Tuesday, December 31, 2013

Dear Anatomy & Physiology Professor

Yesterday I finished a 12 week anatomy and physiology 2 part course. At the end I posted my professor a note in the discussion area.

I have enjoyed both Anatomy classes and have learned lots of information valuable for the various things I do. I am a birth doula, birth educator, La Leache League Leader, parent educator and more. I do have some ideas about the labor and birth chapter which I meant to contact you about. I'll still try to do that before the discussion areas get closed. 

Thank you,

The professor responded, "I'm glad you enjoyed the course and look forward to your input!"

So I spent a considerable amount of time yesterday going carefully through her lectures and formulating my response. I posted it into the discussion area as I had no other way to connect with her. I found out this morning that she took it down and sent me this reply, 

"To Jennifer,

Thank you for the information.  I am not able to keep that type of post up in the Discussion Area, but I read it carefully and copied and pasted it into a Word document for further review.  I am looking forward to checking out the references you included.  I think the pendulum has swung some on medication during childbirth.  When I was having my children (my oldest is 33 and my youngest is 18), women were encouraged to avoid medication if possible, while women in my mother's generation were significantly medicated.  Now, it seems that epidurals are used almost routinely, rather than reserved for special situations.

I think it's very important for women and their partners to learn as much as they can about pregnancy and childbirth, understand the pros and cons of different types of pain relief, think about their ideal situation for labor and delivery, and then discuss their wishes and concerns with a physician who comes highly recommended and who they trust.  

Thanks again for the info!"

I couldn't agree more. Women should learn all about the pros and cons, safety and risks of ALL medical procedures before they give birth but NOT in an anatomy and physiology class. In an anatomy and physiology class they should learn how a woman's body works without any outside interference. How her musculoskeletal, integumentary, sensory, hormonal, chemical and nervous systems work in concert to bring a baby into this world. 

Here is what I posted on the discussion board:

I have some thoughts about the sections in your lectures which cover normal vaginal birth. Let me explain my background. I have been a doula for over 20 years. In case you aren't familiar with this profession, a doula supports couples during the entire birth process and into the early postpartum period as well. I have been at over 100 births. Some have happened in homes and birth centers, but the majority of my clients have chosen to birth in a hospital setting. I have seen lots of babies come into this world vaginally and some via cesarean section. Along with this I am a birth educator and La Leche League Leader. La Leche League International has been educating and supporting breastfeeding women for over 50 years. They have the most up to date information and studies on lactation, breast milk, and breastfeeding. As a Leader I am trained to support mothers who desire to breastfeed through facilitating meetings and providing one-on-one support.

Throughout your classes I have been impressed with how well you explain the body's systems both anatomically and physiologically. The more I know about the human body the more amazing its abilities seem to me. I am very passionate about women, birth and families. It is very important to me that women are given accurate information about their body's birthing and breastfeeding abilities. Unfortunately in our culture women know very little about birth and what they are told is not at all from an anatomical and physiological stand point. Instead it is heavily mixed with cultural beliefs with no regard for science. Unfortunately I believe your section on birth is skewed in this manner. Women need to know how we were designed to give birth. If they then choose to use medical and pharmacological props or interventions that will be an educated cultural choice. As this is an anatomy and physiology course, I am hoping you will consider taking a more physiologic approach to how you present birth to women. Please understand I am NOT advocating women should birth without skilled help at the ready. How much they use or need that help will depend on their unique situation. I want them to learn what their bodies are capable of doing. 

Here is what I have learned from watching women, keeping up with the latest science, and opening my mind to see past our current birth culture. Women are designed anatomically to labor and birth in upright positions. Left to their own instincts it is very rare indeed for a woman to choose to lie down to birth, especially on her back. Imagine a woman choosing to lie flat on her back to defecate or urinate. Most un-medicated women will choose to stand, semi-squat, full squat or be on their hands and knees. Unfortunately all of your graphics clearly show the supine position. This position is brought about through the use of pain medication and for doctor and hospital convenience. It is considered normal only because of cultural influences on the physiologic birth process. Anatomically it flattens the pelvis and doesn't allow for the sacrum and coccyx to move out of the way of the descending head. It also immobilizes both of the illiac bones making it harder for them to spread laterally giving the additional space needed for the baby. You mention the doctor placing the woman in a semi upright position but as long as her bottom is against the surface of a bed she will be hampered in her abilities to birth unassisted, but unassisted is what we are anatomically and physiologically designed to do.

