Well folks... after a WAY too long and unanticipated hiatus. I am, in fact, back. I w
as doing my duty helping out another community pediatrician who had a medical crisis. She now fine and settled back to the office. But this left me back in dreaded, Primary care. To make matter worse, she also has a large population of non-vaxxers and people on "alternate schedules." So that means they have some vaccines, not others and are largely unprotected from the usual vaccine preventable diseases. As you can imagine I'm an opinionated and passionate proponent of science. So this situation made me feel like I was in purgatory - probably for cursing too much. But I made the best of it by irking parents with my insistence on vaccinating their children. Here's a typical interaction. Dr. Austin: Its December; not too late for the flu vaccine - hang on I'll send the nurse back with one Parent: ?? But we don't believe in that!! Dr. Austin: Oh, its for real! We've got some in the fridge - lemme show you Parent: That's not what I meant...... Dr. Austin: Oh, I know what you meant and its sounds just as foolish Man, being a pediatrician is tough. I went to school for a wicked long time, studied, sacrificed my 20s to the "gods" of medicine for a chance to help people.....and who are they taking medical advice from??? Jenny McCarthy! - if all I had to do was show my cooch in order to to care for patients, I never would have needed those student loans. Hey , I'm even game. I'll show you my cooch too - I'll go get ladyscaped and vajazzled--- if you just vaccinate your kid! I've always been a passionate advocate for vaccinations. When I was a child; instead of an au pair - I had Grandma caring for me while my parents worked. She was born in 1905 and came of age in a time when medical science was rapidly changing. She would tell me about the delirium she experienced with diphtheria - she would tell me how frustrated her mother had been as she kept begging for "bananas" while sick - what she meant was "water". She told me how so many people she knew died during 1918 Spanish flu - A strain so deadly its still being studied by infectious disease doctors and historians- that coffins filled with the deceased were piled on the side of the rode. That flu killed so many young healthy people; it probably was a main catalyst for ending WWI. I bet you learned that it had something to do with trench warfare or mustard gas. Wrong! It was the Flu! She saw children ravaged by Polio, nursed my father through Chickenpox, Measles, Mumps and Rubella and Whooping Cough. There were the babies that died of pertussis, meningitis, pneumonia - all largely preventable now. And why do I know all this? She told me. She was fond of the saying "If you don't learn from the past, you are doomed to repeat it." So I heard lots of stories about her childhood and how things had changed (cars, electric lights, airplanes, radio, TV, moon landings) but she was always most impressed by what medicine could now do. After a dose of whole cell pertussis vaccine at age 5 I developed severe arm pain, swelling and fever ( not an uncommon event with the old vaccine- especially at the 4th booster). I was in a sling for almost a week. I moaned, "Why did that mean doctor give me a shot?" She was quick to point out, that it was probably because he cared if I lived or died. The anti-vaccine industry flourished in large part because vaccines have been so successful. Not many people remember what it was like in the times before vaccines. The horror of summer for parents because it came with the threat of polio. Infant deaths - were commonplace - unlike today. SIDS deaths are all tragic, but relatively speaking, a rare occurrance. Back in the day it was not - because they were often due to vaccine preventable diseases not suffocation, cardiac arrthymias and metabolic disorders. They were due to pneumococcal pneumonia, HIB meningitis, Whooping Cough. Mumps caused, hearing loss, encephalitis and sterility. Measles lead to pneumonia and fatal subsclerosising panencephalitis. Rubella, acquired prenatally, used to be the main cause of mental retardation. And they're all coming back! I find we are indeed repeating history. I've now seen a case of congenital rubella, was exposed to measles while pregnant with my daughter, and I contracted pertussis while in medical school (despite vaccination). Every Pediatric resident can tell you about the previously healthy child who died in their PICU from influenza as well as those chronically ill children, who we came to love, who we lost to the flu as well. So while I was on the front lines of vaccinations- losing the war - a miraculous event occurred! Sidney Crosby, celebrity star of the hockey world, member of the Pittsburgh Penguins, and local sport hero, got the Mumps. Suddenly, the parents who the week before refused the vaccine, now lined up at the office door to get it. The irony of this is not lost on me, but if I can protect just a few more kids against the diseases that I know are still lurking just outside of our collective memories - I've done my job. So thanks Sidney Crosby - by highlighting the need for herd immunity you convinced some reluctant vaccinators to do their part to protect themselves and the community and I didn't even need to vajazzle! ;)
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After a lice scare at my daughter's preschool, I thought to myself - this is the glamorous life a pediatrician! Nit combing random kid's hair - Wow!
