lohud.com — Throat ailment on the rise: Disease narrows esophagus

Throat ailment on the rise: Disease narrows esophagus

 Linda Lombroso, llombros@lohud.com 11:25 a.m. EDT May 11, 2015

 

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Jack Weiss, 11, of Suffern has EOE, a severe food allergy that affects the esophogus. He has started a facebook page as a support group and to raise awareness. (Video by Peter Carr/The Journal News)

Eosinophilic esophagitis (EoE) is a chronic allergic inflammatory disease of the esophagus. Cases have risen dramatically in the past 20 years, say doctors, and there remains no cure for the disease.

 

(Photo: Peter Carr/The Journal News)
(Photo: Peter Carr/The Journal News)

STORY HIGHLIGHTS

  • Eosinophilic esophagitis is a chronic allergic inflammatory disease of the esophagus
  • Many people are not aware they have the condition, which is increasing in prevalence
  • Symptoms include stomach pain, throat pain, reflux, regurgitation and difficulty swallowing
  • If left untreated, eosinophilic esophagitis can lead to narrowing of the esophagus

Most people have never heard of the disease that runs Jack Weiss’ life.

But eosinophilic esophagitis (EoE) is on the rise, say doctors — and many children and adults have no idea they’ve got it. Left untreated, the condition can lead to narrowing of the esophagus and severe difficulties swallowing. Treatment options vary, but there exists no cure.

“Everybody knows about Lyme disease and celiac disease, but they’re totally blindsided when you bring this up,” says Dr. Howard Bostwick, a pediatric gastroenterologist with Children’s and Women’s Physicians of Westchester. “It’s become probably one of the major diagnoses we make.”

Symptoms of EoE can include throat pain, abdominal pain, vomiting and trouble swallowing, according to the Cincinnati Center for Eosinophilic Disorders, one of the nation’s few research centers devoted exclusively to the condition. Young children with the disease may have slow or poor growth. Adolescents who are undiagnosed may suddenly have food impacted in the esophagus.

Regurgitation and reflux-like symptoms are also common in children, says Bostwick.

Jack, who lives in Suffern, found out he had EoE three years ago, when he was 8, after he started getting stomach aches and throat pain at summer camp. “I was thinking it was in my head, but my allergist and the GI doctor said to take an endoscopy, and that’s how they diagnosed me,” he says.

The condition, a chronic allergic inflammatory disease of the esophagus, is caused by an overgrowth of white blood cells called eosinophils. Most who are diagnosed with EoE must dramatically alter their eating habits or risk causing permanent damage.

“You take a 14-year-old boy who’s eating, and all of sudden the food sticks and he becomes completely unable to swallow it,” says Bostwick. “Overwhelmingly, when this happens to a child of this age and we investigate it, they turn out to have eosinophilic esophagitis.”

While Jack’s family was aware of his peanut allergy, finding out he also had EoE opened up a dark new world. “I was hopeful the diagnosis could put us on the road to recovery, so he would feel better,” says Alyssa Weiss, Jack’s mother. “But I was devastated to find out this may be a lifelong battle for him.”

Alyssa began researching treatment options for Jack, and learned the choices were limited. Children with EoE are sometimes put on feeding tubes. Others need to drink an elemental amino acid formula that tastes so terrible, many can’t get it down. Some are treated with steroids.

Ellyn Kodroff, the president of CURED (Campaign Urging Research for Eosinophilic Diseases), first learned about EoE when her daughter, Jori, was diagnosed in 2003 at the age of 11. At the time, doctors told the family that 1 in 10,000 had the conditon. Now it’s up to 1 in 1,000, she says.

Bostwick says the reason for the rise in cases of EoE remains unclear. But the toll it takes on patients and families is profound, says Kodroff.

At 14, Jori had to go on formula and stop eating all food. Now, at 22, she is able to eat only six things: apples, pears, bananas, shrimp, broccoli, potatoes and lettuce. She has been on steroids for 10 years.

Alyssa didn’t want Jack to go the steroid route. So, with the help of an allergist and a gastroenterologist, he started an elimination diet that omitted foods believed to provoke an allergic reaction. Since his diagnosis, he’s had an endoscopy every two to three months and is responding well to his current diet, which allows for about 20 foods, including corn, bananas, raspberries, chicken and rice.

