Archive for August, 2009

Some Moms-To-Be Fear Swine Flu Shot More Than The Flu

Pregnant women are among the first in line to receive the Swine Flu vaccine, when it becomes available, because not only does the flu — any kind of flu — usually hit pregnant women harder than other people, but this strain appears to be particularly nasty for moms-to-be. Pregnant women are more likely to end up in the hospital with this flu. Pregnant women are more likely to face complications associated with this flu that can lead to death.

So the Centers for Disease Control wants you to get the swine flu vaccine, just like it wants you to get the seasonal flu vaccine.

The problem? The H1N1 vaccine is in clinical trials now. When pregnant women line up for the vaccine, they will be getting a shot that is new. A lot of women don’t like that. They don’t like that at all. They are afraid to expose their unborn baby to a relatively untested vaccine. I spoke with Baylor College of Medicine obstetrician Kjersti Aagard about this. She offers her recommendations, and tells you what to do if you don’t plan to get the vaccine.

Listen to Dr. Aagard’s advice here…

Stay tuned to this page, and the Pea in the Podcast Facebook Fan Page, for all the latest information about the H1N1 flu virus, the vaccine and pregnancy.

Circumcision: It’s YOUR choice!

The New York Times says “Public health officials are considering promoting routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., the virus that causes AIDS.”

I do not understand this at all.

The study on which this idea is based was done awhile back on African men in an area where AIDS is rampant and condom use is rare. I cannot imagine a study with less relevance to the lives of American men.

If American men are practicing safe sex — i.e. condoms use, etc — what does their foreskin have to do with anything? Absolutely nothing. So are we promoting safe sex, or are we promoting circumcision, CDC? I don’t get it?

(Oh, and by the way, another study of African men found that circumcision did nothing, nothing at all, to prevent the transmission of HIV to women. Circumcised men in Africa infect women at the same rate as uncircumcised men. So moms, we’d better be teaching our little girls about safe sex and condom use regardless of whether their partner is circumcised or not.)

I have not spoken with a single doctor who says there is any reason at all to recommend routine circumcision of boy babies, and I have talked to a lot of doctors. It is a choice parents can make, and many do, for many reasons. That is what is great about being a parent…you get to make that choice.

If you choose to circumcise your boy baby, I support you in that choice (which is actually none of my business, anyway, so who cares what I think?). There are religious reasons and cultural reasons and personal reasons that make circumcision the best choice for many families.

If you don’t choose to circumcise your boy baby, that is also a perfectly valid choice. According to Baylor College of Medicine pediatrician Dr. Sara Rizvi (and she is far from alone), there is no medical reason to circumcise .

I, personally, would never choose to circumcise a boy child (barring some great new revelation about the practice), even if the Centers for Disease Control was actively promoting it, particularly if that promotion was based on the suspect assertion that the practice might decrease the H.I.V. infection rate in America.

That is my choice.

The American Academy of Pediatrics does not recommend circumcision of baby boys. I does not not recommend it. It’s the Switzerland of the circ debate. It says (although I understand it may be rethinking its language)…

“Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child.”

The bolding and italics were added by me lol, because that’s how I feel. This is a parent’s decision. No one else’s. What you decide for your baby is no one else’s business.

The end.

For much more on caring for your newborn, from their foreskin (or circumcision) to their belly button and so much more, please listen to what our wonderful pediatrician has to say in our Pea in the Podcast on Caring For Your Newborn.

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H1N1 Swine Flu Update From Dr. Jay Gordon, Leading Holistic Pediatrician

We posted Dr. Jay Gordon’s update a few months ago about how the best plan of attack against the swine flu for pregnant women or anyone is simply washing your hands. Now, Dr. Gordon is giving us a real-time update on flu cases in his office and what he plans to do to help keep families safe. His views can be considered controversial but he is an extremely smart, world-renowned doctor who should be heard no matter how you decide:

Dr. Gordon: I have seen more children and adults with influenza-like illness: 104 degree fevers, muscle soreness, sore throat and negative tests for strep, than in any summer I can remember. I haven’t used the “flu swab” to test anybody, but I’m sure that many if not most of these sick people had Swine Flu. They all felt miserable, and they are all feeling just fine now.

Preventing outbreaks of this “novel H1N1″ influenza may be a mistake of huge proportions. Yes, sadly, there will be fatalities among the 6 billion citizens of the planet. Tens of millions of cases of any illness will lead to morbidity and mortality, but this is completely (tragically) unavoidable. The consequences of not acquiring immunity this time around, however, could be really terrible and far outweigh a mass prevention program.

Here’s my rationale for not using Tamiflu: If (if, if, if) this virus circles the globe as the rather innocent influenza it now appears to be, but mutates and returns as a very virulent form of influenza, it will be quite wonderful and life-saving to have formed antibodies against its 2009 version. These antibodies may be far from 100% protective, but they will help. This is incredibly important but being ignored in the interest of expediency.

In 1918, it appears that influenza A (an H1N1, by the way) did this globe-trotting mutation and killed millions. The times and state of medical care are not comparable, but a milder parallel occurrence is possible. Perhaps this happens every 100 years or so, perhaps every three million.

Whenever possible, we should form antibodies against viruses at the right stage of their existence and at the right stage of our lives (For example, chickenpox in childhood and EBV/mono in early childhood. There are many other examples.) Getting many viral illnesses confers lifetime immunity, and very few vaccines do.

