Married to Medicine

Married to Medicine

Sunday, September 29, 2013

My Baby Food Staples

In the Baby Blogosphere you'll find no shortage of articles on baby food.  Parenting sites offer lists of the "best foods for your baby" seemingly once a month.  And entire blogs are devoted to "baby food recipes" and the new practice of "baby-led weaning" (a more apt name might be "puree avoidance").  All of these are well and good and I delved into each of them with Baby #1.  But now that I'm onto #2, I don't have time to cook actual "baby recipes" or even to putter around with baby-led weaning (plus, my father remains convinced that many of his patients are creating unnecessary choking hazards with BLW... I know: 'gagging is different from choking' - but I eventually concluded that I don't like to gag on my food so I'm not into it for my daughter either).  In any case, at this time I'm only interested in baby foods that:

  • Make as little mess as possible;
  • Are as portable as possible;
  • Are as quick and easy to put together as possible; and
  • Are still as healthy and natural (unprocessed) as possible.

If you're in my boat, here's what I've come to rely on.  And I'd love to hear of your best finds as well.

(1) Oatmeal + Oat Bran + Milk.

Why It's Great:  Adding Oat Bran to your standard oatmeal and making it with milk means two major things.  First, no mess - it's not runny at all while you're feeding.  Second, it's thick enough not to boil over in most microwaves, depending on the bowl.  Just take your 1/4 cup and scoop it half full with Oatmeal, then finish with Oat Bran (use Quaker for both - and get Old Fashioned Oats, they're healthier).  Then fill the scoop twice again with whole milk and microwave 1-2 minutes.  Chill in the freezer if you need it right away.

Why It's Healthy:  It packs protein, calcium, and whole grains (even soluble fiber).  I went straight to this with Baby #2, no rice or oatmeal "baby cereal" this time.

What To Add:  Add fresh diced fruit if you've got some good stuff on hand.  Otherwise, you can sweeten it with a fruit puree (prunes are nice to avoid constipation) or with YoBaby Yogurt - which I find to be too sweet by itself.

(2) Fresh Mozzarella.

Why It's Great:  No prep, no mess, no staining, easy to gum - even for toothless babies like my 8 month old.

Why It's Healthy:  Great source of protein - much better than the baby food purees that include ground meats - and high fatty content is good for baby's developing brain.

Photo Credit

(3) Petit Suisse Montebourg

Why They're Great:  Okay these are a little pricey.  But especially if you need to feed baby on the go, they're so worth it.  They're actually fresh cheese - not yogurt - so they're thick and fluffy rather than runny (no mess) and they're high protein so they'll fill your baby up.  They're also just the right size.

Why They're Healthy:  Each small container packs nearly five grams of protein and 24% of the recommended daily value of calcium... for a mere 67 calories!  We should all be eating these!!  Whole Foods carries them but we get them cheaper at a local place.

(4) Berries, berries, berries.

Why They're Great:  Just rinse and eat.  Blueberries are so perfect for taking on the go, and you can just smash them a bit with your thumbnail as you feed them so they're not a choking hazard.  Raspberries can be ripped in half for smaller bits.  Strawberries need to be cut up ... unless they're the tiny home-grown kind!

Why They're Healthy:  Superfoods, hello!

(5) Scrambled Egg (& Spinach and/or Quinoa)

Why It's Great:  So easy to make (and "chew"), and keeps well.  Just throw some spinach (and quinoa, if you have it - can top with cheese as well) into the egg you're scrambling.  Easiest way to scramble an egg is to take a chilled stick of butter and lightly run it over the bottom of the heating pan.  Crack the egg, and push it gently around with a spoon or spatula a few times as it cooks.

Why It's Healthy:  Eggs are no longer reviled for their high cholesterol content.  That's because we've found that dietary high blood cholesterol is caused by diets high in saturated fat, not cholesterol - you can read more about it here.  Eggs have almost no saturated fat and are packed with nutrients - they're a good source of protein too.  They're often featured on those "best baby food" lists mentioned above.

