It probably won’t surprise parents that the amount of TV their children watch can impact the ability to maintain a healthy weight. After all, watching TV is a sedentary activity, so the more TV a kid watches, the less exercise he or she gets. However, parents must also be aware that the type of TV their children watch can also have an enormous effect.

In February, the UCLA School of Public Health issued a press release in February titled “Childhood Obesity: It’s not the amount of TV, it’s the number of junk food commercials.” Researchers Frederick J. Zimmerman and Janice F. Bell found that children who watch commercial TV programming with junk food commercials are more likely to be overweight than children who watch other types of TV.

Everyone has experienced the siren call of the refrigerator after a commercial for a popular snack chip. The viewer sees the ad, feels a pang of hunger, and checks the pantry. Children have less impulse control than adults, and less awareness of the consequences of their actions.

And children are bombarded with junk food commercials.

For every half-hour television program, there are about eight minutes of commercials. Adult programs come with ads for cars and life insurance and all sorts of things that won’t make anyone gain weight, but commercials during children’s programs advertise toys and food, and that’s about it. This wouldn’t matter so much if the food ads touted the benefits of leafy green vegetables and smaller portion sizes. But no, the food commercials advertise high sugar, high fat, high salt, high calorie foods with little to no nutritional value. Junk.

The ads are loud, bright, and entertaining, and they feature attractive people singing catchy little songs that kids hear over and over again in their heads. At the grocery store, many kids sing jingles or re-enact commercials when they see a heavily promoted product. That’s a good sign that the children are being brainwashed by junk food companies, and it’s the parents’ job to put a stop to it.

The American Academy of Pediatrics recommends no TV viewing whatsoever for children under the age of 2. For older children, they recommend no more than 1-2 hours of TV… but specifically of educational, nonviolent TV. To that, I’ll add my own personal recommendation that children avoid commercial TV altogether. If parents find that to be impossible, then I recommend that at a minimum, they develop a family habit of muting the TV during commercials.

According to the UCLA study, “Non-commercial viewing, including watching DVDs or educational television programming, had no significant association with [childhood] obesity.”

Parents on a budget can often get DVDs for free at their local library, or purchase used DVDs at yard sales and video stores. Even if the children watch the same programs on DVD that they would have been watching on TV, they won’t be tempted by the commercials.

Children may complain about the change in their routine, but parents should stand firm as they remember the long-term goal of helping their child to reach and maintain a healthy weight. This is one change that every parent can make, and that will show positive, measurable results.

Dr. Marta Katalenas

Flu season in Texas is usually during the months of February and March; we did not see much activity yet, but I am sure it is still to come. Experts believe the H1N1 will continue to show activity throughout the season.

Human beings don’t kill each other for food and territory any more, at least it doesn’t happen in our civilized, modern society; but we spend lots of money and effort trying to investigate diseases in order to learn how to prevent and treat them.

Over the last 100 years the life expectancy for humans has been increased by a couple of decades. During the 19th century, a person of 40 years of age was already considered old, since he/she could expect to have about 20 more years around the mortals, if lucky. Today, a 40 year-old man or woman is in his prime time. We don’t consider a person old until in his 80’s. I can tell you that my personal definition of “old” has changed as I added birthdays to my calendar.

One of the biggest success stories of the 20th century includes the discovery and world-wide use of serums that, when injected, stimulates the production of defenses against infectious agents in such a way that, when you are in contact with the infective organism, it reduces the chances of getting sick by it. Very cool, right?

That is the way vaccines work.

And some vaccines have a double advantage: they protect you against the disease, but they also protect the whole community you live in. Every one of us becomes a vehicle to spread disease when we get sick with an infectious agent. When we are immune to it, we create a shield of protection for those around us, even those who are not immunized. If we all become immunized, the infectious agent will have nowhere to go and it could be eliminated from the face of the earth. This is exactly what happened with Smallpox; when enough people became vaccinated, the virus didn’t have any more susceptible hosts and disappeared.

The World Health Organization had the goal of eradicating Polio from the earth by the beginning of the 21st Century. The goal is not going to be met and many countries still suffer from this devastating disease. I just read an article explaining how politicians in some countries in Africa are discouraging their citizens from obtaining the vaccine, brought to them free of charge, because they don’t trust the intentions of those trying to promote it. Sounds familiar?

During the yearly flu outbreak many people can’t get vaccinated. It may be because they are allergic to some of the components of the vaccine; it may be because they have some disease of their immune system that keeps them from responding to the vaccine; they may be too young or too old. Some groups are at increased risk of getting sicker with the influenza virus, such as the elderly or pregnant woman. When you immunize a significant number of people, those individuals are more likely to be protected. Immunized individuals are not going to pass the flu along to their 80-year-old neighbor who may have asthma; they are not going to transmit it to the pregnant woman waiting in line next to them at Target; they are less likely to infect the small child on chemotherapy sitting next to them in church. This is HERD immunity. This is the way vaccines protect even those who are not vaccinated, by creating a shield of immune people around those who are susceptible.

