More on the milk issue

I know my Mother is going to start really worrying about her precious (or should that be precocious?) grandkids, but don't panic mum. I am being responsible in a fairly British way.

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To help answer some of the questions parents are asking, I am posting Dr
Gordina's opinion from today on the China Milk Issue yahoo group. Please keep
in mind that this is her opinion and I am not telling anyone what to do about
their own situation. As parents we make the decisions that are right for our
own family. I just wanted to try and clarify some of the questions, that I am
constantly asked.

If you do not agree with me or Dr Gordina, then please just delete this message
and accept my apologies for sending this information. I have no problem with
parents that disagree with me (on the contrary, I like to hear other opinions
and I like to think about both sides) but I would ask that you do not flame me.
,
Best wishes,
Kim C



OMG, so many questions in so many threads ;-)!

I will try to express my views on testing and follow-up as short as
possible. Remember, some of my believes do go (at least for now)
against the AAP SOAFC and ASPN standpoints. Therefore, this is not a
policy statement, not an evidence-based recommendations, but just a
personal common sense, down-to-Earth realistic approach to how to
tackle the problem that ... nobody seems to really know how to deal
with.

1. Whom to test.

EVERY child, who was potentially exposed to melamine, regardless of
age, gender, and/or adoption status.

2. When was the exposure.

As we are now aware of the "secret" recall in 2006 and we can not
prove when and where this all had started, I would prefer to test
everybody who were potentially exposed (read - CAME FROM CHINA, not
born) on or after 01.01.2003. Why 2003? because Chinese are testing 5
yo and because we had a 5 yo testing positive for stones.

3. What about kids arrived/adopted before 2003?

As you can not prove to me beyond the reasonable doubt that the kid
was not exposed, every parent who has a question should have an
opportunity to comprehensively test their child(ren). The notion that
"82% of all affected were under two, therefore we will test only 1
year olds" does not and should not be a reason not to test.

4. What signs and symptoms to look for?

Please note, that symptoms below are very non-specific and can be
related not just exclusively to melamine exposure. Even more, we don't
know what is normal or abnormal for our adopted children. That's why I
am fighting so hard for comprehensive testing of all potentially
exposed children.

- unexplained failure to grow as expected or failure to have a
catch-up growth after adoption,
- unexplained crying,
- discomfort, associated with urination,
- vomiting,
- frequent unexplained fevers,
- urinary tract infections
- blood-stream infection or bacteremia
- any history of urinary obstruction
- blood in the urine, either seen by naked eye or detected by the
urineanalysis
- acute kidney failure
- stones discharged while passing urine
- elevated blood pressure
- edema - swelling of the eyes, ankles, etc
- back/kidney pain
- any other symptoms that are concerning you

5. What to do with the asymptomatic, but potentially exposed kids?

Test comprehensively and then - observe. They still have to be on
database and have the opportunity to be contacted if any new
information will become available.

6. What to do with asymptomatic kids with abnormal UA/blood results
and normal US?

Repeat US, review the films in the reputable radiology department of
the reputable university clinic with a reputable urology/nephrology
service. Close follow-up.

7. What to do with asymptomatic kids with normal UA/blood results and
a detected stone(s)?

Educate local physicians, contact nearest hospital with a reputable
urology/nephrology service. Most of the time after the initial
evaluation by a specialist, follow-up can be done distantly.

8. What to so with the test results (UA/bloodwork reports, US reports
and US films/CD's)

Keep the copies of all results. "Normal" would not work, you need the
printout report. If you doctor is doing UA's in his/her office, ask
for detailed break-down of all data (SG, Ph, etc), as we don't know
what exactly with be specific for the kidneys, exposed to melamine. It
is imperative to keep copies of the US reports, but I would also
recommend to keep copies of the US films/CD's, as films can be read
wrong or you will need the reference point if any changes will happen
in the future.

9. Where to go if you local and not so local hospital is not providing
you with the answers you need/

Good question. We do need a database of "melamine-friendly"
specialists, so we will have a reliable network.

Yes, you are free to cross-post and share the above information.

Thank you,
Alla Gordina, MD, FAAP
Clinical Assistant Professor of Pediatrics
Drexel University School of Medicine
Global Pediatrics
International Adoptions Medical Support Services
7 Auer Court, East Brunswick, NJ 08816, USA
732-432-7777 (voice)
732-432-9030 (fax)
www.globalpfm.com
drgordina @globalpediatrics.net