To meet the needs of the families, we are now open on Saturdays, starting April 10, 2021. This will give many working families the flexibility to come on the weekends for physicals and acute visits as needed. Our aim is to provide optimal access and service to our patients, and this is one way we are aiming to achieve it! Hope to see you tomorrow, meanwhile, stay safe and healthy!

Let's talk about urinary tract infection (UTI). For those who have experienced an UTI, it's an unpleasant or uncomfortable experience to have. Good news is that it is easy to treat and even prevent. Typically, the normal urine has no bacteria in it (or sterile). Bacteria may get into the urine through the urethra and travel up into the bladder. Once it colonizes the bladder, it then multiplies and causes inflammation/infection; the bacteria can even travel further up to the kidneys as well. When there is inflammation, symptoms of UTI depends on the age of the child. Infants may have fever and irritability, whereas older children may have abdominal pain and/or back pain.

Here are some other signs of a UTI:

Pain, burning, or a stinging feeling when urinating

Urinating often or feeling an urgent need to urinate, even without passing urine

Foul-smelling urine that may look cloudy or have blood in it

Fever

Pain in the low back or around the bladder

Is there more than one kind of UTI? When we say UTI, we should know that there are 2 basic types of UTIs: bladder infection (cystitis) and kidney infection (pyelonephritis). Kidney infections are more serious than bladder infections, since they have a higher chance for causing permanent renal damage (or renal scarring). If we get enough renal scars (from one big UTI or multiple UTIs), we can sometimes see a decline in kidney function (often seen as an increase in the serum creatinine when we do blood work). The good thing is that the kidney is very a resilient organ and compensates very well. In fact, one has to decrease the kidney function by at least 50% before we see a rise in the serum creatinine.

If your child as a UTI, what can be done to find out the cause? Many children who get urinary tract infections have normal kidneys and bladders, but abnormalities should be found as early as possible in life to help protect the kidneys. The first step is to do a renal (kidney) ultrasound, which helps to identify any structural renal/bladder abnormalities such as hydronephrosis, duplicated collecting system, cysts or even ectopic kidneys. If there is an abnormality on the kidney ultrasound, a VCUG may be ordered. This test is a little invasive, but helps to identify vesico-ureteral reflux or VUR. High grade VUR is concerning because it is often associated with higher risk for kidney infection and damage. Sometimes a DMSA scan may also be ordered to identify renal scar and localization of inflammation. A DMSA scan is done with an IV contrast, and if done at the time of a febrile UTI, you can localize which kidney and extent of the infection involved; if it is done 6 months after a febrile UTI, you might be able to visualize any renal scars. But don't worry, not every febrile UTI results in renal scar or even means a kidney infection. However, one should still be vigilant.

How do we diagnosis a UTI? UTI is based on urine culture (> 50K of one organism), of which most common is E.coli (bacteria found in the stool), but there are many others as well. Urine should be obtained by mid-stream clean catch or catheterization (with younger children who can not void) if possible; urine bag specimens are not advised due to high rates of contamination. Once you have identified the organism causing the UTI, the treatment typically involves antibiotics to eradicate the bacteria in the urine. Meanwhile, you can also do some preventative measures to avoid further UTIs, which include: proper hygiene/wiping, double voiding, wearing cotton underwear, avoiding urinary retention (not waiting at the last minute to void/pee), avoiding bubble baths, and avoiding constipation.

When should you see a kidney specialist? You should see a kidney specialist if you have had multiple UTIs and/or have any kidney abnormalities on ultrasound or bloodwork. You should see a a kidney specialist who can help prevent and manage of UTI/kidney disease and to ensure that your kidney function is closely followed. Sometimes, we also use the help of our urology colleagues when a surgical correction is needed.

For now, drink plenty of water (even some cranberry juice now and then may help) and void more frequently. The simplest way to prevent UTI.

Nirupama Gupta, MD

As of March 2021, over 3.1 million children have tested positive for the COVID19 in the USA. Even though children represent 13.1% of total cumulated cases in the states reporting cases by age, COVID19 associated hospitalization (0.1% -2.2%) and death (247) is still uncommon in children.

