My child has a rash! What should I do?

Rashes are often a cause of concern for parents, as well as physicians, as many things can cause our child to develop spots on the skin.

Skin is our biggest organ and it can be a mirror into your child’s health. Children can present with different types of rashes including eczema and allergic manifestations, such as hives. The biggest concern for physicians is to determine whether the rash is caused by an infection, which can be challenging for parents to detect by themselves.

So, what should you do if your child develops bumps on his or her skin? First, examine the behavior of your child — is he or she crying more than usual, less active, less playful, or too sleepy? Are there other symptoms such as fever, change in appetite, cough or runny nose, or episodes of vomiting or diarrhea? Are any of your child’s schoolmates or friends exhibiting the same symptoms?

If any of these are the case, it is imperative that you contact your pediatrician for an emergency visit or go to the emergency room as some bacteria can cause an overwhelming infection in a short amount of time. In younger children, symptoms of a severe infection might be subtle and healthcare providers will usually do some lab tests to help them better understand the cause of the rash.

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Gabriela Moraru, M.D., is a pediatric infectious disease specialist in her second year of fellowship training within the University of Miami Health System.

Most rashes in children are caused by viruses. The two that parents are more familiar with are the coxsackie virus — or “hand-foot-and-mouth disease” — and roseola. “Hand-foot-and-mouth disease” will manifest with bumps on the skin, palms and soles as well as lesions in the mouth that could prevent your child from eating and feeding correctly. The treatment for both coxsackie virus and roseola are typically the same — keep your child hydrated, manage the fever with Tylenol or Motrin, and watchful rest.

Parents may be tempted to apply creams and lotions on the skin or give antimicrobial medications, however they usually do not change the progression of the illness. There are a few exceptions though — herpes simplex virus and varicella can cause a particular type of rash that resembles tiny blisters, are very contagious, and typically require antiviral medication.

Herpes usually develops around the mouth, on the border of the lips and it appears as a bouquet of vesicles. You may probably know the infection as a “cold sore.” When these lesions are situated in concerning locations such as closer to the eye or if they seem to progress fast and severely, Acyclovir, an antiviral medication, is usually administered.

Varicella is an infection that is being seen less and less in the United States because the majority of children are vaccinated. However, if your child is not vaccinated yet, varicella will appear as a red bump that will progress over the course of few hours into a vesicle that will then dry and form a crust. There will be tens of lesions that spread over the next few days accompanied by spikes of fever. Because varicella can get complicated both in young kids as well as older children and teenagers, it is advisable to contact your pediatrician. Antiviral medication could shorten the course of the illness and prevent complications.

Living in Florida also can have its unique differentiators when it comes to rashes. Outdoor play can expose children to different species of ticks that exist throughout the state, even though the majority of the infection transmitted by them are acquired in the North and Northeast regions of the United States. A ”bull’s eye” rash or a “spotted rash” are seen in either Lyme disease or Rocky Mountain Spotted Fever. For these types of infections, your pediatrician will usually prescribe antibiotics.

It is not an easy task for parents to properly identify what kind of rash their child may have, so always consult with a doctor to determine the best course of treatment. Be sure to jot down as much information as you can for your conversation with the doctor such as symptoms and when and where the rash appeared.

It is a good rule of thumb to also take a few photos of the rash. And don’t forget, if your child has a fever, a little fever-reducing medication like Tylenol before you start your journey to the pediatrician office or to the hospital will ensure your child is more comfortable for their visit.

Gabriela Moraru, M.D., is a pediatric infectious disease specialist in her second year of fellowship training within the University of Miami Health System. For more information, visit UHealth.com/patients/pediatrics.

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Pharos gives Echo Park and Silver Lake a stylish local hangout

Echo Park and nearby Silver Lake can’t compete with the fitness-laden Westside. It’s not uncommon for Echo Park locals to trek to Glendale or downtown Los Angeles just to break a sweat in a nice gym with easy parking. But the sleek Pharos Athletic Club, which opened its doors this winter, is changing that.

The boutique gym, in the heart of Echo Park, features high-tech machines and weights along with a series of classes that vary from spin to Olympic weight-lifting.

Among the classes, available for members and nonmembers alike, is the high-intensity conditioning class Work, which is inspired in part by Pharos co-founder and coach Pieter Vodden’s experience whipping actors into shape for film roles.

