Joey Wahler (Host): This is Health Matters, insights from WCH medical experts. Thanks for joining us. I am Joey Wahler. Our guest is Dr. Michael Lemon, a Pediatrician at Wood County Hospital. Hi Dr. Lemon. Welcome.

Michael Lemon, MD: Well, thanks for having me on. Hi.

Host: Appreciate the time. So first, we're discussing some common childhood conditions here, to start ear infections. They sometimes seem to just pop up out of nowhere, especially in toddlers, right? So what are some signs parents might miss that indicate it's something more than just a crankier teething child in that case?

Michael Lemon, MD: I think that's a well phrased question because multiple things can be going on at the same time, such as indeed teething. We all get colds. We all are subject to immune response in terms of environmental allergies and all those things can make congestion, can make grouchy, can interrupt sleep. So some of the things that I've suggested to parents over the years to watch for is if there's an ear infection, then there's inflammation in there, which makes the eardrum tender. So things that would irritate the eardrum, like increased pressure. So sucking on the bottle, sucking on the pacifier. You have a kiddo who's hungry and you know they really want to eat, but they take three or four sucks and then they stop.

Or the pacifier is how they go to sleep. And again, three or four socks and stops; certainly could hint that there is pressure against that eardrum. The same with laying them down. They fall asleep in your arms and you lay them down. You lay him down, that increases the pressure against the eardrum; it could be more than just than a cold or allergies or teething.

Host: You mentioned pressure. One thing I think of is what you feel when you're on an airplane, and I remember feeling that more as a kid than I do now as an adult. Does that affect kids more?

Michael Lemon, MD: Yes, it does. They're not used to it as much, obviously, first of all, but more importantly, it's the anatomy's actually different. The eustachian tube that connects your middle ear to your pharynx, the back of your throat is much more pliable, it's more prone to be collapsible than in our age where it has stiffened into bone. And so once that happens, then that's when you can feel that pressure gradient.

Host: I remember my mom used to give me gum to chew, and said that should take care of it. Right.

Michael Lemon, MD: Still holds true today.

Host: That's great. Good old mom. So, snoring now. Snoring isn't something perhaps most parents expect to hear from their child. So what can it mean if you do hear it, and how do you know when it's time to talk to a pediatrician?

Michael Lemon, MD: Sure. So snoring, it means that something is at least partially in the way of that upper airway. So it can be your adenoids, it can be your lingual tonsils themselves, those sorts of things. So it's not that uncommon for a kiddo that has enlarged tonsils to snore when they're sick, for instance.

But we don't really expect a kiddo to snore when they're well. So if I have a kiddo who snores and I always ask, can you hear it from the next room when they're not sick, then of course that means more to me. I'm going to take a look. You can't see the adenoids when you look down the throat, but you can see the tonsils themselves.

And so there's a kind of an expected range of size of tonsils for age. And so if we have the symptom of the snoring, and I always ask about having a problem swallowing, especially textured food items. So if you have those two plus an enlarged looking tonsil, then the usually the next step is to ask the ear, nose, and throat to look if they are too big.

Host: And so what could be in play there?

Michael Lemon, MD: Well, at the end of the day, that's where sometimes the adenoids are removed or the tonsils are removed. They serve an important immune function because they're basically lymph nodes, so they help your infection fighting system. So you really don't want to give them up unless there's more important reason to give them up. Everything's a risk benefit.

Host: How about allergies now, doctor? How do you know if your child has any, and with so many possible triggers for them, pollen, pets, how do you narrow down what's actually causing those symptoms?

Michael Lemon, MD: Sure. Well in terms of narrowing it down, the allergist can actually do allergy panel testing. Some can be tested by looking for immunoglobulins in the blood and some is still the traditional scratch testing on the back, around the arm so you can narrow down what you might be reacting to. The problem for so many of us is it's in our environment and we really can't change it.

I have allergies myself and I can't exactly move away from cottonwood trees, maple trees, oak trees, and so on, the grasses and so forth. So just because we can identify what it is, many times we can't make a difference. What we can make a difference with sometimes is pets, although that's a hot topic sometimes, but if you react significantly to dog or cat, then the decision could be made.

