Interesting Conversations with Parents March 2016 (Pedcast)

Topic Introduction

Welcome to another edition of Portable Practical Pediatrics, home of pedcasts. From the womb to the W-2, if the subject involves children, we take it on here. A few months ago i started a new series of pedcasts I call”Interesting Conversations with Parents” and I must say, these posts have been particularly popular with my listeners. The parents of the children I take care are so interesting, curious, and informed and they bring up the most interesting things in our time at the office–they never cease to amaze me and i must share some of these conversatins.  In today’s pedcast, I going to bring a few more of the recent “Interesting conversations” I have had with parents in the past month. So, sit back and enjoy the conversation.

Musical Introduction

Conversation 1: 

A few days ago I was doing a checkup of a young school age child. His mom was with him and the conversation turned to his peanut allergy. Unfortunately, this is a conversation I have all too often these days. I know that this is an emotionally charged topic anytime the subject of food allergy comes up. In fact, peanut allergy reactions are the most common trigger for severe life threatening food reactions in America today, and parents know that. No wonder parents get so freaky about the subject. I would too, especially considering that their children often are eating away from home where their  parents can’t supervise their food. It’ s very frightening. During our conversation, this mom turned to me and asked “Have you heard of a “menu card”?  Well, actually, I had not. She explained to me that this is a card that the family or child takes to a restaurant to inform the chef that one of their diners has a life threatening food allergy. I subsequently learned that they are also  more called “Chef cards”. Well, this was the first that I had heard of these cards but I am glad she told me about them. They sound like a great idea and they are becoming more and more commonly used. From there, our conversation turned to food testing and specifically, food challenges to diagnose food allergy or determine whether these allergies had disappeared.  A food challenge is the ultimate way allergists determine that someone is not allergic.  I was telling this mom of a growing trend that i have read and heard about from parents, that of testing children with suspected food allergy, not in an allergist’s office or health facility but rather, in the family car, outside a health facility in case a child does have a serious reaction. This practice is even mentioned in this NY times article on childhood food allergy I have a link to in the Smo notes of this pedcast. I guess this practice makes some sense but I am not endorsing it. And while we are talking about foods as allergens, just for fun, try this food allergy quiz I came across during my research for this pedcast. See how you do. I learned a few new things taking it and I bet you will too. Make sure you look up the foods you are unsure of.

 

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Conversation 2:

It is winter in Charlotte right now which means it is cold and flu season.   Last week I was talking to the family of a sick child whose family was from India. The child had a lower respiratory illness with a bad cough. After I did my assessment, I came to the conclusion that he had an uncomplicated viral illness, requiring nothing more than time, symptomatic treatment, and some tender loving care. I went through the usual symptomatic measures that I usually recommend, honey, Vicks rub,  a humidifier for the cough, saline for the nose, and chicken soup as a natural form of aspirin.  As I uttered the chicken soup words I realized that this family might be vegetarian and sure enough they were, but this mom quickly replied, “No worries, we have our Indian vegetarian version of chicken soup for sickness.”  She said it is a soup made with,  “Lentil broth, curry, tumeric, and garlic. She insisted it was as effective as chicken soup. After she left, I did a little research to find vegetarian equivelants for traditional chicken soup. I found two groups of recipies, from our Jewish friends of course and an Indian version, just like this mother said. I have put links to a few of them in the Smo notes at the end of this post. My understanding is that the broth of chicken soup contains elements of the chicken’s bone marrow that give it the anti- inflammatory, feel better effect. For the vegetarian versions, I think the vegetables and spices may do the same thing.

Conversation 3: 

The final interesting conversation for this pedcast occurred actually with a child, not a parent. It was a routine visit for a sore throat and fever where of course, I obtained a throat culture to determine if this child had a bacterial infection from Group A Beta hemolytic strep (what we call strep throat), a really mean potentially dangerous germ that often invades children’s throats. We do what most pediatricians do, collect two samples from the throat and first do a rapid strep detection test and then, if that test is negative, follow up with a traditional throat culture since the rapid strep sometimes misses children with only a little strep in their throats. His rapid test was indeed negative, so I was telling him and his mother that we would now culture his germs, the old fashion way, to make sure we didn’t miss the germ on the rapid test. The young man asked me how we grew the germs so I told him that we put the germs (called plating them) on an agar (jello like substance) with sheep’s blood in the agar. He was shocked and exclaimed, “Why sheep?” I knew that it was important to have red blood cells in the agar because they serve as the germ food and provide a visible pattern of the red cell’s destruction, caused by the strep. Group A Strep, the germ of strep throat breaks up the red cells and changes them from red to an is easy to a transparent color in the agar. But why sheep’s blood? To this child, this test sounded more like a religious ceremony than a lab test. So I did a little study and found that “Blood agar” is still used for the culture but actually, any animal’s red blood cells can be used.  Sheep’s blood just seems to still be the standard. I did remember that different types of animals have different size red blood cells with their own unique properties. I distinctly remember on a hematology exam in med school, being shown camel red cells under a microscope and being asked what was up? It turns out the sheep red blood cells are very small and tough, maybe giving them good properties for this test? those camel red cells… they are huge!  After he left,  I thought it was great that this young man was interested in the why of his lab test and had the gumption and interest to ask.   I think he is going places.

 

I hope you enjoyed hearing about these conversations.  If so, please take a moment to leave a review on iTunes or a comment at my blog. Share your insights about the topics discussed. If you have ideas of how I can improve what I bring my listeners or specific topics you would like me to address, share your thoughts with me at my blog www.docsmo.com. My passion is your children and family. This is Dr. Paul Smolen, broadcasting from studio 1E, hoping you enjoyed hearing this chat, about pediatric this and that.

 

Smo notes:

Conversation 1-

Eating out with food allergies

Chef Card

http://www.foodallergy.org/file/chef-card-template.pdf

Food allergy quiz

http://www.foodallergy.org/file/ingredient-quiz.pdf

NY Times article about Food allergy

http://www.nytimes.com/2013/03/10/magazine/can-a-radical-new-treatment-save-children-with-severe-allergies.html?_r=0

 

Conversation 2-

Jewish Vegetarian chicken soup

http://www.pbs.org/parents/kitchenexplorers/2012/03/06/no-chicken-noodle-soup/

http://www.jweekly.com/article/full/31969/not-chicken-soups-for-veg-and-vegan-souls/

Indian version

Indian Spiced Chicken (or Vegetable) Turmeric Soup

Converstaion 3-

Blood Agar-blood not specified

http://textbookofbacteriology.net/streptococcus.html

Sheep blood still used

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920295/

Why sheep’s blood? Any will do?

http://spot.pcc.edu/~jvolpe/b/bi234/lab/differentialMedia/bloodAgarPlates.htm

Sheep have very tough, small Red blood cells!

https://www.meduniwien.ac.at/hp/fileadmin/prf/windberger/Handbook_2007.pdf

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