My Doctor Online The Permanente Medical Group

Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Overview

Whooping cough, or pertussis, is a contagious disease that can spread easily from person to person through coughing.

Whooping cough is most common in young infants and in teens, but it can affect all age groups, especially those who are not properly vaccinated. Most cases of whooping cough are caused by Bordetella pertussis, a bacterium that produces toxins that can make people cough for weeks. Teens and adults with whooping cough have a cough that lasts an average of 4 to 6 weeks, with lasting some up to 14 weeks or longer. In Chinese, the term for pertussis is the “cough of 100 days.”

Antibiotic treatment given within the first 3 weeks of infection can shorten the cough and prevent transmission to others. Most cases of whooping cough are diagnosed after the first 3 weeks of infection, however, and in these patients, antibiotics will not shorten the number of days of coughing but may prevent others from becoming infected.

Most people with whooping cough recover without long-term problems. However, babies less than 6 months of age and older adults are at risk for complications requiring hospitalization and resulting in long-term health problems. However, there are vaccines available to prevent pertussis.

Outbreaks of whooping cough still occur in California, so it is important to make sure that you (and your child) are immunized against whooping cough. Immunity from vaccines is not permanent, so boosters during childhood and adolescence are necessary. People who have been properly vaccinated are less likely to become ill, to be hospitalized, and to transmit infection to others.

Symptoms

Symptoms of whooping cough usually begin within 7 to 14 days after being exposed to a contagious person, but they can start as late as 21 days after exposure. Whooping cough has several phases.

First stage. Symptoms are like a common cold and usually last a week or 2 (sometimes less in young infants). During this phase, runny nose and mild cough may be the only symptoms, and fever is rare. Most bacteria are transmitted to other people during this first stage of illness.

Second stage. This is the coughing phase, which lasts 4 weeks to 6 weeks in most teens and adults but can last up to 14 weeks or longer. Coughing tends to last longer in young children or in persons who smoke. Although most patients with whooping cough are diagnosed during the cough phase, the risk of transmitting the bacteria may be lower during this phase. Younger children with whooping cough are usually more contagious and transmit infection for longer periods than teens and adults.

Teens and adults with whooping cough frequently have no symptoms other than a prolonged cough. Some patients, though, have nausea or vomiting after they cough (called posttussive nausea or vomiting). Up to one-third of adults and even more infants and toddlers develop severe fits of coughing (coughing paroxysms) and can have problems catching their breath. Some of these have such difficulty catching their breath that they have to gasp for air, generating a loud noise known as a “whoop.”

Complications of whooping cough

Complications of whooping cough are most common in infants and elderly adults. Hospitalization is sometimes needed, depending on the severity of medical conditions, especially among infants with fewer than 3 doses of DTaP (diphtheria, tetanus, and pertussis) vaccine. Infants with whooping cough have the highest rates of complications, including pneumonia, seizures, and death. Unimmunized toddlers may also have these complications. Elderly adults can have rib fractures from the severe coughing fits. 

Hospitalization and other complications of whooping cough in teens and otherwise healthy adults are rare.

When to call us

Call us immediately if you suspect that you or your child has symptoms of whooping cough. Be sure to tell us if you suspect whooping cough because we may ask you to take precautionary measures when coming into the clinic for your appointment, such as wearing a mask to prevent transmission to others.

Infants have the highest risk of death from whooping cough. If you suspect that your infant has whooping cough, call us immediately.

If you or your child has already been diagnosed with whooping cough, immediately call 911 and seek emergency medical care if any of these symptoms appear:

  • Difficulty breathing or no breathing
  • More rapid breathing than usual (seen with pneumonia)
  • Seizures
  • Bluish-colored skin
  • Lethargy

If you or your child has prolonged vomiting or signs of dehydration, you may also need emergency care. Signs of dehydration include decreased urination or fewer wet diapers, few to no tears during crying, dry mouth, fatigue, headache, dizziness, and muscle weakness.

Additional References:

Causes and Risk Factors

Some groups of people are at increased risk of transmitting whooping cough to high-risk persons (infants and elderly adults). If you fall into any of the following groups, you should make sure your pertussis vaccinations are current:

  • Parents and caretakers (for example, grandparents) of newborn infants (especially if an infant is under 6 months of age).
  • Pregnant women. Ideally, women should get vaccinated between 27 and 36 weeks of each pregnancy, but vaccination is safe during any trimester. For a woman who has just given birth and has never received her Tdap (tetanus, diphtheria, and pertusiss) booster, we recommend vaccination prior to leaving the hospital.
  • Adolescents. One dose of Tdap vaccine is routinely given to all U.S. teens starting at age 11 years. Tdap vaccine is now required for all California teens before they enter the seventh grade.
  • Health care workers. Health care workers, particularly those who work with infants, children, or pregnant women, should get vaccinated to prevent transmission of whooping cough in health care settings.

Diagnosis

Whooping cough is usually diagnosed by a test called polymerase chain reaction (PCR). The test is performed using material swabbed from the back of the nose (the posterior nasopharynx). Pertussis PCR detects DNA of the bacteria Bordetella pertussis and Bordetella parapertussis. PCR testing is usually positive within the first 3 weeks of symptoms and can still be positive after patients take antibiotics that are effective against whooping cough.

