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Welcome to Dr O’s Blog

Introduction

 

Dr. Ayodeji Otegbeye, better known as “Dr. O” is the President and Founder of Central Florida Pediatrics Intensive Care Specialists and Night Lite Pediatrics Urgent Care in Orlando, Florida, USA which developed a novel approach to care of children and adolescents in Central Florida. He is the Medical Director of Children’s Medical Services in the Central Florida Region (Orange, Seminole, Osceola and Brevard Counties) where he oversees the care of children with special health care needs and the Medical Director of Leesburg Regional Hospital Pediatric Hospitalist Program.

The Truth About Ear Infections: 6 Common Myths Every Parent Should Know

Ear infections are one of the most common infections that we treat here at Night Lite Pediatrics. But because ear infections are more common in children than adults, we often come across parents that are misinformed about the symptoms, treatments, and severity of an ear infection. So, we wanted to debunk six common myths regarding this topic with hopes that it will help bring some clarity the next time your little one has ear pain.

MYTH 1: All Children or Adolescents with Middle Ear Fluid Need To Be Treated With Antibiotics ANSWER:NO Acute otitis media – AOM refers to acute infection of middle ear fluid; whereas, Middle ear effusion (MEE) or Otitis media with effusion (OME) refers to fluid in the middle ear cavity, which can happen after AOM or if there is dysfunction of the Eustachian tubes. Middle Ear Effusion occurs in both otitis media with effusion and AOM. MEE can be seen after antibiotic treatment of AOM, but it is not an indication for repeat antibiotic treatment unless it gets infected again. The importance of accurately diagnosing AOM cannot be overstated. Accurate diagnosis ensures appropriate treatment for children with AOM, which requires antibiotic therapy, while avoiding antibiotics in children with OME, where antibiotics are unnecessary. Ultimately, accurate diagnosis prevents overuse of antibiotics, which can lead to the development of resistant organisms.

MYTH  2: Children and Adolescents with confirmed Acute Otitis Media (Ear Infection) Must Be Treated With Antibiotics. ANSWER: NO Roughly 80 percent of children with acute ear infections get better without antibiotic treatment. Also, studies show delaying antibiotic treatment with watchful waiting does not increase the likelihood of developing a severe illness. The clinician should either prescribe antibiotic therapy or offer observation with close follow-up based on joint decision-making with the parent(s)/caregiver for unilateral AOM in children six months to 23 months of age.  During observation, steps must be put in place to ensure follow-up and to begin antibiotic therapy if the child worsens or fails to improve within 48 to 72 hours of ongoing symptoms. Gathering as much info on the tempo, severity, and duration of illness is also essential because a progressively or severely ill child is more likely to have a bacterial process that may not resolve right away. Starting an antibiotic is reasonable if your child is:

  • Six months or younger and has a diagnosis of certain or suspected acute infection.
  • Between the ages of six months and two years and has severe symptoms with a diagnosis of certain or suspected acute infection.
  • Between the ages of two and twelve years and has severe symptoms with a diagnosis of certain acute infection.
  • Severe symptoms defined as moderate or severe otalgia for at least 48 hours or temperature 39°C [102.2°F] or higher).

Myth 3:  My Child’s Ear Infection Should Always Be Treated With Amoxicillin? Answer: NO Here are some reasons to go with something different or stronger than Amoxicillin:

  • If the fever and fussiness are not improving after 48-72 hours of an antibiotic, your child may need a stronger one.
  • If amoxicillin has not worked two or three times in the past, then it’s OK to start with a stronger antibiotic for future infection.
  • If your child has taken amoxicillin in the past 4 to 6 weeks, and then develops another ear infection, chances are that this infection is resistant and needs a stronger antibiotic
  • If your child is allergic to amoxicillin
  • If there is accompanying pink eye with discharge which increases the likelihood of bacteria (Non-Typeable Hemophilus influenza) which is commonly resistant to Amoxicillin.