Recently, he helped train svelte Amazons for “Wonder Woman.” But you don’t have to be superhero-strong to try a Work class; it’s designed for beginners and experienced gym-goers.

LOS ANGELES, CALIF. - DEC. 19, 2017. Coaches and club members participate in a "Work" class at the
Pharos Athletic Club is a new fitness facility in Echo Park. Luis Sinco / Los Angeles Times

Aura

The Pharos space is part airport hangar, part downtown loft, with skylights that flood the gym space with natural light and green plants that frame large windows.

Vodden said that instead of guests being greeted by people slamming barbells they wanted them to enter a comfortable space, and they have created a warm environment with brick walls, coffee and leather couches for lounging.

There’s also a pristine white locker room with showers, a towel service, on-site massage therapy and chiropractic care.

LOS ANGELES, CALIF. - DEC. 19, 2017. Coach and co-owner Pieter Vodden supervises a "Work" class at
Coach and co-owner Pieter Vodden supervises a Work class. Luis Sinco / Los Angeles Times

Effort

The Work class is especially good for weight loss and building strength. If you’ve ever taken a CrossFit class, you will recognize a few similarities, but Work’s calorie-busting movements are safer and easier to pick up.

The intimate classes are made up of stretching, high-intensity cardio — often rowing, running on a treadmill, or skiing on fun, high-tech machines — as well as resistance training (think kettlebells and free weights).

Be prepared to be pushed to your limits, but no one will scold you if you need to take a break. The coaches give personal attention to each attendee and coach/co-founder Jeff Scarborough is especially patient with beginners.

LOS ANGELES, CALIF. - DEC. 19, 2017. Coaches and club members participate in a "Work" class at the
Coaches and club members participate in a Work class at the Pharos Athletic Club in Echo Park. Luis Sinco / Los Angeles Times

Style

Co-founders/coaches Vodden, Scarborough and the kind and energetic Emylee Covell live within a few blocks of the gym, and are champions of making Pharos a neighborhood spot where they host the occasional barbeque at the gym and members hang at the nearby Semi-Tropic bar/cafe.

They have created a welcoming and friendly vibe. There’s a high price point for membership, a sign of the gentrifying neighborhood, and it also attracts a crowd that’s serious about fitness. It’s not unlikely for a 10 a.m. Work class to be abuzz with young professionals that include artists, musicians, producers and other creatives.

“Whether it’s performing or working out in a gym, it’s all just an expression of self,” Vodden said.

Pharos Athletic Club

Where: 1316 Glendale Blvd., in the Echo Park neighborhood of Los Angeles. Free parking accessed through Sunset Boulevard across from the Echo.

Cost: $25 per class; $240 for 10 classes; $460 for 20 classes; $125-$275 for membership.

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A Connecticut Woman Had a 132-Pound Ovarian Tumor Removed

Dr. Vaagn Andikyan, a gynecologic oncologist at Connecticut’s Danbury Hospital, had never seen anything like it.

A 38-year-old woman had been referred to Andikyan after rapid weight gain — nearly 10 pounds a week over the course of two months — prompted her to seek medical attention. By the time she got to the hospital, a three-foot-wide, 132-pound ovarian tumor was taking up her entire abdomen. The tumor wasn’t cancerous, but it had caused her legs to swell so much that she couldn’t walk, leaving her wheelchair-bound. She was severely malnourished because of its position over her digestive tract, and her intestines had been pushed into her chest. She was desperate for relief.

“I was very cautious. Nobody wants their patient to have a negative outcome,” Andikyan says. “What gave me a second wind was that we wanted to help the patient. When you have this internal feeling that you’re helping, positive thinking helps you to achieve your goal.”

Photo via Danbury Hospital

In the end, a team of almost 25 Danbury clinicians — including surgeons, cardiologists, gynecologists, physician’s assistants, anesthesiologists, nurses, operating room technicians and office staff — worked together to develop a treatment plan. On Valentine’s Day 2018, doctors carried out a five-hour surgery, which involved removing the tumor and reconstructing the patient’s abdomen all in the same procedure.