If the household environment is not a healthy environment in terms of, for instance, mold allergies, that's something that can be remediated. But so many times it's the environment and it's the grasses and the trees and the molds and that sort of thing out in the environment around us. As the environment heats up, plants have a longer and more intense pollen season. They make higher amounts of pollen, they make it sooner and it lasts longer, so that's not helping matters any.

Host: And so what are some of the symptoms of allergies? Remind us, please, what to look for.

Michael Lemon, MD: Well, typical, what you're going to have is itchy, watery eyes, itchy, runny, stuffy nose, a lot of postnasal drip many times. So you have the throat clearing. Many times you'll have fluid behind your ears and a mucus membrane makes fluid and that includes the lining of your middle ear, many times you will have a cough. And so those are most common symptoms with allergies.

I forgot to mention skin rashes, but many times skin rashes can go along with it as well.

Host: Okay. How about asthma now? Asthma can of course look different depending on the child. So what are some early signs that might not seem obvious, but could point to a bigger issue? And if a child does have asthma, that doesn't necessarily mean they'll have it for life, right?

Michael Lemon, MD: Most of the time, if a child is having reactive airway disease, spasm of the airway as a result of having a respiratory infection, that is not necessarily classic lifelong asthma. So you're absolutely correct that if it's a kiddo under two and when they get a respiratory illness, classically RSV or bronchiolitis, and then they have some bronchospastic coughing, for the next couple infections after that; that is not necessarily a lifelong asthma type of person. So in terms of symptoms, I always try to turn the parents into a musician and listen to the quality and the character of the cough. If your airway is spasmed, you gotta think about the pipe organs at church, the smaller pipes emit a higher pitched, more of an almost squeaky sound, if you will, and the large pipes emit that deep bass, low tone type of sound.

So when you get that repetitive, tight, harsh, high pitched, squeaky cough, then that is an indication that many times the airways are spasmed and they're smaller in diameter. So that is a hint. Again, a cough that lingers after a respiratory infection, like I mentioned before, would be another hint. We're all used to coughing a couple days after you're sick, but someone who's coughing a week, 10 days, or longer after they're sick again, something else could be going on.

Host: That's a great analogy with the music, by the way. I can, I can definitely hear that, if you will. And then finally on asthma. But if a child, to take it to another step appears to be having some difficulty breathing. That's obviously something that needs to be addressed right away, right.

Michael Lemon, MD: Well, yes, if you're truly worried, your child's having respiratory distress, they need to be evaluated. The analogy that I use there, of course, is for those of us who are from the older ages, the field athletes used to run a hundred yard dash, the shot putters and the discus throwers. So since they weren't used to running, of course what you saw in them was some signs of temporary respiratory distress. So if you picture back to your high school days, what'll happen with the kids is the nasal alae will flare out, the outer edge of the nose here. You'll sink in right here at your shoulders. Every single rib will show up like a washer board, and then the belly is going to heave out significantly with every breath.

Those are all signs of true respiratory distress. If you wait till you start having a color change and purple's not a good color, blue's a worse color, then really you've waited too long. You really want to look for these earlier signs and seek treatment while it's easier to take care of.

Host: Absolutely. How about eczema? For many families, it's more than just dry skin. So what should parents know about what's going on beneath the surface, literally? And how have eczema treatment plans evolved over the years?

Michael Lemon, MD: Well, eczema happens to the largest organ our body has, you know, your skin surface, and it's a reactivity. It's a sensitivity to something in the environment. Whether it's excessively dry, whether it's a chemical reaction to some soap that you shouldn't have used in terms of a fragrance or a color, and how would you know until it was applied, whether it's again, a reaction to an allergy, but something is triggering an immune response in the skin.

And then the response you get is that itchy, red, flaking cracking, irritated skin patches. It can occur as one large patch, or it can occur as any number of smaller patches. It can occur in creased areas of your body. Like if you have, you know, a belt line and you're reacting to nickel is always a classic test question.

