Houston Area Pediatric Specialists

Independent pediatric specialists aim to serve our community. We want to share news and analysis regarding our specialties and our practices.

Wednesday, July 31, 2013

Dealing with a new asthma diagnosis

A move to the gulf coast followed by new respiratory symptoms is a common theme in my practice.  Getting proactive by consulting a pediatric pulmonologist can make coping with a new asthma diagnosis a lot easier.  Dr. Susarla

Asthma arrives with move to Florida

My son did not win a perfect attendance award at school last year.
Instead, he set a personal record for the most days spent at the pediatrician's office.
Since moving from Colorado to Florida six months ago, my 7-year-old son, Ryan, developed asthma. He did not have allergies or any respiratory problems before we moved, but once we got to Florida, everything changed.
I noticed that he was constantly sneezing and sniffling, and his eyes were red and itchy, especially after being outside. These symptoms were manageable with the help of an over-the-counter antihistamine, but it was the cough that was troublesome.
Every few weeks, Ryan would start coughing and it would get so bad that and we'd end up at the pediatrician's office. At first, the doctor prescribed an oral steroid to alleviate the symptoms. This worked, but eventually the cough came back. After several more trips to the pediatrician's office due to severe coughing and wheezing, she determined that Ryan had asthma, or a reactive airway.
Ryan's body was reacting to something it perceived as harmful, and the airways of his lungs became inflamed and constricted. Since Ryan grew up in Colorado, he had never been exposed to certain allergy triggers that are common in Florida.
Working with Ryan's doctor, we came up with an asthma plan. He now has two prescribed inhalers to help control his asthma. He uses one inhaler on a daily basis to prevent asthma symptoms, and another he uses before playing sports to help his breathing. The doctor also had Ryan allergy tested so we could discover what his allergic triggers were. It turns out that he is highly allergic to mold, oak, and certain grasses, all things which are not common in Colorado.
In doing research, I found one website that was particularly helpful and has a lot of great information, asthma.com. It has a "For Parents" tab that discusses triggers and how to minimize exposure, and even a guideline for when your child should stay home from school due to symptoms.
Since Ryan is 7, he's old enough to understand and learn about his condition, so I found two websites that have informative and interactive games for him to play. Ryan likes watching Arthur, and pbskids.org has the Buster Baxter, Lung Defender game. There is also lungtropolis.com, which has a game for kids and a separate, informative section for parents.
Finding out that your child has asthma can be scary, but working with your doctor and arming yourself with information can help ease that anxiety. My goal is that Ryan won't have to miss any school because of his asthma, and he can win a perfect attendance award this year.

Read article here.

Monday, July 29, 2013

Turmeric Component Can Prevent Lung Damage in Premature Babies

Perhaps another nod to medicine through better nutrition, curcumin is a known potent antioxidant found in turmeric.  Oxidative injury is thought toplay a major role in bronchopulmonary dysplasia, a chronic lung condition affecting premature infants. Dr Susarla

Turmeric Component Can Prevent Lung Damage in Premature Babies

Sunday, July 28, 2013

Evaluation & Treatment of Abnormal Facial Movements after Bells Palsy / Facial Nerve Palsy.

After Bell's Palsy  or Facial nerve palsy   Nerves can regrow into muscles that were not originally mapped  together.  Some people will have problems with activating individual muscles like they did before. 

I see patients who will wink and smile the same time or who will tear when they taste spicy food.

 Parents and physicians should note that this can be successfully treated. - JR

 2010;32(17):1414-8. doi: 10.3109/09638280903514697.

Evaluation and treatment of synkinesis with botulinum toxin following facial nerve palsy.


Department of Physical Medicine and Rehabilitation, University of Pavia, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy. elena.dallatoffola@unipv.it



To assess the effect and efficacy of botulinum toxin type A (BTX-A) in reducing synkinesis in aberrant facial nerve regeneration (following facial paralysis).


A total of 55 sessions of BTX-A (Botox) infiltration were performed on 30 patients (23 female) with synkinesis after facial palsy. Each subject was injected with 2.5 units of BTX-A in each injection site (the sites were chosen on a case-by-case basis). The synkinetic muscles targeted include: orbicularis oculi, zygomaticus major, depressor labii inferioris, platysma, healthy frontalis and healthy corrugator supercilii. The patients were examined using the Sunnybrook Facial Grading System, both before the BTX-A treatment and after an average of 35 days.


All 30 patients experienced improvement to the synkinesis after treatment. Total scores: median pre-BTX-A: 40; post 53 p = 0.004. Resting symmetry scores: mean pre-BTX-A -7.1; post: -3.5; median pre -5 [interquartile range (IQR) -10 to -5]; post: -5 (IQR -5 to 0); p = 0.0001. Symmetry of voluntary movement median pre-BTX-A: 56 post 60 p = 0.10. Synkinesis scores: median pre-BTX-A: -9 post -3 p < 0.0001. Mean duration of improvement was 4 months.


BTX-A injection treatment was effective in reducing facial synkinesis, thus improving facial expression symmetry both at rest and in voluntary movements.

Sunday, July 21, 2013

Obesity and Asthma: Study Finds a Link in the Genes

New evidence identifies a genetic link with allergic inflammation. Dr. Susarla.

Obesity and Asthma: Study Finds a Link in the Genes

July 18, 2013 — Genes linked to chronic inflammation in asthma may be more active in people who are obese, according to new research that uncovers several biological ties between obesity and asthma.

"Our findings point the way to the management of asthma in the obese through simple weight reduction," said first author Paresh Dandona, MD, PhD, SUNY Distinguished Professor and Chief of Endocrinology, Diabetes and Metabolism at the University at Buffalo.
The research appeared online June 26 in the journal Obesity and involved two related studies: A comparative study between obese people and people of normal weights; and an experiment that looked at how various biological indicators -- including the behavior of asthma-linked genes -- changed when morbidly obese patients received gastric bypass surgery.
In the comparative study, the scientists found that four genes associated with chronic inflammation in asthma were more active in obese and morbidly obese people, by more than 100 percent in some cases. The highest activity was found in the morbidly obese.
This increased gene expression matters because it can cause white blood cells called mononuclear cells to produce far greater amounts of inflammatory factors like interleukin 4, LIGHT and lymphotoxin╬▓ receptor which contribute to allergic inflammation and other abnormalities in the bronchial passages in asthma.
The scientists also found higher concentrations of two asthma-related compounds in the plasma of obese and morbidly obese patients: MMP-9, which is associated with inflammation, and nitric oxide metabolites (NOM), which are an indicator of oxidative stress.
Following gastric bypass surgery in morbidly obese diabetic patients, MMP-9 and NOM levels dropped, along with the expression of six asthma-related genes including the key factors, interleukin 4, LIGHT, lymphotoxin╬▓ and interleukin 33 in parallel with weight loss and improvements in the status of their diabetes.
"Ours is the first study to provide a mechanistic link between obesity and asthma through biological/immunological mechanisms," Dandona said. "There has been, until now, no biological, mechanistic explanation other than the fact that obesity may raise the diaphragm and thus reduce lung volumes."