A complete blood count (CBC) can be useful in infants with whooping cough because some have a high number of specialized white blood cells called lymphocytes.

Patients who are believed to have whooping cough are usually given antibiotics to prevent transmission to others. Antibiotic treatment can also shorten the duration of cough if started before 3 weeks of symptoms have passed. Once a case of whooping cough has been confirmed, preventive antibiotic treatment (called antibiotic prophylaxis) may be prescribed to all household members of the patient with the positive test. Using antibiotic prophylaxis can prevent illness as well as time off work or school, and it can be lifesaving for families with infants at home.

Prevention

Unlike other kinds of illness, natural disease from whooping cough does not provide permanent protection. The best way to prevent whooping cough is routine vaccination. Two types of pertussis vaccines are used to prevent whooping cough: childhood vaccines (DTaP) and teen/adult booster vaccine (Tdap). 

DTaP vaccine

DTaP (diphtheria, tetanus, and acellular pertussis) vaccine is one of the immunizations required for school entry in California. DTaP vaccine is given to infants starting at age 2 months (and as young as 6 weeks). It is not recommended for infants less than 6 weeks old because the immune response is inadequate at younger ages.

The usual ages for DTaP vaccine doses are:

  • 2 months
  • 4 months
  • 6 months
  • 12 to 18 months (at least 6 months after the third dose)
  • 4 to 6 years

Common side effects of DTaP vaccine include redness at the site of injection, mild swelling, and occasional fevers. These symptoms usually go away in 1 to 2 days.

DTaP vaccine should not be given to children 7 years of age or older because it is more likely to cause larger areas of swelling or high fevers at that age. 

Tdap vaccine

Tdap vaccine is currently given as a single dose to teens and adults starting at age 11 years. It can be given to children 7 years and up who did not receive adequate vaccination with DTaP vaccine before age 7.

Tdap (teen/adult tetanus, diphtheria, and acellular pertussis) vaccine contains a lower amount of pertussis antigens than childhood DTaP vaccine. The lower amount of pertussis antigens in Tdap vaccine makes it safe to give to teens and adults, but the trade-off is slightly reduced protection from whooping cough. Tdap is currently the best vaccine available for preventing whooping cough among teens and adults.

Special groups who benefit more from Tdap vaccine

Pregnant women should receive the Tdap vaccine during each pregnancy, preferably between 27 and 36 weeks. The vaccine is safe in pregnancy and transfers additional protection to the baby.

Women who were never vaccinated for pertussis and do not get the vaccine while pregnant, should get the Tdap shot after the baby is born before leaving the hospital. It is safe to get the whooping cough vaccine while breastfeeding.

Caregivers and other family members should get the Tdap shot. This includes parents, grandparents, babysitters, older siblings- anyone who comes into contact with an infant.

Older children need a Tdap shot. Proof of a Tdap vaccine is required for all children starting in 7th grade.

Secondary prevention

By federal law, all cases of whooping cough are reported to the local Public Health Department. This is done to detect outbreaks and to prevent additional cases. If you have been diagnosed with whooping cough, do not go to work or school until you have taken at least 5 days of antibiotics. If you have been exposed to whooping cough and have not developed an active infection, antibiotics prescribed by your physician or the Public Health Department can prevent harm to yourself, your family, and your community. Make sure you complete the prescribed medications even if you don’t feel sick. The antibiotics used to treat whooping cough are safe and have minimal side effects compared with many other antibiotics.

Additional References:

Treatments

If you are diagnosed with whooping cough, your doctor will likely prescribe an antibiotic. Make sure you take all doses as instructed by your doctor.

In addition to taking all antibiotic medicines as prescribed, good self-care is essential. Get plenty of rest and fluids (including water, soup, and juice). Eat smaller meals to reduce vomiting. You might want to use a humidifier to keep the air in your room moist. This may help with breathing. Offer the same care if you are looking after a sick child. If you smoke, consider stopping smoking. Smoking cessation classes are available to help you.

If you think your child may have whooping cough, do not attempt to treat the cough with over-the-counter cough suppressants or expectorants; these medications are not helpful in suppressing the severe cough typical of pertussis and can even be dangerous, especially to children under 4 years of age.

If you or your child develops other complications from whooping cough, we will treat each complication as needed.

Hospitalization

Young infants often need to be hospitalized until their symptoms improve. It is difficult for many infants with whooping cough to breathe. Very young infants may temporarily stop breathing and can develop seizures from low oxygen levels in the brain. 

During hospitalization, we will monitor your child’s breathing and may need to give oxygen by mask. We may also need to suction secretions from your child’s nose.

If your child is not able to eat due to violent, uncontrollable coughing spells, we may give fluids through a vein (IV fluids). 

For Caregivers

Persons with whooping cough should stay away from others for at least 5 days after starting to take antibiotics. Do not allow your child or teen to go to school, or an adult to return to work, until your doctor indicates that it is safe to do so.