The nickel in the belt buckle, so it's just right there. And nowhere else on the body. So you try to figure out what's making the skin react. Then you asked about treatment. So the mainstay of treatment is helping bolster the skin's natural defenses. So keeping the skin non irritated by using a soap that's not an irritating soap, like an Aveeno or even a Dove, something that doesn't have a lot of chemicals to it, doesn't have a lot of smell to it.

Something that just basically tries to leave a little moisture on the skin itself. And then in terms of moisturizers, it's always better to use a thick, an ointment, or at least a cream based, rather than a lotion, something that's very runny. Most lotions have alcohol in them, which is what helps them make, so easy to apply, so runny.

But of course that can be an irritant to the skin again. So the mainstay of treatment really is again, bolstering that skin. Many times steroids are seen as a miracle cure. You apply that steroid cream and again, being an anti-inflammatory, it does its job and it reduces the irritation. But it's the same as using Tylenol for fever.

In six hours that fever is going to come back if we haven't helped the reason for the fever. So you stop using your steroid cream, and if we haven't helped fix the reason for the rash, then the rash is going to come back. So that's one thing that sometimes you have to help the parents kind of get away from is that, well, the steroid fixes it and you gotta understand that it's more of a, that temporary help measure.

Host: And before we move on, just a couple other questions. But you're saying there are people that react badly to nickel from a belt buckle. Yeah?

Michael Lemon, MD: That's correct.

Host: Interesting. I'll have to keep that in mind when I go belt shopping next time, doc.

Michael Lemon, MD: And your earrings as well. You want to

Host: Right?

Michael Lemon, MD: get the good ones.

Host: Okay. Great advice indeed. So, switching gears a little bit. You work with naturally many families that are managing chronic conditions in children. How about some common myths or misconceptions you hear from parents that you can clear up right here for us?

Michael Lemon, MD: I'm not sure if I use the term myth or misconception. I think many times what happens is more confusion. A lot of times when we have child who's chronically ill, a child who has multi organ system issues, the problem is that there's the relative loss of the traffic cop, if you will, the person in the center who's trying to help keep everything organized and together.

So the cardiologist tells them this, the neurologist tells them that. Pulmonary doctor tells them something else. And how do you mesh all that together? How do you bring that forward to help the school formulate a plan to take care of the child and keep them safe at school? How do you maybe reconcile if the re advice from the pulmonologist doesn't reconcile with the advice from the neurologist, so I see that more often is trying to help bring all those care suggestions together from single organs to the whole organism, if you will. And how do you make that all work together?

Host: And so that being said, you led me beautifully with that answer into my last question. In summary, if a child has multiple issues, let's say some of the things we've spoken about, allergies, eczema, asthma, you name it, how can parents work with their provider or providers to make sense of it all and avoid bouncing between specialists more than needed?

Michael Lemon, MD: Well, I think it goes back to what we had just talked about. If you don't consider the whole person, if you don't bring the parts together to the whole, then a lot of times you're going to bounce back and forth because A might make B worse. And hopefully by us doing our job as primary care pediatricians and then you know, for the adults, your family practice or internal medicine doctor, it's really sort of our job to be that traffic cop to take all the pieces and put it together in a cohesive whole in terms of caring for the kiddos.

So I think that's the most important thing you can do is not miss those routine annual visits or more often visits. A lot of times what I've actually found since you asked, is you'll go see the ologist and the ologists are very smart and they can do amazing things, and I am very, very grateful to have them.

But many times they'll come back to me and say, what did he say? What did he mean? What does this mean? Again, I see that as part of our job to try to help demystify and help bring it forward to the best way to help take care of the kids.

Host: Yeah, I guess you're saying communication is the key, right? Because the care and the knowledge on the part of a doctor is great, but at the end of the day, it's only as good as how effectively it can be communicated to the patient, right?

Michael Lemon, MD: Absolutely. Communication is just always so key. And again, bringing those parts into a cohesive whole.

Host: Absolutely. Well, folks, we trust you're now more familiar with the world of pediatrics these days. Dr. Lemon, keep up all your great work and thanks so much again.

Michael Lemon, MD: Thank you for your time.

Host: Thank you for yours as well. And to make an appointment, please call Wood County Medical Associates, (419) 352-6890. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being part of Health Matters, insights from WCH medical experts.