Injecting medicine back into vaccination decisions

Puttering around on the interwebs, I came across this nice little opinion piece on CNN regarding the influence celebrities have on health-related decisions and why that’s not necessarily in your best interests. I’ll admit, I read Jenny McCarthy’s books while I was pregnant. Her book about her pregnancy, “Belly Laughs”, was recommended to me by a friend, and I got into reading her humorous, highly-accessible writing. I was also impressed that someone who made a career out of playing a ditz or a bombshell actually had the ability to write well. As I got deeper into her oeuvre, I saw her pain as she went through the nightmare of seeing her son change before her eyes, eventually to be diagnosed with autism, and what she went through to try to bring him back to some semblance of “normalcy”. (My term, not hers, and the definition of “normal” is really very much up for grabs.)

As I read “Louder Than Words”, I could tell that she was describing what SHE went through and what SHE thought, and it never seriously crossed my mind that I shouldn’t vaccinate my then-newborn dd. I took it for what I saw as “what it was worth”: here’s a person with (I’m guessing) greater financial means at her disposal and (I’m also guessing) a more flexible work schedule than those of us who work 9ish-5ish jobs. So, even if something happened with my dd and I needed to deal with it in the manner that Jenny had outlined from her personal journey, it’s not like my journey would map 100% to hers.

My memory’s a little fuzzy, so I can’t recall the specifics of the conversations I had with dd’s pediatrician about the vaccine schedule. I know that I did ask at some point about the Measles-Mumps-Rubella (MMR) vax that Jenny McCarthy blamed for her son’s autism (on the basis of a scientific paper which has since been discredited). I also remember that the doctor told us that the vaccine was safe, and I trusted her.

Now, why would I trust the pediatrician in the face of the story Jenny McCarthy told? It’s simple: Jenny McCarthy’s story, in the world of statistics or market research, would be described as “an n of 1”. She’s one example. She could be an anomaly. If she were indicative of the norm, rather than the exception, one would think that parents would be coming out of the woodwork left, right and center saying that their child became autistic as a reaction to that 18mo MMR shot. But it just wasn’t happening. Plus, there’s also this really overwhelming thing on the pediatrician’s side: she’s actually been through medical school. She studied and stuff. She did a residency. She actually KNEW things from having learned on the job.

This isn’t to take anything away from Jenny McCarthy’s experience. I can’t imagine what a nightmare it was for her to find her son a boy transformed seemingly overnight from a happy boy to one who shrieked and had trouble eating and whose communication skills dwindled rapidly. I can’t imagine the strength it took to go through everything she did to try to restore her son to his former self. I do know that, as a parent, you keep going even when you’re at the point of exhaustion, so I can hazard a guess about how difficult that must have been for her.

I appreciate that she shared her story and I wish that more people would take it for what it is: an n of 1. I’ve seen too many news stories in the last few years about outbreaks of measles and other easily preventable diseases, clustered in areas where the parents were turning anti-vax. It just seems horrifying that the fear of non-fatal medical problems leads people to court the danger of potentially fatal diseases.

I realize that I’m no more a doctor than Jenny McCarthy, and I also realize that the decision to vax should be within the purview of a parent’s discretion. However, I like the idea behind the bill moving through the CA legislature right now that would require parents opting out of vaccinations for their children to have to consult with a doctor first. Now, before any anti-vax folks start to freak out, this bill DOES NOT say that you can’t choose to opt-out of vax. However, it does require documentation (a form) that shows a health care professional advised what the risks were of declining the vaccine.

I see this as a step forward and I hope that states beyond California adopt this type of legislation. We shouldn’t require people to act against their beliefs when it comes to vaccination – but for everybody’s sake, it seems like it makes sense to require that they don’t decline without getting a consult from a real healthcare professional. Until folks like Jenny McCarthy have earned their LPN, much less their MD or PhD, it seems safer to leave the practice of medicine to those who actually know it best.

How to tell if you’re “mom enough”

So, TIME Magazine decided to kick over a tracker jacker-level nest this week by putting an extended breastfeeding (EBF) mom and her 3 year old ds on the cover. With him breastfeeding. While standing on a toddler chair. [The article can be read in print or, if you can unlock, you can read it on their web site. More links – unlocked – here and here.] The basic premise is that it’s fun to star a holy war amongst moms during a year when we’re already talking about a “War on Women”.

Oh TIME, you are so awful sometimes.