The severe food restrictions means Jack can’t go to restaurants. Birthday parties are difficult. And family trips require extensive planning.

But Jack considers himself lucky. He’s feeling better, he’s not on steroids, he’s doing well in school and he’s kicked off a fundraising campaign through his own Facebook page, Allergy Island, aimed at raising awareness of EoE.

So far, he’s gotten more than 1,000 likes — and his original dance, the Allergy Island shuffle, is finding people jumping around on camera in hopes of helping Jack spread the word. He’d like to see the dance go viral, the way the ice-bucket challenge put the spotlight on ALS.

“If I’m able to raise awareness and donations, bring us closer to a cure or make even a 1 percent difference, then I couldn’t ask for more,” he says.

Kodroff, whose foundation is the primary source of funding for EoE research, says Jack’s attitude is extraordinary. But for this 11-year-old, it’s just a matter of looking on the bright side.

“Everything happens for a reason,” he says. “If I could make one person feel less alone in this, one school more conscious of how they treat students with allergies, or help one person get answers, then I’ll be happy.”

Twitter: @LindaLombroso

Learn more

CURED (Campaign Urging Research for Eosinophilic Disease): curedfoundation.org

Cincinnati Center for Eosinophilic Disorders: cincinnatichildrens.org/service/c/eosinophilic-disorders

American Partnership for Eosinophilic Disorders: apfed.org

lohud.com — Maternity: Doctors say childhood vaccines are critical

Maternity: Doctors say childhood vaccines are critical

Vaccines protect infants, children and teens from 16 diseases, says the CDC. Pediatricians recommend that babies get vaccinated on schedule, as they’re most prone to complications from illness.

Between birth and age six, children get dozens of vaccinations — and with good reason. According to the American Academy of Pediatrics, childhood immunizations have reduced the number of infections from vaccine-preventable illnesses by 90 percent.

Babies are at the highest risk for developing dangerous complications from illness, which means it’s critical to get them vaccinated on schedule, says Dr. Vicki Iannotti, a pediatrician with Children’s and Women’s Physicians of Westchester in Hawthorne.

“It all boils down to a simple thing,” she says. “The reason to immunize early is because the youngest are the most vulnerable.”

Vaccines can prevent infants, children and teens from developing 16 diseases, including whooping cough (pertussis), polio, measles, mumps, rubella (German measles), and bacterial meningitis, according to the Centers for Disease Control and Prevention.

Infants get their first shot, against Hepatitis B, shortly after birth. The next round of immunizations is given at two months, against Hepatitis B, rotavirus, diphtheria, pertussis, tetanus, polio, Haemophilus influenzae type B and pneumococcus. The recommended immunization schedule for children from birth to age six includes vaccines at regular intervals.

“The diseases of pertussis and Haemophilus influenzae cause the most serious infection in young babies,” says Iannotti.

“If you wait, you’re playing Russian roulette until the kids are vaccinated,” says Larchmont pediatrician Dr. Alain Le Guillou. “And as we’re seeing with measles, not only do you put your kids at risk, but all the other kids around you.”

The measles outbreak that started in late December at Disneyland, in California, led to 147 cases of the virus in seven states, according to the CDC, and reinvigorated the debate about vaccine safety.

“There are some people who feel the shots carry a danger as opposed to recognizing the danger is often in not doing the shots,” says Dr. Michael Lasser, a pediatrician in Cortlandt.

Parents who want to delay vaccines, or skip them altogether, are putting their children at risk, says Dr. Daniel Cohen of North Rockland Pediatrics in Garnerville. The first dose of the measles vaccine (MMR, which includes protection against mumps and rubella) is given to children between 15 and 18 months of age. “I think it’s dangerous on a public-health scale not to give the vaccine,” he says.

Le Guillou often sees families that question the efficacy of vaccines in general.

“It’s a strange misconception in some of the fairly educated young parents — who obviously are not reading and are just listening to some weird urban myth — that breastfeeding is going to be the key to keeping their children healthy,” he says. “That’s some bizarre myth, because it’s been proven for 5,000 years or more that it didn’t work enough to protect infants from dying at a very early age.”

Vaccines have gone through rigorous testing, says Iannotti, and are known to protect children from unnecessary illness.