Photo Credit

(6) Del Monte "Peas & Carrots"

Why It's Great:  My toddler and now my baby eat these like candy - seriously, my toddler asked for these as a snack the other day.  Can opens easily and you can store it in your refrigerator with out a top on, if you're in a rush.

Why It's Healthy:  These do have some added salt and sugar but that's fine by me because (a) I harbor no belief that my children will love 100% plain veggies as adults, no matter what I do; and (b) Um, my kids are filling up on veggies - anything else they'd fill up on would likely also have some sodium and/or sugar and ... NOT be veggies.

(7) Cottage Cheese

Why It's Great:  It's a no-prep super high-protein main course, and my kids both love it.

Why It's Healthy:  Check out the nutrition info - it's higher in protein than Greek yogurt.  It's a nice way to get protein while you're eating other fruits, veggies, and grains.

(8) Mashed Avocado (and Miralax for any constipation!)

Why It's Great:  Ripe avocados can be easily fork-mashed.  Add a little water and you've got a Superfood for your baby.  Add a little Miralax if your baby is having constipation - it's safe and natural, not a "laxative."

Why It's Healthy:  Avocados have an insane amount of heath benefits, just do a quick google search!

(9) Mac and Cheese Add-Ins

Why It's Great:  Opening a can of black beans or tuna is an easy way to ramp up the nutritional value of this childhood staple.

Why It's Healthy:  Black beans are not only high-protein, but they're one of the few foods out there high in soluble fiber - the only kind of fiber that actually lowers your blood cholesterol.  Sometimes I stir in a little salsa or avocado when I make mac and cheese this way too.  And I don't think I need to rehash the health benefits of tuna.  As far as what kind of mac-and-cheese, I usually use Annie's Whole Wheat Shells With White Cheddar.  But I've found that Kraft Whole Grain Macaroni and Cheese works better for adding tuna.  Boxed mac-and-cheeses are pretty high protein.  They're high in sodium and I'm certainly not arguing that they're the healthiest thing, but I think it's fine on occasion especially if you serve it with fruit and veggies.

(10) Raw Apple Sauce

Why It's Great:  Well aside from the fact that my mom and I came up with it and coined it with such a "now" sounding name, it's SUPER healthy and my daughter goes CRAZY for it!  All you do is take your favorite apple (Pink Ladies or HoneyCrisps please!) and put it through the food processor.  Voila. A thousand times easier than making your own apple sauce.  Plus it's less messy; my daughter won't waste a bite of this stuff!

Why It's Healthy:  Apples are one of the very best things you can possibly eat.  It's no joke what they say about "an apple a day."  And keeping it "raw" instead of eating it in the "sauce" form means you get to keep all the benefits in the skin, and all the benefits from eating it in its natural, unprocessed form.

All right, those are my faves.  I started this entry quite awhile ago and my daughter is about to turn 1.  If you have favorite EASY and healthy baby or toddler foods, I'd love to hear them!

Thursday, September 26, 2013

Vaccination: A Layperson's Perspective

Needles:  Scary.  No medication - not even Tylenol - is 100% safe or side-effect free. 
Neither is highway driving, for that matter.  
But vaccines are a thousand times safer than driving.  

Fulminant Meningococcemia:  I'll take the needle, please!

Polio:  A vaccine success story; completely eradicated in the U.S. (though not globally, yet).  Smallpox too; Smallpox eradication has been so successful that
we no longer vaccinate for it.
Even though there's an alleged pharmaceutical conspiracy forcing us to get vaccines we don't need...
If this guy found out that you could vaccinate your children but chose not to... 
NPR article from 9/30/2013:  Study confirms that a recent whooping cough epidemic in California that killed ten babies was due to failure to vaccinate and receive boosters. 
People who lived in areas with high "personal belief exemptions" from public school vaccination requirements were 2.5 times as likely to live in areas with high incidents of whooping cough.
Link to original study appearing in Pediatrics.

