Reflux, irritability and spitting up in infancy

Today a 6 month old with irritability and reflux came to the office. He is most irritable after large feeds, when laying down. Mom says he doesnt sleep for more than two hours at a time. He arches his back when irritable and in pain.

He takes 32 ounces of formula a day. He gets one teaspoon of oatmeal in 6 ounces of formula.

In the last 10 days he cries during feeding. He seems to have an aversion to feeds. During burps he spits up. He cries for 1-2 hours secondary to gas. No bile or blood in vomitus. Mom has noted thick clear spit up.

He is uncomfortable and arching his back at night as well. . He is not comfortable during a nap time during the day.

He is on nutramagen. When taking soy, he vomits worse.

He presently gets 6 ounces of formula every 4 hours 6 times a day for a total of 32 ounces a day

MY SUGGESTIONS TO HER WERE AS FOLLOWS-

To treat infant reflux, and irritability:

Food is better tolerated than liquid

Add one teaspoon of oatmeal to each ounce of food-

4 ounces would equal 100 calories

Needs 800 calories a day for growth

will get 100 calories from thickened food ( 4 ounces)

Then he needs- 4 ounces formula with one tablespoon and one teaspoon of oats

give 4 ounces of the above mixture every 3 hours 7 times a day.

SMALL THICKENED FEEDS are a treatment for reflux-

it keeps the food in the stomach

Upright at least one half hour after feeds, one hour is best.

Head of bed elevated 45 degrees.

Super overweight

Recently I saw an 11 year old boy who was 100 pounds overweight for his age. Besides getting a school lunch, he eats when he gets home from school, and eats right through playtime and dinner. Mom goes to work at 6pm so he stays indoors supervised by grandmother. He was referred to me because of overweight and high cholesterol.

In the office, upon questioning the mom, she said she was powerless to control his eating habits. He sneaks food when no one is around. He is not physically active.

When I suggested he not eat before dinner and go outside to play, he became visibly upset. He cried when it came time to examine him because of his large breasts which he did not want me to look at.

In the end, I suggested to mom to start with small changes. For example, no fruit juicesat school or home. He is eating enough that he doesnt need the sugar drink they offer at school. They are empty calories.

Mom will try to keep him outdoors now that the weather is nicer.

Lyme and Crohn’s

About four months ago a 12 year old girl who had crohn’s and was in remission came to see me because she had a relapse of her crohn’s after two years in remission. She presented with severe abdominal pain ( like 10/10 in severity). Her evaluation in the possible causes of her relapse yielded a positive Lyme titer- showing exposure. She was treated with Doxycycline and now a few months later dad reports that her abdominal pain is minimal.

Take home lesson- One of the triggers of what we call Crohn’s disease, can be lyme and its coinfections which include bartonella, mycoplasma, ehrlichia, anaplasma, and rocky mountain spotted fever. In a person with a predisposition to autoimmune disease and a family history of autoimmune disease, these infections could trigger the autoimmune process.

Dont Monkey around when you read this

A guy walking down a street one afternoon passes an old man sitting on the side of the road with a large sack.

The younger guy says to the old man, “Watcha got in the sack?”

The old man responds, “I got some monkeys in that there sack.”

The younger man asks, “If I guess how many monkeys you got in the sack, can I keep one?”

The old man replies, “Son, if you guess how many monkeys I got in this sack, I’ll give you both of ’em!”

Dairy has become the Food to avoid

Certain Milk products promote insulin resistance ( and diabetes) . The milk sugar lactose acts like a soft drink and can spike insulin levels and contribute to prediabetes

Studies at Harvard’s school of public health found that children who drink three servings of milk a day ( even skim or 1%) were more prone to overweight than those who drank fewer servings a day. Possibly this was due to the higher relative content of lactose lower fat milk

Dairy creates acne – Those who drink more milk as teenagers had higher rates of severe teenage acne than those who rank less according to a Nurses Health study. Besides lactose, researchers surmise the presence of hormones in milk might have been the cause.

Cows milk may be responsible for eliciting autoimmune response that leads to diabetes in children. Bovine serum albumin may lead to the destruction of the beta cells of the pancreas.

Celiac enzymes may enable patients to eat wheat

Currently, a gluten free diet is the only way to manage celiac disease. But new drugs in clinical trials with humans, as well as more in the pre-clinical phase, may one day allow people with the disorder to enjoy gluten again.

These options are still years from commercial availability, but early results have been encouraging, according to a review of the drug pipeline in Gastroenterology Report.

“Based on data on ClinicalTrials.gov, there are two investigational products we are aware of which may enter large confirmatory trials in the not too distant future,” said lead author Dr. Klaus Gottlieb, senior medical director of the immunology and internal medicine department for Quintiles, a company that provides bio-pharmaceutical development services and consulting in Durham, North Carolina.

One of them is an enzyme that splits the molecule in wheat that causes celiac disease, gluten, into smaller harmless products and another one promises to make the gut less leaky and thus prevent potentially toxic substances (from) reaching deeper layers where they may cause inflammation,

For one potential oral therapy, patients take a mixture of two enzymes that split the gluten molecule into smaller harmless products. In a trial of adults with celiac disease, those taking this drug had no change in their intestinal biopsies after eating gluten, while those taking a placebo did have evidence of injury to the intestinal lining.

frog joke

Hoping for good news he goes to meet with a fortune teller.

The fortune teller closes her eyes, makes some strange sounds, and finally says, “You will meet a beautiful young girl that will want to know everything about you”

The frog gets excited and says, “Wow! When will I meet her? At a party?”

“No,” replied the fortune teller, “in her biology class.”