In order for herd immunity to be effective the majority of the population must be immunized, that is, the number of susceptible persons must be minimized and the number of immunized persons must be maximized.

Talk to your doctor about this issues. Get informed. Get the facts.

Like Dr. Laura would say: “Go and do the right thing”.

Marta Katalenas M.D.

At this time we have only the injectable form of the vaccine. We are also administering the Seasonal Flu vaccine as well. We give vaccines during the week by appointment only. Please call (512) 733-5437 to schedule an appointment.

Pediatric Center of Round Rock.

I want to inform our patients that the Pediatric Center of Round Rock DOES NOT have any of the H1N1 recall lots. The vaccine administered at our office remains safe and strong at inducing immunity.

This news does indicate the commitment of the CDC to the ongoing monitoring of the safety and efficacy of the vaccine by health authorities.

Click here to read the full article from the Centers for Disease Control.

Pediatric Center of Round Rock

There is some confusion and questions about the administration of those two vaccines that I am going to clarify by giving you some case scenarios.

Q - My child received the first H1N1 injectable vaccine over a month ago. Can he now get the second H1N1 dose in the Mist form?

A - Yes. It is safe to get one dose of the injectable H1N1 and the second dose in the Mist form if your child is over 2 years of age and doesn’t have asthma. The mist is safe, very effective and easy to administer. The only limitation of use relates to those who have asthma and children less than 2 years of age.

Q - I am pregnant and I know I can’t get the H1N1 Mist; can my 3-year-old child get the mist?

A - Pregnant woman should get the injectable form of the H1N1 instead of the mist, but it is safe for you to be around your son after he gets the mist form of the vaccine, even if you are pregnant.

Q - My daughter had the Seasonal Flu Mist vaccine at school last week. We now have an appointment in the office to get the H1N1 Mist. Is it safe?

A - We should wait a month before giving her the H1N1 Mist. She can get the H1N1 injectable at any time, but when administering the Mist form of Seasonal and H1N1 vaccine, they should be at least one month apart.

Q - My child was diagnosed with Influenza A, H1N1 back in September. She had mild symptoms that resolved within a few days. Should she receive the H1N1 vaccine?

A - Yes. The rapid test we have in the office to check for H1N1 is not reliable enough to assume she did have the infection. Since we can’t be certain, we don’t know if she is going to have antibodies to protect her when/if we have a second wave of H1N1 cases in the coming winter months. The safest thing to do is to immunize her.

Please call our office if you would like to schedule an appointment for the second H1N1 vaccine dose.

We have also received some H1N1 vaccine from the Health Department. We have the Mist form only at this time. The H1N1 mist can be given to children over 2 years of age. Those with a history of asthma should not get the mist form of the vaccine; they should wait until they can get the injectable.

Pediatric Center of Round Rock

It is a childhood disease and we all got immunized when we received the DTP vaccine, which stands for Diphtheria, Tetanus and Pertussis. But over the last few years those who look at national statistics for a living realized that the incidence of Whooping Cough in adolescents and beyond was increasing at a rate that was not acceptable.

The Center for Disease Control then issued a recommendation for adults and children over the age of ten to receive a booster dose of the Whooping Cough vaccine.

Here is how it is done: your adolescent or preadolescent child (over 10 years old) is going to be given a booster of Tetanus combined with Pertussis; the vaccine is called TdaP. The big letters indicate the main antigens present in the vaccine, Tetanus and Pertussis. The “d” refers to a small amount of diphtheria antigen that is present only to enhance the recognition by our immune system of the other two antigens, and the “a” (in case you are interested) refers to the presence in the vaccine of the “acellular” type of pertussis antigen.

Back a couple of decades ago, the Pertussis vaccine had side effects such as very high fevers, irritability, etc. This lead to the development of the current “acelular” Pertussis vaccine, which enables the vaccine to stimulate the immune system without making us sick.

If you are an adult you probably know you should receive a booster of Tetanus every 10 years.  Tetanus is an almost-always fatal disease, and one for which there is no herd immunity. (Note to self: explain what “herd immunity” is). That is, no matter how many people you get immunized and protected, we are still going to see cases since the bacillus lives in the soil and it is not transmitted from person to person.

So, you need your tetanus booster every 10 years, right? Next time you see your doctor, ask about the status of your tetanus protection. If you are due to receive a booster, ask to be given the TdaP. You don’t need to receive this combination every 10 years, just once is enough. Then you can continue with your regular tetanus-only vaccine every 10 years.

By now you may still be wondering how this Pertussis business is affecting you. Well, it is not a pleasant set of symptoms when you get Whooping Cough; they last for a long time and the disease is very contagious. It may start like a cold, with runny nose and cough, fever and sneezing. After a couple of weeks the cough gets worse, occurring in very strong fits lasting six or more weeks. Children usually have fits of cough followed by a “whooping” sound as they try to catch their breath. The cough is often worse at night.

