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OFFICE NOTES

Office closure: Please note that due to major family events in both Dr. Yankus’s (his son’s wedding) and Dr. Ungerleider’s (her daughter’s Bat Mitzvah) families, the doctors will not be in the office from the afternoon of August 30 through Labor Day weekend. The office staff will be here for most of the day on August 30 and 31 and September 1 to answer questions, triage and fill out forms. There will be a covering physician available for any problems (not for physicals or prescription refills) needing to be seen for those days and for Labor Day weekend. Please keep this in mind as you schedule physicals for your children.

Flu vaccine: We have been informed by the manufacturer of the Fluzone vaccine (the shot), that we will not be receiving shipment of the vaccine until December 2006. We will call those patients on our list when we receive the vaccine to schedule appointments.

TICK REMOVAL

Ticks are brown or black insects that range in size from 1/16” to 1 /2”. There are several varieties (species). They attach to the skin and look like brown or black bumps.

Inspect your child’s skin and scalp for ticks after play or hiking, so that they can be removed promptly. The best way is to pull the tick off with a tweezers. Grasp the tick firmly, as close as possible to the skin, and pull with steady traction. If you are not able to remove the tick or if parts of the tick are left embedded in the skin, call our office so that we can give you further advice. After removal, clean the area with soap and water or an antiseptic.

Record the date of the tick bite. Then, if your child develops a rash, fever or flu-like symptoms, we will know when the bite occurred. Not all ticks transmit Lyme disease. It is the smaller deer tick which can. Even all deer ticks do not transmit the bacteria causing Lyme disease. The tick needs to be attached for more than 24-48 hours and even then may not cause disease.

To prevent tick bites, have your child wear long pants and long-sleeved shirts when hiking or playing in tick-infested areas. You may also use insect repellent containing DEET; spray it over your child’s clothing, not on the skin.

GARDASIL

Gardasil is a new vaccine that helps protect against the following diseases caused by certain Human Papillomavirus (HPV) Types: cervical cancer (cancer of the lower end of the uterus or womb), abnormal and precancerous cervical, vaginal and vulvar lesions and genital warts. Gardasil helps prevent these diseases – but it will not treat them.

HPV is a common virus. In 2005, the Centers for Disease Control and Prevention (CDC) estimated that 20 million people in the United States had this virus. There are many different types of HPV; some cause no harm. Others can cause diseases of the genital area. For most people the virus goes away on its

own. When the virus does not go away it can develop into cervical cancer, precancerous lesions, or genital warts, depending on the HPV type.

In 2005, the CDC estimated that at least 50% of sexually active people catch HPV during their lifetime. A male or female of any age who takes part in any kind of sexual activity that involves genital contact is at risk. Many people who have HPV may not show any signs or symptoms. This means that they can transmit the virus to others and not know it.

Cancer of the cervix is a serious disease that can be life-threatening. This disease is caused by certain HPV types that can cause the cells in the lining of the cervix to change from normal to precancerous lesions. If these are not treated, they can turn cancerous.

Genital warts are caused by certain types of HPV. They often appear as skin-colored growths. They are found on the inside or outside of the genitals. They can hurt, itch, bleed, and cause discomfort. These

lesions are usually not precancerous. Sometimes, it takes multiple treatments to eliminate these lesions.

Vaccination does not substitute for routine cervical cancer screening. Females who receive Gardasil should continue cervical cancer screening.

As with all vaccines, Gardasil may not fully protect everyone who gets the vaccine. Gardasil will not protect against diseases due to non-vaccine HPV types. There are more

than 100 HPV types; Gardasil helps protect against 4 types (6, 11, 16, and 18). These 4 types have been selected for Gardasil because they cause approximately 70% of cervical cancers and 90% of genital warts. This vaccine will not protect you against HPV types to which you may have already been

exposed. Gardasil works best when given before any contact with these types of HPV.

Gardasil is approved for girls and women 9 through 26 years of age, but is currently recommended for ages 11-26.

It is given as a series of 3 injections; the second is 2 months after the first and the 3^rd is 6 months after the first. The side effects, if any are pain, swelling, itching and redness at the injection site and fever.

If you are interested in having your daughter receive this vaccine, please contact our office so that we may order it for you.

SWIMMING POOL SAFETY

Drowning is a leading cause of injury-related death in children. Near-drowning events, in which children survive for at least 24 hours, also occur frequently. Toddlers and adolescent males are statistically at greatest risk.

There are certain precautions that can be taken at different ages to minimize the risks of drowning. For newborn infants and children through 4 years of age, the most important safety precaution is to never, even for a moment, leave children alone or in the care of another child while in bathtubs, pools, spas, wading pools or near other standing water. All water should be removed from containers such as pails/buckets. Whenever children are in or around water, at home, neighbor’s, a party or elsewhere, they should be within an arm’s length of an adult. The adult should also not be engaged in distracting activities, such as talking on the phone, socializing or doing household chores.

Residential homes should have a 4-sided fence that prevents direct access to the pool from the house. This fence should be at least 4 feet high (preferably higher), should be climb-resistant, i.e. an iron fence with bars, as opposed to chain-link, and the bars should be less than 4 inches apart and less than 4 inches from the ground to the bottom of the fence. One of the most important parts of the fence is a self-latching, self-closing gate that opens away from the pool. Pool covers and alarms are not substitutes for an effective fence and gate.

Many people think that if their child has learned how to swim, they are safe; however, under the age of 4, most children are not ready for formal swimming lessons and even if they are ready to learn how to swim at a younger age, the above safety measures should be taken. Parents, caregivers and pool owners should learn CPR and have a telephone and approved rescue equipment at poolside. Air-filled swimming aids (such as water wings) should not be used in place of life preservers. Parents should make sure that all caregivers are aware of and understand the need for constant supervision around water.

Between the ages of 5 and 12, in addition to the above measures, children should be taught to swim (although just as with younger children, this does not mean they are totally safe). They should also be taught not to swim alone or without adult supervision and the different safety requirements in different types of water, such as lakes, streams, rivers and oceans. At this age and older, children should be cautioned about the risks of diving and jumping into water.

The adolescent age 13 and up presents other risk factors around bodies of water. They should be counseled about all of the above, in addition to the risks of alcohol and drugs during water recreation. Adolescents should also learn CPR.