Next time I will do this with while wearing a tiara and opera gloves - because my life is THAT glamorous! I also found a lot of misconceptions about lice and lice treatment exist. So I pulled an old article I wrote for Dermatology Central in 2007. Enjoy! http://dermatologycentral.typepad.com/resource/2007/03/dr_austins_lice.html So the big mommy dilemma.... I know you experience it too. Is my kid actually sick or is she faking? Usually this is easy, even predictable. Not wanting to go to school because of a test, a fight with a friend, doesn't like gym, playground bully, it's Thursday and not Friday.... the list is lengthy, but with a little prodding the answer usually becomes obvious.
My tight-lipped 7 yr old can be an entirely different matter. School avoidance has been the name of the game since her first day at day care at 14 months old. She has run away from daycare more than once. But she has a tough mommy and sick kids don't wait. So often, she gets a cursory exam and is deemed fine- by yours truly- and deposited at school. Unlike your average mom- doctor mom (DM) can check ears, throat, chest, and belly. The usually cause of fake complaints. Doctor mom can also ask pertinent questions of little fakers to catch them in a lie. Faker: Mommy it hurts went I pee? DM: What color is it? Faker: I don't know, pee colored? DM: Does it glow? Faker: Yes! DM: You have to tell me if it turns purple? Faker: It is purple - but a very faint purple Okay, gotcha! Urine doesn't glow and since I doubt my kid took her pee outside for a porphyrin test, it'snot purple. Faker caught with purple glowing pee! Now you never let on that you've caught them. But you absolutely should quietly revel in the satisfaction. Now just this week Miss Faker complained of right sided abdominal pain and nausea. At 7, she's getting better at her faker form. I quickly ran the list of faker reasons to skip school - but none seemed applicable. I even reminded her this is Wednesday and she gets a day off with me on Friday. Still, she's sticking to her story. She picked a good one, because just about every doctor has a story about sending their kid to school with appendicitis. Ok, kiddo. Let's see how this goes. How would she know about appendicitis - she's 7. Maybe she's not faking. She is hobbling around with her hand over McBurney's point. But, she doesn't have fever or vomiting. But, she won't eat breakfast either. Crap! Instinct tells me she looks too healthy to actually be ill - but I just can't catch her in fake, faker symptoms. So she gets to stay home. Because I know if she goes to the nurse with right sided belly pain - the nurse is gonna call me anyway. The nurse knows my rule with Faker - don't call me unless she's puking or has a temp >100.5.But everyone freaks about right sided belly pain. Did I mention, since I'm covering another docs office due to sudden illness, it's also my only day off to run errands- and we 're almost out of toilet paper? I mean THIS is an emergency! Oh yeah, and Daddy Dear, is out of town. DM: Okay, can we go to the store for 2 minutes? Faker: No mommy, I'm too weak. DM: Good grief! DM: Speaking of toilet paper- when did you poop last? Faker: I don't remember- DM: huh? A day, week, month? (Since faker is 7 I'm no longer privy to her toilet routines.) Faker: Few days ago DM: Was it normal? Faker: It wasn't purple and it didn't glow DM: Shit, she's on to me Well then, I guess we'll be having a quiet day on the couch doing school work. She puts up a quiet fight - but we muddle through Then Faker asked to watch TV. She looks ok- so I leave her to the TV and I take refuge in my bed. An hour later - DM: How are you feeling honey? Faker:I threw up (nonchalantly) DM: Huh? When? Where? Faker:In the toilet while you slept? I flushed it So she threw up and no tears and didn't wake me and cleaned herself up? LIAR!!!!! Faker: So do we go to the ER now? In my head I'm thinking well yeah now I'll be spending the next 8-24 hours in the ER with you. Gotta find someone to take little baby faker for the night til Daddy Dear comes back from Texas. And just when I find someone to take a 3 yr old for a sleepover ......