No shots? No school.

In SA, many children can't start school or college without certain immunizations. Watch Dr. Ratner in this KSAT video for more info.

Districts: No shots? No school.

Group B Strep Awareness

It’s July, and that means summer fun, 100-degree+ heat and (if you’re lucky) water slides! It also means it’s International Group B Strep Awareness month, which is a very common but little-known (apart from mommies and doctors) bacteria that effects babies in utero, newborns and babies up to six months old.
Huh? What is that, and why have I never heard of it?
GBS (Group B Streptococcus), or Streptococcus agalactiae--not strep throat--is a type of bacteria that can potentially effect babies as they pass through the birth canal or when the mother’s water breaks. Though up to 25% of women have this naturally-occurring bacteria in their digestive tract and/or birth canal, few babies who are exposed become ill.

However, that illness can be severe, such as meningitis, pneumonia or a permanent handicap like blindness, deafness or cerebral palsy. In some cases, GBS has caused stillbirth or miscarriage.
It’s a good idea to get tested for GBS before your baby is born (even if you’ve been tested on a previous pregnancy, that doesn’t mean you don’t currently have GBS living in your system). There are little to no symptoms associated with GBS for the mother, with the most common being yeast-infection-like symptoms or even a bladder infection. If your doctor suspects GBS when you are pregnant and have a bladder infection, they will likely perform a urine culture apart from the routine urine tests performed on all pregnant women. In the US it’s now standard practice for GBS testing to be part of your routine prenatal testing. If you test positive for GBS, you may be placed on IV antibiotics when you go into labor. Just four hours of IV antibiotics given to the mother in labor can prevent up to 90% of newborn GBS infections. Taking these prior to the onset of labor won’t help much, as the bacteria can grow back very quickly.
Just a side note: testing positive for GBS does not mean you’ve done anything wrong during your pregnancy, or are unclean. GBS can live in just about anyone.
Now your beautiful baby has been born, and you want to provide them the absolute best in care. There are some strategies you can follow to avoid infecting your baby (not just with GBS; some of these are common-sense guidelines to protect against bacteria in general)

• Everyone, yourself included, needs to wash their hands before handling your baby. Antiseptic wipes won’t cut it--get out the soap and water.
• If you’re able to breastfeed, it’s a great choice to supply your little one with antibodies to help fight infection.
• Make sure everyone who takes care of your baby knows the symptoms of GBS infection in babies and how to respond.

Most cases of GSB will start in the first few hours after birth. Symptoms may include:

• High-pitched cry, shrill moaning, whimpering
• Constant grunting as if constipated
• Projectile vomiting
• Sleeping too much, difficulty being aroused
• High or low or unstable temperature; hands and feet may still feel cold even with a fever
• Blotchy, red, or tender skin
• Blue, gray, or pale skin due to lack of oxygen
• Fast, slow, or difficult breathing
• Body stiffening, uncontrollable jerking
• Listless, floppy, or not moving an arm or leg
• Tense or bulgy spot on top of head
• Blank stare
• Infection (pus/red skin) at base of umbilical cord or in puncture on head from internal fetal monitor
• Problems with temperature regulation
• Grunting sounds
• Fever
• Seizures
• Breathing problems
• Stiffness or extreme limpness

Of course, if you have questions about GSB it's a good idea to ask your doctor! If you'd like to read more, check out these useful sites. There's even a Facebook page:

http://www.groupbstrepinternational.org
http://www.groupbstrepinternational.org/gbs-articles/
http://www.drum.amedd.army.mil/news/2010/0710/Strep_Awareness.htm
https://www.facebook.com/GroupBStrepInternational
http://sites.conversionplanet.com/group-b-strep-awareness
http://en.wikipedia.org/wiki/Group_B_streptococcal_infection
http://groo.com/newgbsi/wp-content/uploads/2012/12/GBS_Awareness_brochure.pdf
http://www.cdc.gov/groupbstrep/index.html
http://www.strepb.ca/
http://www.aap.org/ 

Why is my child limping?

You’re wor­ried about your child. They’ve been wak­ing up com­plain­ing their knee hurts, or you notice their fin­gers seem swollen, but they can’t remem­ber hurt­ing them­selves. Maybe they’ve been limp­ing a lit­tle in the morn­ing, or they seem to have a mild flu with a  pink­ish rash that comes and goes. What could be happening?

All of these are symp­toms of Juve­nile Arthri­tis, which effects more than 250,000 chil­dren under the age of 18 in the US alone. If your child has swollen, ten­der joints that last for more than six weeks, he/she could be among their num­ber. Com­monly, the knees, hands and feet will be the most effected, though some­times chil­dren with JA can also have inflamed eyes.

Diag­no­sis comes at the end of exten­sive test­ing per­formed by a juve­nile rheuma­tol­o­gist, who will exclude other con­di­tions through imag­ing, lab work and phys­i­cals before diag­nos­ing your child with arthri­tis. Most forms of arthri­tis are known as autoim­mune dis­or­ders, where the body’s own immune sys­tem attacks its own healthy tis­sues, caus­ing swelling, sore­ness and stiff­ness in joints and the sur­round­ing mus­cles and sup­port­ing tendons/ligaments. The result­ing inflam­ma­tion can dam­age the joints.

Some­times the dam­age done to joints can effect a child’s growth, caus­ing one leg or arm to grow longer than the other, or even slow­ing the child’s over­all growth.