As a medical "layperson," it's ironic that I'm blogging about vaccination - or at least think it is.  While my husband slaved away on all the pre-med courses in college, I avoided science like the plague (terrible pun, I know.).  When he scored within the top 2% of MCAT takers I was pretty impressed, but truthfully I don't know much about the MCAT.  While he busted his butt - to put it politely - through four years of medical school and two years of grant-funded medical research, I studied the health care system... in law school.  And over the past 4.5 years that he's been putting in 60-100 hour weeks in medical training at the #1 hospital in the U.S., I've thankfully managed to continue to ... not study or practice any medicine.  That means that he has 14.5 years of grueling medical training that I don't have.  And - conservatively estimated - 28,160 hours.  My father has infinitely more; he's seen tens of thousands of patients over the course of his forty-year career as a pediatrician.

Clearly, I can't run a google search on a complex medical topic and eventually cobble together a better answer on it than these two can.  Not even if I spent ten hours on it.  Not even if I spent forty.  Not even if I spent weeks.  They don't hand out medical degrees for running google searches.  Or for talking to non-nurse (home birth) midwives... or doulas... or anybody else.  Imagine if they did though, and you got in a car accident or you had a heart attack, or you needed a liver transplant or something.  Um... yikes.

But the problem is that lay people are blogging about vaccination.  And they're meeting up and talking about "vaccine choice."  They're imagining conspiracy theories and refusing to trust anyone other than each other.  And they've managed to convince others of their "practice of medicine" to the point where there are schools at which only about half of the children are vaccinated and many states are falling below vaccination levels considered to provide herd immunity.  "Herd immunity" is real and it protects us all (see this explanation by an immunologist mom), especially those who are too young to receive their first vaccines or who are immunocompromised because of a childhood illness like cancer (see the comments for further discussions on this).  Herd immunity even protects the vaccinated, as vaccines are "only" 90+% effective, not 100%.  Herd immunity is the reason we're not currently in this situation (or this one, or countless others).  Would anti-vaxxers still refuse vaccines if they had to travel to one of those nations? And if not, are they only refusing them here since the rest of us do vaccinate?  

This topic is so vast and so complex that I'm not going to pretend to be able to address it in single coherent blog entry (unlike so many anti-vaxxers).  But I do want to put together a bullet-pointed list of what I, as a layperson with personal access to the medical community, believe that you, as a layperson without that same access (clearly - if you're considering not vaccinating) might want to know.  I've followed and participated in many discussions on this topic and there are some repeat misconceptions or missed points that are worth cobbling together.  Here are a few of them:

(1)  Vaccines do not cause autism See also this, this, this, thisthisthis and this.  Kudos to Dr. Andrew Wakefield for getting published in a legitimate medical journal, since everything else on this topic either wasn't, or has been misleadingly taken out of context and interpreted by non-medical minds to mean something it doesn't mean to any other physicians, who are also parents themselves.  Too bad though - after other labs were unable to get any results by repeating his study, and after he was unable to reproduce the results himself, the original study was found to have fraudulently falsified its data (this "caught ya!" process is called peer review, and it's why we can rely on science).  He made millions and children died.  Not sure what that makes him in your book, and I don't want to mention what that makes him in mine.  Maybe we should honor those deaths... by vaccinating.  Here's some more persuasion though, if that's not enough:
  • We've been vaccinating since the 1950s, so we vaccinated for many decades before autism rates went up.  The spike has been most significant over the past five years, in spite of the decline in vaccination rates.  Hmm.  Doesn't seem that vaccines are the cause, does it?
  • Maybe you know or have heard about someone who went from "normal" to autistic right after his shots.  Well, autism is an early-childhood onset condition, and it happens that we vaccinate early in childhood.  There are lots of children out there whose symptoms started shortly BEFORE their shots, too; they're just not organizing themselves and speaking out about their experiences.  Anecdotal evidence, while compelling to those personally experiencing it, does not show or prove correlation (let alone causation).  Medical studies do, but they have repeatedly disproven that vaccines have any relation to autism - every single legitimate, peer-reviewed study (see the links above).  If that weren't true, and this was, then your pediatrician wouldn't be vaccinating his or her own children - at rates even *higher* than the official recommendations.  
  • Okay okay, you still can't be convinced, and perhaps you would like to speak at the next national AAP conference on this topic, and present to them the articles you found on the internet.  Well how about the point that my friend made?  Her brother is autistic.  She loves him just the way he is, and would much rather an autistic brother than a dead one; she takes more than a little offense when people don't vaccinate for fear of autism.  I'd rather an autistic child than a dead one myself, personally.  But thankfully, we don't have to choose ... because vaccines do not cause autism! 
(2)  On "alternative schedules."  Some people acknowledge that vaccines don't cause autism, but remain convinced that all those pediatricians out there who are vaccinating their own children "on time" - meaning, on the schedule created and monitored by the AAP and the CDC, among other professional organizations - are sadly mistaken.  They believe there is a "true" best vaccine schedule out there but that pediatricians aren't recommending it - or using it on their own children - because:

