Monday, December 1, 2014

On call with Dr. Kolsky

Although it's important to get vaccinated early in the fall, it's not to late to get your children vaccinated for the Flu. Dr. Kolsky recommends parents read this article from Kids Health, the most-visited site on the Web for information about health, behavior, and development from before birth through the teen years.

Dr. Kolsky believes it's important for parents to become educated on the vaccine and how it can help keep your family healthy through the holidays and into the new year.

Is it too late to get the Flu vaccine? 
Flu season runs from October to May, with most cases happening from late December to early March. But the flu vaccine is usually offered from September until mid-November. Getting vaccinated before the flu season is in full force gives the body a chance to build up immunity to (protection from) the virus. 

Even though it's best to get vaccinated as soon as the flu vaccine is available, getting the vaccine later can still be helpful. Even as late as January, there are still a few months left in the flu season, so it's still a good idea to get protected.

Who Should Get the Flu Vaccine?

The flu vaccine is recommended for everyone age 6 months and older. It's especially important for people who are at greater risk of developing health problems from the flu to get vaccinated. They include: 

  • all kids 6 months through 4 years old (babies younger than 6 months are also considered high risk, but they cannot receive the flu vaccine)
  • anyone 65 years and older
  • all women who are pregnant, are considering pregnancy, have recently given birth, or are breastfeeding during flu season
  • anyone whose immune system is weakened from medications or illnesses (like HIV infection)
  • residents of long-term care facilities, such as nursing homes
  • anyone (adults, teens, and kids) with a chronic medical condition, such as asthma
  • kids or teens who take aspirin regularly and are at risk for developing Reye syndrome if they get the flu
  • caregivers or household contacts of anyone in a high-risk group (like children younger than 5 years old, especially those younger than 6 months, and those with high-risk conditions)
  • Native Americans and Alaskan Natives
Kids under 9 years old who are getting the flu vaccine for the first time will receive two separate doses at least a month apart. Those under 9 who have received the flu vaccine before still might need two doses if they did not receive at least two vaccines since July 2010, or if the number of doses they've received since July 2010 is unknown. This is to ensure that all kids are vaccinated against the H1N1 flu strain that surfaced in 2009. Kids older than 9 years old only need one dose of the vaccine.

It can take 1 to 2 weeks for the flu vaccine to become effective, so it's best to get vaccinated as soon as possible.


Types of Flu Vaccine

Different types of vaccines are available. One type (called trivalent) protects against three strains of the flu virus (usually, two types of influenza A viruses and one influenza B virus). Another (called quadrivalent) protects against four strains. 

The vaccine can be given to kids in two different ways: by injection with a needle (the flu shot), or sprayed into the nostrils (nasal spray or nasal mist).

Both ways of delivering the vaccine are effective, but recent studies show that the nasal spray may work better in younger children. So experts recommend that healthy kids 2 to 8 years old get the nasal spray vaccine when available. If it's not available, the flu shot should be given (kids should not wait for the nasal spray to get vaccinated). The nasal spray isn't recommended for kids with certain medical conditions or pregnant women. 

Some vaccines are approved only for adults at this time, such as egg-free vaccines and intradermal shots, which are injected into the skin (instead of muscle) with a smaller needle.

Those Who Should Not Get the Vaccine

Certain things might prevent a person from getting the vaccine. Talk to your doctor to see if the vaccine is still recommended if your child:

  • has ever had a severe reaction to a flu vaccination
  • has Guillain-Barré syndrome (a rare condition that affects the immune system and nerves)
In the past, it was recommended that anyone with an egg allergy talk to a doctor about whether receiving the flu vaccine was safe because it is grown inside eggs. But health experts now say that the amount of egg allergen in the vaccine is so tiny that it (but not the nasal mist) is safe even for kids with a severe egg allergy. This is especially important during a severe flu season.
Still, a child with an egg allergy should get the flu shot in a doctor's office, not at a supermarket, drugstore, or other venue. And if the allergy is severe, it might need to be given in an allergist's office.

If your child is sick and has a fever, talk to your doctor about rescheduling the flu vaccine.

Are There Side Effects?

Most people do not have any side effects from the flu shot. Some have soreness or swelling at the site of the shot or mild side effects, such as headache or low-grade fever.

Some people who get the nasal spray vaccine may develop mild flu-like symptoms, including runny nose, headache, vomiting, muscle aches, and fever.

Where Can My Family Get the Vaccine?