The outcome, Andikyan says, surpassed anyone’s hopes. Not only was the tumor removal successful, but the team was also able to spare her uterus, one ovary and most of her fallopian tubes, preventing early menopause and preserving her ability to get pregnant. Had they waited even a week or two longer, Andikyan says, the patient might not have made it.

Because the tumor was benign — as is common with very large masses — the patient is not expected to have any lingering health issues, Andikyan says. “She’s totally fine. She should be back to her baseline,” Andikyan says. “I’m very proud of our hospital.”

The tumor is among the largest ever recorded. Though a few ovarian tumors weighing more than 300 pounds have been reported in the past, most are significantly smaller. A 50-pound tumor, Andikyan says, would typically be considered very large, making a 132-pound lesion exceedingly rare.

“No one knows, really, why certain benign tumors get so big,” Andikyan says, adding that Danbury’s laboratories are conducting genetic tests on the tumor. “Maybe in the future we’ll know why these benign tumors get so big, so fast.”

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When Do Consumer Boycotts Work? – Room for Debate


Social Media Boycotts Succeed When They Reflect a Movement

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Boy, oh boycotts! Do they work?

Trick question. It all depends on what you mean by “work.”

If the aim is to hurt company sales, boycotts rarely succeed. But if the aim is to undermine companies that stand in the way of a movement, there is a greater chance that a boycott may tarnish a brand.

To get a boycott off the ground, awareness and consideration of the issue must spread. Intent to boycott must be followed up by action. Finally, once a boycott is underway, the leaders of it must find ways to sustain the effort.

That can be hard, considering the number of people involved in a boycott inevitably decreases over time.

Mostly, that’s because people have busy lives and plenty of their own personal problems. News of a boycott has to cut through the personal. It has to withstand the constantly changing streams of information on the internet to truly gain traction. And memory fades fast. The accelerated 24-hour news cycle has become a sort of Catch-22 for boycotts: Social media can be very useful for spreading awareness of a boycott — but the hourly nature of the news cycle can bury it within the next day or week.

Social media can be very useful for spreading awareness of a boycott — but the hourly nature of the news cycle can bury it within the next day or week.

Even if a boycott stays in the news, strong opinions are not the same as action. It’s always easier for someone to express outrage than inconvenience him or herself. In a world where everyone is a one man/one woman P.R. department on social media platforms like Facebook, Instagram and Twitter, “moral peacocking” — outrage on social media that is not combined with action — becomes convenient and costless.

Outrage comes and goes, and so do boycotts. Companies may suffer short sales dips, but social media boycotts seldom hurt the business bottom line of organizations in the long run.

However, there is a very strong exception. If the ultimate source of a boycott is constantly featured in the 24-hour news cycle — say, because he is president of the United States — and continues to engage in controversial and outrageous behavior, the boycott has an increased chance of living beyond its usual few days.

If the boycott reflects a movement — rather than a moment — it can change the world around it.


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Boycotts Force Corporations to Confront Consumer Ideals

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In the book “The Naked Corporation,” Don Tapscott and David Ticoll examine novel business risks that have popped up with the internet. The democratization of free information and rise of social media means business practices can be discovered and scrutinized on a much wider scale.

“You’re going to be naked,” the authors warn businesses, “so you’d better be buff.”

At a minimum, that means considering customers and employees beyond tomorrow’s profit margin.

As people take to the streets to protest the actions of the new president, C.E.O.s of corporations are being challenged to take a stand — something many have been reluctant to do in the face of market pressures to keep one’s head down and focus on the numbers.

The challenge today for all corporations is clear: Citizens are looking for leadership on issues of real consequence, and they are aligning their dollars with their ideals.

But for some businesses, taking a stand is good for the brand. Tech C.E.O.s are speaking out forcefully against the visa ban because they depend on the best skills and talent, no matter the nationality. Other tech employees may believe it is morally wrong to turn away refugees and legal residents — or, at least they are confident that their customers feel that way. There’s safety in numbers of course, and its best when corporations can articulate why an issue matters to their business bottom line.

Still, cultivating positive brand identity has become undoubtedly important for consumer-facing companies. Take #DeleteUber. The real aim of the boycott that went viral seemed to be to punish a business — for placing profit over community and/or for appearing to support President Trump’s refugee ban on seven Muslim-majority countries. The boycott could not reverse President Trump’s executive order, but it did cause Uber’s C.E.O. to drop out of President Trump’s business council.