In your course you say the doctor will tell the mother when second stage has begun. But anatomically when a mother is un-medicated she does not need to be told when to begin pushing. When the baby descends to a certain point in the pelvis he naturally triggers the fetal ejection reflex in mom. Just as when you need to vomit you know you are about to vomit. No one needs to tell you it is time or how to do it. No one needs to say how long each vomiting session should last. This is exactly like the 2nd stage of labor. The mother, even a first time mother, will spontaneously begin to push with her diaphragm and abdominal muscles. She will not be able to help it. She will not be able to stop herself. She will naturally tend to push 3 times during each contraction for approximately 6 seconds. This amount of time works physiologically for the baby. When a mother is pushing she tends to hold her breath to bear down. This breath holding reduces the available oxygen to the baby. Six seconds is an amount of time that babies tolerate well. Longer than that can cause a drop in oxygenated blood with a corresponding rise in fetal heart rate as they physiologically struggle for homeostasis. 

The un-medicated mother will know when she is crowning from the burning sensations she will feel. Most mothers stop pushing and cry out. This releases the vaginal muscles and allows for the last stretching. I agree with you that it can be helpful for a provider to gently put counter pressure on the head to keep it from coming so quickly mom’s vaginal tissues tear but this is not how the system was designed. It was designed for the mother to birth like other mammals, without assistance. Further there have been many studies done that show that an episiotomy does not keep a woman from tearing. As a matter of fact they all agree that a woman is more likely to have a 3rd or 4th degree tear if she has an episiotomy. Currently most doctors only do an episiotomy if the baby's heart rate is dropping into the danger zone. In this situation it can be life-saving.  

When the baby's head appears the supine or semi-reclined position necessitates a care provider to hold the head so the head doesn't flop backward, hyper extending the baby's neck. When a mother births in a squat the head stays perfectly in line with the body as it hangs down. In your lecture you say the doctor will rotate the baby's shoulders but most babies rotate without any assistance. It is part of the anatomical fit between mother and baby that causes them to sort of cork screw out. It is only if their shoulder is stuck under the pubic bone that this doesn't happen. Finally rather than a doctor needing to catch the baby as you suggest, the mother is capable of reaching down and catching the baby as it pops out after the body rotates into position. I have witnessed this. 

As to the physiological process, you mentioned the hormones oxytocin and prostaglandin but equally important in the process are dopamine and endorphins. This combination of dopamine, endorphin and oxytocin is the same combo released during orgasm which causes intense pleasure and a feeling of floating. In labor this powerful chemical combination changes the laboring woman's perception of the pain allowing her to endure much more than she would otherwise. On top of that she is chemically driven to bond with her new baby as soon as he or she emerges. This is a very important feed-back loop which pitocin and an epidural disrupt. It has consequences for the next phase, mothering the baby outside the uterus.

The latest studies all show conclusively that immediate skin-to-skin contact is what we are physiologically designed for rather than taking the baby away even briefly and presenting it back to mother as a wrapped bundle. The mother and baby should continue to be considered one biologic unit. They share bacteria, hormones, body fluids, antibodies, fats and proteins. A neonate has no ability to self-regulate. He does this through his mother. Hearing the mother's heart beat and feeling the rise and fall of her breath regulates his heart rate and respiration. It keeps the levels of adrenalin and cortisol at their appropriate levels; enough to cause the baby to be hyper alert without causing him physical stress. Science has proven babies should not be taken away or wrapped in blankets. This is part of the WHO Baby Friendly Initiative. Their goal is to have all babies go immediately onto their mother’s abdomen or chest unless they need life saving measures. Normal suctioning doesn't count as life-saving. If needed this can be accomplished quite easily on the mother while baby remains skin-to-skin. They are to stay this way undisturbed for the first 2 hours of life so that all of the above sharing and regulation can occur. If you haven't watched a video on delivery self-attachment yet you will be amazed! We are much more like other mammals than we have given our babies credit. When un-medicated, undisturbed, and left skin-to-skin with mom they move themselves into position and find the nipple, latch on, and begin feeding. I just attended a conference where I was blown away by the latest info about epigenetics and breastfeeding. Breastmilk contains, histones, lepten, and microRNA, which all pass to the baby. They attach into their genes and change how the genes are expressed. This is an important further step in passing on genetic information from one generation to the next.  

