A Pediatricians Advice About H1N1

This is a direct paste of a letter sent by Dr. Kenneth Polin to my wife, Kerry, along with what I assume are many other parents today. Dr. Polin works out of Town & Country Pediatrics who operate three offices here in Chicagoland. The immunizations being provided by Town & Country Pediatrics are all Thimerosal-free, so are in limited supply and high demand. This is causing the offices to get swamped with calls throughout the day, making it difficult for actual sick children to get appointments to be seen. The offices have informed all parents this morning that they will only accept calls for day-of vaccinations for a single 30 minute period each morning…so a bit of a lottery system if you will. In any case, here is the letter…

Dear Kerry,

There has been a lot of information and misinformation regarding the current influenza as well as relating to the flu in general. We would like to inform and clarify in order to calm fears and help our patients cope with the current situation.

Influenza is an annual event caused by a virus which changes each year. That is why patients need to have a new influenza vaccine annually. The vaccines given in past year do not cover the new strains which appear. Most of the strains we see annually are somewhat related and can cause significant complications in the healthy population as well as in the population with underlying medical issues.

Every year, in the US, approximately 36,000 people die of the flu and related complications. This new flu which has been around since the spring of this year has taken a toll with about 1000 patients dying including 100 children (this is over six months time). The majority of these deaths have occurred in patients with other medical conditions however, this has not been exclusively the case and some healthy patients may have severe complications and even die. It is important to keep things in perspective and if your child gets sick, to be armed with information and not worry needlessly.

The signs and symptoms of the flu (all types) are a quick onset of fever with a dry cough. There are often accompanying body aches and many patients complain of eyeball aches. There may be vomiting also. Not all patients will have all symptoms. If your child has these and has no other medical issues, routine health measures for comfort are all that is needed. If your child is young (under two years old) or has other health issues we should discuss whether we should see your child or manage at home without a visit to our office. Additionally, if your previously well child appears to be compromised in areas of shortness of breath, significant vomiting, acting strangely, or you are just uncomfortable with his/her appearance, call us ASAP. The CDC no longer recommends the use of a flu test as the in-office test is not that reliable and better diagnoses are made using a history and physical diagnostic skills. The use of antiviral medications has also been discouraged in healthy patients in order to avoid development of resistance by the virus to these medications.

The best way to prevent the disease is vaccinating, but there is at the time of this writing only a limited supply as well as a limited resource availability to administer the vaccine. If you want the vaccine, consider all possible sources. Our office supply of seasonal flu vaccine was reduced as the manufacturers were told to shift their production from seasonal to swine flu. All of the swine flu vaccine was sent to the public health sector who in turn have distributed it to multiple sites including, to a limited extent, our office. We will be sending out information about what we have and what we can reasonably be expected to administer via email and on our website.

Keep in mind this is not a panic situation and with your help we can weather this storm together and not fall into the trap of fear that is not warranted.

As it relates to my previous post, The Drama is Deafening, this letter will hopefully show that both extremes are unwarranted right now, perhaps the hysteria about H1N1 even more so.

Be Well!

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Toe Walking – Not Just For Ballerinas Anymore

I know nothing about dancing. I’ve never been fond of dancing myself. Aside from some occasional thrashing about in nightclubs back in my early twenties, I am generally standing on the sidelines, or more likely, near the food/bar. From what I understand however, dancers, particular those in the ballet, work long and hard to build the strength and flexibility in their calves to allow for dancing on their toes. Apparently this makes movements more graceful and beautiful.

In children, toe walking takes on a completely different meaning. Many children walk on their tip-toes as they learn to walk, and will generally abandon that for a more typical heel-first walking style early on. Sometimes, children do not shake the habit, however, and despite its cuteness, can be pretty damaging both physically and emotionally. We have just begun officially dealing with this in our own little toe-walking son.

