Study Shows We Can Accurately Predict Who Needs to Have Surgery for Appendicitis Using Labs and Ultrasound

AppendixWhen a child comes to the office with abdominal pain, the two things you don’t ever want to miss as a doctor are an ectopic pregnancy (a pregnancy in the fallopian tubes) that could rupture and potentially cause fatal bleeding, or an appendicitis that could rupture and cause a fatal infection.

Ectopic pregnancies can only occur in sexually active girls and women thus in that category you get a pregnancy test and if positive you refer directly to the surgeon.

For the rest of the children (or adults for that mater) with severe abdominal pain that might be appendicitis, we need ways to avoid operating on those who don’t have appendicitis and ways to quickly identify those that have it so they can get to surgery before the appendix ruptures (usually it ruptures in 24-36 hours after the onset of symptoms, though this can vary a lot).

The study, ‘Use of White Blood Cell Count and Polymorphonuclear Leukocyte Differential to Improve the Predictive Value of Ultrasound for Suspected Appendicitis in Children,.” confirms what we already knew about the importance of a CBC (complete blood count) in determining if the infection is bacterial or not.  Appendicitis is basically always associated with a bacterial infection and a high white blood cell count (WBC) with a left shift meaning more neutrophils and immature neutrophils compared to other cell types, like lymphocytes for example.  You can read the study here…

What this study does so well is gives us data on exactly how accurate you can get by combining the use of the WBC with ultrasound.  When the exam was suspicious for appendicitis, the labs were indicative of bacterial disease AND the ultrasound showed signs of appendicitis the risk of appendicitis reached 96.8%.  This is enough accuracy to prevent the need for CT scans and allow hospitals to identify those at greatest risk and needing surgery without waiting for a CT scan which may or may not be available and, in many cases, seems would not be necessary.

Use of the CT scan is still the gold standard in my opinion, but I remember the days when kids went to surgery just based on the surgeon’s exam and in the hands of an experienced pediatric surgeon a thorough history and exam were about all you really needed.


Dr. Paul


Influenza Treatment for Severe Cases- Interferon (study)

happykiddoThe article, “Life-threatening influenza and impaired interferon amplification in human IRF7 deficiency,” March 2015 by Ciancanelli et. al., describes a child who almost died from influenza and was found in their study to have null mutations in IRF7, which encodes the transcription factor interferon regulatory factor. Due to this genetic mutation, this child did not produce much interferon in response to the influenza infection.

This may explain why a few normal children end up with life-threatening influenza while most recover. This also points to a potential life-saving treatment for the severe cases of influenza, namely the use of interferon.  This shows how the single-gene inborn error of immunity, the IRF7 mutation, can influence the severity of the influenza illness.  As we learn more about our children’s genetics, we may be able to personalize medical care for better outcomes.

You can read the article here…


Dr. Paul

Folic Acid Supplementation Reduced Stroke in Hypertensive Patients- Why Everyone Probably Should Supplement Methyl-Folate +/- Folinic Acid

spinachAny time you can improve your health outcomes by eating right or taking a nutrient that you are deficient in seems like a no-brainer to me.  This study, “Folate Supplements for Stroke Prevention,” JAMA March 2015 randomized over 20,000 patients with hypertension to analapril alone or analapril plus 0.8 mg folate. You can read the study here…

The study was terminated early  (after 4.5 years) due to the significant reduction in strokes found in the group taking folate; 2.7% vs 3.4% in the group not taking folate.

Authors speculate that the MTHFR defect individuals would benefit the most as they are the ones who have difficulty processing folate to methyl-folate.  I would agree and I suspect they would have had more significant improvements in the folate group had they supplemented with methyl-folate +/- folinic acid.

Here in the USA, we have 30-40% of the population with the MTHFR defect. Because many cereals are fortified with folate, those who eat that processed stuff (I don’t recommend it) would at least not be severely deficient in folate.  The preferred road to health, would be to eat lots of whole foods, including plenty of green leafy vegetables and take a methyl-folate +/- folinic acid supplement.

