Bambini June 2016 Newsletter 
Bambini News:  Portal Progress; Doc on the Way
Our portal is now fully functional! There was a bit of work involved, and we wanted to do things right. Thanks for your patience. The final services we added were appointment scheduling, secure messaging, and credit card payments.
 
Imagine it's 9 PM on a Friday night and your daughter gets an earache. She's been swimming. No fever. Not sick enough for the Emergency Room. You'd like her seen in the morning, but realize there are a limited number of openings Saturday AM at Bambini. So, you check the patient portal, find a slot for 10 AM, and book visit on the spot! No waiting in phone queue the next morning. 
 
At this time, 15-minute urgent visits with any Bambini practitioner can be booked online. We hope to add 30-min physicals / consult visits soon. To book visits through the portal, your child must be an established patient. New patients should call the office or submit a request through the website.

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For the last seven years, we have spent increasing amounts of our day corresponding with parents by email. Although we found it an excellent, convenient form of communication, we now ask that families use the portal. Why so?
 
Well, we need to be HIPAA compliant. Our current email provider is not. The service you use at home may not be as well. Moreover, parents sometimes send us photos of rashes - even on private body parts. We want this all kept secure! Our portal does allow for attachments such as photos, camp forms, etc.
 
The portal allows parents to only message practitioners that have seen their child Over the next few weeks, if you do happen to forget and send a Bambini practitioner an email, you may get an auto-response directing you to the portal. You might be wondering, "how do I use the portal to book an appointment or send a message? Can someone give me a three-minute crash course?" Please click here for that. 
 
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Okay, did the header to this section really mention a new doc at Bambini? Wasn't there some vague mention of this in the newsletter a couple months back? Yes! We are pleased to announce that Rafiu Ariganjoye MD, MBA will be joining Bambini.

We anticipate the doctor's return to the US and orientation here in early August. We will have details on his training and experience in our next newsletter, but you can glean some of that info now by clicking here.
Reducing Vaccine Reactions
As we know, for the fourth time in the last two year, the New York State Department of Education has increased, at the behest of the Department of Health, the number of vaccines kids must receive to attend school. Parents thus ask us, with increasing interest, what can be done to lessen the side effects of these shots?
 
Of course, we don't recommend Tylenol for this. Back in 2009, a report in the Lancet indicated that there is no free lunch with this approach --- although fever and fussing were reduced, so was antibody production.
 
To reduce injection pain, you could ask our nurse to use either ethyl chloride coolant spray or, better yet, a Buzzy, or a Shot Blocker. You could also ask the clinician for a script for EMLA cream.
 
But what about the after-effects like reaction site swelling, fever, etc.? We like reasonable doses of vitamin C. For a 20 pound child, for instance, 250 mg three times a day for three days after DPT, IPV, and HBV shots would be about right. After varicella and especially MMR, going 10 to 14 days (or adding a couple doses of vitamin A) might be something for parents to consider.
 
For children that seem medically fragile, parents can discuss other measures such as zeolites, glutathione, or NAC with us. Parents familiar with homeopathy may want to apply arnica, Traumeel, or Topricin to the injection site for a couple days.
Help for Those with Vitiligo
Auto-immune disorders seem to be on the rise these days. Among them, vitiligo can be pretty demoralizing - especially for children with a dark complexion.
 
How do we approach this condition at Bambini? Well, we don't start with referrals to dermatologists, some of whom still focus on harsh treatments like high-potency steroid creams and even lasers.
 
Rather, we start with a good history and exam. Has there been an emotional trauma? What is the diet like? Have there been frequent illnesses? Then, we check labs - especially thyroid function, vitamin D level, immunoglobulins, and inflammatory markers.
 
Next, we introduce basic measures such as a gluten-free diet, supplemental probiotics, vitamin D, and marine oils. This alone has brought back pigment in mildly affected patients.
 
We then add immune modulating supplements such as reishi and astragalus. If need be, adding turmeric, low-dose naltrexone, CBD oil, or digestive enzymes. More recently, we became aware of the usefulness of the oral sunscreen Polypodium (we stock this in the office) in helping to clear vitiligo. One parent recently brought pseudo-catalase to our attention as a safe, topical option as well.
Vitamin D and Scoliosis
For years, we have suspected a relationship between vitamin D and scoliosis. We were a little surprised that no one had studied this until a few weeks ago when two papers were finally published. The results were not too surprising.
 
In the first paper, doctors from Istanbul compared vitamin-D levels in 229 patients with adolescent idiopathic scoliosis (AIS) and 389 age-matched controls. They found that the lower the vitamin D level, the greater the Cobb angle (that is, the worst the scoliosis).
 
A second study from Poland, that also was published in April, likewise reported an association between low vitamin D and idiopathic scoliosis in girls.
 
In our opinion, any child diagnosed with AIS (girls that develop scoliosis around puberty that have no other risk factors such as cerebral palsy) severe enough to merit follow-up should have a vitamin D level checked. If it is low, these young ladies should be put on supplemental vitamin D. Who knows? It might keep them out of a scoliosis jacket - and even the operating room!
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