A neighbor of ours brought it to our attention over a year ago now. She told us about her own son’s toe-walking, and his need for a serial brace work for portions of every day in order to stretch out the tendons in the Achilles area to allow for a heel-first strike. Xavier advanced through most of his physical milestones early than average, and began walking just as he turned 10 months. Very shortly thereafter, he began running and kicking (I proudly share that he already has “mad” soccer skills). I must admit, it was tough to hear that my budding athlete might have an issue with his legs, but our neighbor’s warning was accurate, and after Xavier failed to shake the habit after more than a year and a half of walking, we decided to have a consultation with a physical therapist at Children’s Memorial Hospital.

The session was held in a typical doctor’s office, but the staff was a bit different. Instead of stethoscopes and tongue depressors, they came equipped with what appeared to be some sort of protractor, some toy cars, and a basketball. As far as Xavier was concerned, there couldn’t be a more entertaining doctor’s office to visit! They asked Xavier to do a series of things like squat down, lay on his stomach (so they could measure the angles his stretched tendons would allow), and walk like a duck. He behaved wonderfully, following every request and suggestion perfectly. Eventually, we made our way to a more gym-like room where other exercises followed.

The result is that while bracing is not necessary right now, we do have some exercises to perform daily with Xavier at home, and will be heading to therapy weekly for the next 4-6 weeks. The exercises are fairly entertaining, so Xavier doesn’t put up a fuss (for now), but it does take even more discipline and diligence in all of us to make sure we are doing them regularly and correctly. I have a high degree of confidence that we are taking care of this early enough that we will be able to correct his walking through exercise alone, but time will tell. Either way, it takes nothing away from his abilities or coordination (remember…MAD SKILLS), so I am not worried.

A word of warning, however, for other parents out there. We were told that though this could just be something natural that he was predisposed to do, some things can exacerbate the problem. Among those things are the family of “exer-saucers” and “walking aids” that seem pretty ubiquitous in children’s playtime rota. Before Xavier was walking, we would frequently let him play in his Rainforest Jumperoo by Fisher-Price. It seemed like an excellent toy to us – he loved it, it appeared to strengthen his legs, and it kept him occupied without crawling all over the condo like some drunken marine doing basic training drills. Come to find out that these toys encourage the child to brace their weight on their toes early on until they graduate to walking. Then, in an evil follow-up, the “walking toys” that seem to help the child walk actually force the child out of control, and that is exactly their problem. When used, the child is encouraged to walk with their weight forward on their toes in order to keep up with the rolling toy. Again, Xavier LOVED his “walker”, though due to frequent collisions with objects both inanimate (the wall or a pile of toys) and animate (my foot or the cat), we were less in love with this one, and will happily forgo its use with Hayden.

Rainforest Jumperoo by Fisher Price

Xavier in his Rainforest Jumperoo, a.k.a. Tendon Compactor

In place of these toys, the therapists suggest loads of “tummy time”. If you are a parent, you know what “tummy time” is, and if your not a parent…well, you can guess. Another problem that comes with toe-walking (or is it a cause – I can’t remember) is weak abdominal muscles. Strong abdominal muscles are developed during tummy time, and in turn encourage the weight to fall back on the heels when walking, standing, etc. You can actually see it on Xavier when he tries to perform a sit-up of sorts. A ridge running vertically down the middle of the stomach pushes up as he tenses his abdominals. This ridge, along with a noticeable flaring of the ribcage is the result of the two sides not yet “coming together” (again, I don’t know the scientific terminology). This too should be corrected with these exercises we are performing.

So, if you child, or soon to be child displays the toe-walking and abdominal ridge after 18 months of age, I suggest a visit to a good physical therapist to catch the problem before it becomes an impairment that needs correcting during school years. Kids can be cruel. We’ve all been there – probably on both sides of the teasing battlefield – and whether the child is forced to wear orthopedic shoes, or walk like a ballerina, chances are some taunts will be uttered in their direction.

If you have a very young child who hasn’t yet gotten into a Jumperoo-type or walking-assistance product, heed my advice, and stick with “tummy time”. Not only is it better for your child, but it will save you a few bucks as well.

Be well!