(a) it's more convenient for doctors to lump the shots together; or

(b) the U.K. doesn't vaccinate for chicken pox so perhaps the U.S. is "shot-happy" since we're "for-profit"; or

(c) they read one book by one physician, Dr. Sears, the "schedule" in which has been completely discredited (see also thisthisthis and this for further confirmation of the safety of the current schedule); or

(d) they think we are vaccinating too early because we want to get kids vaccinated before irresponsible parents stop bringing their children to medical checkups.

Well, (a) and (b) cannot possibly both be true, since more visits means more money.  So pick just one first, please.

(a) is not true.  Doctors wouldn't care if people came in a few more times to get shots; what's it to them?  And again, they vaccinate their own children on the AAP/CDC recommended schedule.  It's actually more convenient for your child to be poked less with a needle.  But none of this is about convenience; vaccines are simply given as early as they can be, because the sooner a baby is vaccinated, the sooner he or she is safe.  Just last winter a baby boy at Boston Children's contracted whooping cough from an unvaccinated toddler.  He died - just days away from his first vaccination.  So did this child, and many others.  Pediatricians are now advising parents on how best to protect their newborns, until their babies are vaccine-eligible.  

(b) Different nations have only very minor differences in their recommended vaccine schedules, and that should help make it clear that vaccines aren't a "Big Pharma" conspiracy.  Indeed, if our vaccines weren't medically necessary, our insurance companies would be the first to let us know by not covering them - they LOVE to do that, and they employ hundreds of physicians whose sole jobs are to review claims so that they can deny coverage for any medical care that is even arguably unnecessary.  You can also check out this story about a mom in the UK whose daughter died of chicken pox, not having been vaccinated since the chicken pox vaccine (Varicella) isn't on on their vaxx schedule.  And this BBC story wherein cost and a flawed fear of increased shingles were given as the UK's reasons for not including varicella.  As it turns out, that particular US/UK difference probably does come down to money - not that we're "for-profit" but that they aren't, and in this particular case they cut costs in an unfortunate way.

(c) why are you trusting someone with whom no other expert agrees, and who is making millions off of this, instead of your own moderately-salaried pediatrician(s)?  Okay I get it - you've had a crappy doctor (or doctors) before.  Me too.  Not everyone is willing to bust their butt like my husband does.  But this debate isn't pediatrician-to-pediatrician.  This debate involves a clear, essentially unanimous medical consensus among all our leading experts.  See, also cited above, this, this, and this.  When you vaccinate on time, you're not "just" trusting your pedi; you're trusting all the top experts on topics including virology, immunology, microbiology, statistics, epidemiology, pathogenesis ... and of course, medicine and pediatrics.  We're talking the guys who went to Harvard and the like, and got MD's and PhD's and devoted their careers to research, which generally pays much less than private practice.  These tend to be, FYI, super nice and super nerdy guys (and gals) - and most of them are also parents.  They make up the AAP and the CDC and other organizations that put their heads together and come out with the schedule.  I truly hope that you don't think that you or I could come up with a better answer than they have, by googling or by doing other layperson "research."  If we were so capable, then what's preventing us from coming up with the next curative cancer treatment, which is another thing we can expect of Md/Phd medical researchers (like the husband I've barely seen for the past decade)?  See also this article - delaying vaccines can increase the chance of a "reaction" (benign, but who wants one?) because older infant bodies are better able to mount stronger immune responses; see this, too, for a further discussion.  See also this video on the dangers of under-vaccination - children who skip doses of their DTaP vaccine are 18x as likely to get whooping cough.