MYTH 4: Most Ear Aches (Otalgia) Are Due To Middle Ear Infection: ANSWER: NO Symptoms such as ear tugging or ear pain (otalgia), while often helpful in nonverbal children, may also indicate middle ear fluid without infection. Other symptoms such as irritation of or blisters on the eardrum may be due to a viral infection (Myringitis). Eustachian Tube (ET) dysfunction with decreased hearing is common in children with Allergic Rhinitis, Enlarged Adenoids especially after a plane ride or referred pain from a dental or throat problem. Ear Pain as a symptom should be distinguished from pain in the external canal due to otitis externa which results in pain on movement of the earlobe and inflammation of the ear canal usually without any systemic symptoms such as fever.

MYTH 5: Are Children’s Ear Infections Ever Serious? ANSWER: Yes, But Rarely A severe or untreated infection can rupture your child’s eardrum. Ruptures don’t happen very often and heal quickly. Repeated ear infections or chronic MEE (middle ear fluid for months even without infection) can sometimes cause hearing loss and scarring.  In rare cases, untreated ear infections lead to mastoiditis (a skull infection behind the ear) or meningitis. It is advised to follow up with your child’s doctor to make sure the infection has cleared up and that the eardrum is healing well.

MYTH 6: There Is No Way To Prevent Ear Infections- It Is One Of Those Common Things Every Kid Gets Breastfeeding until at least 6 months is recommended to help prevent acute ear infections. Parents should also avoid “bottle propping” and eliminate your child’s exposure to secondhand smoke.

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Urgent Care vs Emergency Room in Orlando, FL

6 Things You Should Know About Urgent Care vs ER in the Greater Orlando Area. By Ayodeji Otegbeye, MD

It’s Friday evening, and you’re heading home from a long day of work. You stop to get some groceries, then quickly swing over to pick up your youngest child from daycare.  As you enter the daycare, you notice your son is a bit sluggish, is not as talkative, and is a bit irritable. The daycare attendant mentions that he may be coming down with a fever. You monitor his temperature throughout the night. Early the next morning, you realize that it is now 101˚F and he has a slight cough. You immediately begin to panic and think, “I need to go to the E.R.” As you are about to head through the door, your mother-in-law quickly mentions. ” What about that Night Lite place for kids we saw the other day while shopping at Publix.” You reply, “Yeah, but that’s an urgent care, and Josh might have the flu. Plus, it’s Saturday, and I doubt they’re open.” You head over to your nearest Emergency Department (E.R.), and there’s an incredibly long wait. With so many medical options now available for patients, it can be hard to distinguish which one to visit based on your medical needs. So, we wanted to share with you six differences between an Urgent Care Clinic vs. the Emergency Room that will help you to make a more informed decision the next time you or your little one becomes ill.

  1. How Do They Match Up

First things first, you should know the difference between the two by their definitions. Urgent Care or Acute Care Clinics are walk-in clinics that are designed for after-hours ambulatory care. Patients are served on a first-come, first-served basis, and scheduled same-day visits may be offered. Urgent Cares have multiple exam rooms that are staffed by nurse practitioners, physician assistants, and medical assistants. Most Urgent Cares have a full-time, on-site licensed physician. Urgent care clinics such as Night Lite Pediatrics fill patients’ needs when your child’s Pediatric doctors office is closed or booked out, especially for urgent health needs that do not require an emergency room visit. Emergency Rooms on the other hand, is a hospital area or free-standing building equipped and staffed for the prompt treatment of acute illness, trauma, or other medical emergencies. Emergency rooms have several exam rooms and have access to extensive diagnostic testing (CT Scan, Ultrasound, Fluoroscopy, etc.) and sub-specialist support.

  1. Wait Times Are Different

Urgent Care wait times for walk-in patients average 15-45 minutes. At an Emergency Room, the wait time to see a provider can be up to two hours or more. Note, the E.R. is for severe emergencies, so patients that come in that are in dire need of medical care are usually seen first, therefore, those with minor or even moderate illnesses may have a wait time that is much longer than average.

  1. How Much Will I Save

Typically, if you have insurance, you’ll notice that your co-pay for an Emergency Room visit is more than an Urgent Care. Not only do Urgent Cares have a smaller co-pay, but you can also save money if you do not have insurance. At Night Lite Pediatrics the starting self-pay rate for medical care is $160, and the maximum we charge for our medical services is $400 regardless of the amount of testing or treatment the patient needs. Note: Some urgent care centers are affiliates of major hospitals.  Be sure to ask if they are billing you as an Urgent Care or as an Emergency Room. The cost of medical care at the Emergency Room can be substantially more for the same treatment.  Emergency Room visits also may include multiple medical charges, which may not be covered by your insurance. The bottom line: An urgent care visit is substantially cheaper than an emergency room visit.

