Dr Victoria Grandage, Consultant Hematologist at the Children and Young People’s Cancer Service at University College London, describes the signs and symptoms of Acute Lymphoblastic Leukemia, also known as A.L.L. She and the mother of a young former patient, Josh, talk about the treatment and experience of ALL; a cancer that, thankfully, has a high cure rate in children. Click on the picture below to go to the NHS YouTube channel to watch the video.
Editor’s Note: Video Highlights
- Acute lymphoblastic leukaemia or ALL is a form of cancer of the blood
- For reasons we do not yet fully understand, immature cells in the bone marrow – lymphocytes or lymphoblasts – rapidly build up and crowd out the normal bone marrow cells
- Some of the symptoms of ALL include:
- Anemia: tiredness, shortness of breath, lethargy
- Infections, high fevers, maybe mouth ulcers
- Bleeding, bruising and rashes
- Enlargement of some lymph nodes around the neck or in the groin
- Enlargement of the liver and spleen
- Bone pain (a prominent symptom)
“When Josh was about two and a half, he went back to crawling rather than walking. He’d say his legs were too sore to walk and he’d crawl around for the first half hour or so (after getting up) and then start walking after that.” Josh’s Mom, Angela
- Initial treatment, before a diagnosis has been confirmed, is supportive to address the above symptoms and can include fluids for hydration, antibiotics, and possibly a blood transfusion
- Treatment of the leukemia itself involves chemotherapy, a broad term for many different drugs that may be given in tablet form, as injections, or directly into the blood stream as IV infusions
- Some ALL chemotherapy drugs are also given via a lumbar puncture
- Side effects of the chemotherapy include nausea, tiredness, and hair loss
- Treatment begins with acute therapy – for Josh this lasted 9 months – and is followed by maintenance treatment for a couple of years
- Josh’s total treatment lasted three years
- The majority of children with ALL go into remission – and 75%-80% of those are cured
- Further intensified treatment, including a stem cell transplant, may be required for children who do not go into remission
Antibiotics are wonderful things. Since penicillin was first found and produced in the early twentieth century and used during the Second World War, it and related antibiotics have saved countless lives and cured many an illness quickly.
Antibiotics work by inhibiting certain growth factors and processes needed by bacteria to reproduce and flourish. As with many significant discoveries, penicillin was found purely by luck when an early twentieth century biochemist was trying to grow Staphylococcus (a type of bacteria). He opened the Petri dish to find that the growth of Staphylococcus seemed to be inhibited by a white substance growing next to it; that substance was studied and named “penicillin”, and indeed, did prevent growth of bacteria. The huge toll of injured and dying soldiers during the Second World War stimulated a renewed interest in the now decades old “antibiotic”, and it was pressed into service on battle fields around the world. Its successful wartime use spread to the private sector. Although initially used to help cure life threatening illnesses, it began to be used for even minor illnesses that would begin a trend that is still going on today.
The number of antibiotics in use today and their complexity is overwhelming and new ones are produced in ever increasing numbers. The primary reasons for producing a new antibiotic are to be able to treat an increasing number of bacteria known to be producing new diseases in people. Also the old antibiotics become outmoded when the existing bacteria develop very intricate mechanisms to shield themselves from the effects of the antibiotics (resistance).
Antibiotics are ineffective against viral infections, but many times well meaning health care professionals put them into use to possibly stop the advance of the viral illness (or secondary bacterial infections). Sometimes, antibiotics are dispensed at the insistent request of the parents who, in a misguided attempt to help “cure” their child of a viral illness, wish to use the latest antibiotic. At least in Pediatrics, an overwhelming majority of illness is due to viral infections and therefore speaks against the use of an antibiotic.
When antibiotics are used indiscriminately and in large amounts the following things can occur:
- More “allergic reactions” because of the widespread use of these drugs
- Increasing numbers of bacteria are developing resistances to these new and old drugs (leaving very few effective antibiotics for some very dangerous bacteria)
This is a trend that will probably continue unless health care professionals make this information available to the public. It is important to note, as new antibiotics are developed, the cost of delivering these to the portion of the population that really need them becomes prohibitive and adds tremendously to the cost of health care in this country. The process of getting a new medicine through the testing and the FDA is both very time consuming and expensive
Most of your child’s illnesses will be viral in origin and will not need an antibiotic. In addition, some routine illnesses that children get, such as ear infections, have been scrutinized carefully by researchers and their findings suggest that antibiotics may not be needed in mild ear infections. In fact, there are times that even severe ear infections can be followed carefully without the use of antibiotics as long as the pain is controlled. Every attempt is being made to limit the use of all antibiotics in general. There are certainly situations that require an antibiotic such as strep throat and certain types of pneumonia, but your doctor will discuss the options at the time of your visit.
