Can You Hear Me Now??

What's that? Are your ears filled up with wax, making it difficult to hear? Well, the good news is that a recent study has validated our long standing recommendation regarding use of a bulb syringe to remove pesky ear wax. The study, Randomized Trial of Bulb Syringes for Earwax: Impact on Health Service Utilization was published in the Annals of Family Medicine this month. The trial was performed in the United Kingdom, with 237 patients who showed up at primary care clinics. They were randomly assigned to receive supplies and education on how to flush out their own ears, or simply treated by staff in the clinic. Not surprisingly, the study found that those who learned how to clear their ears with a bulb syringe had half the number of return visits for the same problem in the next couple of years compared with those who were treated but not educated on home therapy. Obviously this saves time and money for all involved!
What is the technique? You simply fill a sink with luke-warm water; cold or very hot water will cause dizziness, so check that temperature. Then, fill up your bulb syringe with that water, and lean over the sink, pulling the earlobe out and towards the back of your head (which straightens/opens the ear canal). GENTLY insert the tip of the bulb syringe into the ear canal and squeeze the bulb so the water squirts into your ear canal and spills into the sink, carrying waxy particles with it. Repeat this process up to roughly a dozen times. You will typically see the offending wax particles floating in the water, telling you that your mission was successful.
I advise following this process with adding a few drops of half and half vinegar and rubbing alcohol, which removes any remaining moisture from the canal. If you STILL feel the sensation of a blocked ear canal the next day, go ahead and schedule an appointment with your doctor and let her take a look inside. And oh yes, please STAY AWAY from the q-tips! They either pack the wax in tighter or cause damage to the ear canal and/or ear drum.
BOTTOM LINE: Using a bulb syringe to remove earwax is a simple, proven remedy that doctors officially recommend.

ADD- Is Zinc the answer?

We are always looking for more and better solutions to Attention Deficit Disorder, so I was pleased to read a study published last month in the Journal of Child and Adolescent Psychopharmacology, entitled Zinc for attention-deficit/hyperactivity disorder: placebo-controlled double-blind pilot trial alone and combined with amphetamine, that looked at the role of ZINC in treating ADD. There have been some studies published in other countries that suggest supplemental dietary zinc may improve symptoms of ADD. This pilot study was small (as pilot studies should be) including just over 50 children.

The kids received zinc or placebo alone for the first two months, and there was no consistent, statistically significant advantage to taking zinc alone (vs. placebo). Then, the children were randomized to receive either zinc plus amphetamine (such as Ritalin) or a placebo plus the amphetamine for the next five weeks. Here is where the results are encouraging. Although the symptoms of inattention were not better for the kids who received the zinc plus amphetamine, the good news is that those receiving the zinc supplement required 37% less amphetamine to receive the same results compared with those taking amphetamine plus placebo.

Simply restated, the zinc seemed to help the amphetamine work more efficiently, so that a LOWER DOSE of the amphetamine achieved the desired results. Why is this important? Because lower effective doses mean LESS SIDE EFFECTS. So, should you rush out and buy zinc to supplement your child's ADD medications? No, I wouldn't do that based on a study with only 50 kids. However, while we're waiting for future studies with more significant numbers, why not be sure your child is meeting the recommended daily allowance for zinc? (~10mg per day for teens) What foods contain the most zinc? Seeds (pumpkin, sesame, watermelon), wheat germ, chocolate and peanuts. Hmm...maybe Snickers had the right idea! Or a healthier choice would be to head for the hummus (made with tahini- sesame seed paste.)

BOTTOM LINE: Zinc may help reduce the amount of amphetamine medication needed to improve symptoms of ADD.

Melanoma's "Ugly Duckling" Appearance

Do you have your ducks in a row when it comes to scanning your body for skin cancer? You may be familiar with the ABCDE's of melanoma (Asymmetry, Border, Color, Diameter, Evolving), but do you know about the "Ugly Duckling" concept? I love this one, because it echoes what I often say to patients when they ask why a certain mole looks "suspicious"- I tell them it's like the old Sesame Street concept that "one of these things is not like the others...one just doesn't belong"!

Like everything in medicine, each body has its own version of what we describe in textbooks. While diseases have a distinctive pattern, the actual specifics will vary from person to person. Along those lines, what we are looking for in melanoma is a mole that simply does not fit the PATTERN that your body has developed. For example, if you are covered in large brown moles, but you notice one small dark black one- it's that small one we worry about. If you have no moles at all except one medium light brown one, we worry about that medium-sized one, not because it is medium or brown, but because your "pattern" is NONE, and this is breaking that pattern. Make sense?


Here is a a graphic from the Skin Cancer Foundation that illustrates this concept. The arrows point to the odd man out, which is the mole that we would tend to prefer in a pathology lab than staying on your body.

BOTTOM LINE: Take a good look at your skin from top to bottom (use mirrors!) and learn to recognize the pattern of TYPES of moles that you have, so you will recognize that "ugly duckling" mole before it turns into full blown skin cancer!