  1. What Services Are Offered

Services can vary depending on the type of urgent care you visit but, in a nutshell. Urgent Care clinics serve more pressing injuries or illnesses that are not life-threatening. Urgent cares also offer higher-level diagnostic equipment such as x-ray, laboratory testing and phlebotomy. At Night Lite Pediatrics we provide services for higher acuity cases than most Urgent Care Centers. Some of these cases include:

  • Pneumonia, Cellulitis or dehydration requiring intravenous or Intramuscular antibiotics or intravenous fluids.
  • Moderate allergic reactions, anaphylaxis, and angioedema
  • Abdominal pain
  • Mild head injury such as concussions
  • Expertise with younger children who are less than the age of 6 years.

Additional services at Night Lite Pediatrics for newborn to 21 years of age patients include:

  • On-site lab and Radiology
  • Eye Injuries
  • Diarrhea & Vomiting
  • Sprains, Broken Bones & Lacerations
  • Fever, Ear, Nose & Throat Infections
  • Asthma, Bronchitis & Respiratory Illnesses
  • Chronic Illnesses: Diabetes, Kidney Disease, Glucose Deficiencies, Sickle Cell, and more.
  • STD testing

Emergency Room visits are necessary when a patient is suffering from a life- or limb-threatening medical condition or severe wounds. If symptoms arise suddenly and you believe that a life is in jeopardy, call 9-1-1. ERs specialize in managing catastrophic illnesses and injuries such as:

  • Signs of heart attacks, including chest pain
  • Signs of stroke, like sudden onset of numbness in the arms or legs
  • Severe shortness of breath
  • Poisoning
  • Major life- or limb-threatening injuries
  • Severe wounds and amputations
  • Coughing up or vomiting blood
  • Suicidal or homicidal feelings
  1. Kid-Friendly Urgent Care

There are Urgent Care Clinics that cater to all age groups, and there are specialty urgent care clinics such as Night Lite Pediatrics that specialize in medical care just for children and adolescents. Night Lite Pediatrics goes one step further in that it is supervised by fellowship trained Pediatric Critical Care Specialists with 100 years of combined medical experience. Specialty facilities like ours are designed to be child-friendly and serve as an alternative to the emergency room for minor to moderately severe health issues. All our offices come equipped with medical devices that are suitable for newborns that are often not found in your family/all-purpose urgent care. Note: We do not perform school physicals, workman’s compensation evaluations or give routine immunizations at Night Lite Pediatrics.

  1. Referrals and Processes

Emergency rooms have the capability of calling different specialists needed to care for the severely ill. At Night Lite Pediatrics, we have a good relationship with and access to many specialists including Orthopedic, Ear, Nose and Throat, Pediatric Surgery, etc. We can also facilitate early follow-up appointments with specialists. Night Lite Pediatrics has excellent relationships with hospitalist groups at the premier children’s hospitals in our coverage area. We can facilitate admissions for observation or full admission when needed without having the patient go through the time consuming and expensive experience in the Emergency Room. Dr. Ayodeji Otegbeye, better known as “Dr. O” is the President and Founder of Central Florida Pediatrics Intensive Care Specialists and Night Lite Pediatrics Urgent Care in Orlando, Florida, USA which developed a novel approach to care of children and adolescents in Central Florida. He is the Medical Director of Children’s Medical Services in the Central Florida Region (Orange, Seminole, Osceola and Brevard Counties) where he oversees the care of children with special health care needs and the Medical Director of Leesburg Regional Hospital Pediatric Hospitalist Program. Dr. Otegbeye completed his residency and fellowship at Cook County Hospital in Chicago, Illinois. He is board certified in Pediatrics, Internal Medicine and Pediatric Critical Care. He is a Fellow of the American Academy of Pediatrics, member of the American College of Physicians and Society for Critical Care Medicine. He specializes in pediatric critical care with special skills and interest in pulmonary medicine.

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It’s that time of the year again when the flu season is back in full swing.