The flu vaccine is available at:
  • many health care settings, including doctors' offices and public, employee, and university health clinics
  • some pharmacies
  • some supermarkets
  • some community groups or centers
  • some schools

If you have an HMO insurance plan, be sure to check with your primary care doctor before having your kids vaccinated outside the office, since most HMOs will pay for shots only if they're given through.

Thursday, September 11, 2014

On Call with Dr. Basil Bruno

Raising teens is both rewarding and challenging from a social and academic perspective. It is also a very important time for teens to learn how to take charge of their health care. Dr. Bruno shares this very informative article from on how to guide your teens through this process.

Please feel free to reach out at any time to ask any of the doctors or staff for assistance in educating your family on important health matters. We are there to support you.

Helping Teens Take Charge of Their Health Care

Preparing kids for independence and adulthood brings many challenges for parents teaching teens to drive, negotiating later curfews, researching colleges, discussing tough topics, to name just a few.
Among these hurdles is helping teens start managing their own health care. It can be hard to let go after all, mom and dad have been handling the doctors' appointments, prescriptions, immunizations, and countless other medical concerns since their kids were born.

But it's important to guide teens toward taking on this responsibility. After all, parents won't always be around to manage their children's health care and in most cases, once their kids become adults, legally they won't be allowed to.
And keep in mind that the decisions made in the teen years about things like alcohol, drugs, healthy eating, exercise, sex, and smoking can have long-term consequences even if teens feel invincible. Becoming more invested in their own health care lets teens learn more about and understand the potential outcomes of choices they make now.
At what age are teens able to start taking some control? It can vary: factors like a teen's maturity level, health issues, and ability to keep track of the details all play a role, as does a parent's willingness to relinquish control.
So, how can parents start handing over the reins? It can begin by talking about medical topics in age-appropriate ways with their kids; for instance, discussing medications they take and why, or teaching kids with chronic conditions ways to help care for their medical equipment. Maybe your teenage son or daughter is ready to handle filling and refilling his or her own prescriptions.

It's important for moms and dads to let their adolescents have some private time to talk with the health care provider. During puberty and the teen years, kids are likely to have questions or issues that they're not comfortable discussing with a parent in the room. (But be assured that a doctor who feels that a patient who might be at risk for self-harm or harming another will alert a parent.) 

If you think your child might need additional help with teen issues, consider having your son or daughter meet with an adolescent medicine specialist. These doctors not only are well-versed in the care of teens' physical health problems but also have additional training in helping their patients deal with risky behaviors and mental health concerns. 

It's also wise to talk about health insurance and medical records to older teens. Although young adults can stay on their parents' plan until age 26 under the health care reform bill, many will be on their own well before that and eventually all will have to know how to navigate the insurance system and keep track of their records.

Monday, June 23, 2014

On Call with Dr. Molly Thomas

Vaccines and Your Teen

Most teens, at this time of year are thinking more about the end of school, graduation, and going to the beach.  As parents, however, what we think about most is keeping them safe.  As you plan the summer and think about your teen's visit for a school physical and forms, keep in mind that teen vaccines are one of the most important ways to keep our children safe.  The following is a summary of some of the most common questions and answers that come up during visits with my teen patients. 

What are the vaccines necessary for teens and pre-teens?

There are 4 vaccines that are recommended by the American Academy of Pediatrics (AAP) as well as by the Center for Disease Control (CDC).
HPV Vaccine:  Human papillomavirus (HPV) vaccines help protect both boys and girls from both cancers caused by HPV as well as the virus itself.  Girls and boys should begin and finish the vaccine when they are 11 or 12 years old. 
Meningococcal Conjugate Vaccine: MCV protects against the bacteria that causes meningitis as well as bacterial sepsis.  Meningitis is a very serious and sometimes fatal condition that includes swelling of the brain and spinal cord.  Pre-teens need this vaccine at age 11 or 12 as well as a booster when they are 16. 
Tdap Vaccine:  This vaccine protects against 3 serious infectious diseases; Diptheria, Tetanus and Pertussis.  Pre-teens should get a booster at age 11 or 12. If your teen did not get one as a pre-teen they should have one now. 
Flu Vaccine: The annual flu vaccine not only protects against the flu virus; it also protects against the health issues that flu causes such as dehydration, worsening of asthma or diabetes for those who suffer those diseases, and even pneumonia. 

