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by Natalie Hodge MD FAAP on January 16th, 2013

We set up and tested Kennedy's Dex following the DIY  training site at Dexcom.com and in two hours we were up and running.    Here are my observations over the past 5 days... 

1.   Insertion did not hurt at all.   No brainer,   Kennedy has very little body fat,  and we had been told it would probably be uncomfortable to wear by our endo.    Really, a human hair is pretty tiny... 

2.   Tape does peel up after the third day a bit, but we left it alone and it seems to be sticking just fine, aside from these tiny edges that peel up at the top and bottom of adhesive.   Kennedy's a dancer, so naturally stretching is going to pull those edges...   

3.   No itchiness at the adhesive site whatsoever on day 5, that has been an issue with us for pods so we are happy to see that. 

4.   Accuracy gets better and better,    day one varied about 15%,  but from then on our calibrations have been scary spot on, varying between 1 to 5 points when blood sugar is in range.     With super high's ( we did have a pod fail this week)  vary's up to 30 points or so, as is to be expected with the variability of the meter at the high level.  

5.   Lag time seems to be around 10 minutes or so for us. 

6.    Low alarm of 80 seems about right,   if she's dropping fast and at 100,  we have still been able to thwart low blood sugars and head them off at the pass with this thing.   

7.    What an eye opener to see these blood sugars in flux,  we really get a new feel for how blood sugars FLOW.    Its always going somewhere, rarely flat, except last night when we finally managed to get basals set right! 

More to come but so far we have been happy and grateful for this incredible new diabetes tech!!     More on Dex here. 

To  Your Best Health, 
Dr Hodge 

by Natalie Hodge MD FAAP on January 9th, 2013

I am excited to be receiving Kennedy's new Dexcom G4 device for us to keep up with blood sugars continuously!   Fed ex to ship friday.    The other exciting development is that through my emr hello health, I will be able to remotely monitor blood sugars for my diabetics through Hello Health's integration with Qualcomm's 2net platform.   Now that is the future!!   All Dmom's should be demanding this of their caregivers!!

To Your best Health,
Dr Hodge

by Natalie Hodge MD FAAP on September 27th, 2011

We use generally the criteria as set forth in the DSM-IV which is our ” Bible” for psychiatric diagnoses. In addition to this the American Academy of Pediatrics has also added in a few additional criteria for ADHD to consider when looking at medication therapy. The AAP’s additional criteria essentially asks that we use explicit criteria from DSM-IV, second that we obtain information about the child in more than one setting, and third that we give consideration to the possibility of comorbid disorders as OCD and Oppositional Defiant Disorder

Here are the DSM criteria…

IA. Six or more of the following signs of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

* Inattention:

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (such as toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.

IB. Six or more of the following signs of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

* Hyperactivity:

1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often “on the go” or often acts as if “driven by a motor”.
6. Often talks excessively.

* Impulsiveness:

1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one’s turn.
3. Often interrupts or intrudes on others (example: butts into conversations or games).

II. Some signs that cause impairment were present before age 7 years.

III. Some impairment from the signs is present in two or more settings (such as at school/work and at home).

IV. There must be clear evidence of significant impairment in social, school, or work functioning.

V. The signs do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The signs are not better accounted for by another mental disorder (such as Mood Disorder, Anxiety Disorder, Dissociative Identity Disorder, or a Personality Disorder).

I like to evaluate the child over the course of several visits. It is important to take a careful dietary history in the process of ADHD evaluation. Many processed cereals and convenience foods are loaded with corn syrup. A high sugar diet may play a role in inattentiveness and hyperactivity in many children. Another important factor is sleep. A child who is not getting enough sleep may present with hyperactivity. A careful physical exam and history are necessary to rule out sleep apnea, which may also present with hyperactivity and inattention. Some children will really improve with a trial of diet and sleep hygiene.

by Natalie Hodge MD FAAP on September 20th, 2011

by Natalie Hodge MD FAAP on August 29th, 2011

Molluscum contagiosum (MC) is a viral infection of the skin or occasionally of the mucous membranes. It is caused by a DNA poxvirus called the molluscum contagiosum virus (MCV). MCV has no animal reservoir, infecting only humans. There are four types of MCV, MCV-1 to -4; MCV-1 is the most prevalent and MCV-2 is seen usually in adults and often sexually transmitted. This common viral disease has a higher incidence in children, sexually active adults, and those who are immunodeficient,[1] and the infection is most common in children aged one to ten years old.[2] MC can affect any area of the skin but is most common on the trunk of the body, arms, and legs. It is spread through direct contact or shared items such as clothing or towels.

The virus commonly spreads through skin-to-skin contact. This includes sexual contact or touching or scratching the bumps and then touching the skin. Handling objects that have the virus on them (fomites), such as a towel, can also result in infection. The virus can spread from one part of the body to another or to other people. The virus can be spread among children at day care or at school. Molluscum contagiosum is contagious until the bumps are gone (which, if untreated, may last up to 6 months or longer).

The time from infection to the appearance of lesions can range up to 6 months, with an average incubation period between 2 and 7 weeks.

Individual molluscum lesions may go away on their own and are reported as lasting generally from 6 to 8 weeks,[4] to 2 or 3 months.[5] However via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously reported as 8 months, to about 18 months,[6][7] and with a range of durations from 6 months to 5 years.

Treatment is unnecessary in kids depending on the location and number of lesions, and no single approach has been convincingly shown to be effective. It should also be noted that treatments causing the skin on or near the lesions to rupture may spread the infection further, much the same as scratching does

It is helpful for toddlers to treat irritated areas with neosporin, and also helps to put a long shirt over the area, so keep the child from scratching the warts. There are medical treatments for molluscum, but we generally don't recommend them as they are painful and can cause permanent scarring, whereas molluscum that run their natural course resolve with no scars.

It seems bizarre for a viral wart rash to last for so long but the best outcome with the least pain and suffereing ( for both the child and the parent) is watchful waiting!

Natalie Hodge MD FAAP

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