With the ongoing global pandemic, vaccines may be one of the most effective means of combating the COVID-19 virus and normalizing our lives. Thanks to modern science, we now have three FDA emergency approved vaccines - Pfizer, Moderna and Johnson & Johnson. Pfzier vaccine is authorized for use in ages 16 years and older, while the latter two are authorized for 18 years and older.

When does the vaccine become effective? Efficacy of the vaccine starts to show in the second week after the first dose. The duration of the immunity is not yet known at this time. Moreover, vaccination is recommended for all those eligible regardless of prior infection. About 48 million people have received at least 1 dose of the vaccine so far.

Will there be a vaccine available for children before the 2021-22 school year?

It is projected that teens are likely to have access to the vaccine later in the spring. Newer trials include children as young as 12 years old and based on the results of these trials, the American Academy of Pediatrics will make further vaccine recommendations for children and adolescents. The decision to require the vaccine for school entry will depend on the state government.

Why should we vaccinate children? Since we do not know which child may be at higher risk of serious, possibly life-threatening illness and to reduce community spread, especially to vulnerable adults who are in their family or in their school, it will be important that children receive the vaccine as well.

What can we do to have children return safely to sports/physical activities? During the COVID-19 pandemic, physical activity came to a halt and many of the children as a result became deconditioned and even overweight/obese. Thus, it is recommended to gradually increase the frequency, duration, volume and intensity of physical activity to avoid injury, such as stress fracture and tendon/ligament injuries, heat stress/exhaustion, etc.

Testing for COVID-19 before participating in sports is not necessary unless an athlete is symptomatic or has been exposed to someone known to be recently infected with SARS-CoV-2.

Any child with a history of a positive COVID-19 test should complete a preparticipation physical exam so that proper screening for cardiac symptoms (chest pain, shortness of breath, fainting, palpitations) are performed, at a minimum of 10 days past the date of the positive test result. If one is positive for cardiac symptoms, an ECG should be considered and referral to a cardiologist for evaluation and further testing.

When should children safely return back to school? At present, it appears that children younger than 10 years of age are less likely to become infected and less likely to spread infection. Some data suggests that children older than 10 years of age may spread COVID-19 as efficiently as adults. Many factors at the local and state level will need to be considered when re-opening schools. Physical distancing (desks at minimum of 3 feet, ideally 6 feet apart when feasible), cloth covering (for ages > 2 years old), adult distancing, limiting unnecessary visitors into the building, and proper hand and cough hygiene, amongst many other considerations, will be fundamental to lowering the risk of spread.

More information about school re-opening in Loudoun County can be found here.

Hello friends and families!

If you have been wondering when BlueJay Pediatrics is going to transition from "coming soon" to "Open", well I have some good news for you! We are now open for membership enrollment and/or seeing patients as of February 8, 2021 :) If you are in the neighborhood of Leesburg Costco or Leesburg Premium Outlet Mall, and have some time to spare, then come by our office between noon-1pm everyday for 1:1 in-person interaction (yes, with Dr. Gupta herself) to find out more about BlueJay Pediatrics (located inside MetroMed Urgent Care, next to the Old Walmart). If you can not drop by and are still curious, then please call us at 571-206-4774 or drop an email to drgupta@bluejaypeds.com. We look forward to meeting you!

Many of you might be wondering why I chose the name 'BlueJay Pediatrics'.

The "BLUE" is in reference to Sri Krishna, a Hindu God, whose complexion is BLUE. With Him as my guide and protector, I feel inspired to start this new journey and take the risk to do something new and different.

The "JAY" is in reference to my dear son, Arinjay. In Sanskrit, Arinjay means, victory and/or one who defeats evil. He was born in May 2020, during the COVID pandemic, and he has truly been a blessing to our family. The developmental milestones that I get to watch everyday amazes me how much this little baby is more of a "little person" with his own set of personality traits. So in his honor, I took "JAY".

Finally, when BLUE + JAY is put together, you get this lovely bird, BlueJay, who symbolizes "family bonds, social network, communication, loyalty and fearlessness!" In essence, this is what I hope to achieve with my direct primary care: A strong doctor-patient bond that is intertwined with trust, transparency and timeless encounters!

So as I open this new chapter in my life to be the physician I went to medical school for, I hope that I can connect with you to bring the best healthcare choices for you and your family! Come learn more about who we are and hope you can fly with us!