The third stage is more easily accomplished if baby stays with mom. This triggers further oxytocin release, especially if the baby latches and begins to nurse, which stimulates the placenta to fully separate and then keeps blood flow to the amount which brings mom back to homeostasis. She loses the extra blood she created to maintain the pregnancy which she no longer needs. There is no need for "a little bit of pitocin" as you have taught unless the mom actually IS bleeding too much. Again our physiology is miraculously designed to take care of most contingencies. Only when it is not able to do its job successfully should we vary from this amazing design which you clearly have so much respect for.

Finally I want you to imagine what would physiologically occur if the mother and neonate were all alone immediately after birth. What would the mother do? Would she immediately clamp and cut the umbilical cord as you have stated the is done in our hospitals? Highly unlikely. Therefore what is supposed to occur? As you detailed so well, the baby's circulation and respiration have major changes that need to happen. These will generally take place quite peacefully without any gasping or stress to the baby. There is significant pressure around the baby's chest when it is squeezing through the vagina. When the baby is born there is therefore a significant drop in pressure which causes air to try to rush into the lungs. Also there are nerves in the skin of the neonates face which, when exposed to air for the first time, trigger him to breath in. This is why babies can be born under water and not drown. They do not attempt to breathe until their face is lifted out of the water. Further as long as the cord and placenta are intact and still pulsing the neonate continues to receive oxygenated blood from the mother through the placenta. The cord is covered with a substance called Warton's Jelly. When the air hits the cord it dries this out and triggers the cord to slowly stop pulsing. Meanwhile inside the baby his body is working to close the foramen ovale and reroute the blood. Most cords will pulse for 5 to 10 minutes after birth and placentas stay adhered to the wall for anywhere from 15 to 30 minutes. This gives the baby buffer time. I don't believe in this scenario there is a fall in blood PH, but I could be wrong. This also gives the mother/baby system time to bring their blood exchange into homeostasis with the neonate receiving exactly the right amount of blood. If you clamp the cord too soon you will leave 1/3 of the fetal blood in the placenta. This blood is needed by the neonate for many reasons. They are discussed in one of the links below. 

Thank you for listening and thank you for expanding and deepening my knowledge of the human body. I'm very glad I took this class. If you wish to ask me further questions about labor, birth or breastfeeding please email me at jenniferstoverdoula@gmail.com.

A standing unassisted birth video: https://www.youtube.com/watch?v=zFMHB4RqpjI  

An MRI study of Pelvimetry in 3 positions:

Further explanation about up right positions: http://www.givingbirthnaturally.com/birth-positions.html

Discussion of labor hormones and how catecholamines disrupt the natural hormonal cascade:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595201/  

Delayed cord clamping: http://www.scienceandsensibility.org/?p=5730

The requirements for a hospital to become Baby Friendly certified:http://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative/the-ten-steps

Importance of skin-to-skin contact: http://www.medscape.com/viewarticle/806325

Breast Crawl video: https://www.youtube.com/watch?v=zrwfIcPB1u4   

I hope dear reader you found this information helpful to you. Please feel free to share it with others. You can link to this blog or share it via Facebook. Even copy and paste it into an email or on your own web site. Please remember to attribute it to me.

Monday, December 30, 2013

California Measles Outbreak; What's a Parent to Do?