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The drama is deafening!

I am a history buff. Yes, I know…yawn, but alas, I am. So, having the historical education that I have, I should not be surprised by the drama that exists in this country right now (drama has existed throughout history), yet I find myself constantly amazed. I also expect that my posting of this article will cause a fair amount of drama among my limited number of readers, but I am going to post it nonetheless in the hopes that I am being logical, and that the vast majority of people will agree with my points.

On Thursday, we took Hayden into the pediatrician for her 6 month checkup. She is very healthy, growing well…all systems go. While we were there, we continued her parentally modified vaccination schedule with a couple shots (Pentacel and Prevnar). She is still behind in her Prevnar, but she will not get “more behind” going forward. As we did with Xavier during his first two years, we chose not to get Hayden immunized against either seasonal flu or the notorious H1N1 (gosh, it’s like uttering Voldemort). Much to Xavier’s chagrin, despite it being Hayden’s checkup, we shanghaied him with an immunization during the visit, as we were afforded the opportunity to get him the thimerasol-free H1N1 nasal mist (he also received the seasonal FluMist 6 weeks earlier). Neither Kerry nor I have ever gotten a flu vaccination.

Kerry has gone on record saying she has never had the flu in her life, and I can tell you that I haven’t had the flu in at least 17 years. Neither of us goes to a workplace, and actually spend most of our time among our own family in our neighborhood. Of course our “neighborhood” consists of something like 1.5 million people, but work with me here. Hayden is still only 6 months old, and in very good health thus far. Hayden (like Xavier before her) does not go to daycare, and is rarely in contact with anything that does not originate in our own house.

Xavier, on the other hand is officially a little boy, and regularly partakes in all the active socializing, and “gross” behaviors that come along with it. As an example, last week he and I walked over to the train station food court so I could try the enticing new “Black Taco” at Taco Bell. As I was waiting to pay, I looked down to spy my beautiful boy licking the front of the service counter! So, figuring that if anyone might bring home H1N1, or the seasonal flu for that matter, Xavier would, we decided to get him immunized for both.

OK, so to the point of the post. Upon returning home, I posted a status update on Facebook asking if our decision to immunize against “swine flu” made me a slave to the media or a responsible parent. I got several answers, and though most agreed we are responsible parents, there was more than one dissension. Being the person I am, and having some time on my hands, I decided to read more about H1N1 than I already had, and am blown away by what I have read.

So, unlike some of my posts, I am not intending to take a particular side of this issue, though it might end up sounding that way. Please remember that my intent here is to call out the unnecessary drama that we continue to create in our lives. Please also remember, we did not get Xavier vaccinated for fear he will die, but more because we would like to avoid him getting the flu because having a sick kid sucks. Additionally, my decision not to get myself vaccinated has nothing to do with fear of the potential side effects of the shot, but rather the laziness with which I take care of myself.

First, I’ll address the drama resulting from the fear of the virus itself. Listen, Influenza is no fun, and is prevalent in our society and the world. It is a nasty virus that attacks the respiratory system, and for most who get it, wastes about a week of their lives with high fever, coughing, and achiness. For too many others, about 3,500 per year in Illinois on average, it unfortunately ends in death resulting from complications associated with this virus, primarily pneumonia. Though a high number, this generally falls well behind heart disease and cancer (#1 and #2), and slightly behind other well-known culprits such as strokes, chronic lung diseases (emphysema/COPD/bronchitis/cystic fibrosis), accidents, diabetes, and Alzheimer’s…in Illinois at least.