(d)  We aren't vaccinating earlier than "we should" just because some parents might "flake out" on later appointments; we're vaccinating as early as possible because unvaccinated newborns are unprotected and they could, and do, catch things like whooping cough in hospitals and at checkups (and from relatives and friends - especially those who haven't had their boosters) and die.  Do you really think that the CDC, AAP, etc., came out with a "truly ideal" schedule, but are keeping it secret because of flakey parents?  If so, why do you think that all these physicians and experts follow the recommended schedule on their own children?  Again, pediatricians are now advising parents on how to protect their newborns until they are vaccine-eligible.

What about Hep B, they give that one at birth, why??  That's because the Hep B vaccine also protects against "vertical" transmission, meaning transmission from the mother (or father ... or father to mother to child), which usually (but not always) occurs perinatally (meaning at birth).  Because there's no risk in giving this vaccine at birth (none *proven*, other than the mildest of reactions for this vaccine - see discussion in comments below and what I quote from UpToDate, and ignore what you read on non-reputable websites), and because doing so for the entire population will prevent cases of this terrible disease (and probably eventually eradicate it), that's standard procedure.  Studies on this topic have shown that prenatal maternal testing is not a good way of preventing or predicting perinatal transmission, or childhood acquisition of unknown origin (think a bite from another child, or perhaps food prepared for you or your child by someone with an open cut who gets careless about hygiene) - this is discussed in greater detail in the comments following the post, and this article discusses the topic in-depth.

(3) Won't breastfeeding offer the same or better protection?  No.  How would there have been polio epidemics in the early and mid-1900s if that were true?  Polio (as one example) was eradicated in the 1960s as we started vaccinating for it.  People actually nursed less in the 1950s and 60s than they do now; nursing fell out of favor when commercially marketed formula was presented as and believed to be "better" than breastmilk.  My mother-in-law was breastfed but she still remembers how horribly sick she was with the measles.  Check out this woman's story about how extended breast-feeding and all the crunchiness in the world didn't save her from multiple illnesses when her parents failed to vaccinate.  And no, these diseases didn't just disappear because of clean water and sanitization - things we had for decades while we still had epidemics.  Here's a great article debunking that myth.  

(4) What if you keep your kids largely at home with you, should you still vaccinate?  Yes.  You and your children could end up in a medical waiting room at any time, and that's where the sick kids will also be.  See the story above, about the boy who died last year here in Boston.  Plus, even if you home school, your kids will be at museums and basically, in public.  These diseases are highly contagious - much more so than a common cold or GI bug.  You don't have to share a toy or even a doorknob to catch some of them.

(5) But my pediatrician approved my proposed alternate schedule.  Ask your pediatrician:  How would he or she vaccinate his own children?  That's the truth of the matter.  Delaying a vaccine leaves you vulnerable until you take it, while offering no proven benefit whatsoever.  It's a small chance, but it's getting bigger as we've seen in the news lately.  Skipping doses is even worse - again, see this video on the dangers of under-vaccination - skipping a DTaP dose makes your child eighteen times more likely to get whooping cough.

(6) But what if it's just a hoax that vaccines are even effective at all?  I mean why else would vaccinated people care whether I vaccinate?  Vaccines do not offer 100% protection (more like 90+% depending on your age, when you had the vaccine, and which vaccine we're talking about).  They don't work for everybody, and they can wear off.  That doesn't mean that they don't work at all.  We've already seen what happens when nobody vaccinates.  And if you happen to be one of the people for whom a particular vaccine doesn't work, you'll much prefer to be surrounded by vaccinated people than by unvaccinated people.  That's called herd immunity.  You know what else offers herd immunity?  Hand-washing.  Washing your own hands is great, but you're far better off if everybody else washes their hands too.