But until infants can get their first round of shots, it is important that they’re shielded from infection. “I cringe when I see a newborn at a crowded event,” adds Iannotti. “Parents don’t realize they’re putting their baby at risk.”

If infants under the age of six-to-eight weeks develop a fever higher than 100.4, they need a sepsis workup, which requires hospitalization and includes a urine culture by catheterization, blood tests and a spinal tap, she says. “That’s because a throat or ear infection could develop into meningitis.”

Family members and caregivers of infants should be sure they’re up-to-date on their DTaP (diphtheria-pertussis-tetanus) vaccines so they can’t pass along whooping cough, she says. It is also crucial that parents, grandparents and caregivers get a flu shot each year, says Iannotti. Flu vaccines are recommended for babies, starting at six months.

Vaccinations are critical to children’s health, adds Iannotti, noting that the past several decades have seen additions to the list of immunizations, including shots against rotavirus, Hepatitis A, pneumococcus and chicken pox.

“It’s a long list, but it’s a matter of saying to parents, ‘This is what we can do to prevent serious illness,’ ” she says.

lohud.com — Claims of arsenic in wine cause health worries

Claims of arsenic in wine cause health worries

Linda Lombroso, llombros@lohud.com 6:38 p.m. EDT March 24, 2015

A class-action lawsuit in California claims 28 wineries are producing wines dangerously high in arsenic. While arsenic is a toxic substance, the amount of exposure determines health risk, says doctor.

Dr. Robert Amler, the dean and professor of public health at New York Medical College, told the Journal News that even if a bottle of wine had 10 ppb of arsenic, you would need to drink 70 ounces to reach the daily EPA limit.
Dr. Robert Amler, the dean and professor of public health at New York Medical College, told the Journal News that even if a bottle of wine had 10 ppb of arsenic, you would need to drink 70 ounces to reach the daily EPA limit.

If you found out your favorite wine might contain high levels of arsenic, would you stop drinking it?

That’s the quandary facing wine lovers, as news of a class-action lawsuit against 28 California wineries left many on the East Coast wondering if their daily glass of low-cost vino might actually pose a health risk.

The lawsuit, filed in California Superior Court, claims that wineries failed to warn consumers of the potential dangers of their “arsenic-tainted” wines — citing some as containing up to 500 percent more than the acceptable safe daily limit. Most of the wines are inexpensive white or blush varietals.

Attorneys who filed the lawsuit created a web site, TaintedWine.com, which contains a full list of wines cited.

Arsenic occurs naturally in the environment, and can be found in soil, water, air, plants and animals. Inorganic chemical compounds containing arsenic — found in building products, manufacturing and arsenic-contamined water — are considered more toxic than organic compounds, according to the American Cancer Society. Exposure at high levels has been linked to certain types of cancer.

When it comes to arsenic toxicity, it all depends on the level of exposure, said Dr. Robert Amler, dean and professor of public health at New York Medical College, and cofounder of the Children’s Environmental Health Center of the Hudson Valley. “The quantity, or dose, is the most important factor in determining what the health effects, if any, would be.”

Arsenic that is inhaled through industrial exposure can be deadly, said Amler, a pediatrician with Children’s and Women’s Physicians of Westchester. “Arsenic in food or drink also can be deadly in the highest concentrations, but we scarcely ever reach those concentrations.”

The Environmental Protection Agency’s acceptable limit — or “reference value” — for arsenic in drinking water is 10parts per billion, abbreviated as ppb.

“It’s not considered entirely or perfectly risk free, and that’s partly because it’s hard to study effects when it gets that low, and arsenic many times is accompanied by other contaminants that are also toxic,” said Amler.

Still, most people don’t drink as much wine as they do water. Even if a bottle of wine had 10 ppb of arsenic, you would need to drink 70 ounces to reach the daily EPA limit, said Amler. Using the same formula, it would take 14 ounces of wine a day, every day, containing 50 ppb of arsenic to reach the EPA limit.

Most of the arsenic found in wine comes from pesticides used in vineyards, he said.

“It appears right now that the risk in the wine, at worst, is uncertain,” said Amler. “It is probably not very high, but we can wait to learn more about exactly what’s being done, and of course there’s the hope that producers will take the necessary steps to lower the arsenic.”

