300450391049 3910400 SBM041, SBM067, SCM037,
SDM027, SEM109
Children's TYLENOL® Plus Cold MS
Suspension 4 oz. Grape
300450296047 2960400 SBM042, SCM015, SCM036,
SDM034
Children's TYLENOL® Suspension 4oz.
Grape
300450407047 4070400 SBM043, SBM044, SCM029 Children's TYLENOL® Suspension 4oz.
Bubble Gum
300450493040 4930400 SBM045, SCM011, SCM030,
SDM035
Children's TYLENOL® Suspension 4oz.
Strawberry
300450122407 1224000 SBM064, SCM033, SDM020 Infants' TYLENOL® Grape Suspension
Drops 1/4oz.
300450186157 1861500 SBM065, SCM005, SCM006,
SDM032
Infants' TYLENOL® Suspension 1/2oz.
Cherry
300450166043 1660400 SBM066, SCM068 Children's TYLENOL® Dye Free
Suspension 4oz. Cherry
300450123046 1230400 SBM068, SCM035, SCM070,
SCM080, SDM005
Children's TYLENOL® Suspension 4oz.
Cherry
300450249043 2490400 SBM069, SBM070, SCM081,
SDM006
Children's TYLENOL® Plus Cough &
Runny Nose 4oz. Cherry
300450122155 1221500 SCM012, SCM067,
SDM007, SDM068
Infants' TYLENOL® Suspension Drops
1/2oz. Grape
300450386045 3860400 SCM013, SCM014, SCM069 Children's TYLENOL® Plus Flu 4oz.
Bubble Gum
300450387042 3870400 SCM016, SFM024 Children's TYLENOL® Plus Cold
Suspension 4oz. Grape
300450247049 2470400 SCM017 Children's TYLENOL® Plus Cough/ST
Suspension 4oz. Cherry
300450122018 1220100 SCM082, SDM039, SDM040 Infants' TYLENOL® Suspension Drops
1oz. Grape
300450167019 1670100 SCM083, SCM084, SDM008 Infants' TYLENOL® Dye Free
Suspension 1oz. Cherry
300450123015 1230100 SDM064 Children's TYLENOL® Pediatric
Suspension 1oz. Cherry
300450186300 1863000 SDM038, SDM009 Infants' TYLENOL® Suspension Drops
1oz. Cherry
300450390042 3900400 SDM033 Children's TYLENOL® Plus Cold/Allergy
4oz. Bubble Gum
300450122100 1221000 SDM078 Infants' TYLENOL® Drops 1oz. Grape
350580144183 1221800 SCM034 Infants' TYLENOL® Grape Suspension
Drops H/G 1/2oz.
350580123034 1230300 SDM028 Children's TYLENOL® Suspension 4oz.
Cherry, Hospital Govt.
Fortunately data related to the H1N1 influenza is suggesting that this new flu is no more deadly than the regular seasonal flu. It is, though, very contagious as most of us don’t have any immunity to it at all. For some reason, it seems that the elderly are slightly less likely to have complications of this flu than younger people. The theory is that over the years they have been exposed to an influenza virus similar to the H1N1 and so have some immunity.
Beginning in October (most likely the end of October), local health departments plan to begin distributing H1N1 vaccine to health care clinics, pharmacies, and medical providers. Those clinics that already participate in the Vaccine for Children Program in Pierce County are already pre-enrolled in this program and will get vaccine. Fir Creek Pediatrics is already pre-enrolled and will carry the vaccine when it is available.
Because it’s unlikely that there will be enough vaccine to immunize everyone at once, there’s a priority list for who gets the vaccine first. These people should be immunized first. As more vaccine becomes available, other people will be able to also get immunized. People getting this vaccine will need two of them in a series to get the highest level of immunity to protect them from complications of H1N1 should they be exposed.
Here’s the priority list for 2009 H1N1 flu vaccine.
1. Pregnant women
2. Household contacts of infants under 6 months of age (this is to protect babies too young to get the vaccine).
3. Healthcare workers (we need to be protected so we can continue to care for sick people; and because we are in such close contact with so many sick people, we need to be protected so we don’t SPREAD H1N1 by being sick ourselves).
4. Children and young people from 6 months old to 2 years old. There is supposed to be preservative free vaccine available for young children.
5.Anyone with underlying health issues such as diabetes, lung disease, asthma, metabolic disorders, neurologic disorders, kidney or liver disease, and any condition that suppresses the immune system.