Yesterday I caught the tail end of Dave Congalton on the radio talking with a local pediatrician who has written a new e-book about baby's first year. She was adamant about vaccinations and was sure that if parents were simply told the facts by their doctor they would automatically want to vaccinate. During the short time I was listening, 2 other docs called in to FULLY support vaccinations.                                 
She also said we were having a measles epidemic in California. At that point I called in. I asked her how many cases there actually were. She backed off and said she shouldn't have called it an epidemic but an outbreak. I told her I thought the cases were in vaccinated people. She said no they were unvaccinated. (Keep reading to see she and I were both right and wrong on that one.) She said this kind of bad information was the problem with the internet spreading false info. She accused parents of getting poor information off the internet and then being too frightened to do the right thing for their kids. So this morning I went to the internet to see what I could find out about measles in CA. Here is some info you should know.

Facts on California's measles outbreak
From the CDC web site:
"Measles causes fever, runny nose, cough and a rash all over the body. About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. For every 1,000 children who get measles, one or two will die."                

Also from our government:                                                
"HEALTH ADVISORY – February 19, 2014

14 Measles Cases in the State of California in 2014

Fourteen cases of measles with onset in 2014 have been reported to California Department of Public Health. (In all of 2013, 189 people have been reported to have the disease. This represents the second largest number of cases in the U.S. since measles was eliminated in 2000.)
Among the 2014 California cases, four case-patients had traveled outside of North and South America, with three traveling to the Philippines. Nationally, an increase has been noted in the proportion of measles cases with travel to the Philippines. Measles cases from recent years have reported travel to Germany, France, England, India, and China, among other destinations.

Of the 2014 California case-patients without international travel, three had contact with known measles cases, two had contact with international travelers and five are under investigation to identify potential sources.

Of the 12 cases with known measles vaccination status, 8 were unvaccinated (7 were intentionally unvaccinated and 1 was too young to be vaccinated). That means 4 were vaccinated and 8 were not. So a third of the cases were in vaccinated people and 2/3 in unvaccinated. Why are vaccinated people getting sick? Had they only had the initial vaccine and not the booster or did they fave both shots and the life-long immunity they said we would have isn't turning out to be true? 

Please note they are NOT talking about deaths or even tell us how severe the cases were; simply that they had measles.

The last large outbreak of measles in the U.S. occurred during 1989-1991, with 17,000 cases of measles and 70 deaths in California.

Let's compare this to influenza. For the 2013-2014 flu season the California Department of Public Health says there were 332 deaths in California. 

Efforts to increase immunization rates in the 1990s were successful and endemic transmission of measles in the U.S. was eliminated in 2000.

Here is what eliminated actually means. In 2000 there were 86 cases in the US and 19 in California. 

 In 2013-2014, a large measles outbreak in the Philippines has resulted in over 1700 cases and 21 deaths. This outbreak has led to measles importations to Australia, Canada, the UK, and in many U.S. states. Additionally, measles is currently circulating in most regions of the world outside of North and South America."

In 2013 there were 189 cases of measles in the US and 15 cases in California. There were NO deaths. Now I want you to think about the numbers of people you know in California who had the flu this year. We probably each know at least 15 people. Of the California measles cases, 11% needed to be hospitalized, so 17 people were seriously ill. Pneumonia was the reason for hospitalization for 4 of the cases. It is important for pregnant mothers to note that 2 of these hospitalizations were for pregnant women and 1 miscarried. Let's look closer. Ninety-nine percent were import associated. In other words there was contact with someone who brought the virus into the US from abroad or was in contact with someone who was in contact with someone who had been abroad. Another interesting item is that 8% of the cases were in vaccinated people. 

How Does This Compare to the Flu?

Let's see what Web MD says about the flu:

Here's a rundown of some important flu statistics, based on the best available data.

Percentage of the U.S. population that will get the flu, on average, each year: between 5% and 20%.
That is with the current flu vaccination rate. So what percentage of the US population is 159 measles cases? The US Census Record says there are 316.99 million people in the US. So last year's outbreak was .00005% of people in the US.

Number of Americans hospitalized each year because of flu complications: 200,000, on average.
Remember there were 17 people hospitalized for measles complications last year. The last big outbreak of measles occurred from 1989-1991. Each year there were approximately 18,000 cases in the US with approximately 3,600 hospitalizations. 

The number of people who die each year from flu-related causes in the U.S.: ranges from 3,000 to 49,000.
During the last big outbreak of measles in the US approximately 41 people died each year.

In the U.S., influenza and pneumonia were the eighth leading cause of death in males in 2009.