I have found an adult (ok for teenagers too) multivitamin made by Dr Ben Lynch (world leader on MTHFR) with both methyl-folate and folinic acid along with just about everything you might need to support your nutrient status.  I now carry this in my office.  There are several options for supporting yourself or your child with methyl-folate.

As the authors of this article point out, “it is likely that the results would apply to normotensive persons”, such that we all can benefit from supplementing with folate.  Just remember to at least look for the methyl-folate version of this B vitamin.



Dr. Paul


Response to Parent with Autistic Child Who Doesn’t Believe MMR or Vaccines Had Anything to Do with the Autism and Quotes the Retraction of the Article in Translational Neurodegeneration

moneyvshealthAs a parent of children who got all the vaccines and I believe are suffering from neurological challenges related to the toxins in those vaccines, I want to first say that it is not our fault that we followed doctors guidelines and took their best advise. We were doing what we thought was best. Now we must do our best to help them recover from the toxic burden, and help get the word out so others don’t have to go through what we are going through. My children, last one born in 1996, all got both aluminum and mercury in their vaccines. I thought that when we got the mercury out in 2001 (and that happened almost overnight it seemed for those of us working as Pediatricians – suddenly you couldn’t buy the vaccines with mercury) that the autism rates would drop. They didn’t, and in fact have continued to go up. The sad thing was that the same year, 2001, that we got the mercury out, the CDC and AAP moved the Hepatitis B vaccine with it’s 250 micrograms of aluminum (known to be a toxic dose at that time) from teens to newborns. We replaced 25 micrograms of mercury with 250 micrograms of aluminum as the toxic burden we were giving to 2 month olds and 6 months old and we added the newborn dose that was never there (a dose of toxin on your birthday). Is it any wonder things got worse?

When the Translational Neurodegeneration article exposed the intentional exclusion of important data that showed a link between the MMR and autism, I knew it would be retracted – why?

I think it’s money and politics, the very reason we have no credible research on vaccines and autism, fear that what happened to Wakefield happens to you the researcher, it’s about as sure a way to get your career derailed as anything. It takes a lot of courage to challenge the status quo that is backed by a 19 billion dollar industry.

Why didn’t they retract the Pediatrics article from 2004 that “showed a link between MMR and autism”? The CDC head researcher Thompson admitted that study protocol wasn’t followed in their exclusion of that data that showed the link.

I hope your kiddo is making great progress. Many of the parents in my practice with autistic kiddos don’t think there is a link between vaccines and autism, and I have one out of the 200 severe cases who got no vaccines. That one is an interesting story, as it was their third child. I asked how the first two were. Neurotypical. I asked if they vaccinated the first two. No they didn’t. Their pediatrician quoted the biased and inadequate literature that you lean on as proof of no connection so they vaccinated child number three who became severely autistic right after the MMR. Is that proof? No. Should you pause and wonder? I do. When you hear this over a hundred times and see it with your own eyes, it’s more than coincidence. But you are right … we need the studies, and until they are done the debate will rage on leaving those without as much experience and exposure to autism and young children and vaccines, to try and sort out the truth amidst the noise – deafening- that is pumped out from big pharma, mainstream medicine, CDC AAP, my peers, and the media.

I wish you the best. The truth will eventually come out. It did about tobacco, and it will about the aluminum toxicity and the MMR as well. It is just a matter of time and how long and how many more need to suffer needlessly. We can still give the MMR and protect the herd immunity so we don’t get epidemics. It just needs to be given after age 3 from what I can tell and there are some families who should not get it at all. One example is yours, where you already have one child with autism. Please don’t vaccinate the next ones. That is not a medical recommendation as I’m not your doctor.  This is just what I would do if I were in your shoes.




Dr Paul


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