HOW TO PROTECT YOURSELF FROM INFLUENZA
Stay home if you are sick with a fever and cough symptoms. Wash hands frequently. Avoid close contact with people with fevers & coughs. Viruses and germs are carried on our hands…don’t put your hands in your mouth (without washing them first), avoid touching your face, don’t put objects that you handle or others might handle like your pen or pencil in your mouth. Use hand sanitizer if you think you’ve touched something that could have virus or bacteria on it and you can’t wash your hands right away. Sanitize toys and other potentially contaminated objects with an antiviral spray or by washing between use. Keep infants out of crowded places or places where they may be exposed to potentially sick people.
The bottom line is to USE COMMON SENSE. There’s no need to be frightened or to panic. Keep clean. Keep safe. And consider immunizing if you or a loved one fall into any of the priority groups.
**Updates about possible adverse effects from the H1N1 vaccine will be posted as soon as I am alerted to them. So far it seems that its side effect/adverse effect profile is similar to the regular seasonal flu vaccine.
To find out more on your own, check the Tacoma Pierce County Health Department Current Issues & Disease Alerts website and the CDC Website.
If you’ve listened, read, or watched anything on the topic of Health Care Reform in America, you’ll notice that physicians and doctors are pretty much the only providers of health care getting the attention. They are taking the lead in formulating plans and working to advise the president that they, alone, are the stars in this important discussion.
People who value the care provided by Nurse Practitioners need to SPEAK UP. Let your legislators know that your NP must be a vital part of the future of health care. Here’s a sample letter (that I sent to Senator Cantwell). Feel free to copy it and personalize it to let your senators, state representatives, and EVERYONE ELSE know that NP’s provide quality, cost effective health care.
Dear Senator Cantwell, I am a pediatric nurse practitioner with a private practice in Lakewood, WA. In several states, including Washington state, nurse practitioners are qualified and allowed by law to provide primary care services for their patients independently. We do not require a medical doctor on staff to provide this care.
I am concerned that Mr.. Obama may not be aware of this fact. Repeatedly, he assures Americans that health care reform will allow people to choose their own "doctor." In order to ensure that Americans can also choose their own nurse practitioner, or keep the one they already have chosen, the language of health care reform needs to change.
Nurse practitioners have often been scorned by the powerful American Medical Association. Their ongoing agenda to limit the ability of NP's to continue to provide independent health care jeopardizes affordable and rational health care reform and limits the ability of many patients to access health care at all.
Please don't allow the language of health care reform to limit access to qualified health care providers by referencing doctors/physicians as the primary keepers of the "medical home."
You may contact me any time to discuss this. I also welcome you to my pediatric clinic, Fir Creek Pediatrics. You will find a great deal of support for broadening the language of health care reform to include all providers of primary care.
Sincerely,
Michelle Hayes, MN, ARNP
My last blog post was about ways to avoid diarrhea illness when enjoying splash parks. I noted that I did not know how our Tacoma splash parks sanitized the water. So, I emailed Metro Parks, and here’s their reply:
The water is sanitized through filtration and UV light at our three newest spraygrounds – Jefferson Park, South Park and McKinley Playfield.
At Wapato Hills the water is not recycled.
Sheree Trefry
Communications Coordinator
Metro Parks Tacoma
253-305-1059/253-305-1098
4702 S 19th St., Tacoma, WA 98405
CREATING HEALTHY OPPORTUNITIES TO PLAY, LEARN AND GROW
Thanks, Ms. Trefry, for the very quick reply. So, you can see that Metro Parks uses methods to try to keep visitors safe. Cryptosporidium, the organism that can cause diarrhea illness at such parks is resistant to chlorine and chemical methods, filtration can remove up to 99%, and UV light will inactivate it entirely.
With the wonderful warm weather we’ve had lately, no doubt the splash feature at Jefferson Park in Tacoma is getting lots of use. These kinds of parks are lots of fun for kids and help moms & dads keep cool too. But there is a potential problem, which was outlined in a recent MMWR article. Splash parks can be a great way to spread diarrhea illnesses.
Most diarrhea illnesses are spread through the dreaded “fecal-oral route.” We don’t like to think of this, but water or food can be contaminated by fecal matter by not washing hands well after using the toilet, changing baby diapers, or direct contamination of fecal matter into the water supply or onto a surface where food is prepared.
Water parks like Wild Waves and pools are regulated and use various techniques to sanitize the water. Examples are chemicals (such as chlorine) and UV light. Remember, there are some organisms that cause diarrhea illness that are actually resistant to chemical decontaminants and filtration (example is Cryptosporidium). Contamination can occur despite the most rigorous efforts to control the water safety. The good thing is that it doesn’t happen often, and so we don’t usually worry too much about it.
Splash parks may also use methods to decontaminate or sanitize the water. Usually, though, they are not regulated in the same way as pools. I honestly do not know how Jefferson Park’s splash feature is maintained, although I do have an email out to Metro Parks Tacoma asking for details. My grandson, Hunter, loves visiting that park as you can see in the picture above.