Number of flu vaccine doses available in the U.S. for the 2013-2014 flu season: Between 135 and 139 million.
That means that if all the doses get used they will have vaccinated 44% of the population for flu. The federal government wants a 90% vaccine rate for measles and they say are meeting or exceeding that goal! Less than 1% of young children are not vaccinated  and most of the unvaccinated kids are for economic reasons. So what percent of all the kids in the US are not vaccinated due to parental choice? I couldn't find that number. Obviously it is less than 1%. 

So where does all this fear come from? Most of it stems from one situation in New York where many people in one extended family became ill with measles. This family had chosen not to vaccinate due to philosophical reasons. They had family members who traveled to Europe and brought home an unwelcome souvenir. In total there were 65 cases of measles in New York. Here is the final word of why the the CDC is concerned:  "imported measles cases can result in large outbreaks, particularly if introduced into areas with pockets of unvaccinated persons."

From the National Vaccine Information Center:
(this is the organization which the medical establishment is talking about when they say crazy 
anti-vaccine people)  
"In 1960, three years before the first measles vaccine was licensed in the U.S., there were 380 deaths from measles recorded."            

Are vaccines safe or not?
Now let's explore the possible side effects from getting the MMR vaccine. Remember very little in life is 100% safe so with life there is risk. What are those risks?

From the CDC: 
"Moderate Problems
Seizure (jerking or staring) caused by fever (about 1 out of 3,000 doses)
Temporary pain and stiffness in the joints, mostly in teenage or adult women (up to 1 out of 4)
Temporary low platelet count, which can cause a bleeding disorder (about 1 out of 30,000 doses)

Severe Problems (Very Rare)
Serious allergic reaction (less than 1 out of a million doses)
Several other severe problems have been reported after a child gets MMR vaccine, including:
Deafness, long-term seizures, coma, or lowered consciousness, and permanent brain damage
These are so rare that it is hard to tell whether they are caused by the vaccine.
(Please note they give us NO numbers)

From the National Vaccine Information Center: 

"Common side effects from the MMR vaccine include low-grade fever, skin rash, itching, hives, swelling, reddening of skin, and weakness. Reported serious adverse reactions following MMR vaccination include seizures, brain inflammation and encephalopathy; thrombocytopenia; joint, muscle and nerve pain; gastrointestinal disorders; measles like rash; conjunctivitis and other serious health problems.

As of March 1, 2012, there have been 898 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following MMR vaccination, including 56 deaths and 842 serious injuries. (Again we have no numbers of doses of vaccines to help us understand what percentage of doses; or true level of risk. I'm not even sure if these numbers include multiple years.)

Using the MedAlerts search engine, as of July 9, 2012 there have been 6,058 serious adverse events reported to the Vaccine Adverse Events Reporting System (VAERS) in connection with measles vaccine since 1990, with over half of those occurring in children 3 and under.

Evidence has been published in the medical literature that vaccinated persons can get measles because either they do not respond to the vaccine or the vaccine’s efficacy wanes over time and vaccinated mothers do not transfer long lasting maternal antibodies to their infants to protect them in the first few months of life."

There are other theories about vaccines long term risks beyond immediate reactions. None of these, as far as I know, have been proven. Conversely I don't know that there are any long-term studies on vaccine safety. Questions out there which I feel bear looking into are the potential vaccine/autoimmune disease link. Especially after seeing that the CDC says one of the moderate immediate reactions can be pain and stiffness in the joints in teens and women. Autoimmune diseases are definitely on the rise. Is this caused by vaccines? The anti-vaccine group would like you to think so. As far as I know we have no scientific studies to definitively make that connection yet. I want long term studies done. I want studies done on bundled vaccines, not individual vaccines. I don't believe the scientific community has done enough research into the possible synergistic effects of bundling vaccines. I think the fact that we now have potential humans to do matched studies on right here in America is fantastic. I don't want studies with unvaccinated people from third world countries compared to people in the developed world. I want us to follow long-term some of the now unvaccinated US kids and a matched group of vaccinated US kids. Let's really find out some concrete answers. Until then I'm not sure anyone knows. 
What's a parent to do?
Parents need to make wise choices for their children. Are you planning to travel outside the US? Will you be having world travelers come into your home or be in contact with them in some other way, such as, airplanes, buses, trains, or hotel rooms? Perhaps you want to vaccinate. Perhaps 2 measles deaths in a 1000 cases is too high a risk for you to comfortably take as a parent. As doctors love to say (the doctor on the radio yesterday said it too) when it is your child 1 death is too many. Of course they NEVER factor in that, 1 death from a vaccine reaction is also 1 death too many for any parent. What is important to me is that you have solid information to make your own best choices. 

