Swine Flu 4.93: Off for the Summer?

It’s now about 7 weeks without a single positive flu test, which makes one wonder: where did it go?  It is certainly around in the Southern hemisphere, where it is winter now (about 1% of New Zealand’s largest cities population was seen with flu-like complaints during one week in July), and even in the Northern hemisphere, some countries are just starting seeing massive numbers of cases, and some states still have widespread flu.  So the question is, why are we not seeing any cases here in Brighton Beach?

Theory 1: Practically everyone in the neighborhood who was going to get the flu, has already done so.

–well, if that’s the case, we should be fairly safe come fall.

Theory 2: Transmission has been interrupted by “summer factors” — better ventilation, moister air, decreased crowding…

– in which case, more open windows, humidifiers, and a liberal school attendance policy should be helpful.  School un-crowding is especially important with swine flu because attack rates for this particular strain appear highest in the 5 to 24 year old cohort.

Theory 3: D-fense!  Vitamin D does appear to strengthen the immune response, especially against respiratory infections, and Vitamin D supplementation (along with A, C, zinc, and others which may be helpful) is certainly worth trying.  In my own practice I have been measuring 25-OH vitamin D levels in the serum of patients presenting for a variety of complaints, and an appalling number have come up deficient.  Although most, as expected, were either dark-skinned individuals or indoor WoW addicts, I did have a low Vitamin D level in a freckled sunburned redhead.  (Yes, I did read the riot act about hazards of sunburn).

Theory 4: An Unknown Factor.  No one knows why, in 1976, swine flu infected 100 soldiers at Fort Dix, and no one elsewhere.  If this flu strain plays a similar practical joke, that X-factor may be easier to find with modern molecular techniques.

Well, off to work…


Swine Flu 4.92: Flu Virus Sailed the Ocean Blue

It has been 6 weeks of relative calm: very few children with fever (and those who did, mostly had obvious hand-foot-mouth disease, pneumonia, or strep throat); not a single positive flu test in these 6 weeks, and that’s after having over 20 a day in June.  We are continuing to do flu tests, so watch this space: we’ll be among the first to know when flu returns.  It is now highly prevalent in the Middle East, the Southern Hemisphere, and other places it did not hit early.  Russia appears to have only a few cases so far, partly due to a vigorous screening and isolation program; whether it works in the long run remains to be seen.  My recommendation (Mexico is now the best and safest place to go on vacation) stands, as do all my previous advices.  I would like to re-emphasize one of them:  vitamin supplementation.  More than half of all the children I have so far tested are Vitamin D deficient (as opposed to none deficient for B12 and Folic acid), and Vitamins D and A are essential for proper immune response.


Mistakes in Choosing a Pediatrician

Babble.com just published an interview with me; my answers were, of course, edited for space, but they kept the most important points.  Here goes:


What are the 3 most common mistakes parents make when visiting the pediatrician?


Buzz up!

Expert: Dr. Anatoly Belilovsky, director of 365-day medical center, Belilovsky Pediatrics, in New York. His blog is www.belilovskypediatrics.com.

1. Choosing a doctor that’s the wrong fit.

“Every pediatrician is not going to fit with every parent personality. So often I hear, ‘Oh my friends said you’re great!’ and it turns out that that while that doctor may have worked for your friend, they’re the wrong fit for you. For instance, if you’re a parent that’s deathly afraid when your child gets a fever, which is a common complaint, you’ll want a pediatrician that displays a bit more empathy toward fevers, as opposed to a doctor that quickly assures you it’s nothing serious. Also, some parents require longer dialogues and explanations than others; find a doctor that complements that. References are a great way to find a trusted pediatrician but ask your friends in-depth questions before you visit: What’s so great about this doctor? Can you describe specific episodes? Why would you choose them for your son or daughter? And of course, don’t feel obligated to stick with a doctor just because a friend referred you. They might be great at what they do, but not a perfect match.”

2. Always wanting a prescription.

“Too often, parents bring their children to their doctor, expecting to leave with a prescription. And when they don’t, they consider it a waste of time. We have a model we follow: treat, counsel, educate. This means some cases require treatment, some only require education. Example: baby acne and bug bites. First-time parents often over-react to these problems, and expect a prescription, when pediatricians can really only offer advice. Of course, if you feel like a doctor is dismissing your child’s case, seek a second opinion. But realize not all problems require the same solution. Another tip: If you don’t understand your doctor’s verbal explanation, ask him to use an analogy or diagram. I once treated a child whose father didn’t understand hip dysplasia. I found out he was a marine engineer, so I made him a diagram, and all of a sudden, he understood!”

3. Delegating visits.

“This is a minor mistake compared to the first two, but still important. And this is sending your child to their pediatrician with someone who doesn’t know the whole story, for instance grandparents or nannies. Often, these people don’t know your child’s entire medical history or the details of the problem at hand, which makes our job more difficult. Later, we’ll get calls from parents who couldn’t be there in person, and it turns out there’s a whole different story we weren’t aware of. Or, we’ll try to reach parents, only to get a call the next day wanting to know what’s going on. It’s much easier for both parties to address issues in person and for parents to get the straight story from the horse’s mouth. Obviously, sometimes parents have to work or travel but, for instance, my practice is open seven days a week/365 days a year. If you’re really invested, you’ll find a time to bring your child that works with your schedule.”  

— As told to Andrea Zimmerman