from their electronic heroin, we’re heading outdoors to woods and parks.  In spring, ticks are also hitting these places, clinging to bushes and grasses that we walk past.  As we brush by, the tick latches on to our clothes with hooks on it’s legs.  It’s swooped up and crawls to a hidey hole on the skin.

Until recently, we didn’t know how ticks actually sucked blood.  It certainly wasn’t the lightning fast stab-and-run of the mosquito.  Ticks take hours before they get their “blood meal.”  Then, in 2013, German scientists filmed the event.  Dr. Dania Richter of the Technische Universitat of Braunschweig is a researcher on how ticks transmit Lyme disease to humans. One day, as I imagine it, her team was lounging around the lab when she said, “Hey Franz (the actual name of one of her collaborators), let’s film some ticks sucking blood!”  They got some high speed, high res cameras and mouse “volunteers,” and made bug research history.

Instead of the quick stab of the mosquito, it’s a time-consuming process for ticks. They first cut into your skin with two tiny saws at the front of their heads.  Then they stick a fat harpoon between the saws.  Alternating thrusts of the saws and harpoon, they claw their way deeper until blood flows back into the mouth.  See it on Youtube!

Ticks occasionally transmit diseases like Rocky Mountain Spotted Fever, Erhlichiosis, and Tularemia.  But mainly, they’re just gross.  Prevent bites just like with mosquitoes: spray repellent on your skin and clothes, wear long sleeves and pants (if you can stand the heat), and keep yard grass short.  After hiking, when you shower off the dirt and sweat, check all your skin for ticks.  If you see one, pull it off with tweezers by the head, as close into your skin as possible.  You don’t have to turn your skin into hamburger getting all those saws and harpoons out- they don’t transmit disease themselves.