Travel First Aid Kit Recipe

What do doctors pack when they travel with their families? If you are heading out for Spring Break, you might wonder what first aid supplies you should pack. There are really only a handful of supplies that I routinely take on trips. Truthfully, if we are traveling in the United States, I often head out with the bare minimum, because I know a pharmacy or grocery store will be available. However, especially if I am chaperoning a group of kids, I always carry the following supplies:
1. Ibuprofen- for headaches, muscle aches, fevers or menstrual cramps.
2. Tylenol- to supplement the ibuprofen if the ache or fever is severe.
3. Antacid tablets (TUMS or Rolaids)- still the fastest relief from heartburn/stomach acid.
4. Hydrocortisone cream (steroid such as Cortaid)- for anything that itches (bug bites, allergic skin reactions.)
5. Triple antibiotic cream- for cuts/scrapes (after washing with water.)
6. Bandaids- the GOOD kind that really stick, with specifics for knuckles, knees, and most commonly, HEELS (for those blisters!)
7. Benadryl tablets- for an intense allergic reaction to food, stings, etc; also may be used to help nausea.
8. ACE wrap- handy to limit swelling of a sprained ankle, knee or wrist.
9. Aspirin- honestly, I only keep this in case an adult has symptoms of a possible heart attack.
BOTTOM LINE: These few basic first aid supplies should get you through 99% of the illnesses and injuries that crop up on your trips, and this entire first aid kit should take up very little room in your luggage. Remember the creams count as "liquids" so slip them into your airline-specified ziplock baggie!

How Safe is Gardasil?

Parents are appropriately concerned about vaccines, but I get frustrated with the enormous amounts of negative popular press that immunizations are receiving these days. Vaccines are not only saving lives, but they are improving the quality of our lives dramatically with every decade. Today I'd like to discuss the statistics with Gardasil, a vaccine that protects against four strains of the human papilloma virus which cause genital warts and cervical cancer.

Gardasil was FDA approved and recommended in June of 2006. Since that time, over 32 million doses of the vaccine have been administered. There have been over 17,000 "adverse events" reported, including roughly 1000 "serious" events. The mild to moderate events (over 90%) include transient local swelling or pain, mild and moderate fevers, and nausea or fainting.

So what about the serious events, including 56 deaths? The serious events included primarily Guillian-Barre syndrome (a severe neurologic disorder) and blood clots. The numbers of GBS are no higher than expected in the age group receiving the vaccine, and the girls with blood clots typically had other risk factors for clotting, such as taking the birth control pill. Though deaths in young people are tragic REGARDLESS of the cause, there has been no identifiable pattern in these deaths to suggest that the vaccine caused them. If you look at any age population of 10 million people (32 million doses divided by the 3 shots in a series), sadly, you will see certain lethal cancers, neurological diseases, and other rare ailments.

It is important to understand that in order to figure out side effects from vaccines, any and ALL events that happen within a month (or up to a year) after receiving an immunization can and should be reported- even if it looks like they are completely coincidental. For example, if you get a flu shot today, and are diagnosed with advanced leukemia tomorrow, it gets reported as an "adverse event" of the flu shot- even though it obviously was going on before your shot. Why do this? Because we want to be SURE that there is NOT a relationship between any serious diseases and vaccines, and the only way to know is to collect all the data.

BOTTOM LINE: For Gardasil, look at these numbers and remember there are 1 million new cases of genital warts per year, 12,000 cases of cervical cancer and 4000 deaths from cervical cancer. You do the math. We are choosing to immunize our daughters.

Let's GO! Rap with tha Hip Hop Doc & Get Healthy!

Last week I was blogging on heart disease in women, and the American Heart Association's new guidelines calling awareness to the NUMBER ONE KILLER of women here in the United States. Today, I'm excited to bring you a HEART-PUMPING song that will stick in your brain and keep you moving and dancing all day!

Meet the Hip Hop Doc- Dr. Rani Whitfield- a very cool FAMILY PHYSICIAN who has found a unique way to reach his patients. His Youtube video "Let's Go!" speaks directly to us women, telling us to "Wait-FREEZE- Don't eat that! Fatty foods cause heart attacks!" (Click on LET"S GO to see the video!)I love it! Our whole house is now dancing and singing these words as we open the fridge and scout around.

Dr. Whitfield didn't stop with just the video, though. Check out his website, www.h2doc and you'll be amazed with all his efforts. From his six month campaign of heart runs and walks to raise awareness about heart disease, to his innovative new comic book and the Legion of Health- super-sized super heroes with names like Suga Free, Six Pack, and of course, h2d (that's Hip Hop Doc, if you're not following closely...)- his message engages everyone, with a special appeal to youth and those young at heart.

BOTTOM LINE: Check out tha Hip Hop Doc, and come on everyone, Let's GO!

Where Did My Favorite Cold Medicine Go?

Today the FDA (US Food & Drug Administration) is removing many allergy, cough and cold products from the shelves of your pharmacy. If you have a favorite that has worked for you, perhaps you should stock up. What's going on? Well, it turns out that there are a ton of drugs out there that lack FDA approval, yet doctors and patients alike are unaware.

Why does it matter? Our FDA actually does a great job of collecting and reacting to adverse events related to medications, acting swiftly to remove products that could cause danger. Though there are not oodles of reports with this group of products, there are enough, especially considering that because most are over-the-counter, adverse events are much less likely to be reported.


Frankly, as I went through the list, I was very surprised that some drugs that I have previously written prescriptions for (like Entex PSE and Bromfed) are NOT FDA approved. The main reason I don't routinely recommend herbal treatments is their lack of FDA regulation, which means there is no guarantee of the amount of ACTIVE product in each tablet or capsule. Turns out, this could be true for any of these allergy, cough & cold remedies as well. Additionally, in the past couple of years, pediatric recommendations have changed greatly, especially for kids younger than two years. Many of these medications do not issue any such precautions.

Here are a few, but go to the FDA website for a full list: Accuhist DM, Aerohist, Allerx, Aquatab, Bromfed, Biotuss, Brovex, Carbodex, Deconamine, Duravent, Entex, Guaifenesin, Histex, Lodrane, Rescon, Ru Tuss, ZCof, etc.

Note that the Triamic brand and Robitussin brand are NOT on the list.

BOTTOM LINE: Go to the FDA WEBSITE and scan the list to be sure YOUR upper respiratory medicine of choice is NOT on the list!