If you are in contact with small children and babies, your chances of passing the disease to them are very high. Babies suffer greatly when infected with whooping cough; the cough may get so bad that it keeps them from eating, sleeping and breathing. Many end up admitted to the Intensive Care Unit, especially when it affects premature babies.

So, the protection of the vaccine goes beyond you, like it is the case for the majority of the vaccines.

Here are some case scenarios to help you clarify what choices you have to protect yourself and others around you.

Q - I am a 50-year-old grandmother of a cute one-month old baby boy. Do I need to get immunized against Pertussis (Whooping Cough)?

A- Yes. In order to protect your grandson it would be advisable for every member of the family, in immediate contact with the baby, to receive a TdaP booster. Remember, babies start their immunizations at about 2 months of age and Pertussis is one of them. But they don’t mount a protective immunity until they go through the primary series of 3 doses, ending after 6 months of age.

Q - My two-month-old premature grandson is coming home after spending his first two months of life in the Neonatal ICU. He got his first set of shots in the hospital and one of them includes Pertussis. Is he protected during this winter Pertussis outbreak?

A- Because this baby is premature his immune system is not as developed and he needs special care and consideration. It is good that the immunizations have been started, but we must add the effect of “cocooning” the baby in order to protect from serious infections. One of the protective measures to take is to make sure all adults and children in contact with the baby are up to date with immunizations, including the TdaP for those older than 10 years of age, as explained above. Breast-feeding, vitamin supplementation and day care avoidance are other protective measures when dealing with a premature infant.

Q - I am 25 years old and pregnant. I had my last Tetanus booster 5 years ago but I don’t think it included Pertussis. Should I get immunized again?

A - The TdaP vaccine is not indicated during pregnancy. It is not that it is unsafe to receive it; we simply don’t have enough data to make that recommendation. But you can make sure your husband and those who are going to be in contact with your newborn are immunized. Right after you have the baby you can ask your doctor to give you the TdaP vaccine, even if you had a Tetanus booster 5 years ago. The added protection provided by the Pertussis part of the vaccine is good for your baby. If you are planning on breastfeeding, you are going to make antibodies as a response to the vaccine and you are going to pass them through your breast milk to the baby. We can’t measure the extent of that protection, but it is a real one.

Q - I am a 16 year-old High School student. The nurse informed the students and parents about a case of Whooping Cough in the school.  I received a Tetanus booster 6 years ago, but it did not include the Whooping Cough. Should I get immunized?

A - Yes. The Tetanus protection is still good, but you are at risk for contracting whooping cough, especially now that you have a case in your school. Those in direct contact with patients suffering from Pertussis get antibiotic prophylaxis, but your doctor or the school nurse will advise you if you need to start taking antibiotics. The best long-term protection you can have right now comes from the TdaP vaccine. Even if your Tetanus part is up to date, it is advisable and safe to get the combination vaccine that includes Whooping Cough.

I hope this explanation and case-scenarios is helpful to you all.

I would appreciate your comments.

Marta Katalenas M.D.

Salmonella Typhi causes a disease transmitted through food or drinks that are handled or served after poor hand washing or when contaminated sewage gets into drinking or hand-washing water. It causes high fever, headache, body weakness, stomach pain and a rash.

The Center for Disease Control and Prevention says there are about 300 cases of typhoid fever in the United States every year, the majority resulting from international travelers. The disease is more prevalent in the Indian subcontinent, Latin America, Asia, Middle East and Africa. Although there is a vaccine to prevent infection by S. Typhi, travelers to those countries should know that the vaccine is not a substitution for careful selection of food and drink. So, the CDC reminds us to “boil it, cook it, peel it, or forget it” as a rule of thumb when visiting countries with a high prevalence of enteric infections.

About 5 % of sick patients who recover from the infection will continue to carry the bacteria in their bodies and pass it in their stools and urine. Remember Typhoid Mary? Mary Mallon was a cook in New York City who was healthy, but she was a carrier of typhoid fever, passing it to over 50 people before the problem was identified.

Traveling is supposed to be fun and one can never pay attention too so many details. If being careful is going to make us become paranoid, we may as well stay home. And, believe me, I am not the kind of person who stays home because of being afraid of contamination. But a little information goes a long way, and I think the slogan the CDC came up with is cute and easy to remember.

Another piece of advice: if you are thinking about traveling to an exotic destination, check with your local Travel Clinic to find out what vaccines you could receive before you go. Some of those vaccines are not going to be “required” to enter the country. Remember, the vaccines are for YOUR protection, that is, to prevent you from catching something in the new location. They are not for their protection, that is, the other country is not afraid you are going to bring in a disease.

The phone number for the Travel Clinic in Austin is: 512-336-2727.

Marta Katalenas M.D.