The power and speed of social media has allowed campaigns to evolve from focusing on the consequences of a product — like the legendary Nestlé infant formula boycott in the 1970s — to labor-related issues that are within the control of the corporation. From there, they have spread to include more complex global concerns like child labor and climate change. Boycotts over an issue like deforestation could require a radical kind of agency from a company if it had to disrupt its entire supply chain to make real progress.

But some companies see real market advantages in this consumer trend. Levi Strauss and Starbucks, for example, have gotten out ahead on issues like H.I.V./Aids and water scarcity to help cultivate positive brand identity. They didn’t wait for a protest or boycott: They took a preemptive moral stance.

For mass market brands, like Pepsi and McDonalds, that road can be more treacherous. Still, to address consumer demands — often articulated by a sophisticated NGO working to corral public opinion — companies typically tie their brand to big social issues, like human rights. These initiatives can require real changes for companies, however, including a change in how they source their products.

The challenge today for all corporations is clear: Citizens are looking for leadership on issues of real consequence. These issues are no longer confined to the ballot box. And consumers are aligning their dollars with their ideals.

The answer for businesses may require new forms of association in which courageous C.E.O.s can stand up and be counted.

There is a challenge for consumers, too. They must distinguish between the companies that truly push positive social change and those that just pay lip service to it.


Join Opinion on Facebook and follow updates on twitter.com/roomfordebate.



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Florida teen with autism spotted ‘dodging’ rush-hour traffic rescued by ‘hero’ strangers

Amanda Miller had just started making dinner when she noticed her 17-year-old son, CJ, was missing. She left the teen with autism “content” in her room watching YouTube videos as she boiled water.

Three minutes later, when she went to check on the boy, she saw a window open with the screen popped out. The concerned mom from Jacksonville, Florida, went into panic mode, running out to her backyard to see if CJ’s father saw him leave.

“We had no idea which way he had gone,” Miller told Fox News. “Our biggest fear seems he has no fear of the dangers of a moving car.”

CJ’s dad took off in his car and Miller started on foot, circling the neighborhood in hopes of finding the teen, who is non-verbal.

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CJ, 17, has autism and is non-verbal, his mom, Amanda Miller, says.

 (Amanda Miller)

“He struggles to communicate with us in his everyday life,” said Miller, adding that she constantly keeps an eye on him. “He is an amazing boy who at 17 can communicate at a 2 to 3-year-old age level.”

Local police joined the parents in their search, dispatching a description of CJ to officers. 

A woman found Miller’s cell phone near a creek on the side of the road and called the mom. CJ apparently took it with him.

“Our panic got much worse as we were worried he may have gotten attracted to the water,” Miller said. “His father went to the bridge at the creek and was down by the water searching for CJ’s footprints.”

Miller waited with police at a nearby Home Depot as they took over the search — ready to deploy a helicopter and release K-9 officers.

At the 2-hour mark, police got a call from Good Samaritans Susan Bolton and Jason Gaston, who informed officers they found a special needs boy “dodging” cars in the middle of Interstate 295 in Jacksonville.

CJ family

Amanda Miller

 (Good SamaritansJason Gaston (left) and Susan Bolton (right) pose for a picture with Amanda Miller and her son, CJ.)

“[CJ was] wandering in the highway looking up at the sky without a care in the world,” a GoFundme page to raise money for the family described in a post. “[Gaston] witnessed a truck almost hit the child doing 70 mph and he went into survival mode.”

The pair both stopped their vehicles to block traffic in order to save the teen. Bolton escorted the boy back to her van while Gaston reported the incident to local police, who arranged for CJ to be transported home to reunite with his parents.

“He was delivered to us safely and we were more than relieved,” Miller said. “We were shocked to find out the horrifying details and the many close calls that CJ had with traffic.”

When Miller opened the police door, she asked CJ where he was going.

“Orlando … Mickey Mouse,” CJ replied.

“He loves Disney world had been asking for Orlando for weeks,” Miller explained. 

Since the incident on April 18, Miller said she personally reached out to Gaston and Bolton to thank the “heroes” for saving her son.

“It’s all about awareness and kind hearted heros that I can say are now our family,” Miller said, adding that she’s planning to purchase a GPS device to track her son’s whereabouts as well as installing alarms on all of the windows inside of her home.