Tamiflu is a very powerful drug with little proven efficacy against this bug, and with its major side effect being tummy upset. I’m not using it at all. Psychiatric side effects are also possible.

I also won’t be giving the flu shot to the kids and parents in my practice unless there are extraordinary risk factors. I anticipate giving none at all this year. I doubt that there will be any really large problems with the vaccine, but I also doubt any really large benefits. As I said, I think that this year’s version of this particular H1N1 is as “mild” as it will ever be and that getting sick with it this year will be good rather than bad. The chances that a new “flu shot” will be overwhelmingly effective are small.

I consider this, and most seasonal and novel influenza A vaccines, as “experimental” vaccines; they’ve only been tested on thousands of people for a period of weeks and then they’ll be given to hundreds of millions of people. Not really the greatest science when we’re in that much of a hurry. Yes, one can measure antibodies against a certain bacterium or virus in the blood and it may be associated with someone not getting sick, but there are very few illnesses common enough or enough ethics committees willing enough to do the right tests. That is, give 1000 people the real vaccine and 1000 placebo shots, expose all of them to the disease and see who gets sick. Seriously. I know it sounds terrible.

This is, obviously, a difficult public discussion because it touches on the concept of benefits and risks, again, of morbidity and mortality. Few public officials have the courage or inclination to present all facets of this difficult decision. I give vaccines to my patients every single day, but I always err on the side of caution. Implying that this is a dangerous new shot is not scientifically or statistically correct and represents hyperbole and even dishonesty on the part of the so-called “anti-vaccine” camp.

It sure isn’t “sexy” to suggest handwashing, good nutrition, hydration, extra sleep and so on. It’s not conventional to suggest astragalus, echinacea, elderberry and vitamin C. Adequate vitamin D levels are crucial, too.

I just think that giving this new H1N1 vaccine is not the cautious nor best thing to do.

Best,
Jay Gordon, MD FAAP

My Daughter’s Car Seat Saved Her Life

One gray morning last week my daughter and I were in a terrible car accident.

My beautiful four year old and I careened off the road at between 60 and 70 miles an hour. We launched through a guardrail and began to roll. I don’t know how many times.

Then, in a quiet field in rural Texas, motion stopped.

Most of this I know because it has been told to me. I have been told that my car and another collided along the highway. We were traveling the speed limit, but that was fast. I lost control of my SUV.

I lost control.

My baby was in the car.

I remember snapshots. Frozen images on which I fixate. I can’t remember what came before. I can’t remember what came after. So I loop what I remember until I realize my heart is racing, I’m drenched in sweat and I’ve lost my breath.

I see a guardrail. I think of my baby. I see an airbag. The fabric has a pattern on it. I think of my baby. I smell something acrid like gunpowder. I think of my baby.

The car rests. There is a shower of blood.

I think of my baby.

“Baby, are you okay?” (Please God, please let my baby be okay)

“I’m okay, mommy!”

I turn to see the eager face of my saucer-eyed child. It looks…it looks like she might really be okay!

She didn’t have a single scratch on her. Not one. Her perfect pink skin remains unbroken. Unblemished. Unbruised.

The blood was all mine. Thank God. I am recovering from a head and hip wound after being taken by helicopter to the hospital, but I, too, am okay.

This is what remains of my SUV.

How is it even possible that my daughter was unhurt?

She was firmly strapped into her car seat with its five point harness. That car seat was tightly connected to the “latches” embedded in the rear seat of the car. It was positioned in the center.*

I am not one to advertise for a particular brand of car seat (unless they’re paying me obscene amounts of money lol. Not the case here). The National Traffic Highway Safety Administration says “all car seats rated by NHTSA meet Federal Safety Standards & strict crash performance standards.” You can evaluate the safety of the car seat you’ve chosen for your child here. I don’t think you have to go deeply into debt to get a safe car seat for your baby.

That said, my child was protected by her Britax Marathon. Her head does not yet reach the top of this particular child safety seat, and the sides seem to surround her. I think that may have shielded her from the variety of things that were flying around as we were rolling.

But I believe the most important contributing factor to my daughter’s survival of this devastating crash was the proper installation of the seat, and the fact that she was properly strapped in. In fact, a police officer has told me as much. But this is not as simple as it seems.

The good folks at SeatCheck.org tell us 7 out of 10 kids in child safety seats are not buckled in properly. The NHTSA tells us motor vehicle crashes are the leading cause of death for children between 2 and 14 years old. I think that is reason enough to check your car seat. Make sure it’s properly installed. Make sure you know how to buckle your baby in correctly.

You don’t have to figure this out on your own.

The NHTSA knows who the experts in child safety seat installation and use are where you live, and they have a searchable database. It wouldn’t hurt to stop by and let the experts help you out.

This isn’t the first time we at Pea in the Podcast have talked about child safety seats, and it probably won’t be the last. Hopefully it will be the last time I will share such a personal story with you about the importance of car seats and proper installation.

Please, take another look at the picture at the top of this blog posting. The newspaper photo.

That’s my car.

That’s my baby.

Alive. Amen.

-Bonnie

*Several smart parents have informed me that many cars do not have “latches” for center positioning, so please check your owner’s manual before latching your car seat in the center.