(7) Medical Malpractice.  Here's another point, since I'm a lawyer and I studied health law:  Physicians these days practice medicine defensively, in fear of getting sued.  Yet they continue to advise their patients to vaccinate and to vaccinate on time.  Don't you think that pediatricians would stop recommending vaccinations if vaccinating was anywhere near as dangerous as not vaccinating?  Or perhaps their liability carriers would force them to do so, or jack up their premiums??  Instead, doctors are increasingly fearing a new kind of lawsuit:  Lawsuits from their immunocompromised patients and newborns who might come into contact with infected, unvaccinated children in their waiting rooms.  They're discussing a new ethical dilemma:  Do they deny care to the unvaccinated, or do they risk creating a highly contagious, potentially lethal waiting room for their other patients?

Ah, and yes, there DOES exist a fund to compensate people for ultra-rare severe reactions to vaccines.  Want to know why they need a fund for that?  Because it's still safer TO vaccinate, so those (VERY rare - far, FAR more rare than people dying of vaccine-prevantable illnesses) people could never win any money by suing their doctors.  You can't sue someone who made the safest possible choice for you - not even in the good old U. S. of A. - so we've established a fund to compensate those children anyway.  AND we've even lowered the standards for getting the money:  Whereas in a law suit you have to prove legal ("proximate") causation, to recover from the fund you just have to prove that your "symptoms" happened within a certain timeframe and that the vaccines in some way contributed to your final condition.  Because of this, and because there are very rare people born with conditions in which a simple fever will set off a chain of reactions in them resulting in cognitive decline, there are a few cases in which claimants have recovered lots of money from the vaccine fund even though all the vaccine really caused in them was a fever, and they would eventually have had a fever from another source - you can't escape life without a fever, unless you literally live in a hospital bubble.  (One last side-note - as a plaintiff's attorney I only accepted about 1 in 5 calls we got, the others were too bogus to take ... so take the alleged vaccine injuries and get rid of 80% of them to give yourself a better estimate of whether vaccines are dangerous... or don't, because even if every claim were true it would still be far safer to vaccinate than not to vaccinate).

(8) False Sense of Control.  I see a lot of anti-vaxxers say "You can always vaccinate later, but you can't take a vaccine back."  Of course, the problem with this thinking is that you cannot vaccinate yourself after you get sick.  In this way, the vaccination fears are much like fearing flying more than driving.  Driving is far, far more dangerous than flying, but people are more comfortable driving because driving gives them the false sense that they will be able to prevent or minimize any collision because they are in control of their own car.  Another good analogy for vaccination is seatbelt wearing.  In almost all situations, it is far safer to wear a seatbelt, and seatbelts have saved hundreds of thousands of lives since they became standard in all cars in the early 1960's.  But there are occasional cases in which a seatbelt causes injury ... probably even cases where a seatbelt effectively traps someone in a burning car, causing death.  That doesn't make it safer to never wear your seatbelt - or to "selectively" wear it!

(9) Social Contract.  Anti-vaxxers get really offended when you try to appeal to their sense of social justice.  (Note:  If social justice on a certain topic offends you, you might be on the wrong side of things.  Just sayin'.).  But the fact is that the choice not to vaccinate is at best paranoid and at worst selfish (the choice... not the person... I'm sure some really good, smart people get fooled by anti-vaccination quackery); anti-vaxxers only have the (false) luxury of not vaccinating because the rest of us continue to vaccinate, thus keeping epidemics back in the history books where they belong (herd immunity).  Meanwhile, anti-vaxxers are endangering not only their own children, but they are especially endangering children who are already suffering from childhood illnesses and conditions like cancer and HIV.  Those children cannot safely be vaccinated with any live vaccines; their immune systems are compromised, so they would risk contracting the illness rather than having a successful vaccination.  And non-live vaccines are less likely to work for them - plus, they have less of a chance of fighting off any serious illness they contract.  I'm sorry, but how would you feel if your paranoid choice resulted in the death of a child who was trying to fight cancer??  Plus, like I said before, vaccines can fail - whether you're immunocompromised or not.  Could you live with yourself if your paranoid choice killed someone else's child, or your own?  Because it happens a lot more often than even just the the alleged internet "vaccine deaths."  And I think it should be considered negligent homicide.  (See this for a discussion of the potential legal ramifications for failure to vaccinate your child).