(God do I have good friends!!!!) I notice what Faker has been watching- Untold Stories of the ER on Discovery Health. No wonder her acting was so good - she got some professional coaching. Oh, it's coming together. DM: Faker, are you curious about the ER? Do you want to see it in person? Faker:Um yeah - DM: Did you ever really have a bellyache? Faker:Yeah, but I farted around 9 and felt fine since.So can we still go to the ER? DM: Well, how did you know about appendicitis? Faker: Remember Madeleine? DM: Madeline who? Faker:The book, Madeleine (The Ludwig Bemelmans' classic) Oh crap, that's how she learned - Madeleine had her appendix out and we must have talked about anatomy and right lower quadrant pain. She's even got a Madeleine doll with a scar there. I had a feeling reading to my kid was overrated! So for all you non- doctor mommies out there, don't feel bad. With all my fancy education, I still get bamboozled too. And we have to accept it. Any time your child will go to such lengths to stay with you rather than go to school - means (for whatever reason) they really, really need to be with you. So as frustrating as it may be, hug them tight, and remember the time will soon come when they want nothing to do with you. And tomorrow, they go back to school! Because Dr. Austin says so! So each year in I think, right around this time, Fall back - Daylight savings time is ending. A blissful extra hour of sleep. And then I awaken from my daydream of Autumns past to
remember I've got 2 small kids. I'm about to enter HELL! From delightful musings of sleep I start running about the house in a full on panic. You'd think the house was on fire - but no. Its time to get wonderdad up to strategize how we will deal with the onslaught of screaming, overtiredness, not tired enough for bed and strange scary darkness at 4PM to get them sleeping again. So that, perchance, we may also sleep again.So, Dr. Austin, why do children react so horridly to time change? Well the answer is simple. Toddlers react horridly to ALL change! My 3 year old had a tantrum this morning simply because her sock was inside out - in the draw. It's what they do. Break the routine and suffer the consequences. Anything from stool witholding on vacation, to refusal to eat certain foods which were your go-to solutions. Anything a kid can control to get the upper hand, they will. That's their job. Now I could tell you all about disruption in circadian rhythms and the pulsatile inputs from the suprachiasmatic nucleus. The neuroscience is fascinating, trust me, but more to the point is my kid wont go to sleep, stay asleep, wont stay in bed, wants breakfast at 3 AM, wakes up cranky and the list goes on and on. And you know- jet lag feels yucky! That's what kids are experiencing, but without any context. The best I can tell you is you're not alone. Sometimes this time of year we try to re-frame it as a positive. For the child who can not yet tell time - now we can start getting her to bed an hour earlier because its dark outside. Of course, this wont work if she's memorized the order of the programs on the "Goodnight Show" and knows that Caillou (that horrible little whiny bitch) comes on before lights out. But, I'm always hopeful to find a way for an extra hour of sleep here or there. BTW - if your'e wondering- this plan never actually works. The next best thing is to stick to your routine. They may start waking you at the butt crack of dawn (4:45AM), but that is what my husband is for. (I don't think he knows it - so shhhhh, don't tell). Watch the naps! Kids can catch up on hours lost during nap time so now they're going to bed at 11P and still getting you up at the butt crack of dawn. This is when you start offering them money to go to sleep. My oldest nearly got a TV in her room during this period while I was pregnant. Because I would have done ANYTHING to sleep more that 4 hours a night. So watch it. A good negotiator vs a sleep deprived mommy is a recipe for a room full of As-Seen- On-TV crap, at best. But honestly, I'd have given her matches, roman candles, a blow torch, ANYTHING...to just sleep. Be ready for some extra whiny, tantrum-y behavior. Knowing what's coming and that it will eventually pass can help you cope - so can chocolate and wine- so stock up! Also, if you're truly at your wits end with a crabby kid and no sleep - I always think now is a nice time for an extended trip to Grandma and Grandpas. I suggest dropping them off at Halloween and picking them up at Thanksgiving. While I'm sure Daylight Savings was a super duper idea when Ole Ben Franklin dreamt it up, with the advent of the electric light it seems rather silly. Getting dark at 4:30PM limits the time a child can get outside and play. Less light means