Are vaccines safe?
These vaccines are very safe.  Many parents and patients are accustomed to researching information on the internet and can be put off by the unreliable literature that is published there.  It is important to always research medical information at a reputable site that relies on research and scientific data to report findings.  Great sites include and  Side effects caused by vaccines are minimal.  Some children may have mild effects such as redness or soreness in the arm.  Some teens may feel light headed or even faint after vaccines or other medical procedures.  Lying down for a few minutes after shots can help preven this.  Side effects are quite mild compared to the serious disease that they prevent.  

Why do I need to give my teen vaccines and do they really need boosters?
Your child is still not protected from an illness until he or she gets a full course of vaccines.  As our kids go off to camp and to college it is important to realize that they will be living in close quarters with large numbers of people and are very at risk for catching communicable diseases and so we do not want to leave them unprotected. 
Missing a shot or a booster may not seem like a big deal but that little two second "ouch" protects you from illness that have major side effects.  For example, older teens and adults who get mumps can become infertile.  Those who get chickenpox as older teens are more at risk for pneumonia, as well as serious skin infections such as MRSA.  Shots do save lives.  Hepatitis attacks the liver and can ultimately kill.  HPV infection can cause cancer.  1 in 10 people with meningococcal disease will die from it.  The good news is that if you have missed a booster or even a whole series of shots you can simply pick up right where you left off.  Its never too late.   

What if I need help paying for vaccines?
Most insurance plans cover the cost of vaccines.  If you do not have insurance coverage, the Vaccines For Children (VFC) program may be able to help.  Our offices participate in VFC and the program provides vaccines for children up to 18 years who are not insured, underinsured on Medicaid or are American Indian. 
As a final thought, it is important to remember that it is normal to be nervous about getting shots.  If your teen has this problem try to suggest techniques such as deep breathing or coughing as the shot goes in.  The pinch lasts for only a second but the protection lasts a long, long time. 

1. Vaccines for Pre-teens and Teens:  What Parents Should Know.  US Department of Health and Human Services
2. Your Preteens and Teens Need Vaccines Too! CDC Website

Tuesday, May 6, 2014

It's time to schedule check-ups now!

It's time to schedule check-ups now!
Its almost summer! Time to make appointments for camp and school physicals for June and July. It's important to schedule now as appointments fill up quickly by August!

Attention:  Important health news for all travelers!
Under the travel advisory all children 6-11 months of age need MMR vaccine for international travel.

Tuesday, April 29, 2014

A Word about Measles by Dr Suldan

There has been recent concern regarding announcements of measles outbreaks in our area. Indeed measles is one of the most contagious viral diseases, spread by respiratory droplets and contact. It can cause high fever, rash, conjunctivitis, pneumonia, and seizures, and can be fatal. Each case carries with it a real risk of a devastating neurological disorder, called Subacute Sclerosing Panencephalitis that can develop years after the initial case of the disease. As of January of this year, there have been total of 25 cases of measles in New York (12 children and 13 adults). Thus-far in 2014, there have been a total of over 120 confirmed cases of the measles in the United States. Compare that to 37-140 cases per year, or less than 1 per million in the population with good vaccination rates.

The infection is most contagious 4 days prior to onset of the rash and up to 4 days after the rash appears. This means that measles can easily spread before the initial patient even realizes he or she is sick. Prior to the vaccine, there were over 500,000 cases of measles infection yearly with 500 deaths per year. The recent upsurge in measles cases has been attributed to lack of vaccination for various reasons.

What are we as parents and those who care for children to do to protect our children? It should not surprise you to know that the vast majority of cases of the measles have been in unvaccinated and under vaccinated patients, some due to philosophical objections to vaccines and some due to a medical or age related reason for not vaccinating. The vaccine is normally given soon after the first birthday, but if there is planned travel or an epidemic, it can be given at as young an age as 6 months. Unfortunately, 5% of first time vaccine recipients will not develop enough immunity with one dose, and that is why a second measles (MMR) vaccine is recommended, indeed required for full protection.

There have been objections to the vaccine, unfortunately based on incorrect data and assumptions. Look on "the internet" and you will find a myriad of blogs and "informative sites" that warn you of the hazards of the vaccine. Actually, the vaccine is extremely safe and claims of its causing autism have been discredited by responsible scientific studies. What the recent outbreaks show, however, is that we are not keeping our children safe by not vaccinating or even by delaying their vaccines! If you have concerns regarding your child’s vaccine status or level of protection, feel free to call you doctor at Pedimedica to answer your questions and update any vaccines that are needed. We are there for you. Together, we can protect our kids.


