Put a Stop to Side Stitches

May 22, 2012

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Side stitches, those stabbing pains in your side that sometimes occur during physical activity, can derail your good exercise intentions. What causes them and what can you do to ward them off?

When Excellence Is the Standard. Part 2

May 16, 2012

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The contest is on and you will hold that disk of iron until the effort of the thumb and forefinger sends sweat dripping down your brow and your whole body twists in anguished resignation as the “Clank!” eventually comes.

When Excellence Is the Standard. Part 1

May 16, 2012

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Can burnout be put off forever? When excellence is the minimum requirement for you and your staff, it takes extreme mental and emotional energy. It’s not enough to spell out and repeat the requirements; everyone involved needs to tap a source that will replenish the energy to drive new excellent performance.

Whooping Cough?

May 10, 2012

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Your 14-year-old son has been coughing for a month. He doesn’t have fever, and he feels well overall. But he coughs very hard several times an hour; sometimes so hard that he vomits. Your son’s doctor wants to test for whooping cough.
Whooping cough? Didn’t your son receive that vaccine several times during his infancy? How can he have whooping cough? Let’s explore how widespread whooping cough is in childhood and adolescence, as part of our series on coughs.

Whooping cough, or pertussis, is a highly contagious respiratory illness caused by the bacterium Bordetella pertussis. This bacterium infects the nose and respiratory tract, producing a protein toxin that results in tremendous inflammation of the lining of the windpipe and bronchial tree that can last weeks or even months.

The illness begins very much like a cold, but the cough is more intense than with the usual cold and gets much worse, rather than better.

Children with pertussis may cough as infrequently as several times a day, or as frequently as several times an hour. The cough is very distinctive in infants and small children: It occurs in bursts, without warning, and can last for 10 to 20 seconds (or longer) without the child being able to take a breath.

During the cough, the child’s face will often become bright red or, occasionally, bluish. The child may appear anxious, as he seems to “strangle” on the mucus he coughs up. At the end of a long series of coughs, the child will take a very deep breath, which may be heard as a “whoop” — hence the name “whooping cough.”

The cough of pertussis usually lasts at least six weeks and perhaps as long as six months, with the time between coughing episodes gradually lengthening. Because the child does not initially seem very sick, whooping cough may not be diagnosed until the child has been coughing for more than two to four weeks. And although antibiotics (oral erythromycin or related antibiotics such as azithromycin) are prescribed to kill the bacteria and to reduce contagion, antibiotics have no effect against the toxin, which is what causes the prolonged cough.

Whooping cough was widespread before immunization was available in the late 1940s. At its peak in 1934, there were at least 260,000 cases of pertussis among children in the United States, with as many as 9,000 deaths in a year — most of them very young and weak infants.

Now, about 5,000 to 7,000 cases of pertussis are diagnosed each year in the United States, and many of these are preventable by immunization.

All children in the United States should be immunized against pertussis. The triple vaccine DTaP (diphtheria-tetanus-acellular pertussis) is recommended and generally required for babies at 2, 4 and 6 months of age, with boosters at age 15 months to 18 months, and again when entering school (age 4 to 6 years). But pertussis vaccine produces only about 70 to 80 percent immunity against this bacterium, and the immunity from each shot lasts only about 5 years.

Who gets whooping cough? Infants younger than 2 months and older infants who have not received the entire series of DTaP immunizations are at the highest risk of whooping cough. Very young babies can become extremely ill with pertussis and may need to be hospitalized for respiratory and nutritional support.

But any age group is susceptible, especially adolescents and adults, whose immunity from the childhood vaccine wanes after about age 10. It is estimated that 25 percent of otherwise healthy adults who have a chronic cough actually have whooping cough, and these infected adults can pass the bacterium to unimmunized infants and children.

Your doctor can diagnose whooping cough by culturing the bacterium from mucus in the nose or back of the throat, by blood tests demonstrating high levels of antibody to pertussis, or by testing the mucus for pertussis antigens or DNA (PCR, or polymerase chain reaction). PCR testing is expensive but very accurate in detecting pertussis.

Antibiotics will be prescribed for the child and for others in the family, and your child will not be able to attend school or day care until he has taken the antibiotic for at least 5 days.

Whooping cough is a reportable disease, which means the doctor is required to report it to the state health department. In some situations, the health department will test or treat other children in the school or day care for pertussis, too.

Be sure your children have received all the immunizations that are recommended and consult your child’s doctor if your child has a persistent cough that you think may be whooping cough.