HERE ARE WAYS TO PREVENT CONTAMINATION OF SPLASH PARKS: as recommended by the editors of the MMWR:
1. Use soap & water to bathe children before playing in the water—be sure to wash their bottoms also.
2. Change diapers in designated areas such as the bathroom and use soap & water to wash the child if there is stool in the diaper. Wash your hands after with soap & water.
3. NEVER play at such a park if you or your child have a diarrhea illness.
4. Don’t drink the water or swallow splashes from the water in the water feature.
5. Don’t allow children or adults to sit on the water spraying part of the water feature.
6. Find out how your park maintains the water safety, and don’t utilize the park if it isn’t maintained and monitored properly to prevent spread of diarrhea illnesses.
7. Check with the local Health Department to find out if they regularly monitor the safety of your favorite park.
This week, on Wednesday, Sofie went to her first appointment with the oncology vet. A week out from her surgery to remove the melanoma from her lip, we trekked all the way to Seattle to Animal Cancer
Specialists. We met with Dr. Gillings who is a vet of 6 years who returned to school to specialize in oncology. She is a tiny matter-of-fact woman who was very easy to talk with. She’d already reviewed Sofie’s pathology report on the oral melanoma tumor, and spoke with me as if I were her peer as we discussed the likely prognosis and treatment options. I’d read about the melanoma immunization (see the melanoma link above) and had just about decided that Sofie would get it.
But earlier in the week I’d noticed a weird lump on Sofie’s hip and so Dr. Gillings did a needle biopsy of that along with her neck lymph nodes. Just to be on the safe side (needle biopsies aren’t the most fun thing to have done), Sofie got to wear a lovely basket muzzle. She was thrilled, as you can see by her face in this picture. She was tense, but cooperative. After two needle biopsies of each lymph node and the bump on her hip, she was taken back for chest x-rays. These were all done to look for metastases.
After the x-rays and biopsies, Dr. Gillings returned to the exam room and told me her findings with the caveat that a radiologist would review the films, and a pathologist would review the biopsies. Her impression of the bump was that it likely was 
a mast cell tumor. Just the act of examining the bump and poking it with the needle for biopsy caused it to release histamine and swell. That made it seem more likely her impression was correct. This is what makes these tumors so dangerous. Sofie got an injection of Benadryl for the trip home. In the picture, she looks a little stoned from her Benadryl shot.
It took until Friday to hear the pathology & radiology results. Dr. Gillings called me just as I was leaving work. The bump is a mast cell tumor. The x-ray shows a shadow in the lung. The melanoma tumor in the mouth is Grade 1 probably as it was small and the nodes were ok.
Meanwhile, I set Sofie up with Dr. Patti Schaefer of Canisport. 
Dr. Patti is a holistic vet that does acupuncture, advises on diet and supplements, and does chiropractic work with animals. Here’s Sofie enjoying her acupuncture treatment.
So, what now? Today, we took Sofie to our vet, Dr. Mark Peterson at Animal Hospital of Parkland. I needed to talk to him as I was starting to feel a bit overwhelmed by the choices that needed to be made. Dr. Mark helped us (Dale and me) sort out what the heck to do next.
Obviously the mast cell tumor must be removed. In fact, it has to be removed with huge margins to be sure that it is completely gone. That’s happening next Tuesday. That tumor and surrounding tissue will be sent to pathology for confirmation of cell type and identification of it’s stage (how fast it is reproducing and likelihood it has spread.) Dr. Mark will also do some more x-rays to see if that shadow in the lungs is just a shadow, or if it’s another tumor of 
some sort. Based on that information, we can decide how to proceed. If the shadow is a tumor, it’s potentially melanoma. It’s unlikely to be mast cell (they rarely go to the lungs). We could monitor it, and if it begins to grow, and if we don’t have to worry about spreading mast cell cancer, then the melanoma immunization would be the way to go.
But if the mast cell cancer is widespread, it would not make sense to do the melanoma immunization. In that situation, keeping Sofie feeling happy and pain-free would be the game plan.
So, that’s where we are in the dog pack scheme of things. Sofie’s eating a cancer-dog diet with low grains. She gets pre & probiotics, vitamins, and other supplements to help her fight the cancer and maintain her health as much as possible. She’s not getting any more immunizations (except maybe the melanoma one). She gets quercetin, organic apples, blueberries, and wild salmon oil. And she’s getting 50 mg Benadryl three times a day. She gets to play, swim, go on walks and chew on bones and every other dog joy that is available. And we’re going to love her as long as we have her to love.