Dora Suldan, M.D.

Tuesday, March 4, 2014

On- Call… with Editor Donna Thomas

As cold as it is outside spring is right around the corner, and for many families that means spring break vacation, or at least getting in shape up for the warmer months ahead.  Donna Thomas asked expert fitness trainer Brian Hernandez to share his thoughts on how your family can prepare to feel fit and healthy whatever your plans may be. It’s going to get warmer soon, so get up and move!

Does your upcoming vacation have you worried about your waistline? You should be!

Brian Hernandez, Personal Trainer and Owner of VIP 1-1 Fitness, Fort Lee, NJ

The average person gains almost a pound a day while on vacation. But that doesn’t have to be you. Most of the time extra pounds sneak up on you when you least expect it, so decide right here and now that your vacation will leave you slimmer than when you left.

All you have to do is have a plan. As you embark on your next vacation adventure, use these 7 tips to come home fitter than when you left.

Trick #1: Cut Your Carbs
Vacation days are notorious for carbohydrate rich meals, and it’s a well-known fact that too many carbohydrates will quickly add up to unwanted pounds. Combat this fat-trap by choosing one meal per day to go carb-less.

  • Breakfast: This may be the most effective meal to use the carb-less trick, since breakfast often involves breads, pastries or pancakes. Skip the toast and fill up on egg whites and lean breakfast meats.
  • Lunch: A great carb-less lunch is a salad with lean meat. It’s so filling and satisfying that you won’t even miss the bread.
  • Dinner: Since you’re on vacation, you don’t want to feel deprived, so dinner is the hardest meal to go carb-less. But if you’ve indulged at breakfast and lunch then make it a point to cut the carbs at dinner. Stick with veggies and lean meats.

Trick #2: Be Active
If your travels keep you too busy for a workout, or if your hotel does not have an exercise room, make a conscious effort to be active every day. Go on a brisk walk after your day’s activities. This is a great way to see a new city, and also a great way to burn off extra calories. Take the stairs instead of elevator in your hotel and any other buildings you visit. Go on a short jog in the mornings or evenings of your stay. If your hotel has a pool, swim a few laps each morning or evening.

Trick #3: Create a Vacation Exercise Plan if You Have the Option
Have your fitness instructor develop a unique exercise program to take on vacation or on the road if you need to go out of town. It can be an abbreviated workout that you can do in the hotel gym or even in your hotel room. The routine should be simple to perform and should compliment your current work out program

Trick #4: Indulge with Control
Eating out is a must while on vacation. Whether you’re visiting 5 star restaurants or fast food diners, you are faced with the same problem: large portions. While the easiest thing to do with a large portion meal is to simply eat it all - you are on vacation after all...right? That isn’t the best decision for your waistline.

When you order your meal ask the waiter or waitress to bring you a to-go box. Take half of your meal and place it safely into the box before you even begin to eat. This gives you no choice but to eat a healthy portion. If you would rather not carry around a to-go box then ask that your entrée be made into a smaller portion. If it is dinnertime ask for the lunch-sized entrée.

Trick #5: Don’t Eat Late
One of the easiest tricks for preventing weight loss is to simply stop eating 3 hours before you go to bed. This is especially effective while on vacation. So skip that late night indulgence and wake up looking and feeling great.

Trick #6: Snack Healthy
Have you ever noticed how travel days create the perfect opportunity for snacking? A coffee and muffin before your flight, a snack on the plane and then before you know it - it’s lunch time! Taking a road trip? This opens up even more opportunities for regrettable stop vending machines, gas station quickie marts and of course the never ending string of fast food restaurants along the highway.

This summer cut unhealthy snacking off at the pass by bringing along your own healthy options. Dried or fresh fruit, unsalted nuts, health bars, cut veggies and low fat crackers are a good start. By filling up on these healthy snacks between meals you will end up eating less when presented with a less-than-healthy meal.

Trick #7: Avoid Fried Foods
Fast food restaurants are definitely convenient, with their low prices and quick service, but the convenience is not worth the additional pounds brought on by chips and fries. As you enjoy your vacation keep this in mind: avoid fried foods. While this is always good advice to follow, it is even more important to abide by while traveling.

While vacationing you will likely burn fewer calories each day than you would burn at home, and you are consuming more calories due to your schedule of eating out. You are walking a fine line, and eating fried foods would throw you right over the edge. A gram of fat contains 9 calories as compared to the 4 calories that proteins and carbohydrates carry - so you can see that consuming fried foods will drastically increase your caloric intake.