My first reaction to seeing a mom EBF her 3yo was shock. It wasn’t that I was repulsed by the idea of a woman bf’ing her son; far from it, I think that’s fantastic. That she’s also incredibly beautiful and has a slammin’ body only made it seem crueller. She’s pretty, she’s got a great bod, and she makes bf’ing look like it’s so fricking easy (when I know for a fact that this is NOT the case for everybody). Ultimately, what bothered me about it is that her child shouldn’t need breastmilk at this stage of his development.

Over the course of a breastfeeding cycle, from when your colostrum first starts to come in all the way through weaning, your milk is constantly changing its composition to meet the nutritional needs of your child. By the time your child is starting to get onto solid foods, your milk is nowhere near as thick or heavy in nutrients because your body just knows that other stuff is going into their system to handle that. So it seems rather odd that anyone would *need* to breastfeed that long…the milk can’t possibly be any better, nutritionally, than what they’d get from a dairy or grocery store. If anything, it may not be as good for you, since it will have less vitamin D and calcium – requiring the child to need to lean more heavily on vitamins or foods rich in the appropriate, otherwise lacking, nutrients.

So, it is mostly me shaking my head say, “This makes no sense.”

I also have a co-worker whose sister just gave birth to an overdue child who has lost a little too much weight since birth. The rule of thumb is that if a child loses more than 10% of their birth weight, they need to be fed more frequently, potentially be supplemented with formula, etc. while the pediatrician monitors more closely. We went through this with dd when my milk didn’t come in well, so hearing that my co-worker’s sister was going through this, too, was giving me flashbacks to my crying fits in the hospital when the milk just wasn’t there and dd was screaming out in hunger until I finally relented and let formula take the place of what I thought only I should provide. Apparently, my co-worker’s sister is taking this in better stride than I did with dd, so good for her. She’s also using a syringe (for those not in the know, this involves a very thin tube that you can strap to your breast so the child is mimicking the comfort of being held close without potentially getting nipple confusion from a bottle). So, she’s better positioning herself for being able to continue bf’ing once she’s gotten the weight issues under control.

As you fast-forward in life, there seem to be no end of times when you compare yourself to other moms. I look around and see moms who appear to be more capable, more patient, better financed, fitter, happier…just generally BETTER. And then I think about my own mom, who’s a superhero to me even more every day as I learn about what it takes to be what I consider a “good mom”. She was epic during my childhood – working full-time, often in managerial roles, being a full-time mom and primary caregiver, cooking dinner every night, keeping the house together and clean…she never seemed to lose it.

And thus I come back to how I feel about my momming. I was “single-momming it” this week, as dh spent the majority of the week out of town for a work trip. Each night, I was on the hook to get the kids from daycare on time, get them home safely and make dinner. I was the only one to put them both to bed, and I was the only one to clean up. On the night when one of them couldn’t sleep well without a parent, I was the only parent who could be woken, and I still had to get up on time the next morning and find a way to shower so that I wouldn’t go into work anything less than clean. I managed. Actually, I did a bit better than managing – I somehow convinced the kids after that first awful night that they should stay in bed all night, and both of them did. Evenings were well-coordinated and everyone played their part, and they ate and slept well for me. I got hot showers 4 out of 4 days that I was on my own. And each day, the kids were happy, got play time, got relaxing time, ate square meals, slept for the required amount of hours, and went to school looking as though we were still a two-parent household all week. Oh, and I managed to get all of my work done at work and then some.

So, then we circle back around to this notion of being “enough” of a mom. In my mind, if you’re trying to do as much as possible within your power (and within the limits of reason) to make/keep your children happy and healthy, then the answer is yes. There’s a lot of stuff that we can’t control, but there is a good bit that we can control, too. Parenting is all about jumping off a cliff not knowing whether the bungee, parachute or other flotation devices are going to work. And, on your way down (or up), you keep experimenting because what worked 5 minutes ago no longer flies, so to speak. You don’t need to EBF to be a good mom. You don’t need to buy the most expensive clothes or toys for your kids to be a good mom. You don’t need to be model-pretty and model-slender to be a good mom.

There’s a big difference between being able to have a child and being a parent. When you decide to BE a mom and devote time and effort to that, then you’re mom enough. Setting up unnecessary fights and agitating an already on-edge population just seems mean-spirited. Shame on TIME for fueling a fire that just needs to burn out, already. I don’t need a magazine to tell me whether I’m “mom enough”. I can figure that out on my own.