Make sure you or your child takes any medications, such as antibiotics, exactly as prescribed.

Make sure you or your child gets enough rest and drinks plenty of fluids. Eating and drinking can be difficult if there are coughing fits. Eating smaller meals and sipping fluids throughout the day may help. Be sure to call us if the person is experiencing persistent vomiting or signs of dehydration such as fatigue, dry mouth, or decreased urination.

Do not let anyone smoke in your home or around the infected person. Frequently wash your hands and make sure used tissues are immediately placed in the trash, which should be emptied often.

Your Child’s Care with Me

If your child is having symptoms that may be due to an infectious disease, his or her pediatrician or hospital-based specialist should be the first health care provider to perform the initial evaluation. If subspecialty infectious diseases care is needed, your provider will then contact a pediatric ID specialist. If appropriate, she or he may call me or one of my ID colleagues while your child is in the hospital or office so we can discuss your child’s care together with you. If an appointment with me is needed after that discussion, we can often schedule it the same day or soon thereafter.

During an office visit, we will discuss your child’s medical history and I will perform a physical exam. I will explain your child’s medical condition. We will discuss any possible tests or procedures that can assist in making a diagnosis, or if a diagnosis is already clear, we will discuss the potential outcomes of the diagnosis and treatment options. Together we will create a treatment plan that is right for your child.

If you need to talk with me after a visit or procedure, please call my office. You can also send secure messages to me with nonurgent issues from this website when it is convenient.

For general medical advice, our Appointment and Advice Line is available 24 hours a day, 7 days a week.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room.

Coordinating Your Child’s Care

Having all of our Kaiser Permanente departments located in the same facility as your child’s pediatrician (or nearby), including pharmacies, laboratories, Radiology departments, and health education offices, makes getting care easier. 

Another major benefit is our comprehensive electronic medical record system, which allows our doctors and other clinicians involved in your child’s care to be kept up to date about their health, including recent visits, medications prescribed, and any test results or procedures. The electronic medical record also allows us to collaborate with each other about your child’s health care. When every member of the health care team is aware of the most recent information about his or her condition, correct care can be given more safely, rapidly, and effectively.

If you come to an office visit

  • At the beginning of your visit, you will receive information about when you are due for your next test, screening procedure, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed or if you just want to check your vital signs or weight. You can also view your AVS online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 

If medications are prescribed

We will work together to assess how your medications are working and to make any needed adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If you need refills of your child’s prescriptions, you can:

  • Order them online or by phone. The most convenient way to refill prescriptions is electronically on kp.org. Another way is to call the pharmacy refill number on your prescription label. It is best to refill prescriptions at least 7 days in advance of when you will need them.
  • Have them delivered to you by mail at no extra cost. Another option is to pick up your medications at the pharmacy. If no refills of your medicines are left when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

Most lab tests can be obtained any day of the week, and many can be obtained while you and your child are in the hospital or clinic. In general, you can go to any Kaiser lab facility to have lab tests. For some uncommon tests, however (for example tests done on living cells that are not performed at our Regional Lab), you may need to go to a lab department in a specific Kaiser facility on a Monday or Tuesday in order for the cells to be received on time by the outside lab. In either case, your lab tests will be ordered electronically with instructions to the lab about the urgency of the test, how often the tests are needed, and, if the test is being performed outside Kaiser, which lab will run the test.

For imaging procedures, we will schedule an appointment with your local Radiology Department. After the imaging study has been done, I will contact you with the results by letter, secure message, or phone. In addition, you can view most laboratory results online, along with any comments that I have attached to explain them.

If I refer your child to another subspecialty colleague

If we decide together that your child’s condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my subspecialty colleagues.

If surgery or other procedures are needed

I will give you educational information about the procedure and will explain why I am recommending it. If you are willing to meet with the surgeon or subspecialist who will do the procedure, then I will make a referral to that physician. The surgeon or subspecialist will discuss with you the details of the procedure, expected benefits, and potential risks and will answer other questions you may have about the surgery. 

If you decide to proceed with surgery for your child, a scheduler will contact you to determine a surgery date and provide you with additional instructions regarding the procedure. Once the surgery is scheduled, your child may also need to have a preoperative medical evaluation by a general internist, family practitioner, or pediatrician that will assure that they are properly prepared for the surgery.

Convenient Resources

As your child’s subspecialist, I have a goal to provide high-quality care and to offer you choices that make health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you and your family.

My Doctor Online is available at any time. From my home page you can:

Manage your child’s care securely
  • View and compose secure electronic messages. 
  • Manage prescriptions. 
  • View past visits and test results. 
  • View Preventive Services to see whether your child is due for a routine screening or updated immunization.
Learn more about your child’s condition
  • Read about causes, symptoms, treatments, and procedures. 
  • Find interactive health tools, videos, and podcasts to help manage your child’s condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at every medical center. 
  • Explore interactive programs, videos, and podcasts that focus on helping you and your family stay healthy. 
  • View your family’s Preventive Services to see whether any of you are due for a routine screening lab test or procedure or for any missing immunizations.

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder. This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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