If I still haven’t convinced you to pass on the curly fries, keep in mind that heartburn and indigestion are never fun...especially while on vacation!

Brian Hernandez is a dedicated fitness professional and his mission in life to educate and motivate ordinary people to achieve extraordinary health and fitness results.  Brian coaches and trains individuals for weight loss, lean muscle gain, holistic wellness, and sports performance.  Brian’s background is in food science and has personal training certifications from the nationally recognized AFAA and ISSA. 

Wednesday, January 15, 2014

The Collateral Damage of a Teenager

What adolescence does to adolescents is nowhere near as brutal as what it does to their.

On call Editor Donna Thomas shares an interesting and very relevant article that recently appeared in NewYork Magazine last week.  We all understand the trials and tribulations of raising children,  but when they enter adolescents parenthood can feel like a life sentence!  

For Full Article,  Click here The Collateral Damage of a Teenager

Monday, January 6, 2014

On-call with Editor Donna Thomas

Happy new year readers from the doctors and staff at Pedimedica! We all know January is a time for resolutions. Why not make a family resolution to get a healthy start on the new year! reports that family meals are making a comeback. And that's good news for a couple of reasons:

Shared family meals are more likely to be nutritious.

Kids who eat regularly with their families are less likely to snack on unhealthy foods and more likely to eat fruits, vegetables, and whole grains.

Teens who take part in regular family meals are less likely to smoke, drink alcohol, or use marijuana and other drugs, and are more likely to have healthier diets as adults, studies have shown.

Beyond health and nutrition, family meals provide a valuable opportunity to reconnect. This becomes even more important as kids get older.

Making Family Meals Happen

It can be a big challenge to find the time to plan, prepare, and share family meals, then be relaxed enough to enjoy them.

Try these three steps to schedule family meals and make them enjoyable for everyone who pulls up a chair.

1. Plan

To plan more family meals, look over the calendar to choose a time when everyone can be there.

Figure out which obstacles are getting in the way of more family meals busy schedules, no supplies in the house, no time to cook. Ask for the family's help and ideas on how these roadblocks can be removed. For instance, figure out a way to get groceries purchased for a family meal. Or if time to cook is the problem, try doing some prep work on weekends or even completely preparing a dish ahead of time and putting it in the freezer.


2. Prepare

Once you have all your supplies on hand, involve the kids in preparations. Recruiting younger kids can mean a little extra work, but it's often worth it. Simple tasks such as putting plates on the table, tossing the salad, pouring a beverage, folding the napkins, or being a "taster" are appropriate jobs for preschoolers and school-age kids.

Older kids may be able to pitch in even more, such as getting ingredients, washing produce, mixing and stirring, and serving. If you have teens around, consider assigning them a night to cook, with you as the helper.

If kids help out, set a good example by saying please and thanks for their help. Being upbeat and pleasant as you prepare the meal can rub off on your kids. If you're grumbling about the task at hand, chances are they will too. But if the atmosphere is light, you're showing them how the family can work together and enjoy the fruits of its labor.


3. Enjoy

Even if you're thinking of all you must accomplish after dinner's done (doing dishes, making lunches, etc.), try not to focus on that during dinner. Make your time at the table pleasant and a chance for everyone to decompress from the day and enjoy being together as a family.

They may be starving, but have your kids wait until everyone is seated before digging in. Create a moment of calm before the meal begins, so the cook can shift gears. It also presents a chance to say grace, thank the cook, wish everyone a good meal, or to raise a glass of milk and toast each other. You're setting the mood and modeling good manners and patience.

Family meals are a good time to teach civilized behavior that kids also can use at restaurants and others' houses, so establish rules about staying seated, passing items instead of grabbing them, putting napkins on laps, and not talking with your mouth full.

You can gently remind when they break the rules, but try to keep tension and discipline at a minimum during mealtime. The focus should remain on making your kids feel loved, connected, and part of the family.

Keep the interactions positive and let the conversation flow. Ask your kids about their days and tell them about yours. Give everyone a chance to talk.

Need some conversation starters? Here are a few:

If you could have any food for dinner tomorrow night, what would it be?

Who can guess how many potatoes I used to make that bowl of mashed potatoes?

What's the most delicious food on the table?

If you opened a restaurant, what kind would it be?

Who's the best cook you know? (We hope they say it's you!)