Don't Forget to Book Your Back-to-School Physical!

July is here already, so before you know it, our kids will be headed back to school. Why am I bringing this somber fact up on July 1st, in the very heart of summer? Because part of back-to-school preparation is that doctor check up, complete with the mountain of forms your child's school has sent you. Whether your baby is starting pre-K or headed off to graduate school, our educational institutions rightly want to protect their students' health, including reducing the spread of preventable, communicable diseases with vaccinations. Prioritize calling your family doctor RIGHT NOW and get your kids appointments on your calendar (and your doctor's) before camps, family vacations and other summer fun fills every day.

Many people have asked me why we "make" kids to come in to fill out these school forms, so I thought I'd take a moment to explain. First of all, kids GROW. Yes, I know this is not news to you, but when the last time we saw your pre-teen or tween was 6 months ago, before his growth spurt, if we use his height and weight from that visit, we'll be off by a couple inches and a dozen pounds. Additionally, with the childhood obesity epidemic we are facing, these vital signs become even more important. I'd much rather talk to "Jessica" about food choices when she is a few pounds overweight, than waiting a year or more and then face telling a teenage girl she is 20 lbs overweight.

This "annual" exam is a wonderful window of opportunity for your physician to talk to your adolescent about all kinds of preventative issues- from helmets and limiting screen time, to diet & exercise, to dating & driving risks. Often kids "hear" their doctor's words as significant information, despite the fact that their parent has preached the same speech to deaf ears. Feel free to give your family doctor a heads up if you have concerns about your child's behavioral, dietary, or peer choices so we can better direct our discussions.

Finally, be aware that our immunization schedules are always changing. For example, HPV vaccinations are now recommended for all boys and girls at age 11-12. "7th grade" vaccinations have included the meningitis vaccine, and the booster shots for chicken pox and tetanus for several years now, but current recommendations today also include a BOOSTER Meningitis vaccine for all college students up through age 21, that must be given on or after the child's 16th birthday. 

BOTTOM LINE: Back to school preparation INCLUDES a doctor's visit for your child (unless she's recently had a checkup). Sign up now and don't forget to bring those school & sport forms to the appointment! 

PS. It's the first of the month...change those air filters!

Gardasil & Increased Promiscuity? NOT an Issue

The Gardasil vaccine is back in the news. Gardasil is the vaccine recommended for both boys and girls to protect them against the Human Papillomavirus (HPV), which causes genital warts and cervical cancer) Yesterday, an article published in Pediatrics confirmed that girls who had received this vaccine did not, in fact, have any increased sexual promiscuity compared with their peers who did not receive the vaccine. Why was this study done? One reason for lower vaccination rates with this recommended vaccine (compared to other vaccines recommended in this age group) was parental concern that giving their preteen and teenage daughters this shot would appear to be giving "permission" to be more sexually active since they would be protected.

This study looked back at roughly 1400 girls over three and a half years. Almost one third of these girls received the Gardasil vaccine, while the other 2/3 did not. After the immunization, medical issues that can result from increased sexual activity- pregnancy and sexually transmitted diseases- were measured and compared between groups. Results? No significant difference in the two groups.

The results are not surprising, but I am happy to have this data to help reassure any parents who may have this concern. I have not yet found a teen who believes that the Gardasil vaccine somehow makes them bullet-proof in the sexual arena, although I have seen many who falsely believe condoms will do so- but that is a different discussion. If teens are aware of Gardasil, they know it is "for cancer". Only the rare teen (and parent, frankly) seems to realize that this vaccine also protects against genital warts- a disease that affects over a MILLION sexually active people each year in the United States; a disease that often destroys the self-image of young people just as they are trying to make critical life decisions. Genital warts make people feel "dirty" and "gross", and although we can treat warts to make new outbreaks resolve more quickly, we do not have a cure. And if you've ever had a wart frozen off your knee or finger, you know it hurts, so add painful plus embarrassing when that wart is in the genital area.

BOTTOM LINE: Gardasil is recommended as part of our routine vaccinations for both girls and boys to protect them from HPV-related cancers and genital warts. If your child is not yet vaccinated, talk with his or her doctor at the next visit.

Need a Vitamin B 12 Shot?

Why DO people get B 12 shots? As always, the answer is not exactly straight-forward. Many people get them because, well, they ask for one! There is a myth out there, quite popular with the entertainment industry, that getting a B 12 injection gives you a "shot" of energy. This idea has been around for many decades, and there are patients who absolutely swear it works. Additionally, many people believe if they are really stressed and run down- say at finals time in college- then a B 12 shot seems to keep them from getting sick. Is this true?
There are not any current evidence-based medical studies that support this theory. There is one recent study that showed high intake of Vitamin B12 (and of B6) is protective against depression in older adults living within the community. (Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time.)
What we primarily use B 12 shots for, however, is the obvious- true B 12 deficiency. Why do people get this? A few get it as a side effect from bariatric surgery (a stomach bypass), but most get B 12 deficiency from making antibodies to B 12 receptors in your stomach. When this happens, you can no longer ABSORB B12 from your diet, so the only ways to get B 12 is from a shot or from a medicine that can be absorbed under your tongue, or more recently, a medicine you squirt in your nose (in the same manner as allergy nose sprays.) When you bypass the stomach receptors, the B12 can then enter your body effectively. Who is prone to getting B 12 deficiency? Anyone with other auto-immune diseases, where the body starts making antibodies to other organs or receptors. This includes adult onset diabetes, vitiligo, thyroid disease and other diseases in the rheumatic family such as lupus.
How about symptoms of B 12 deficiency? There may be none. In severe cases, the patient develops anemia. Often, we see nonspecific symptoms such as brittle fingernails, fatigue, and forgetfulness.
If you have a family history of true B 12 deficiency, that is also a risk factor.
The good news is that B12 is easily replaced, and though it will take a few months to get tanked back up, you should completely recover with time as long as you are consistent about your method of B 12 replacement. Additionally, extra B12 should not be harmful to anyone, as it is a water soluble vitamin (which means you may have lovely, expensive, bright yellow/green urine if you over-replace, but no other worries!)
BOTTOM LINE: B 12 replacement is only really necessary if your levels are low- check with your doctor if you are concerned!