7 Things You Should Know About the Flu and the Flu Vaccine

It’s that time of the year again when the flu season is back in full swing. A recent CDC Health advisory report indicated influenza activity has increased significantly over recent weeks in the United States. With an increase in flu patients at our clinics, we wanted to share with you some of our top tips to help avoid the flu, or in the event that you or your little one catches the bug, to get over the flu more quickly. Here are our seven (7) flu tips to keep in mind this flu season:

Look for Symptoms

After you have been exposed to the flu, it takes usually between 2-4 days for the symptoms to kick in. Typical flu symptoms in kids include a high-grade fever up to 104 degrees F, aching muscles, sore throat, tiredness, and a dry cough.

Bring in Your Child If:

  • Your child is 3 months of age or younger and has a fever of 100.4°F (38°C) or higher.
  • Your child is finding it hard to breathe
  • Wheezing develops
  • His or her fever lasts longer than 3 days
  • If he or she has an extremely high fever

Be Aware of Risk Conditions

If your child has or lives with someone with any of the chronic underlying medical or other high-risk conditions listed below please have them visit us or their pediatric physician for testing.

  • Children younger than 2 years (although all children younger than 5 years are considered at higher risk for complications from influenza, the highest risk is for those younger than 2 years)
  • Lives with adults aged 65 years and older
  • Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), hematological (including sickle cell disease), and metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury)
  • People with immunosuppression, including that caused by medications or by HIV infection
  • Women who are pregnant or postpartum (within 2 weeks after delivery)
  • People younger than 19 years who are receiving long-term aspirin therapy

Watch for Other Severe Health Complications

If your son or daughter gets the flu please be mindful that other symptoms may arise.  Children who are considered high risk (as listed above) have an increased risk of other complications. Although infrequent, healthy kids can develop rapidly progressive secondary bacterial infection due to Staphylococcus or Streptococcus. These superinfections can progress rapidly to shock, respiratory failure and death.  Our doctors recommend early and close follow-up with your PCP if “things don’t look right”. At Night Lite Pediatrics we do complete blood counts, chest x-ray and blood cultures to check for complications of influenza if deemed necessary. We also can give intravenous fluids and intravenous antibiotics if needed for secondary infections.

Take Preventive Measures

Here at Night Lite Pediatrics, we love treating your little ones and restoring them to their fun-loving selves, but we also emphasize keeping up with preventive methods.  So, it’s no surprise that we would recommend getting the flu shot. Now, I know some of you may be thinking, “Doesn’t the flu shot give me the flu?” No, the flu vaccine is made from an inactivated virus, that does not transmit the infection. Do keep in mind, however, that getting the flu shot does not guarantee that you will not get the flu. Instead it reduces your chances of catching the bug by 60% and is 30-35%effective. Other great preventive methods are to carry around a hand sanitizer or sanitizing wipes, at all times, to disinfect your hands and surfaces throughout the day. Also, maintaining a healthy, balanced diet (which includes vitamin intake) and an active lifestyle are essential.

Get a Flu Shot (Even if You Have a Cold)

Our doctors recommend delaying the flu shot if you or your little one has a fever.  If the symptoms only include a cold or any other mild illness (respiratory or otherwise), you can get the flu vaccine. Please note that because there are different strains of the flu, you can contract the flu more than once. While we do not offer flu vaccines at any of our Night Lite Pediatrics clinics, you can make an appointment to get your son or daughter vaccinated at your local pediatric physician, CVS or Walgreens.

Avoid Schools and Daycares

Germs can easily spread in school or at daycare.  If your child comes down with the flu, we suggest that you keep your child home until he or she is fever-free for at least 24 hours, without the assistance of an antipyretic (Acetaminophen or Ibuprofen). This may take 5-7 days. Little ones getting sick and coming down with the flu can be hard for any parent. In the event that they come down with the flu this season, Night Lite Pediatrics performs special flu testing using an up- to -date Rapid Influenza Diagnostic Test (RIDT) with analyzer. This test will be able to detect influenza A and B viruses in respiratory specimens in 10-15 minutes with moderate sensitivity. With 10 locations throughout Central Florida that are open from 4pm-midnight during the weekdays and 12pm-midnight on the weekends.  Night Lite Pediatrics is here to get your child back to their healthy, fun-loving selves quickly.

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