health

Tips on Soothing Your Teething Baby

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | August 19th, 2017

Dear Doctor: My son has started teething, and I'd like to ease his discomfort. I see that several homeopathic teething products have been recalled. Could they really be dangerous? If so, what are my options?

Dear Reader: It's six months into your baby's first year. Chances are, you've finally got a good parental rhythm going. Your sleep deficit is manageable, and your child is increasingly engaged in the world around him. Just as you're thinking that maybe you've got this parenting thing figured out, here come the joys of teething.

Babies enter the world with 20 primary teeth ready to emerge from their jawbones and through their gums. Six months is the average age at which that momentous first tooth makes its appearance, but it can happen anywhere between 3 and 12 months of age. And while plenty of babies breeze right through with minimal fuss, for others it's prime time for more than a little crankiness.

As the rough surface of the tooth advances, it can make the gums swell and ache. Some babies will drool freely, which can cause skin rash and irritations. And because Mother Nature apparently has a wry sense of humor, the process of tooth eruption -- that's when the tooth breaks through the gum -- tends to be more active at night. Say hello again to sleepless nights.

With multiple teething stages to deal with as lower and upper teeth, canines and molars emerge in the next two-plus years, parents want safe and effective ways to smooth (and soothe) this time of transition.

One remedy, available since the early 1900s, has been the herbal teething tablet. However, tests recently performed by the Food and Drug Administration on tablets by Hyland, a well-known maker of homeopathic products, revealed inconsistent amounts of belladonna, sometimes more than was listed on the label. Belladonna is an herbal ingredient with sedative effects that, in excessive quantities, can be toxic. Symptoms include lethargy, muscle weakness, constipation, excessive sleepiness, flushed skin, breathing difficulty and seizures.

The FDA asked Hyland to voluntarily recall its teething tablets and gels, which it did. The FDA has since also warned consumers that all homeopathic teething products may pose health risks for infants and children.

So how can you safely help your teething baby?

Although over-the-counter soothers like Orajel are an option, the American Academy of Pediatrics says that topical preparations wash away within minutes. For extreme discomfort, you may opt for an infant pain reliever. Always check with your pediatrician for proper dosage and duration of use.

After that, it's the age-old basics: pressure, massage, cold and cuddling.

-- Teething toys: Find an array of smooth, solid (not liquid-filled) toys for your baby to chew on. Rings are a nice option because they're easy for little hands to hold.

-- Massage: Use a clean finger and gentle pressure on baby's tender gums.

-- Ice: Freeze the toys for another element of pain relief. A wet washcloth, wrung out and then frozen, offers both cold and texture.

-- And don't forget the power of a soothing cuddle. Chances are that during the stress of teething time, the benefits will go both ways.

Do you have a great teething remedy to share? We'd love to hear from you!

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Treatment Options for Peripheral Artery Disease

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | August 18th, 2017

Dear Doctor: Could you please tell me about peripheral artery disease? I have it and recently underwent angiograms of both legs, including insertion of one stent. One leg is now normal, but the other is back to square one. Do I just suffer through the sleepless nights of pain while waiting for the inevitable stroke or heart attack?

Dear Reader: Think of peripheral artery disease as being like any other arterial disease. Arteries transfer oxygenated blood from the heart throughout the body. The carotid arteries provide blood to the brain, the coronary arteries provide blood to the heart, and the iliac and femoral arteries provide blood to the legs. The inside of each of these arteries is lined with a thin layer of cells called the endothelium. This smooth layer allows blood to move freely within the artery without sticking or clotting.

Injury to the lining of the arteries leads to a mixture of cholesterol and fibrous plaques accumulating on the walls of the artery. This buildup is known as atherosclerosis and, over time, causes the arteries to narrow. In peripheral artery disease of the legs, the narrowing causes decreased blood flow to the legs. The first sign is cramps, usually in the calves, with walking. As the narrowing increases, the cramps can occur simply while lying down, because blood flow decreases without the benefit of gravity. Your worries about strokes and heart attacks are understandable. As with other arterial disease, such plaques can break off and lead to those potentially fatal conditions.