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Drug epidemic ensnares 25-year-old pill for nerve pain

WASHINGTON (AP) – The story line sounds familiar: a popular pain drug becomes a new way to get high as prescribing by doctors soars.

But the latest drug raising red flags is not part of the opioid family at the center of the nation’s drug epidemic. It’s a 25-year-old generic pill long seen as a low risk way to treat seizures, nerve pain and other ailments.

The drug, called gabapentin, is one of the most prescribed medications in the U.S., ranking ninth over the last year, according to prescription tracker GoodRx. Researchers attribute the recent surge to tighter restrictions on opioid painkillers, which have left doctors searching for alternatives for their patients.

Those same forces are changing the drugs that Americans abuse, according to experts.

“We’re basically squeezing people into other drugs because the prescription opioids are becoming a lot harder to get,” said Dr. Richard Dart, who tracks drug abuse through a national data network owned by the state of Colorado.

While prescriptions for opioids like Vicodin and Oxycontin have been falling since 2012, health regulators have seen increased overdoses with unexpected medications, including the over-the-counter diarrhea drug Imodium.

The Food and Drug Administration is now studying patterns of prescribing and illicit use of gabapentin and will soon share its findings, said Commissioner Scott Gottlieb.

“One of the lessons from this whole opioid crisis is that we probably were too slow to act where we saw problems emerging and we waited for more definitive conclusions,” Gottlieb said. “I don’t want to be sitting here five or 10 years from now lamenting that we didn’t take more aggressive action.”

Many doctors aren’t aware of gabapentin’s potential for abuse, particularly among those with a history of misusing drugs, said Rachel Vickers Smith of the University of Louisville.

People tracked in her research describe gabapentin as a “cheap high” that is almost “always available.” They report mixing the drug with opioids, marijuana and cocaine to enhance the high, with effects ranging from “increased energy” to a “mellow” numbness.

Medical journal articles estimate that between 15 and 25 percent of opioid abusers also use gabapentin. And emerging research suggests combining gabapentin and opioids heightens the overdose risks.

Gabapentin, on the market since 1993, has long been considered nonaddictive and is not tracked as closely as riskier drugs like opioids. But calls to U.S. poison control centers show a stark rise in abuse and overdoses.

The abuse rate increased nearly 400 percent between 2006 and 2015, according to poison center data analyzed by the RADARS research group within the Denver Health and Hospital Authority, a state-owned health system. The group’s work is funded by drugmakers and government agencies, though they don’t participate in the analysis or publication of the data.

In some parts of the U.S., the rise in gabapentin abuse has led to new restrictions and surveillance.

Last year, Kentucky became the first state to classify the drug as a “scheduled substance,” placing it among other high-risk medicines subject to extra restrictions and tracking. Gabapentin was detected in a third of fatal overdose cases analyzed by Kentucky medical examiners in 2016. Now, only health professionals registered with the federal government can prescribe the drug and patients are limited to five refills.

Ohio, Minnesota, West Virginia and several other states have begun tracking gabapentin through their prescription databases. Ohio took that step after gabapentin became the most dispensed drug in the state. State surveys of drug users also indicated it was “extremely easy to get” with a street price around $1.50 per capsule.

Alyssa Peckham, a researcher at Midwestern University in Arizona, believes a more comprehensive federal response is needed, including possibly reclassifying it nationwide. Like others, Peckham says gabapentin is not dangerous on its own, but can be when combined with opioids and other drugs that suppress breathing.

Still, there is little consensus about the next steps, or even the scope of the problem.

Michael Polydefkis, a neurologist at John Hopkins University who primarily treats seniors with nerve pain, says he has never seen patients deliberately misuse gabapentin.

And given recent restrictions on opioids by hospitals, insurers and government authorities, many physicians are wary of limiting any other medicines that can help treat pain. The Center for Disease Control and Prevention’s prescribing guidelines endorse gabapentin as a good choice for nerve pain.

But there are questions about how much is being prescribed for proven uses – and to what extent patients are benefiting. A recent review of research by the Cochrane Group confirmed gabapentin’s benefits for several forms of nerve pain, but found little evidence of its effectiveness for more common muscle and joint pain.

Historically, the vast majority of prescriptions have been for uses not OK’d by the FDA as safe or effective.