H1N1 has been “around” since April 2009, or at least this strain of it. There have been H1N1 outbreaks in the past, the most recent of which was contained to a single military unit at Fort Dix, NJ, and killed only one soldier. So far, in Illinois, H1N1 has resulted in 542 hospitalizations and 22 fatalities. Only 5 of those 22 were children 18 years and younger, and only 1 was under 4 years of age. Even if we acknowledge that the major outbreak might just be gearing up, and we have only really experienced about a month of this nastiness, that trend is suggesting about 265 fatalities in the next 11 months. I understand that I am using grade school math here, and that the actual trends suggest this outbreak will be slightly higher than the 2008-09 seasonal epidemic, but even that suggests that if we take the simple preventative measures that are both being advised and should be common sense, most of us will not perish at the hands of this virus. So, cover your mouth, wash your hands often, and for the love of everything holy, if you are sick, sit your butt down, and don’t go to work, functions, meetings, recitals, or anywhere else where you think your are “needed” for life to move forward until you are over it.

On the flip side, of course, are those afraid or opposed to the immunization. Really, you are scared of the flu shot? What is going to happen? Flu shots do not cause the flu. Side effects of the flu shot are by all reports, rare (though I must admit I can not find any actual reported numbers, just the word “rare”). The worst is an illness called Guillain-Barre Syndrome which is associated with a swine flu vaccine developed and administered in 1976…yes, 33 years ago! Since then, studies have shown that only 1 in 1,000,000 people may be at risk of the illness associated with a flu vaccine. Science has done some remarkable things, and the development of vaccines to prevent illnesses is most certainly one of those things. It is easy to distrust things that we do not personally understand, but why is it so easy to trust those things that are so contradictory to them? I read somewhere that there is going to be an episode of “Sid the Science Kid” created by Jim Henson’s gang airing on Monday and will be about getting your flu shot. The writer was suggesting that the episode was evidence of Big-Pharma backed programming using propaganda to sell more immunizations, as if kids are going to all of a sudden enjoy getting shots.

So, as with so many things in life, I am suggesting that we all relax and attempt to fall somewhere in the middle of the two sides of this drama. This H1N1 is a virus that has, and will continue to cause fatalities among us. More often, it is going to knock people out of commission for several days leading to the usual wintertime decrease in productivity at offices and schools across the country. No doubt, the manufactures of the vaccines will push for more vaccinations as we still live in a capitalist economy designed to allow those corporations to profit from a demand. Take care of yourself, take care of your loved ones. Get the vaccines or don’t, but let’s recognize this for what it is (a respectable viral outbreak), and for what it is not (a conspiracy). So when I stupidly come down with either the seasonal flu or H1N1, the blame will only be mine.

Be Well!

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Actually…maybe.

I have heard it said on more than a handful of occasions that children are the toughest job and the greatest joy one can experience. While I am sure that isn’t exactly true for everyone, it is for me. One of the greatest challenges that I have had with my young children is understanding what the hell they are talking about.

Obviously, little Hayden at 6 months old isn’t talking yet, but she is definitely communicating. Her cries, whimpers, screams, giggles, and coos all mean something, and can often mean several things…oh, wait…maybe she is speaking Hawaiian?

Kerry seems to understand her better than I do. She seems to know that one kicking fit means Hayden is hungry while another means she is tired. For me she is either happy, sad, content, or asleep. While simple, it seems to work between Hayden and I, until it’s time to eat, of course.

Xavier’s speech, on the other hand, has exploded recently. Just 7 months ago on his second birthday, Xavier possessed a handful of words and could compose a rare, brief, and somewhat intelligible sentence to ask for water or to see a train. Today, he speaks primarily in sentences, and possesses a shockingly complex vocabulary (along with a word or two I wished he hadn’t picked up on – though sure to get a bit saltier in future years). According to one of my favorite “assistance books”, What To Expect, The Toddler Years, children about Xavier’s age should be able to carry on a conversation of 2 or 3 sentences, so he is right on target, but it still amazes me.

Among his favorite words of late are actually and maybe. Listening to him talk gives me perspective on what it must be like for immigrants to this country, suddenly trying to learn the English language. “Maybe” doesn’t so much mean that something might or might not happen, but rather acts as a lead in to a request for something…assuming a yes response, of course.

“Maybe us go see trains?”

“Maybe I can have juice?”

“Actually” is even more enjoyable to listen to. Xavier sounds like a wise instructor always correcting our sentences.

“Actually we are watching Nemo.”

