Thanksgiving holiday hours

Have a safe and happy holiday! We’ll have special hours this week. As always, our doctors are available after hours by phone for emergencies. You can also send us a portal message for NON URGENT questions.

All office hours are by appointment only.

Wednesday 11/21 Open morning only, Roswell and Windward.
Thursday 11/22 Closed
Friday 11/23 Open morning only, Roswell and Windward
Saturday 11/24 Usual hours (Roswell open Saturday mornings)

In addition, the Kids Time after hours clinics are open for walk-ins with no appointments necessary:

Thursday 11/22 Sandy Springs ONLY open 9-1 am
Friday 11/23 Alpharetta and East Cobb open 10 am-1 pm
Saturday 11/24 East Cobb and Alpharetta open 1-5 pm
Sunday 11/25 East Cobb and Alpharetta will be open regular weekend hours, 1-7 pm
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Acute Flaccid Myelitis – what parents need to know now

You’ve probably seen it on the news – a rare, polio-like illness is causing cases of paralysis in children. Here’s the latest info, based on our best current knowledge from the CDC.

AFM is a sudden illness that causes weakness in one or more extremities – one arm or (less likely) a leg, or any combination of arms and legs. The words in the name express the key features: it’s acute, beginning over hours or sometimes a few days; it’s flaccid, meaning the affected body parts are floppy and weak; and it’s a myelitis, meaning the disease occurs in the spinal cord. The muscles are fine, the brain is fine, but the area of the spinal cord that carries signals to the muscles becomes inflamed and stops working. You can see distinctive changes on an MRI scan of the spine to help confirm the diagnosis.

The first cases of what was later named AFM were reported in California in 2012. The CDC started closely tracking cases of AFM in 2014, when a surge of reports about the illness began to appear in the United States and overseas. Since then, we’ve seen a striking pattern, with most cases occurring in the late summer and early fall, August through October. In the US, we’ve also seen an unexplained pattern where most cases occur in spurts every other year – in 2014, 2016, and now again in 2018. 2015 and 2017 had far fewer cases.

Over 400 cases of AFM have been reported in the US over the last four years, including about 80 in 2018 so far. Most states have reported at least one case, including Georgia. There doesn’t seem to be geographic focus in any area. Overall, the rate is less than one in a million people – AFM is a very rare disease. Almost all cases of AFM have occurred in children, at an average age of 4-6 years.

Several different viral infections have been found in children with AFM, though it’s unclear that these viruses were the cause of the symptoms. The most-commonly associated viruses are from a family called “enteroviruses”, including one that has been implicated in groups of acute severe respiratory disease called enterovirus D68. Other viruses have been investigated including West Nile or Japanese Encephalitis viruses, herpes viruses, and adenoviruses. Most commonly, no specific viral infection is found. The cause of most cases of AFM is unknown.

Still, it seems most likely that a viral infection is the trigger, because of the seasonality of the disease and its propensity to strike children rather than adults. Similar symptoms were once seen with the polio virus, and multiple tests for polio have been performed in  children reported with AFM. But it’s never been found — polio itself is not the cause AFM in the United States or abroad. The CDC is continuing to investigate the possibility of one or more viral triggers, an inflammatory condition triggered after a viral infection, or a possible environmental trigger as causes of AFM.

Children with AFM typically have a preceding illness with fever, runny nose, cough, vomiting, or diarrhea 1-2 weeks prior to the beginning of AFM symptoms. Often these common viral symptoms have resolved by the time AFM begins, with its rapid onset of limb weakness. There may be near-complete paralysis (inability to move the limb), or varying degrees of weakness. Sometimes, symptoms including stuff neck, headache, or pain in the limbs accompanies the weakness. It’s also sometimes possible for AFM to affect the nerves in the upper neck and head, causing a face or eyelid droop, difficulty swallowing or speaking, or a hoarse or weak voice.

Children with AFM need to be hospitalized. Many tests need to be done to narrow down the diagnosis and rule out other causes of weakness (including blood tests, a lumbar puncture, and MRI scans.) Children with AFM can develop weakness of the muscles that help them breathe, and may need to be treated in an ICU. Neurologists, infectious disease specialists, and public health officials will all help guide care.

There isn’t solid evidence that any specific treatment is effective, since good clinical trials of therapy haven’t been performed yet. It’s been difficult to study AFM because it’s so rare, and the disease progresses quickly. In addition to supportive care, many people with AFM have been treated with intravenous immunoglobulin, steroids, and plasmapheresis. Though some children with AFM have recovered quickly, many continue to have lasting paralysis requiring long term care.

So what should parents do about this? First, there’s no need to panic. The press and Facebook like to stir up trouble with blaring headlines and clickbait titles – but remember that AFM is really rare, with about 100 or so cases a year occurring across the entire country. Polio caused about 15,000 cases of paralysis a year in the 1950’s before a vaccine was introduced. We’ve come a long way, and your children are, overall, far safer than children have ever been from infections, environmental illnesses, and trauma.