Think both locally and globally when it comes to the use of antibiotics: it will help your child and children all over the world.
Editor’s Note: with temperatures fluctuating wildly, (often by as much as 20 degrees on a day to day basis), it’s no wonder we’re seeing sniffles, sneezes and coughs that just won’t go away. With the questions on every parent’s mind: “is this a cold? maybe the flu? should I take them to the doctor? do I need to keep them home from school an extra day”, it seemed the perfect time to re-share this Dr Joe classic from 2010 (Antibiotics…Not Always the Answer).
New guidelines issued yesterday by experts from the US National Institutes of Health (NIH) recommend introducing peanut-containing foods to babies as early as possible as a way to lower their risk of developing a peanut allergy.
The recommendations reverse previous advice to add peanuts later, but are driven by new scientific research that showed early introduction of peanuts could cut allergy development by 81%. The guidelines are tailored for a child’s risk for peanut allergy, as follows:
- Infants at HIGH risk for peanut allergy (have severe eczema, egg allergy or both)
- Add peanut-containing foods as early as 4 to 6 months
- Consult with health care provider prior to adding peanuts – specialized testing may be needed
- Infants with mild or moderate eczema
- Add peanut-containing foods around 6 months
- Infants without eczema or any food allergy
- Add peanuts to infant diet as appropriate/desired
- IN ALL CASES, start babies on other solids before adding peanut-containing foods
If you have specific questions or concerns about introducing your child to peanuts, speak to your pediatrician or family doctor.
Most complementary therapies for asthma haven’t been shown to work. The exception is some types of breathing exercises, which do seem to improve symptoms and quality of life.
According to Dr Mike Thomas from Asthma UK, there’s little evidence that complementary therapies in general improve asthma symptoms.
Specific remedies that are sometimes tried include homeopathy, acupuncture, air ionisers, the Alexander technique and Chinese herbal medicine, but the results have been disappointing. Read more about asthma treatment.
Breathing Exercises for Asthma
The exception is certain types of breathing exercises, which can help some people with asthma. These include breathing exercises taught by a lung (respiratory) physiotherapist, some types of yoga breathing exercises, and the Buteyko method of breathing.
People with asthma are taught slow, steady “diaphragmatic” breathing through the nose. This type of breathing is done by contracting the diaphragm, which is located between the chest and the stomach. This can result in fewer asthma symptoms and better quality of life. However, these exercises are not a cure, and people with asthma still need to use their regular inhalers.
The Buteyko Method
The Buteyko method, a system developed in Russia, teaches similar exercises and may improve asthma symptoms for some people. However, some find that the breathing exercises used during yoga also help their symptoms.
According to Leanne Male, Asthma UK’s assistant director of research, people with asthma who gain some relief from Buteyko and other types of breathing exercise should not rely on it so much that they stop their conventional medication.
“We know that some people with asthma use breathing techniques such as Buteyko but, while they may reduce symptoms, they will not reduce the sensitivity of the airway, and should not replace regular asthma medicine. Also, we don’t know what the long-term benefits are.”
Chinese and Other Herbal Medicines for Asthma
There isn’t enough clinical evidence to recommend the use of Chinese medicine, other herbal medicines, acupuncture, hypnosis and other complementary therapies.
Some surprising flu shot facts to spur you to protect yourself and your family this winter.
Our house recently got hit by a VERY nasty virus. We had someone sick at home for over a month – and each of us missed about a week of work or school, with lingering after effects. It’s been a tough road! I was the last to get the bug and the timing couldn’t have been worse. I was so sick I wasn’t able to attend national music championships that my son was competing in….and his school WON! Best in the country….but I missed it.