“This drug was kind of unusual in that it was prescribed as a kind of miracle pill that could be used for anything,” said Dr. Joseph Ross, a researcher at Yale University’s school of medicine.

In a recent Journal of the American Medical Association, he called for new studies of gabapentin’s real-world use.

The freewheeling prescribing dates to years of aggressive marketing by the drug’s original manufacturer, Warner-Lambert. The company pleaded guilty and agreed to pay more than $430 million in 2004 to settle charges that it promoted gabapentin for a slew of unapproved uses, including migraines, attention deficit disorder, bipolar disorder and Lou Gehrig’s disease. While doctors are free to prescribe drugs for any use, drugmakers can only market their products for those uses approved by the FDA.

Warner-Lambert was bought in 2000 by Pfizer, which continues to sell gabapentin under its original brand-name Neurontin. Pfizer also sells a similar drug named Lyrica, a blockbuster medication approved for fibromyalgia, diabetic nerve pain and several other uses. Unlike gabapentin, Lyrica is a scheduled substance under federal law, in part due to reports of euphoria and other side effects suggesting “abuse potential.”

With tighter restrictions and a lone manufacturer, Lyrica has not seen the same problems as gabapentin.

“Pfizer recognizes the importance of preventing the misuse and abuse of our medicines and will continue working with regulatory authorities and health officials to monitor the safety of these medicines,” the company said in a statement.

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Matthew Perrone can be followed on Twitter: @ AP_FDAwriter

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The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Copyright © 2018 The Washington Times, LLC.

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Diet linked to menopause timing

(Reuters Health) – A UK study suggests that diets rich in certain foods may be a factor in the timing of menopause.

Researchers who studied more than 14,000 women found that those whose diets included lots of fish and legumes entered menopause years later, on average, than women who didn’t eat much of these foods.

Conversely, eating more refined carbohydrates, including pasta and rice, was tied to earlier menopause, the research team reports in Journal of Epidemiology and Community Health.

“Evidence shows that while an earlier menopause increases the risk of cardiovascular diseases, osteoporosis, and depression, it also protects against breast, endometrial and ovarian cancer which makes it interesting to investigate whether diet, which is one of the modifiable behavioral factors, is linked to the onset of natural menopause,” lead author Yashvee Dunneram said in an email.

“Several studies have looked into the association between socio-demographic factors such as smoking, socioeconomic status, ethnicity as well as reproductive factors (parity, age at first pregnancy) and age at natural menopause,” said Dunneram, a researcher at the University of Leeds.

“Evidence shows a link between diet and timing of natural menopause as well,” she added. However, very few studies have investigated this association and the findings are also contradictory. “Our findings show that diet can be linked to the timing of natural menopause,” she said.

At the beginning of a long-term study in the UK, researchers examined health and diet information for 14,712 women ages 35 to 69, including 1,874 who were premenopausal and 914 who entered menopause during the next four years.

The average age at menopause, defined as going 12 months without a period, was 50.5 years, and half of women were 51 or older at natural menopause, researchers found.

After accounting for weight, smoking and other factors, each additional average daily portion of legumes was tied to nearly a year’s delay in onset of menopause, while each additional portion of oily fish was tied to a three-year delay.

More vitamin B6 and zinc in the diet were also tied to slightly later onset of menopause, while each additional average daily portion of rice or pasta was linked to onset 1.5 years earlier.

The study wasn’t a controlled experiment and can’t prove whether or how eating particular foods might have influenced menopause timing. The authors speculate that antioxidants in certain foods could offset aging of ovaries, and different diets’ effect on body fat and insulin levels could also affect estrogen levels.

“Since this study does not prove any causality, we would not expect women to change their diet based on these findings,” Dunneram said.

“In my opinion, the study is very well done because it includes a large population and accounts for an important number of cofounders,” said Sandra Arevalo, a registered dietitian at Montefiore Hospital in New York City who wasn’t involved in the research.

“However, the quality of the food can change from region to region and I feel that it is necessary to extrapolate the research to other territories that include different foods origins and ethnicities to learn if the same results prevail for different populations,” Arevalo said in an email.

SOURCE: bit.ly/2FAAuu9 Journal of Epidemiology and Community Health, online April 30, 2018.

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