It's Just Facial Flushing

Side effects from medicines may be expected, but they are not always pleasant, especially when they affect your appearances. Sometimes they can be avoided; other times you learn to deal with them. Either way, you want to monitor for them, especially if you are on other medicines that may increase your risk for these side effects or the condition you are treating already may worsen with the new medicine.

I have high blood pressure treated with hydrochlorothiazide. As much as I love basking in the sun with a book, I can't for prolonged periods. The diuretic increases skin photosensitivity (sunburn easily). Of course, I was recently diagnosed with rosacea a little less than a year ago. Another reason to slather on sunblock.

Last Friday, I got a cortisone injection into the shoulder bursa. Before I agreed to it, I asked the doctor if he's seen worsening blood pressure with the shot. (I just finished a month of Mobic, melixicam, a once-a-day Nonsteroidal Antiinflammatory Drug that can increase blood pressure, but I checked frequently and had been fine.) While high blood pressure patients are going to be fine, diabetes patients need to be careful, because it could worsen the blood sugar levels and also increase the risk of infection with the breech of skin. (Don't ever look at the long needle.)

The most common side effect was the worsening pain within 24 hours. Since it was expected, I tolerated it. I even iced the site of injection. The worst was not that, though. It was the facial flushing 12 hours after I had received the injection. I had been out with my son's playgroup, but had worn sunblock. I figured it was a sunburn or acute rosacea anyway because I had not expected the facial flushing that occurs in 15% of patients, especially females. My face felt like it was emitting flames. Then I noticed a contact dermatitis reaction from the bag I wore while running. Eventually (after 24 hours), both areas began to cool down.

What have I learned? It doesn't hurt to ask about all the side effects from a cortisone (or any injection).

Going Under

My 6-year-old daughter just went in for surgery about 15 minutes ago. She had chosen me as the parent who gets to watch her fall asleep with the laughing gas. I was fine with that, because I did that with my son when he went in a couple of years ago. They had "Finding Nemo" playing so the mask did not phase him, and he quickly went out.

This time, there was no TV playing. She got up on the table and just lay still. There was something tugging at my heart, though, as I watched her stare into the operating table lights while taking breaths diligently into the mask. My heart dropped when I heard a beep. It was standard. Slowly, but too quickly for me, I watched her smile become a straight line. Her breathing became even. I had been worried about nothing.

She was done in less than 30 minutes. I thought for sure she'd be in recovery for an hour. Nope, she was awake 15-minutes after we were told it went well. The next 4.5 hours were spent trying to get her to eat popsicles or drink apple juice. We were lucky that we had to be transferred to the pediatric floor, because she was in and out of consciousness. One minute she would be chatting about something, the next she would be throwing a mini-tantrum about nothing, and then suddenly be snoring. In order to be discharged, she had to walk. Four hours after her surgery, she decided to sleep off the anesthesia. Nothing woke her. Finally, she took a stroll and was cleared. Wow, what a long day for us all.

A Kid's Advice: "Run for your eyes!"

"Run for your eyes!" my daughter cried as I sprinted back into the house from the playground last Monday. Normally that line would tickle me; my daughter's friend thought that was the actual line and introduced us to it. I wasn't laughing this time, because it was true; I had to run to save my eyes.

My seasonal allergies had been pretty much under control until last Monday when I sat outside to sunbathe under a flowering tree without sunglasses. Then I drove home with the sunroof open to enjoy some more spring weather. The last straw had been the few minutes in the backyard, and, of course, some gentle eye rubbing. It didn't help that there was pollen on my car, deck, and porch.

What's wrong with this picture? 1) I didn't protect my eyes; 2) I exposed myself to allergens while driving; 3) I didn't wash my hands before rubbing my eyes; 4) All of the above. The answer? All of the above.

What happened next? After telling the children that playtime was over, I ran in to rinse my eyes with cold water, but they still itched. So, I rubbed them some more. Within minutes, I had swollen eyelids and ridiculously red eyes; the right more horrific than the left. After antihistamine eye-drops and cold compresses were used, the itching was better. An hour later, there was a large water blister coming out of my eye. I felt like a bullfrog.

