You thought it was dead. The credits had started to roll and you whispered to the random guy sitting next to you that “there’s no way it’s coming back after that. Yep, definitely dead this time.” But you were wrong.

There was a post-credit scene where a hand shoots up from a freshly filled grave in the middle of a thunderstorm. So no, it wasn’t dead. In fact, it’s found you. Yet another collection of medical (and sometimes pseudomedical) odds and ends that have caught my attention recently is walking up the stairs. You can hear the creaking floor as it approaches. Now it’s slowly turning the doorknob. It’s too late to run.

It (the flu season) has begun!

Cases of the flu are now starting to be pop up across the country. Just as I was taking my daughters to get their yearly flu shot this week, the first report of a pediatric death was announced in Florida. No details have been provided, only that it was a child with no underlying health conditions who had not been vaccinated. We don’t know why, and I wouldn’t jump to conclusions considering how early it is in the season.

Last year was a particularly bad season, with an estimated 80,000 deaths caused by the influenza virus. 180 deaths occurred in pediatric patients between 6 months and 17 years of age, which is about on par with recent years. Unlike the child in the most recent fatality, most deaths caused by the flu involve patients with an underlying health condition such as asthma or an immune deficiency. These patients benefit from as many people as possible, including themselves unless contraindicated, being vaccinated. Unfortunately only about 60% of eligible children received the vaccine last year. This just isn’t good enough.

Mysterious polio-like illness has now been reported in 22 states

Almost exclusively effecting young children, a mysterious polio-like illness that damages the spinal cord has been confirmed by the CDC in 62 patients, and 60 more are currently being investigated. The condition, acute flaccid myelitis (AFM), presents with muscle weakness and decreased reflexes that can be severe enough to require the use of mechanical ventilation. The prognosis varies from good in mild cases, with some having a full recovery, to severe persistent weakness or paralysis.

AFM isn’t a new condition, rather it is a rare final common pathway seen in several different processes. Polio and West Nile virus infection, for example, can cause AFM, and various autoimmune and genetic processes can cause a very similar presentation. What is different about the current spate of cases is that there has been a significant (though still rare) increase in the number of cases without any clear cause despite extensive investigation since 2014.

In 2014, pediatricians saw an increase in severe respiratory infections caused by the first ever national outbreak of a particular enterovirus (EV-D68). While it was plausible to suspect a link between the surge in AFM to EV-D68, because this virus has been known to target the spinal cord in addition to the lungs, most cases since 2014 have not tested positive. And after the 2014 EV-D68 outbreak, reported cases plummeted to typical numbers.

The CDC currently considers the cause of increased cases of AFM to be unknown. They are asking that samples of blood, spinal fluid, and stool (enteroviruses love to infect the gut) be sent in for analysis in any suspected case. So far, no cases in the United States have been caused by the poliovirus, but this is a very small taste of what it would be like should that disease come back.

Lawn mowers are extremely dangerous, especially for kids

Earlier this month, The New York Times reported on the surprisingly (not to emergency department doctors) large number of injuries related to the use of lawn mowers. A recently published study that tracked these injuries across the country revealed that just over 51,000 were seen in emergency departments during the 8-year-period of 2006-2013. Of the reported ED visits, there were roughly 11,000 broken bones and the same number of amputations. The researchers estimated that these injuries cost about $36 million every year.

These numbers, which were obtained from the US Nationwide Emergency Department Sample, underrepresent the actual number of cases, however, likely because they focused on a single diagnosis code involving only powered mowers. A study published one month later in the American Journal of Emergency Medicine reported significantly larger numbers of lawn mower-related injuries using the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System and all codes relating to mowers. In this database, there were almost a million ED visits for lawn mower injuries in the United States from 2005-2015.

One thing is clear in both studies, and it’s that children suffer the worst injuries. Though representing a small percentage of the total number of visits, young children were by far more likely to present with severe injuries and to require amputation. These injuries likely occur when they wander close to the mower and are struck or when they fall from a caregiver’s lap. I’ve personally taken care of a toddler who was accidentally run over by a riding mower and it isn’t something I’ll ever forget.

Here is some good info from the AAP on kids and lawn mower safety.

A few colorful and stretchy scraps left on the cutting room floor

Runner’s World published an article on kinesiology tape this week, and it’s bad. It’s very bad. It’s essentially just an ad for certified KT roller-unrollers and is deserving of its own dedicated post, especially considering how we have surprisingly never covered this topic in any real detail. Maybe next time, but until then here is a choice quote:

“It looks easy, but you don’t want to be turning on or exciting a muscle that’s already overactive or turning off a muscle that’s already underactive,” says Scantlebury. “Over time, that can cause even more damage. Getting some education from a licensed professional is tremendously valuable.”

Don’t laugh. I think I read an article about the dangers of haphazard and unprofessional Kinesio Taping a couple years ago. Oh, here it is.

You survived!

Yet another edition of the MMM is in the books, and you’ve survived…for now. You can relax and return to the water, unless of course you want to read about a measles outbreak in Brooklyn among unimmunized children in an Orthodox Jewish community that has the potential to become very serious, very fast. As for me, that’s it, man. It’s game over, man. Game over!

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @SBMPediatrics and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey. The comments expressed by Dr. Jones are his own and do not represent the views or opinions of Newton-Wellesley Hospital or its administration.