less Vitamin D. We know that's not good for growing bodies. While I think I read that this practice somehow saves energy, I already do that (we're buying a Prius !) And basically, I'd be up for slashing and burning a jungle if if gave me an extra hours sleep. Sorry nature lovers. So get your copy of "Go the F^&% to Sleep" and a bottle of wine, let them cry it out for awhile and snuggle by the fire for long winters night. Why? Because Dr. Austin Says So This week I was invited to a home business presentation of a product line. I didn't know what these ladies were selling but the lure of adults and mojitos proved strong. So I went. I arrived to find they were selling a "natural alternative" grocery line - makeup to household cleaners to vitamins. And the presentation started- "my child couldn't breathe......the pediatrician, well meaning but clueless, prescribed steroids- so I took him to a naturopath....."
What ever was being sold - I didn't care because I inherently know, that if the naturopath says so, it's bullshit! This is the snake oil of the 21st century. The Naturopath We're not nutrient depleted! Everything we eat is fortified up the wazoo! Could we use more calcium, Vitamin D and fiber, sure. But as for the others - highly unlikely! But what kills me is the naturopath prays on the truly desperate -parents of autistic kids. Not only have they convinced these folks that heavy metals are to blame for their child's condition, they convince them they need expensive and painful chelation. Now they are putting them in hyperbaric chambers at exorbitant costs to "cure" their autism. In fact, in my area there are now many free standing hyperbaric centers. While they may be effective for wound healing; this is not why most are plunking down cash for the natural healing by the power of oxygen. I'm in Pittsburgh, nobody here gets" the bends." Sounds like snake oil to me! The naturopaths are also proponents of my pet peeve (and you thought is was the breast feeding nazis!)- Anti-vaccinators. I guess modem medicine has come too far. We're so healthy that these diseases are such a distant memory that people don't recall how devastating measles, mumps, polio, haemophilus influenza, tetanus really were....they were horrible! Now, due to the anti-vax movement, I've gotten to expirience treating many of these first hand! A big Thanks! If you want to put your kids at risk, I suppose that's your right; but you put everyone's kids at risk by lowering herd immunity. You put my kids at risk! And for that, I am disgusted by you. The Chiropractor Which brings me to my next perveyor of snake oil - the chiropractor A chiropractor did not go to med school. In fact, he may have tried and didn't get in. They are not qualified to do a sports physical on your child- because tight hip flexors won't kill them, but that murmur they can't identify, because they've never used a stethoscope, potentially could. Might as well have that bagger at Walmart do your kids physical. They will also try to sell you "packages" for "adjustments" to cure ear infections and now "adjustments" on newborns. Unbelievable and potentially dangerous! The science isn't there. There's nothing they can provide you with that a good massage couldn't do. They also will tell you vaccines are poison and that puts them on my shit list for sure! The Doula Doulas (some, but not all, midwives). Anyone who suggests its a good idea to eat your placenta should be suspect. No studies support this. None. It may have its place in the third world where people are truly malnourished and starving. Not here. The claims range from increased milk production to increased energy to decreased baby blues. Until true scientific studies are done - I wouldn't buy any of it! I will refer you to the NYT article "I regret eating my placenta" Because some Hollywood starlet does it - is not good reasoning. (Other things you probably shouldn't do with your placenta - make a teddy bear, use it for decorative prints, or plant it under a tree--- not because it affects me in anyway, but just to know we're all snickering at you) So this week I've realized that peace of mind cleaning does not come from $20 tea tree oil infused cleaning products. Common sense tells me it comes from using diluted vinegar. But even more sense tells me those Clorox wipes are just fine too. Snake oil is everywhere. Keeps your eyes open! Why? Dr. Austin says so.... This is it folks, I've started a blog!