Some common-sense steps can probably help. Most cases of AFM seem to have a viral trigger, so avoiding infections is a good idea. Teach your children to practice good handwashing, and keep them out of group care when they’re ill. Though we don’t have a vaccine to prevent AFM, vaccines can prevent the neurologic complications of other infections like influenza, measles, and mumps – so be sure to keep your child fully vaccinated. And seek care immediately if your child becomes weak in one or more limbs.

And, please, support your public health community and the scientists who work to keep your children safe. There’s always another new health challenge out there (Ebola, Zika,  SARS, and MERS, to name a few.) We need to keep our public health infrastructure strong to help tackle AFM and whatever the next challenge turns out to be. Go science!


More info from the CDC’s AFM home page, the October 2018 CDC press briefing, and the November 2018 webinar for clinicians

Republished from Dr. Roy’s blog, The Pediatric Insider

© 2018 Roy Benaroch, MD


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Coming soon: Improved electronic check in

Based on your feedback, we constantly work to improve the patient experience at our office. Our next step is to upgrade the check-in process to include far less paperwork, while still giving you the opportunity you need to give us important health information about your children and your family.

Over the next several weeks, we’ll be moving to an all-electronic check-in process. It’s simple and easy, and you’ll be able to do it in advance, in the quiet and privacy of your home (if you wish). Before your child’s appointment you’ll get a text or email with a link that will take you to the electronic forms. If you prefer, you can complete them in the office after you arrive, or we’ll also have paper forms if you need them. These electronic “forms” can be done on a computer, tablet, or smartphone.

Some advantages of electronic check-in:

  • You can do them in advance, so you don’t have to fiddle with all of forms while you’re in the office. You’ll be able to put down all of your questions and concerns, without feeling rushed or distracted.
  • You’ll only have to fill out items that are necessary (for instance, insurance companies require certain disclosures once every 12 months. If you’ve already signed off on those within that time period, you won’t be asked again.)
  • Answers that don’t typically change from year to year will be “sticky”, and your previous answers will pre-populate the next time you get the form. You’ll be given an opportunity to put in new information (for instance, for any changed in family health history), but if nothing has changed you won’t have to repeat your answers.
  • All of your answers will instantly, automatically, and correctly appear in your electronic record.
  • Electronic submissions help protect your privacy. We won’t have paper forms that can be mislaid. As a bonus, it’s better for the environment to not have paper to shred.

Thank you so much for all of your feedback — we’re listening, and you’re helping us become a better practice. Other projects are in the works, too, based on what you’ve told us is important to you. Stay tuned!

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Join the fight – learn how to help prevent suicide

Suicide is among the most common causes of death of teens and young adults, and the rates are rising. Unfortunately, people at the most risk of suicide may not be able to get themselves the help and resources they need.

I’ve written and taped a short, 45 minute lecture series, A Practical Guide to Suicide Prevention, to help family and friends recognize the warning signs of suicide risk, and to help people learn the best steps to take when someone is in danger. It’s part of The Great Courses Plus streaming service, and you can watch or listen to the audio as part of a free trial.

If you do join The Great Courses Plus, please check out my other courses. I have three audio/visual series titled Medical School for Everyone. They’re all presented as medical mystery cases for laymen to figure out. While figuring out the mysteries, you’ll learn about medicine, physiology, therapeutics, and how doctors think through solving diagnostic mysteries yourself. The feedback has been great – I think you’ll enjoy the courses! You can watch them via the free trial on The Great Courses streaming service, or buy them individually (with a no-hassle money back guarantee) from The Great Courses. Links below!

Next year I have a new course coming out called A Skeptic’s Guide to Health, Medicine, and the Media. It’s going to be great – look out for it around February 2019.

My courses:

A Practical Guide to Suicide Prevention – via The Great Courses Plus

Medical School for Everyone: Grand Rounds Cases – medical mysteries for you to solve! From The Great Courses Plus streaming, from The Great Courses to purchase, or from Amazon

Medical School For Everyone: Emergency Medicine – mystery cases from the Emergency Department. From The Great Courses Plus streaming, from The Great Courses to purchase, or from Amazon

Medical School For Everyone: Pediatric Grand Rounds – mystery cases from the worl of pediatrics! The Great Courses Plus streaming, from The Great Courses to purchase, or from Amazon

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Flumist now available

We now have a limited supply of Flumist, the nasal spray version of the flu vaccine, available at both offices. This kind of vaccine can only be used in children age 2 and up, and only in children who don’t have asthma or other chronic diseases. Getting a flu vaccine — either the traditional injection or the mist — is one of the best ways to protect your children, your family, and your community, and now’s the time to do it. Book your appointment soon!

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