Although “one or two” shoppers called Stew Leonard’s Wines of Yonkers with questions about arsenic, there are no plans to remove products cited in the lawsuit from store shelves, said wine specialist Paige Donahoo.

“Obviously, our greatest concern is for customers, and if they’re having a problem, we will exhange items or take them back,” said Donahoo. “But I’m not worried about drinking a glass of wine from these bottles myself.”

Tony Russo, owner of Aries Wines and Spirits in White Plains, said he’s more concerned about the “irresponsible publicity” generated by the lawsuit than the actual arsenic content of the wines in question.

“There’s no research that shows the amounts found in wine pose a health risk to consumers, and again we’re talking parts per billion,” said Russo. “What they’re doing is blowing this all out of proportion.”

Twitter: @LindaLombroso

Times Herald-Record: When should you call your baby’s doctor?

When should you call your baby’s doctor?

DR. JEFF HOROWITZ
DR. JEFF HOROWITZ
By Beth Kalet
For the Times Herald-Record

Posted Mar. 16, 2015 at 11:17 AM

When it comes to babies, sometimes a cry is a call for cuddling, and sometimes it’s much more serious. It isn’t always easy to know what those more urgent cries mean. Wouldn’t it be nice if babies could simply describe their symptoms to parents and pediatricians? It would make diagnosis a whole lot easier.

Because babies and children don’t have the vocabulary to detail their symptoms, pediatricians need to help parents recognize when it’s imperative to visit the doctor.

“There are some things that are red flags that I want parents to call me about,” says Dr. Jeff Horowitz, a pediatrician in Warwick for 30 years. He’s part of the Herbert Kania Pediatric Group, which is part of Children’s and Women’s Physicians of Westchester, with offices in West Milford, N.J., too.

Horowitz listed four major situations where “I absolutely want to be called.”

1. Fever. If a baby under 2 months old has a rectal temperature above 100.3, this is cause for concern. “That is something I want to be called about right away,” Horowitz says. “Babies don’t localize infections very well, and they don’t tell us what’s wrong, so when they have fever it could be something trivial like the start of a cold or it could be something serious like sepsis.”

2. Vomiting. Of course all babies spit up, Horowitz acknowledges. But vomiting is a more serious situation. If a baby vomits a full feeding twice in a row, “doctors need to be notified.”

3. Respiratory difficulty. “Clearly any child with respiratory difficulty, who is breathing fast, breathing hard, where you can see their rib muscles going in and out” is in distress. Don’t wait and to see if it will pass. Contact the pediatrician.

4. Irritability. “This is different from fussiness,” explains Horowitz. “There are fussy baby cries and whines and complaints and then you pick them up and they stop. A baby who’s irritable no matter what and doesn’t stop” falls into a different category. Bring the baby in for a consultation. While the cause may not be directly evident, it’s the physician’s job to try to find out the reason behind the symptom.

“The thing with kids,” Horowitz says, “is all of the these symptoms are non-specific and can be the sign of serious illness.” By heeding these guidelines, parents can help pediatricians to discover what’s behind the complaints — “to help us differentiate a kid who’s not feeling well from a kid who’s really got something bad.”

“We worry about congenital anomalies, for example babies with obstructions; we worry about infectious diseases, about babies with metabolic conditions, where they don’t digest food properly,” Horowitz explained. “Those are the biggies.”

Keeping kids safe and healthy

Above and beyond being on the lookout for these symptoms, Horowitz says there’s an overriding everyday parental mandate: “It’s not so much recognizing when they (children) are sick, but keeping them healthy and keeping them safe.”

“The biggest cause of mortality with kids,” stressed Horowitz, “is accidents: household accidents and car accidents.”

Ensuring a child’s safety and health are the most important jobs for parents and caregivers. Here are Horowitz’s top tips for keeping baby safe and strong.

Car seats. Make sure car seats are properly installed and being used correctly.

Sudden Infant Death Syndrome. For newborns, preventing SIDS (Sudden Infant Death Syndrome) is a parent’s first priority. Current research dictates that babies should sleep on their backs. “The newborn environment, the crib, should be a very stark environment with just a mattress and a sheet. No bumpers, no blankets, no stuffed animals. Nothing soft that babies’ noses could get into.” The suspected process that leads to SIDS, Horowitz says, “is rebreathing your own air.”