How did it end? To make a long story short, I got in touch with a doctor, took some short-acting antihistamines by mouth, and went to the ophthalmologist the next morning. I did not go to the emergency room, since there was no pain and no vision loss. By the time I made it to the ophthalmologist, the blister was already smaller. It turned out I had a severe antigen-antibody reaction to the pollen and a Staphylococcal aureus infection. There were also some evidence of ulcers. I was the worst case the ophthalmologist had seen this season. I was given more eye-drops, and by the next day I was already looking and feeling 90% better.

What can we learn from this? If you have seasonal allergies, here are some tips to minimize your suffering during the next round of blooming after all of this rain:

• Seek medical care (I know we're busy, but we have to take care of ourselves, too), especially when the condition affects your eyes.
• Minimize contact with allergens. Wear sunglasses, stay indoors, keep windows closed, don't drive with your sunroof open, and wash your hands after gardening or being outside.
• Take an antihistamine regularly, not as needed, at about the same time every day during allergy season. Use antihistamine eye drops and/or nasal steroids for additional symptom relief if you need it. These should also be used on a regular basis. Avoid decongestant use, like oxymetazoline spray (AFRIN).
• Use cold compresses for itchy eye relief. Use eye drops and nasal sprays properly to avoid wastage and side effects.
• See your general doctor if the over-the-counter medicines are not helping with your allergies. You may also be referred to a specialist like an ophthalmologist or an allergist.
• Children can suffer from allergies, too. The American Academy of Pediatrics has a good review on this topic. Talk to your pediatrician or pharmacist about age-appropriate medicines and how to give them. Using the medicines on a regular basis is also important in this age group. KidsMeds offers instructions on how to administer eye medicine to children.

Timing is Key

Having knowledge about common childhood infections does not mean that I always know when to bring my children in to the pediatrician when they have signs and symptoms of colds. In fact, there have been a few times when I knew the cause was viral and there would be nothing for the pediatrician to offer, but I made an appointment anyway. I needed to prove to myself that that was the case and nothing more, especially before the weekend. Or perhaps I wanted to be able to tell the school that she's fine and can be in school. On the other hand, there was a time when I thought it was just a cold when in fact it was a "strep" infection that was rather contagious. After that episode, I err on the cautious side, but I still don't rush her in with every sniffle or cough -- unless she has a companion rash (turned out to be a contact dermatitis).

My daughter has had a cold for 3 weeks. It started out with a sore throat, sneezes, runny nose, and cough, but has not had a fever or changes in energy level or activity interest. Gradually her coughing started to get better, and her thick, yellow mucus stopped being a messy problem. And then at 5 am yesterday, I heard loud whimpering and complaints that her left ear was hurting and "I don't like it I don't like it I don't like it!" She felt warm to the touch, but too bad my thermometer chose not to work anymore. She had also kicked her covers off of her, claiming that they were making her hot. I tried a warm water bottle for her ear, which consoled her for 3 minutes. She then complained about her face hurting (probably from leaning on the mouth of the bottle). Nevertheless, I gave her 2 chewable ibuprofen tablets (2 acetaminophen would have been fine, too) in hopes of relieving her acute ear pain and treating her discomfort from the fever. She immediately fell back to sleep (without her lullabies cd) for 4 solid hours. She woke up yelling that she didn't feel pain anymore. By then I had already scheduled an appointment for her. Thankfully(?), she did have a slight headache. I wasn't going to take her complaints about ear pain lightly because it was sudden and she has had the lingering cold. But, yes, I did consider not calling and just letting her sleep it off. Despite her quick turnaround, I brought her in. The verdict? She was diagnosed with bilateral acute otitis media. Most of the cases are viral and don't require antibiotics, but this was likely a secondary infection. Ten days of antibiotics. I must say that despite her refusal to rest properly, my daughter is a good patient. She drank a lot of fluids, including chicken soup that my friend made and brought over. Moreover, she took her first dose of the antibiotic immediately in the car. The pharmacist made it easy for us with the free dosing spoon.