Unfor­tu­nately, there is no cure for Juve­nile Arthri­tis. It’s con­sid­ered a chronic con­di­tion that will require care and treat­ment with exer­cise, phys­i­cal ther­apy and pos­si­bly med­ica­tion. Since every child is dif­fer­ent, there is no one right treat­ment plan for every­one. Your child’s doc­tors will work with you to come up with an indi­vid­ual plan that works for your child. Some chil­dren will have one or two flare-ups of arthri­tis and never suf­fer again, while oth­ers may have to deal with it on a day-to-day basis.

Some doc­tors may pre­scribe med­ica­tion right away, while oth­ers will advise treat­ment dur­ing flare-ups like swim­ming, which allows the child to exer­cise and move their joints with­out putting pres­sure on them. It’s impor­tant to sup­port your child not only with their phys­i­cal but also their men­tal needs to sup­port them through JA.

There are a lot of great resources avail­able to learn more about Juve­nile Arthri­tis online. We rec­om­mend the fol­low­ing sites for more detailed info:

http://www.arthritis.org/conditions-treatments/disease-center/juvenile–arthritis/

http://www.niams.nih.gov/Health_Info/Juv_Arthritis/

http://www.mayoclinic.com/health/juvenile-rheumatoid-arthritis/DS00018

http://orthoinfo.aaos.org/topic.cfm?topic=a00075

http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/juvenilearthritis.asp

http://www.findarthritistreatment.com/five-common-symptoms-of-juvenile-arthritis/

http://www.aaos.org

http://www.rheumatology.org

http://www.arthritis.org

http://www.kotb.com

https://www.carragroup.org

www.arthritis.org

www.arthritis.org/ja-article.php?id=15

www.niams.nih.gov

www.rheumatology.org/Foundation

Photo credit: danieljohn­sonjr / Foter / CC BY-NC-SA

Photo credit: Lau­ren Grace Pic­ture Place / Foter / CC BY-NC

Children's Mental Health Awareness Day

Today we hear from Dr. Dan Powell, our soft-spoken and much-loved provider who mainly works at our Woodlake location. Here, he teaches us how to speak about mental illness without the stigma that's commonly associated.

Today is Children's Mental Health Awareness Day.  The National Federation of Families has declared this year's theme to be: "Out of the Shadows: Exposing Stigma."

As healthcare providers at Impact Urgent Care, we frequently have the privilege of providing care for children with mental health issues who present with acute illness.  While addressing the child's acute illness is paramount, an equally important issue (as with all children we treat) is addressing any associated family or parental concerns.  Without a doubt, one of the greatest challenges parents face when caring for their child with any mental health diagnosis is dealing with the stigma of mental illness.

Whether your child is struggling with Depression or Situational Anxiety, or more chronic conditions such as ADHD or Autism Spectrum Disorder/Aspergers, you are already well-aware of the overt and sometimes subtle ways that the stigma of mental health illness can impact a child and his or her ability to navigate the waters that other children breeze through at school or athletics, or even just going out to eat and going to the movie theater.  Reversing the stigma of childhood mental health illness will not happen overnight, but efforts are definitely underway to begin the process, and events such as Children's Mental Health Awareness Day are critical in raising public awareness and educating all of us on how we can make a difference.

The Hogg Foundation for Mental Health (www.hogg.utexas.edu) has produced a brochure titled Language Matters in Mental Health that gives excellent guidelines for HOW WE TALK about persons with a mental health condition.  Saying, "He has a mental health condition" instead of, "He's mentally ill" - or "She has Anorexia Nervosa" instead of, "She's an Anorexic" may seem like potato - po-tah-toe to folks who don't have (or live with a family member who has) a mental health condition but for those of us who do, it's a night-and-day difference that expresses volumes about a person's attitude toward mental health and/or the stigma of being labeled.  Educating your child's siblings, friends and teachers on the impact of the word choices we make when talking about a child with a mental health diagnosis is crucial to helping shape a healthy and encouraging environment for them to thrive.  This approach is called "people-first language" and can open up communication lines with others that take a concern for your child's well-being.

Caring for a child with mental health issues can be an enormous challenge for their parents, and we hope you will consider us a resource you can depend on at Impact Urgent Care.  We count it as a privilege.

Dr. Dan Powell

Dan Powell, M.D.

Staff Physician, Impact Urgent Care

Photo credit: alles-schlumpf / Foter.com / CC BY-NC-SA

Breakfast: The Yummiest part of School!

The yummiest part of school!

March 4-8 is National School Breakfast week. Here are a few words of wisdom from our own Dr. Gutierrez about the importance of breakfast for children:

We have all heard it said, “Breakfast is the most important meal of the day”.  With that in mind, the week of March 4 recognizes National School Breakfast Week.

National School Breakfast Week raises awareness about the availability of the School Breakfast Program (SBP), as well as highlights the benefits, especially academic, of eating a healthy breakfast.

My grandfather grew up very poor in South Texas, near Refugio.  He tells stories of how he did not have food in the house for days.  He and his brothers would survive on the oranges they picked off the trees in the neighborhood.  He admits he was not a good student and recalls how he had lots of difficulty concentrating.  He remembers feeling extremely fatigued as well as having terrible diarrhea due to eating nothing but fruit for days in a row.  He could have really benefited from a nutritious, well balanced meal provided at school.

The School Breakfast Program started under the Child Nutrition Act of 1966.  This program offers breakfast to children free or at a reduced price.  Currently, about 7 million children eat breakfast at school daily with approximately 85% of participants receiving their breakfast free or at a reduced cost.

According to “Ending Childhood Hunger: A Social Impact Analysis” children who ate breakfast scored 17.5% higher on standardized math tests and attended 1.5 more days of school.  Now that’s powerful food for thought.

Visit the National School Breakfast website to learn more. There's all kinds of cool merchandise for sale to help support the program, and even a writing contest for kids!