You may ask yourself, "what has this bitch got to share with the world that the bazillion other blogs don't already say" And to that I say , "Plenty!" As a pediatrician and pediatric hospitalist I find I'm constantly talking well intentioned new mothers "off the ledge." Why are all these mommies so upset? Other peoples' parenting blogs.... I've read them. I'm appalled! They're not giving parenting advice, they're giving medical advice - and people are listening! Then I have to come along and pick up the pieces. I'm gonna start with my own experience with breast feeding. Nursing is awesome! Breast milk is the most economic and natural thing to feed a human baby. But not all babies can do this and not all woman produce adequate milk. If they did then, there would never have evolved the "wet nurse." And by the way," she" seems to becoming back in the form of donor milk. I digress. I am so pro nursing I even sang a song about it in med school "breast is best" (sung to the tune of "be our guest"). But the tables turned when I had my first. While I have to admit I have lovely knockers - they're so nice they look fake- I have flat nipples and big boobs - its like trying to latch on to a dinner plate. I tried every trick and device imaginable- nothing worked. I resolved to pump and bottle feed. I had the backpack pump and tube top with the nipple holes, you know the one, and tried my hardest to make that work. To no avail :( I blistered the skin off my nips which left them open to infection - 6 episodes if mastitis. And still not making enough to feed my baby adequately. She persistently lost weight and screamed bloody murder . Then I developed a mass in my right breast. I was advised to stop breastfeeding immediately so I could be worked up for peripartum breast cancer. Turned out it was only fat necrosis from trying to force every last bit of milk out to feed my kid. What a nightmare! But it was compounded by statements like from my boss at the time a very old, well regarded, and male pediatrician "I've never met a mother who truly wanted to breastfeed who could not make it work" Seriously! In the postpartem hormonal storm I thought he was telling me I had given up on my baby. And if I gave up on her I must not love her enough. I just wasn't as good as other moms. As a doctor, I dealt with the complications of dehydration in the newborn for years. I should have known better. You can see, hormones and sleep deprivation left me susceptible to this negative thought spiral! Ya know what, thank God for formula! My daughter is now 5 and a half. She is happy, healthy, smart, athletic and an all-around good egg. And without the advent of formula both she and her younger sister would be severely malnourished, if not dead. So the next time you see a mom giving a kid a bottle, instead of thinking "too lazy to nurse", think awesome job feeding and nourishing your beautiful baby. And now at work I hold a lot of hands of weeping moms who are in my boat. And I remind them that the amount of milk they produce is not proportional to the love of their baby. They may have big babies and they don't have adequate supply, giving a bit of formula initially won't "nipple confuse" - its a myth, it won't make breast feeding impossible in the future, and may keep them from getting hypoglyemic. BTW pacifiers aren't evil and they decrease the risk of SIDS. We expect that a baby should come out and nurse like a baby cow- immediately and vigorously. And human babies are just not cows. It's the minority that have any easy time. Some will struggle in the first couple of days and get there. Some will never get there. And it's all, ok! Now there's a push by some of my NICU collegues for use of donor milk. I gotta say personally this grosses me out. In the preemie to prevent the development of necrotizing enterocolitis (NEC) it may have its place. But you are sharing bodily fluids which can pass all sorts of viruses, including HIV, to your recipient babe. While I know they are careful and do testing, what scares me is the virus they dont yet know about, which may or may not be out there. Is it worth the risk in a term baby who could be drinking formula? Personally, I don't think so. So bottom line, feed your baby- you're a great mother no matter if you give your singleton a bottle or you breast feed your Quads. Dr. Austin says so! |