Author: Kat J. McAlpine

Lyme disease: What to know, how to treat and when to refer

Image of the deer tick, which transmits Lyme disease
Lyme disease is transmitted by the deer tick.

We asked pediatric infectious disease specialist Catherine Lachenauer, MD, of the Boston Children’s Hospital Division of Infectious Diseases, to answer some frequently-asked questions about Lyme disease in children. Here’s what she had to say:

How common is Lyme disease and what are some early symptoms?

Lyme disease is the most common tick-borne infection in the US. The number of reported cases has been rising over the years.

One of the best recognized and earliest symptoms of Lyme disease is the erythema migrans, or EM rash, that may appear within the first month (usually within the first two weeks) following the tick bite.  The EM rash occurs at the site of the bite, typically as a circular red rash that enlarges over the course of several days.  Often, there is clearing as the rash enlarges such that it appears as a “bullseye,” although it may also be a solid, or confluent, rash.  Patients may also have non-specific, flu-like symptoms including fever, headache, joint aches and fatigue, as early symptoms of Lyme disease.

A tick needs to be attached for at least 48 hours to transmit the Lyme-causing bacteria

What are some later-stage symptoms of Lyme disease in children?

Most symptoms of Lyme disease occur in three stages: early localized, early disseminated and late-stage disease.

In the early localized stage, usually within one to two weeks following the tick bite, a single EM rash may appear. Patients who are not diagnosed and treated with antibiotics in the early localized stage, they may go on to have symptoms of early disseminated disease. …Read More

A film called ‘Squint’ will open your eyes to the power of strabismus surgery

The film "Squint" follows six patients who undergo strabismus surgery.
The short film “Squint” follows six patients who undergo strabismus surgery with Dr. David Hunter of Boston Children’s Hospital. Click here to watch on YouTube.

When Dr. Bernard Dib was medical student, he was struck by the impact that Dr. David Hunter had on patients who visited him for strabismus (crossed eye) surgery.

“I saw people from all over the world thanking him for changing their lives,” Dib says, who rotated electively into Hunter’s clinic as part of his medical school program. “Adults would say that they had a crossed eye for years and their doctors hadn’t ever said that surgery was an option for them.”

Hunter, who is ophthalmologist-in-chief at Boston Children’s Hospital, is not only an expert at performing surgery to correct crossed eyes in children but also in adults. …Read More

How to help an adolescent who is using cannabis

A greenhouse where cannabis plants are grown legally.
A greenhouse where cannabis plants are grown legally.

Over recent years, big shifts in the marijuana landscape have made it easier than ever for American teens to be exposed to cannabis and to have the opportunity to use it.

Currently, only six states consider all forms of cannabis use to be illegal. Meanwhile, most states legally allow at least some medical cannabis use and several (including Massachusetts) have already legalized both medical and recreational use for adults.

“Whatever your views are on medical or recreational cannabis use for adults, however, there’s near-universal agreement that adolescents should not use cannabis,” says Lydia Shrier, MD, MPH, who directs clinic-based research in the Boston Children’s Hospital Division of Adolescent/Young Adult Medicine.

But the legal system’s increasing support of cannabis and a rise in public approval of the drug has lowered the perception of risks associated with its use. As a result, in states where medical or recreational use for adults is legal, adolescents between the ages of 12 and 17 are more likely to use cannabis than in states where all uses of the drug are illegal. …Read More

Preparing patients for spinal fusion surgery

A nurse assists as a spinal fusion surgery patient practices giving a medical dummy an IV drug.
Hands-on experience before surgery day: A simulation of what to expect during spinal fusion surgery.

Several studies have contributed to the school of thought that thoroughly preparing patients for surgery can reduce their anxiety and even lead to better recoveries and outcomes. That notion appears to be corroborated by the first-hand experience of Michael Glotzbecker, MD, a pediatric spine specialist and surgeon in the Boston Children’s Hospital Spinal Program.

“In my experience, patients do better when they are well prepared for surgery,” says Glotzbecker. …Read More