Then I want you to find a doctor who will listen to you as a parent, help educate you and then will allow you to make your choices without shaming you in any way; or worse yet fire you as a client. I want to take a moment to acknowledge one such local pediatrician, Dr. Renee Bravo. Here is what one of my "Whole"istic Mamas said about a recent visit. 

"Just wanted to share my positive experience yesterday. I've known Dr Bravo for probably 25 years & have been bringing my children to him since my 1st was born almost 11 years ago. I respect him & think he's a great person. Yesterday I brought baby #4 in for her 2 mos checkup. I was really nervous to tell him I didn't want vaccines for my baby since I'd unknowingly vaccinated my other 3 children & thought he might possibly hassle me like his associate did. When he asked about shots for this visit I declined & he said "no problem, whatever you want to do I'll support!" He said we could do delayed vaccines (he said he really likes Dr. Sears schedule), even more delayed, or none at all, just let him know. Then he said "you know you really only need most of these if you're traveling to a 3rd world country anyway." No hassle, no debate, just pure support. Yet another reason why I respect him!"

I know this was a lot to read but it is important that all of us base these kinds of parenting decisions on a real understanding of the facts. 

Next, since it is "going around", I wanted to give you info on how to tell if your child has measles and what your doctor can do. If you think you or your child has measles, or you have been exposed to measles, the sooner you go to your doctor the better if  you want to utilize their help. 

IMPORTANT: Do NOT go to your doctor without FIRST calling. Let them know you think your child has been exposed to or come down with measles. Ask IF they wish you to come in and HOW they plan to minimize risk to their other clients. Babies do not get vaccinated for measles until they are 12 months old. Therefore the kids most vulnerable to having difficulty fighting off the infection are not vaccinated.   

What do measles look like?
From the Mayo Clinic web site:
Description: a red, blotchy rash that usually appears first on the face and behind the ears, then spreads downward to the chest and back and finally to the feet.

Measles signs and symptoms appear seven to 14 days after exposure to the virus. Signs and symptoms of measles typically include:
Dry cough
Runny nose
Sore throat
Inflamed eyes (conjunctivitis)
Sensitivity to light
Tiny white spots with bluish-white centers found inside the mouth on the inner lining of the cheek, called Koplik's spots
A skin rash made up of large, flat blotches that often flow into one another
The infection occurs in sequential stages over a period of two to three weeks.

Infection and incubation. For the first seven to 14 days after you're infected, the measles virus incubates. You have no signs or symptoms of measles during this time.

Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. This relatively mild illness may last two or three days.

Acute illness and rash. The rash consists of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first, particularly behind the ears and along the hairline. Over the next few days, the rash spreads down the arms and trunk, then over the thighs, lower legs and feet. At the same time, fever rises sharply, often as high as 104 or 105 F (40 or 40.6 C). The measles rash gradually recedes, fading first from the face and last from the thighs and feet.

Communicable period. A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days.
When to see a doctor

What if I think my child has measles?

More from Mayo
Call your doctor if you think you or your child may have been exposed to measles, or if you or your child has a rash resembling measles.

No treatment can get rid of an established measles infection. However, some measures can be taken to protect vulnerable individuals who have been exposed to the virus.

Post-exposure vaccination. Nonimmunized people, including infants, may be given the measles vaccination within 72 hours of exposure to the measles virus, to provide protection against the disease. If measles still develops, the illness usually has milder symptoms and lasts for a shorter time.
Immune serum globulin. Pregnant women, infants and people with weakened immune systems who are exposed to the virus may receive an injection of proteins (antibodies) called immune serum globulin. When given within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe.