Vaccines. “Make sure you give your kids the vaccines. For vaccine-hesitant people, we try to allay their fears with data. They really are safe.”

Baby proof your home. Keep medicines and poisons locked. Install gates by stairs. Set hot water temperature below 120 degrees F.

Pool safety. Keep swimming pools fenced and locked.

Encourage a healthy lifestyle. Horowitz urges parents to follow the “5-2-1-0 plan.” “Five fruits and vegetables per day. Not more than two hours of screen time during the day. At least one hour of exercise every day and zero soda.” That’s a lifestyle choice that benefits children throughout their lives, he adds.

Lohud.com — View: Vaccines keep all our kids safe

View: Vaccines keep all our kids safe

Re “Some chiropractors turn their backs on vaccines,” Feb. 18 article:

As a responsible citizen and pediatrician, I cannot let your headline about chiropractors and vaccination go unnoticed and unanswered.

Yes, many chiropractors avoid vaccination. As a matter of fact, I have taken care of dozens of their children, and to no one’s surprise, many of them developed pertussis (whooping cough), with severe coughing which lasts from 10 to 26 weeks. No, none of the patients in our office who were vaccinated caught it from them – fortunately.

Vaccinations are not a joke, or a manipulation by doctors, pharmaceutical companies or the government. They are the greatest medical miracle in history. Ask your grandparents what it was like to live in an era of paralytic polio or rampant bacterial meningitis. The unvaccinated chiropractor lives in a community where everyone else’s vaccine protects him, allowing him to snidely think he knows the answers to infectious disease.

Please don’t spread the wrong message. Our children’s lives are at stake. Pay attention to our brilliant scientists. Get your children vaccinated.

The writer is a board-certified pediatrician practicing at North Rockland Pediatrics.

Lohud.com – Students stay home as flu, viruses hit area

Students stay home as flu, viruses hit area

Jane Lerner December 18, 2014

“We have really seen an increase in respiratory illness and fever this week,” said Dr. Alanna Levine at Orangetown Pediatric Associates, an affiliate of Children’s and Women’s Physicians of Westchester.

Colds, viruses and the flu are keeping kids at one Lower Hudson Valley school district home in droves and experts predict more will get sick as people swap germs at holiday celebrations.

Ramapo Central School District has seen the number of student absences rise dramatically over the past several days.

Suffern High School principal Patrick Breen sent a letter to parents Thursday asking them to keep sick students at home to prevent further spread of illness.

The school is taking special steps to sanitize desks, keyboards, door knobs and other common areas to kill germs.

Influenza is already widespread in Westchester, Rockland and Putnam counties as well as much of the rest of New York, according to the state Department of Health.

The flu season usually peaks in January or February and can continue until the spring.

This is the time of year when people start to get sick.

The Mamaroneck schools are seeing a slight increase in the number of students out sick, which is common this time of year, a spokeswoman said.

Doctors’ offices are becoming packed with people – especially youngsters – with fever, coughs, sore throats and other symptoms.

“We have really seen an increase in respiratory illness and fever this week,” said Dr. Alanna Levine, a pediatrician at Orangetown Pediatric Associates, an affiliate of Children’s and Women’s Physicians of Westchester.(Photo: Courtesy)

“We have really seen an increase in respiratory illness and fever this week,” said Dr. Alanna Levine, a pediatrician at Orangetown Pediatric Associates, an affiliate of Children’s and Women’s Physicians of Westchester.

Many of those young people were diagnosed with RSV, or respiratory syncytial virus infection, which is similar to a bad cold. Others have strep throat and a few have been diagnosed with influenza, she said.

After a few days at home most people are recovering quickly, Levine said.

She recommends that families visiting other people for the holidays isolate a sick child and wash their hands often to prevent spread of the disease.

Flu shots are still available.

Twitter: @JaneLernerNY

Tips to fight the flu

Its not too late to get vaccinated.

If you are exposed to someone with the flu, consult your health care provider to see whether treatment is necessary.

Wash your hands frequently.

Disinfect surfaces like telephones or desktops.

If sick, stay home and rest.

Cover your coughs and sneezes.

Source: New York State Department of Health