Health Menu (Childrens/infants)

Everything on this menu is thimerasol and mercury free

State Required (unless waived)

1. DtaP with a side of Hib- This shot protects against the very nasty Diphtheria, Tetanus and Pertussis (Whooping cough) bacteria.  All 3 of these disease are alive and fresh in the environment.  Although the death rate is no longer 1 in 10  these diseases can still kill and most importantly are still around.  There have been epidemics of Pertussis recently in several states,with a small number of deaths all of which were under 3mo of age so probably too young for the immunizations to have been a factor at that time.  The side of Hemophilus Influenza vaccine compliments it well and prevents the strain that used to cause one of the more common Meningitis and was one of the most common causes of ear infections.  It is served on one plate (combined in 1 syringe) or on separate plates (2 separate shots) both are good protection but the separate one is a little better.  It is served preferably at the age of 2mo, 4mo, 6mo, and then the Chef prefers at 15mo for the last one.   *** Chefs Pick.

2. IPV – This is the American version of the old traditional Oral Polio Vaccine, but since there has not been a wild case of Polio in the U.S.A. since 1978 and 6 cases each year in the whole United States of Vaccine Associated Polio derived in mostly people with poor immune status such as HIV, the American version has changed to another shot to prevent shoes 6 cases out of the entire U.S. Population.  This is generally served at 2mo, 4mo, and 6mo.

3. Hepatitis B- This is an old favorite that has now become a favorite of schools.  The people at risk for Hepatitis B are people who inject drugs, have multiple sexual partners and health care workers.  I would imagine most of  your children do not fit into these categories.  Although the vaccine has been around for a long time it was used only for high risk groups of which only realistically the health care workers really received since the other groups did not generally get vaccines real well.  As a result of the old way not making a dent in the amount of Hepatitis B in the country it is now offered on the childrens menu.  This one is served at any point in your life as a series of 3 shots, the second one 1-2 months after the first, and the third one 6-18mo after the first shot.

4. MMR- (Measles, Mumps and Rubella)  This is a traditional dish which has received a lot of attention.  There are a lot of people who feel this is responsible for the rise in Autism.  According to what the Chef has seen however the Measles vaccine may have been implicated in some of them, however not the mumps or rubella.  You will need to weigh the risk of a bad event from the shot (rate of autism 1 in 150 x whatever percentage you think is from this shot- chef suggests maybe 10%- or 1 in 1,500)  vs the risk for a bad event with Measles which is 1 in 1000.  Mumps vaccine protects against infertility.  Rubella vaccine protects them or others exposed to them when they (or others) are pregnant.  In 2010 there were more cases in the US in decades, a total of ~220 in the whole United States of a population of ~300,000,000. There were no deaths or encephalitis in the US from that.  Of those 220 , 90% of those migrated in from Europe. *** Chef suggests waiting until 2 or 5 yrs old instead of the traditional 15-18 mo to allow for more brain chemicals to form.

5. Varicella – (Chicken Pox)  Mild dish but very contagious disease.  Worse in adults.  Potential problems with this one is that some people will get Chicken Pox from the vaccine (about 6%, although its said to be mild)30-40% will get it despite the vaccine, and it is not well established how long you would be protected from it.  There is a medication that cuts the number of pox in half and the amount of time in half.

Prevnar (pneumococcal) - This vaccine is different in that the disease it is protecting you against is not usually deadly but it is very common.  It is designed to reduce 60-80% of the ear infections, bronchitis and pneumonias.  Although not deadly it is more practical as we see this in our fine establishment fresh daily.

Newest Menu items

1. RotaTeq -  Rotavirus vaccine.  Rotavirus is the main cause of what people commonly call the stomach flu- infectious diarrhea or gastroenteritis.  It is not actually flu or influenza. The gastroenteritis caused by Rotavirus is estimated to cause 20- 60 deaths per year in the United States.  Please keep in mind that is out of the entire United States.  This is an oral vaccines like the old oral polio vaccine. there are 3 doses - 1st one is at 6-12 wks old, the next two are at 4-10 wk intervals.  For those of you who remember that we had a Rotavirus vaccine in 1999 which was taken off the market for the bowel folding in on itself called intussception.  This vaccine is different.  This one has been studied in 70,000 children and no intussception and in post licensing study of 44,000 and no intussception. 

2.  Hepatitis A vaccine is now recommended routinely.  Previously it was just recommended in endemic areas (areas with significant amount of Hepatitis A ).  Now they are recommending it everywhere for ages 12-23 months.  This area is not endemic.

All of the above vaccines are special order so once you notify me you want it I can order them, until such time insurances routinely cover it and then we can stock them if sufficient request.

Side Orders.

Lab work such as CBC and Lead level-  a CBC checks hemoglobin (or the stuff in red blood cells which carry oxygen and is low if anemic), White blood cells (which fight off infection and may be abnormal if leukemia for instance was present or elevated if infection), and Platelets which help you clot.  Some of those abnormalities will only be found with a CBC.  Lead is found in old paint, leaded pipes, some industrial sources which can come home on clothes, and in some crystal.  Although lead protects Superman from Kryptonite, it makes us humans anemic and effects our nervous system.  The Chef has found only about a half a dozen abnormal leads in his career in children, and luckily all of them have done fine, just needed to find the source of the lead and watch.  n For the blood tests the Chef prefers to send you to the Lab to be drawn if an infant.  It is best served around 9 mo old.