Fever reducers. You or your child may also take over-the-counter medications such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) or naproxen (Aleve) to help relieve the fever that accompanies measles. Don't give aspirin to children because of the risk of Reye's syndrome — a rare but potentially fatal disease.

Antibiotics. If a bacterial infection, such as pneumonia or an ear infection, develops while you or your child has measles, your doctor may prescribe an antibiotic.

Vitamin A. People with low levels of vitamin A are more likely to have a more severe case of measles. Giving vitamin A may lessen the severity of the measles. It's generally given as a large dose of 200,000 international units (IU) for two days.

How do you tell if it is measles or chicken pox? 
Also from the Mayo Clinic site:

Chickenpox infection usually lasts about five to 10 days. The rash is the telltale indication of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include:

Loss of appetite
Tiredness and a general feeling of being unwell (malaise)Once the chickenpox rash appears, it goes through three phases:

Raised pink or red bumps (papules), which break out over several days
Fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking
Crusts and scabs, which cover the broken blisters and take several more days to heal
New bumps continue to appear for several days. As a result, you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over.

The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, and lesions may form in the throat, eyes and mucous membranes of the urethra, anus and vagina. New spots continue to appear for several days.

What if my child has Chicken Pox?

Most children do not need to see a doctor other than to tell you they have chicken pox. When do you need to see a doctor?

From the CDC:
For people with chickenpox at risk of serious complications, call a health care provider if the person:
is older than 12 years of age
has a weakened immune system
is pregnant
develops any of the following:
fever that lasts longer than 4 days
fever that rises above 102°F (38.9°C)
any areas of the rash or any part of the body becomes very red, warm, or tender, or begins leaking pus (thick, discolored fluid), since these symptoms may indicate a bacterial infection
extreme illness
difficult waking up or confused demeanor
difficulty walking
stiff neck
frequent vomiting
difficulty breathing
severe cough

Good luck with your decision and good parenting!

Sunday, December 29, 2013

How to Not Gain My Trust

Dear Doctor,

You will not gain my trust by pigeon-holing me at an unrelated professional public event and in a loud confrontational tone telling me I don’t know what I am talking about. Do you realize how disrespectful it is to assume that if people just knew what you know they would obviously agree with you?

You will not gain my trust by going on and on with rarely a break long enough for me to get in a word. This was not a respectful rational dialogue between two equally intelligent individuals. Instead it was an overly emotional barrage of highly charged personal experiences bound up with concern for your own children.

You will not gain my trust by not being considerate of time and place. Did you give any thought to the fact that you were in the middle of an organization that has worked very hard to establish trusting relationships between often competing parties by keeping our focus on the ways in which we agree, respectfully sharing information, and focusing on a common goal? Did you take a moment to consider that I was about to get up in front of a room full of people and speak? Luckily I am confident enough to be gracious to you, while not backing down in my defense of parents who you feel make the wrong choice about vaccine, and immediately after still get up and give a caring, warm introduction for a woman I greatly admire. Did you know that about me? No because you don’t know me at all.

You will not gain my trust by not being conscious of who else is around you and how they might be affected by our exchange. Did you know that it was mortifying to me that the evening’s presenter, a professional who inspires me, was listening to you? Did you never give it a moment’s thought that sitting all around you might be parents who have chosen not to vaccinate or are following less traditional vaccination schedules? How do you think this made them feel? Do you think you gained their trust?

As I said to you that night you are obviously sincere in your concern about the potential for children to become ill and die because of parents choosing not to vaccinate. I can tell you care deeply. I too care deeply. It is very important to me that I give out as accurate information as I can to parents and prospective parents. What they do with that information is up to them. I believe in their abilities to make good choices for their children. In the past when it has been brought to my attention that I may have printed inaccurate statistics I have gone back and taken a second look at my original information and, with guidance by far better statisticians than I, I have made corrections as needed. Based on the discrepancies between your numbers and mine I am reviewing my original measles outbreak post, my sources and the original numbers, and will be posting an up-date. I will also be working on a post as to how the medical establishment as a whole lost our trust. Unfortunately you, dear doctor, did nothing to re-gain mine.