Data collection and your baby

{aside: YES, I KNOW I said I’d post a recipe for the Carolina-style bbq chicken. I still will…I just haven’t gotten to it yet. Work, exercise, tired, parent, work, tired, parent, exercise…you get the drift}

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So, dh decided to interrupt my Angry Birds Space/me time with a copy of the most recent Atlantic magazine. It seems that there was a piece written called “The Data-Driven Parent”, all about how parents are turning to technology to help them track their infants’ behavior, feedings, etc., in order to bring some order into the chaos. On many levels, I SO GET this.

Flashback to nearly 5-1/2 years ago when, recovering from my c-section for dd, I suddenly realize that A) breastfeeding is WAY harder than I thought it would be, B) I don’t appear to be getting the hang of it and neither is she, and C) I have a supply of breastmilk that’s directly inverse to the size of my breasts, which turned into porn-sized bazooms by day 3 post-delivery. With my child losing too much weight in the hospital from lack of nutrition, I tearfully turned to formula and, pretty much immediately upon arriving home, a Medela Pump-in-Style. I pumped, really I did, but I was producing half-ounces at a time. Meantime, my friends from the online birth group were producing gallons, it seemed. Self-esteem, meet the toilet.

Because dd’s weight was such an issue, I tracked everything about her eating and her diapering. We were actually told to do this for a few weeks, and then we continued long after the doctor told us it wasn’t necessary. Pages and pages of double-sided log sheets were completed until we had finally gotten to the point where I was willing to back away from the spreadsheets that I’d used not just to track the feedings but to draw charts with trendlines. {Yes, I’m THAT person. I’m willing to acknowledge it.}

With ds, my supply was better, but breastfeeding was still no better of an option. He and I never clicked, and while I was in the hospital, he actually gnawed me to the point where dh had to run out to a nearby compounding apothecary to get me super-special healing salve. I won’t get into all the gory details, but suffice to say that I wanted to hug and kiss the LC who managed to get me a Medela Freestyle breast pump from our insurer as a fully covered benefit the LAST DAY that they offered it, which coincided with the day I said, “Screw this, I’m jumping on the pump.” {Also side note: Ladies, health care reform is brilliant and some pumps are now going to be fully covered benefits. If you’ve ever pumped or plan to, VOTE OBAMA this November. #thatisall}

I leaned on the spreadsheets I had from dd’s infancy and just made a copy for ds, tracking his feedings and (Oh Dear Lord) comparing his intake to hers. He got significantly more milk than she did, although I did have to supplement with him anyway. But he had whole days where he got nothing but milk. It’s amazing. It’s victory. It’s probably completely incomprehensible that this was a BIG DEAL to me if you never had an issue with feedings yourself.

And this all does have a relationship to the Atlantic article – which talked about how parents are turning to technology to do pretty much what I did, only they’re going quite a bit farther. The parents interviewed for the article are turning to mobile and tablet apps to do their tracking (“Back in my day,” she wheezed, “We used EXCEL and we made those formulas BY HAND! GET OFF MY LAWN!“).

I have no issue with them doing this, but when they get to the point where folks like Belkin are going to enable – nay, encourage – parents who own their tech to share their results with each other so that you can compare and contrast your infant with some other random infant, that’s where I bristle. In my mind, checking the kiddos up the street for “what’s normal” isn’t always your best bet, since that’s a sample that’s often less than statistically significant. Really, if you want to know “what’s normal”, check with your pediatrician. They know this stuff. They went to school for this stuff. They can talk you down off the ledge about how some kids will be 99th percentile because – and I know this is a hard concept to grasp – when you have a scale, SOMEBODY is gonna be at the top of it and SOMEBODY ELSE will be at the bottom of it. That’s why it’s a range. Or a scale. Else they’d change the scale.

What worries me about this is that, instead of enabling parents to do the tracking that makes them feel more secure by having knowledge at their fingertips, it will actually encourage them to worry more, to get even more irrational by going all Dr. Google on their infants about what’s normal and what’s not normal for a 4-week-old baby.

Maybe I’m overreacting, but it seems to me that data collection and productivity apps are cool, and things that encourage panic and contextually-insensitive faux diagnoses are uncool.

Maybe I should just get back to Angry Birds Space; I was a LOT less cranky then.