“Actually us going to the park today.”

Every day brings new developments, and already the word maybe seems to be finding its’ more proper role as a frequently used adverb to express the possibility of something. He has thankfully picked up on “please” in the last few days, and now politely asks for things like water, or to see trains…unless we say no, that is.

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T-T-T Terrible Twos and the Time Out

When I first discovered that I was going to become a parent, lots of things sped through my mind, bombarding my fears and preconceptions from every angle. Everyone was ready to offer advice, which I repeatedly solicited, and everyone shared their own stories and experiences. It was hard to avoid two in particular. The first is so ubiquitous it’s ridiculous (like that?), and that is the concept of “Terrible Twos”. The second, almost as famous, is the method of punishment/discipline known as the time out.

As much as I heard about both of these things, it never really hit home until I experienced them for myself beginning several months ago. I have to say that being at home all the time simultaneously with this kicking in has given me a better perspective on the whole thing. My conclusion thus far? The “Terrible Twos” are, hm…OH SO REAL, and the time out, while grounded in good intentions, has thus far been an exercise in futility.

Ah yes, the proverbial exercise in futility, first conceived, I believe, when the biblical Jesse of Bethlehem kept sitting son David in a corner for throwing rocks at the bigger children…or did it really start with a young Dennis Rodman? One can never be sure. In any case, my experience with the time out method tells me that it is marginally effective at best, though we are not intending to abandon it yet. Much like my other current time-consuming project, the job search, it is an exercise that you must continue to utilize until it either proves successful or irrelevant.

This all comes into play only due to the firestorm that is the “Terrible Twos”. I have been told that not all children go through the “Terrible Twos”. For some it waits until the threes, or even the fours. For some, I hear whispers, that it never arrives, and those shame-on-you-for-how-lucky-you-are parents just skate on by with some abnormally well-behaved little darling. Without researching any kind of data, I will go out on a limb and say that those special little children are by far the exception, so most parents reading this will know exactly what I am writing about.

It begins with the child learning two key words, i.e. “No” and “Mine”. Please understand that these two words will sometimes mean what the dictionary says they mean, and sometimes will mean almost anything else. This is quickly followed by the child’s development of favorite things to do/eat, and finally a desire to test the limits of his or her independence. In the case of my little Jekyll/Hyde, Xavier, this phase (Era) has arrived right on schedule, and with a vengeance.

Please don’t misunderstand me, a good portion of the time, Xavier is as sweet and happy as any two-year-old could be. He is outgoing, charming, funny, and packed with energy. I absolutely love him, and cherish all the time I do get to spend with him right now…unfortunately, he spends a fair amount of that time in the aforementioned time out.

"It wasn't me..."

"It wasn't me..."

The root cause for his extended stays in time out revolves around his complete and utter unwillingness to listen. He “knows” this is why he spends so much time there as most of his sits resolve with an amazingly sincere-sounding “I’m sorry for not listen.” So, why then does the time out seem to lack any real impact? I think it is because this is simply part of the development that any child must go through to help them understand and define their own personality and moral/ethical barometer. The fact that their undesirable behaviors are consistently followed by an unwanted consequence must help reinforce in their mind what they should and should not do in life…right?

One alternative, spanking, is not an option for me. One thing I do believe is that we teach our children what is right and wrong through our own behavior as much as anything else, and I would prefer that my child learn to deal with conflict calmly and rationally, e.g. the time out, than through corporal punishment. It seems to me that I and my siblings grew up as very normal, law-abiding citizens (my brother’s penchant for being a parking scofflaw aside) and were never subjected to either spanking nor the time out to the best of my memory. Those friends of mine who did get spanked, seemed to get it A LOT, so how effective was that?

So, we will continue on with the time out, hope that these “Terrible Twos” end sooner than later, then move on to the next phase, whatever that may be…until Hayden hits the “Twos” that is.

What about you all?  Any opinions on the subject, either yea or nay? All feedback is welcome from both those with experience and without.

Be Well!

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