Ear infections are not contagious, but the resurgence of her cold may be, so she won't be going to school until she has taken 24 hours of antibiotics. However, she does not want to miss her clay class after school. Her first dose of the antibiotic was in the car. I just gave her her second dose. I had to wake her, but I wouldn't want to delay her dose to give the bacteria a chance to adapt to the antibiotic. Giving this class of antibiotics (cephalosporin) on time ensures killing of the bacteria. Timing is key; for the visit with the pediatrician and for giving the medication.

"Isn't he a little young to see the dentist?"

Not too long ago, I blogged about my son's decaying teeth from breast milk. We just finished a series of visits to remove the decay and then place crowns on his four front teeth. He was a champ overall, despite waterfalls of tears. However, every morning he has been asking, "No doctor? No doctor?" The poor boy has suffered through immunizations, local anesthetic injections, drilling, and discomfort in the last couple of weeks. Fortunately, the medical staff who have worked with him have been marvelous and my son has not been too traumatized, though he hasn't chuckled in his sleep lately.

Anyway, while we were sitting in the waiting room one time, a mom asked me, "Isn't he really young? Why is he here? When should children start seeing the dentist?" It depends on what you read and who you ask. I remember when my son was 14 months old I had asked my daughter's dentist if I should set up an appointment to see him now that he has teeth. The dentist looked in his mouth and said, "He just had his first visit." That was all that was said. I might have been more diligent about wiping his gums after feeds if he had mentioned it. Six months later, I brought my son in because I noticed the brown discoloration on one of his incisors. We were told to brush with adult toothpaste and go back when he turns two for his first visit. Unfortunately, the tooth that I had been worried about broke off. It was later restored with a crown placed over it (by the way, the process of making crowns for young children is not as painstaking as it is for adults). To prevent the other three front teeth from collapsing, we opted to clean the teeth and make crowns for them.

So when should you take your child in for the first check up? The American Dental Association (ADA) recommends that the first "well baby checkup" for the teeth as soon as the first tooth erupts or no later than the child's first birthday. They have a great summary about baby teeth. Other experts say not until the age of three. If you're not sure, ask your child's pediatrician. Parents can find pediatric dentists in your area via an online search, including federally funded health centers that provide dental check ups at http://findahealthcenter.hrsa.gov/. A smile with healthy teeth starts with good dental hygiene at an early age. Even if the dentist just shows you how to wipe the gums or brush the few teeth that your child has, it is important to start getting into the habit. Tooth decay is preventable. Don't let the first dentist appointment be when the first sign of decay is visible. It can leave a lasting emotional effect on the child.

"Manufacturing Deficiencies" Lead to Recall of Some McNeil Products

A voluntary recall of certain children's over-the-counter liquid medicines has been issued by the McNeil Consumer Healthcare unit of Johnson & Johnson. These products include Tylenol Infants' Drops, Children's Tylenol Suspensions, Infants' Motrin Drops, Children's Zyrtec Liquid in bottles, and Children's Benadryl Allergy liquids in bottles. "Manufacturing deficiencies" may affect affect the potency (strength), purity, or quality of the products. Parents are urged to check the products they have at home and stop using them if the lot number matches one on the list of recalled medicines. According to the company, some products may actually have too much of the active ingredient in the product, others may have tiny particles or inactive ingredients that fail testing requirements. Even though it is unlikely that a serious medical problem will occur as the result of giving the recalled medicine, it is not recommended that these products be given to children.

Be sure to talk to the pharmacist or doctor about alternative options to these recalled medicines for children to treat pain, fever, or allergies. For additional information, please visit McNeil's website or call 1-888-222-6036 (8 am - 10 pm ET on Monday-Friday and 9 am - 5 pm ET on Saturday and Sunday). Any suspected reactions may be reported to the FDA's MedWatch program on the FDA's website.

By the way, generic products are not affected by the recall. They are made by other companies that have been approved by the FDA and distributed by the pharmacy/drug store. Generic drugs have been tested and meet the standards of the FDA and work just as well as the brand name equivalents. If you are interested in knowing if a generic version is available, you can check the Orange Book, which is an official list of approved generic drugs.