For the Older Children

Tetanus Boosters (Adult TDaP or Td) are served every 5 yrs (per new CDC recommendations). 

recommendation of getting an adult DTaP instead of the adult Td that we give as adult tetanus shots.  Basically adding Pertussis which has been found more common than we used to think and may be responsible for 20% of the bronchitis around.  Whooping cough is still very rare in adults.  But the thought is that by immunizing the adults would cut down on the population of Pertussis that is available to give kids whooping cough.  It spreads quickest within a family.  This has some particular merit for those of you who had chosen not to immunize your children with DTaP.  Thus at least limiting their exposure to Pertussis, as well as decreasing some of your bronchitis exposure.

Before Kindergarten Special-  Before Kindergarten they are due for DtaP, IPV, and MMR, and Chickenpox vaccine. You can choose to order a side order of a CBC as well.

Teenage Girls Special-  Rubella titers-  It is sometimes a good idea to check a Rubella titer as you are approaching reproductive age.  It is good to be immune to Rubella before getting pregnant since if the disease is contracted during pregnancy there is a 90% congenital anomaly rate.

1.  Gardisil  - HPV vaccine to prevent Cervical Cancer-  this vaccine is to prevent the most likely subtypes of Human Papilloma Virus (HPV) to cause Cervical Cancer in women.  These subtypes are estimated to cause  70% of cervical cancer.  It is given in 3 doses similar to the Hepatitis B vaccine and is recommended as early as age 9 and preferably before the girls are sexually active , as HPV is a sexually transmitted virus.  *** It is important to note that it is still important to get routine paps after age 21 or sexually active within 3 yrs, whichever is first as it is only preventing 70% not 100%. This vaccine may have limited insurance coverage so you may want to check first. 

Before College Special-  Many universities are recommending Meningitis vaccine.  This is different then the Hib, it is for Neisseria Meningitidies bacteria.  It is still a low incidence in college but higher then the general population.  * It is not always stocked in our fine establishment- please inquire if interested.  

Menactra- which is a Meningococcal vaccine.  It is currently being served to ages 11-19 and on special for young adults going away for college.  It is an interesting dish designed to appeal to your emotions with such comments from the reviews like- “wouldn’t you feel awful if your child got meningitis and you could have prevented it ?”  When you look beyond the hype, just read the label of statistics.

The risk of the usual adult is 1 out of 100,000 people can get Meningococcal meningitis.  Of which approximately 35% of those people will have a very serious outcome (20% death, 15% permanent brain damage or similar serious problem).  College freshman staying at dorms have approx risk of 3 out of 100,000 chance of getting Meningococcal meningitis.  One way to look at that is they have 3 times the risk.  Another way to look at that is that if you had a 1 in 100,000 chance of winning the lottery,,, do you seriously think you will win if you bought 3 tickets?  Is it really that different?

The vaccine will protect against 85% of the strains of the Meningococcal meningitis.  So it is not 100%.  Another way to look at it is , if you do the math, and you have 1 million freshman in college without the vaccine 30 will get Meningococcal meningitis and 10.5 will die or have a serious reaction.  On the other hand if you immunized 1 million freshman in college only 4.5 kids will get Meningococcal meningitis and only 1.6 will die or have a serious reaction.  So at the cost of approx $100/ vaccine times 1 million people or $100,000,000 you will have saved 9 people from a very serious problem.

The flip side of the equation is what is the risks of the vaccine.  Because it is new there is no real good data on the risks.  The insert says 1.2 % serious adverse reactions, but in fairness that was done on less than 100 people and the serious reaction was esophagitis which is not as serious as what your preventing.  If  you could extrapolate that, it would mean for those 1million people immunized 12,000 will get a serious adverse reaction meaning the esophagitis.  If you use statistics from a similar vaccine- the Act Hib given to infants- in a large study in Finland there were 3 serious reactions – such as unresponsiveness or encephalitis  out of 30,000 infants.  So out of 1 million doses if given to infants as opposed to college freshman than you would expect 100 truly serious reactions, except you cant extrapolate that found in infants to college freshman.

Now that I have confused you, take your time to decide on this menu item.  If you decide on getting it because you would feel awful if something happened to your child, wouldn’t you also feel awful if something happened to the rest of the family as well which have a similar risk ( 1 lottery ticket vs. 3 tickets)?  Just something to think about J

**Of note is that the Chef’s specialty is to mix and match for the unique preference of his patrons.  He encourages questions.

The Chef would like to acknowledge the fine work of the makers of the vaccines.  They have provided us with a tremendous freedom from suffering and death from terrible disease that were once rampant through our country.  As our tastes and needs change we have the honor and foresight to change our menu as well.  

David Schindler M.D.

Personal Care Physician  P.L.L.C.  

(248) 912-1919

drbatman@twmi.rr.com

26179 Novi Rd

Novi, MI 48375