This got me thinking about the flu and annual flu shots. The illness we had seemed every bit as bad as the flu, but we knew the bug wasn’t influenza. We had all been to the doctor – and the symptoms just didn’t quite fit (see the F.A.C.T.S. in the box to the right). Plus 2 out of the 3 of us had already had our flu shots for the season. It was just a really bad cold. But it made me think about the benefits of the flu shot – something which CAN avoid the risk of an illness as bad as the one we all just suffered through.
Critical Info for 2016-2017 Flu Season
The nasal flu mist vaccine is NOT recommended this season due to concerns about how well it works – so kids will need to get the standard shot. And it’s not too late for kids or adults to get vaccinated. Click here for more information on this season’s guidelines.
Benefits of the Flu Shot
- Prevent your kids from missing lots of school (in higher grades this can really set them back and create stress – which it did for our son)
- Prevent you from missing lots of work – or REALLY important events – like your child competing in a national championship!!
- Protect you and your child from the most severe risks of the flu
- The flu kills – as WW1 drew to a close in 1918, more people died from the flu pandemic of the time than from the war – which any female who followed the Twilight series would know!
- But even in regular flu seasons people (and kids) die – over the past 10 years, the number of children killed by influenza in the US has ranged from 34 to 171 per year – EXCEPT for the 2009 flu pandemic when well over 300 children died!
- Not so concerned by these small numbers? How about protecting your child from ending up in the hospital with influenza complications?
- Each year an average of 20,000 children younger than 5 years old are hospitalized in the US because of flu complications – the risk is especially bad for kids under age 2
- The most common complication of influenza is pneumonia – which was found to be one of the main drivers of the death toll during the 1918-19 flu pandemic
- Other less common but very severe flu complications include
- Breakdown of muscle tissue that can cause kidney damage (rhabdomyolysis)
- Inflammation and damage of the heart muscle (myocarditis)
- Swelling and damage of the brain, including seizures (encephalitis)
- Protect those you love and others in your community – not everyone can get the flu shot, including babies younger than 6 months, so help keep everyone safe by getting vaccinated
Fun Fact About Flu Shot Development
Did you know that the experts who decide what flu strains go into the seasonal vaccine don’t just guess or pick what goes in the vaccine at the last minute? They are constantly monitoring the state of the flu all around the world. For example, when flu season is over in the US and Europe – it moves south to places like Australia, since their winter occurs when it’s summer in the Northern Hemisphere. There are 5 major centers around the world that coordinate with the World Health Organization on flu tracking – in the US, UK, Australia, Japan and China. All this information helps with choosing the best possible strains for the seasonal vaccine in each region.
In this brief video, a podiatrist explains common foot problems in children, including verrucas (*warts) and curly toes, and the possible solutions.
Editor’s Note: Video Highlights
- When assessing children’s feet, podiatrists are interested in symmetry and good developmental progression
- They ask about the child’s birth as well as key stages like crawling and walking
- The most common problem with children’s feet is verrucas – known in the US as warts
- The video states that warts or verrucas are a normal infection and don’t necessarily need treatment – unless the child is limping or in pain due to the wart
- The second most common problem is curly toes – which looks like crossing-over or overlapping toes, or toes that are more crooked than they should be
- For children under 4, the podiatrist can tape the toes and help straighten them out over a couple of months
- This is because at young ages the toes are still soft with lots of cartilage
- However, they may also need an insole in their shoes
- Another common issue is tiptoe walking – but it is only a problem is the child cannot obtain heel contact with the ground
- If there is significant tightness in the calf muscle because of contstant walking on tiptoe, then calf muscle stretches and a foot assessment may be needed
- Flat feet should be looked at by a podiatrist – symptoms can include foot tiredness, tilting and rotating feet – and family history of foot problems is a risk
- Children can also suffer from painful heels – which occurs when they get an overpull of the heel due to uneven growth
- These kids may be a bit flat-footed and they might need shoe insoles and stretches
- Occasionally children can also get bunions – starting as early as eight years of age
- Bunions have a strong family history – so are inherited to a large degree
- Evidence shows that surgery on young children with bunions is NOT a good idea
- Your physician or podiatrist is likely to take less extreme measures until they grow to age 18 or 19 and their bones have stopped growing
- Typical foot treatments for children include shoe and exercise advice, specialized insoles (also known as orthotics), which are often shaped specifically for the child
Editor’s Note: *clarification provided for our US readers.