Effective 1/1/2023 refills will only be done either through the patient portal or calling your pharmacy. Please be sure you have an active patient portal for your refills.

12/1/2021-We are giving the Covid-19 Moderna vaccine for children 6 months & up and also have Covid-19 Moderna booster vaccine available at our office-call to make an appointment.

Revised Covid-19 Practice Information (August 2022)

MASKS are REQUIRED for all entrants aged 2 years and older in all areas of the office at all times… even when the doctor is not in the exam room with you.

The waiting room is open, but please call the office (ext. #4) from your car to let us know when you have arrived for your appointment.

Patients with appointments for communicable, infectious illnesses are directed to enter through the side door on the left side of the building.

Well visits/physicals and non-urgent appointments are rescheduled if a patient has any Covid-19 symptoms. Your child may be seen for a sick visit that day, but we need to know in advance, so we can direct you to enter through the proper entrance per above.

Refer to the Erie County DOH website for information about the latest isolation recommendations. (Note that the new, less strict guidelines may not apply to a patient who cannot mask because of their age (<2 years) nor to patients who cannot consistently/reliably wear a KN95 [or better] mask.)

https://www2.erie.gov/health/index.php?q=coronavirus

The American Academy of Pediatrics and all our doctors recommend Covid-19 vaccinations and updated boosters for all children aged 6-months and older. You may call us to book an appointment for the vaccine.


CARDIAC CLEARANCE after Covid-19 Infection
Your child needs a cardiac clearance exam for sports participation after infection with Covid-19 if they meet any of the criteria below:

  • ≥12 years of age and engaged in varsity sports or high intensity/highly competitive sports (regardless of symptom severity)
  • For children ≥5 years of age(including non-athletes ≥12years)
    • they had Covid-19 illness with any of the following:
      • fever (≥ 100.4) for 4 days (96 hours) or more
      • chills, severe muscle aches, or severe fatigue for ≥7 days?
      • chest pain or shortness of breath
      • hospitalization
    • since the Covid infection:
      • they passed out or felt as if they were going to pass out
      • they mentioned anything strange about their heart beats
    • they have a cardiac condition that requires periodic follow up with a cardiologist

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Appendicitis

What is Appendicitis?

Appendicitis is the most common cause of an acute surgical abdomen in children. It occurs when the appendix, a small tube which protrudes from the large intestine, becomes acutely inflamed.

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What Causes Appendicitis?

Appendicitis is usually caused by some sort of obstruction of the appendix or it's opening (appendiceal lumen) by feces, any foreign object or body, or, in a few cases, a tumor. It can also be caused by a twist of the appendix, which can result in ischemic necrosis, a disease in which blood vessels are blocked by this twist so blood supply to the organs decreases and many cells die.

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Who Gets Appendicitis?

Though appendicitis usually occurs in children over the age of two years and peaks during the teen and young adult years, it can occur in infants and toddlers. The disease is more commonly found in males than in females. The exact incidence of appendicitis is unknown. In terms of genetics, appendicitis has been found to show a familial tendency.

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What are the Symptoms of Appendicitis?

The typical first warning sign of appendicitis is dull pain around the navel. The pain continues and often becomes more localized at the site of the appendix, downward and to the right side of the navel. Usually, pressure applied to this area will cause tenderness and pain. It is important to note that there is variability in the location of the appendix and so the location of the pain may also vary. A loss of or reduction in appetite is always present. Other symptoms may include: nausea, vomiting, and a low-grade fever, however, the vomiting never precedes the pain.

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What are Some of the Other Possibilities?

The differential diagnosis for appendicitis is extensive. In the case of gastroenteritis (commonly called the stomach flu), vomiting and diarrhea usually occur before the onset of pain. Constipation can often be confused for appendicitis however this its pain pattern is not located in the lower right quadrant of the abdomen. A pneumonia in the right lower lobe of the lung can present with symptoms similar to appendicitis. Other conditions that may mimic appendicitis are: Urinary tract infection, inflammatory bowel disease, sickle cell crisis, diabetic ketoacidosis, ovarian torsion, ectopic pregnancy, dysmenorrhea, Mittelschmerz, intussusception, Meckel's diverticulitis or post-surgical adhesions in the abdomen.

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How is Appendicitis Diagnosed?

If symptoms are present, the health care provider may perform tests while the patient is lying on his or her back to determine the severity and proximity of the pain such as: extending the right leg or rotating a flexed leg. A rectal exam may show right-sided tenderness. He or she may also choose to perform an abdominal ultrasound, an abdominal CT scan, or an exploratory laparotomy, a procedure using a small camera and an incision. Your health care provider may also choose to perform a chest x-ray, a complete blood count (CBC) and/or a urinalysis and urine culture. A pelvic examination may be indicated in a female adolescent with abdominal pain.

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How is Appendicitis Treated?

Most commonly, appendicitis is treated by a surgery called an appendectomy whereby the appendix is removed (open surgery). More recently, surgeons have performed laparascopic surgery whereby smaller incisions are made to pass a camera and surgical instruments. A systematic review of 5 studies in 436 children aged 1 to 16 years found that laparoscopic surgery significantly reduced the number of wound infections and the length of hospital stay compared with open surgery. The review did not find any significant difference between laparoscopic surgery and open surgery for intra-abdominal abscesses, in postoperative pain, and in the time to mobilization.

Another systematic review of several studies found that prophylactic antibiotics reduce the number of wound infections in children with complicated appendicitis compared with no antibiotics. Further studies are under way to determine whether antibiotics in children with simple appendicitis are indicated.

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What are the Complications of Appendicitis?

Due to the variability in symptoms upon presentation and the subsequent progression of symptoms in young children appendicitis sometimes is not diagnosed in time, causing the intestines to perforate before surgery can be performed. Other complications of the disease include peritonitis (an infection in the intra-abdominal fluid and tissues, and/or decay of the intestines (gangrene).

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Can Appendicitis be Prevented?

Studies have been done in adults whereby antibiotics were given to try to avoid surgery, but the recurrence rate was too high to make this a viable option. At the present time, there is no evidence that dietary or lifestyle regimens will help to prevent appendicitis.

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References

Hoekelman RA, Blatman S, Friedman SB, Nelson NM, Seidel HM. Primary Pediatric Care 1987 C.V. Mosby

Suerland SR, Lefering R, Neugebauer EAM. Laparoscopic vs. open surgery for suspected appendicitis. The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley and Sons

Milewczyk M, Michalik M, Ciesielski M. A prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis. SURG Endosc 2003; 37: 1317-1320

Reviewed 9/5/2009

By Daniel Feiten M.D.

Greenwood Pediatrics

Copyright 2012 Daniel Feiten M.D., All Rights Reserved

 

Transit Office Hours

4899 Transit Road Depew, NY 14043

Monday – Friday: 8am-4pm
Saturday: 8am-12pm

(716) 558-5437