Smoking cigarettes is the biggest risk factor for peripheral artery disease. In fact, chronic smoking is a risk factor for all arterial disease. Other risk factors include diabetes, high blood pressure, kidney disease, high LDL cholesterol and the unavoidable risk factor of being older than 70.

The first course of action should be controlling any risk factors. If people smoke, they should stop. If they have diabetes, they should make sure to keep their blood sugar low. And if they have high cholesterol, they should lower it with medication and diet.

Second, taking a blood thinner, such as aspirin or clopidogrel, will lower the likelihood of clots forming within the blood vessels.

Third, a gradual course of exercise therapy can improve blood flow and decrease calf pain with walking. People without access to a supervised exercise program should walk three days per week for 30 to 45 minutes. A slow start is fine; a more rapid pace can come later.

Fourth, the medication Cilostazol, which works by dilating the blood vessels and not allowing platelets to clot in the arteries, has been shown to increase the distance that people with peripheral artery disease can walk without pain.

As you have experienced, when symptoms are severe or when blood flow to the foot is severely compromised, surgery may be advised. This can be done by angioplasty and stenting, as you had, or, if symptoms are still unrelieved or if the blockage is too long, a bypass graft can be created to skirt the blocked area so that blood can move through unimpeded.

All that said, speak to your doctor. It's possible that not all your pain at night is related to peripheral artery disease. But if it is, controlling your risk factors, using the medications described above and possibly a bypass procedure (if you are a candidate) may help your symptoms. Your physician is in the best position to recommend next steps.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Child Looks for Evidence to Convince Parents to Get a Pooch

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | August 17th, 2017

Dear Doctor: I'm 12 years old, and I really want to get a dog. Can you help me find some studies to convince my mom and dad about the benefits of having a dog?

Dear Reader: First, we think it's terrific that you're going for a fact-based approach to persuade your parents to get a family pet. The good news is that plenty of scientists share your enthusiasm and, to that end, have amassed quite a body of research about the benefits of having a dog in your life.

We're going to begin by assuming no one in the family has pet allergies. It'll be a game-changer if they do. But if there's no sneezing, coughing, itching, asthma or other adverse reaction among the people in your home, then let's get to what science has to say.

Many studies suggest that dogs help their owners in many realms: emotionally, physically and mentally. That's because pet owners tend to walk more, get emotional support and comfort from their pets, suffer less depression, are more social thanks to regular dog walks, and may even get a protective effect against allergies. This last point is thanks to the constant low-grade exposure to the dander, dirt and pollen that an active indoor-outdoor dog brings into the house.

One study showed that older adults who had dogs and walked them regularly had a lower body mass index, had fewer visits to the doctor, and generally spent more time interacting with people than those without dogs. Other studies have shown that being around a dog can reduce stress, which translates to lower blood pressure and better sleep patterns. Several studies have found a link between having a dog in the home and lower rates of asthma and certain allergies among the young children who grow up with the dog.

A study that your parents might like looked at 240 married couples. The couples with a pet in the home had lower blood pressure and heart rates than those without a pet. This applied to when they were just sitting around, as well as while undergoing the rigors of a stress test. And when something did cause them to feel stress, the pet owners' physical responses were less extreme, and their recoveries were faster.

If a list of the many benefits of dog ownership isn't working, try some amazing facts about dogs themselves, like that dog noses are so sensitive they can sniff out certain types of cancer more accurately than actual lab tests.

To be fair, we have to address some potential drawbacks. One is that dogs tend to get ticks and fleas, each of which is associated with disease. Dogs that are not properly trained (and even some that are) may bite. And pets getting underfoot are responsible for some of the up to 8 million visits to the ER for falls each year.

As pet lovers ourselves, we have heard from our own patients about how much their dogs mean to them. We wish you a happy outcome when you talk to your mom and dad.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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