I'm not writing this blog entry to convince the unconvinceable - and that's why I'm not sugar-coating it.  I'm writing it for the people who are on the fence:  the middle ground that we've been losing by being too nice about this because there is such an outrageous amount of false and misleading information on the internet that appears reliable.  I have absolutely no bias or financial gain in this equation (neither, by the way do the salaried pediatricians or pediatricians in small practices that sometimes lose money on vaccines, or the history textbooks).  I'm not a physician and my husband is going into cancer research.  My father is nearing retirement.  I have nothing to gain but what I do have is access to two brilliant medical minds who carefully considered this issue when choosing to vaccinate their own children.  My father and my husband have heard, through me, all the arguments brought up against vaccines and expertly batted them away.  Perhaps your pediatrician isn't taking the time to do so with you; that may simply be because there is not enough time built into a well-child visit for it, and you probably don't want to pay out of pocket for 30-60 minutes of your pediatrician's time and expertise (much as you're willing to spend hours of your own time googling).  Or perhaps your pediatrician has simply given up because it's so rare that he or she changes anyone's mind - see this recent article on the frustrations physicians are facing out near me in Western Massachusetts.

What I would love to see happen is for each pediatric office to publish a brochure on vaccines that answers the most common questions and addresses the most common misconceptions.  Until then, here's a brief list of resources for the curious.

** And I'd like to just note here that I am unable to "link to" a lot of the sources provided to me for this blog entry.  That's because you have to have to pay for a subscription to a lot of the major medical journals and other legitimate scientific sources - or make the big trek to your nearest medical school's library.  In other words, a lot of the best stuff out there isn't available by googling the internet.  And in fact, some of the very worst stuff is - check out this recent sting operation that found that some of the online journals will actually publish fake science for a fee.  See also this December 2016 NYT article ("There are real, prestigious journals and conferences in higher education that enforce and defend the highest standards of scholarship. But there are also many more Ph.D.-holders than there is space in those publications, and those people are all in different ways subject to the 'publish or perish' system of professional advancement. The academic journal-and-conference system is subject to no real outside oversight. Standards are whatever the scholars involved say they are.")

** Also, comments will be disabled as of Friday, October 18th.  With nearly 500 comments, I can't imagine we haven't covered it all... and I need to get back to doing other stuff with the limited free time I have as a busy mom of two healthy, vibrant, fully vaccinated children.  Many of the comment threads are fascinating and informative, with lots of physicians and other experts responding.  A Command+Find search *after* you scroll and upload to the end of all the comments - which you now have to do several times to reach the end - might help you find threads that are of interest to you.  I took care during the nearly one full month since this was originally published not to delete a single comment.  So you can rest assured that the integrity of the comment threads is fully preserved.

  1. AAP article discussing the problems with alternative vaccine schedules and the concerns vaccine-hesitant parents have.
  2. "Do You Believe In Magic?  The Sense and Nonsense of Alternative Medicine"
  3. "Deadly Choices:  How the Anti-Vaccine Movement Threatens Us All."
  4. How to Protect Your Newborn from Whooping Cough by Dr. Wendy Swanson.
  5. Vaccine FAQ's from The Children's Hospital of Philadelphia.
  6. How Physicians Immunize Their Own Children:  Differences Between Physicians and Non-Physicians from the AAP.
  7. Excellent article on the Chicken Pox vaccine from "Seattle Mama Doc" Wendy Swanson.
  8. NPR article from 9/30/13 confirming by location that failure to vaccinate and failure to get boosters caused California's recent whooping cough epidemic that killed ten infants in 2010.  Link to the original study, which just came out in the journal Pediatrics.
  9. On whether vaccines are made from aborted fetal tissue.
  10. On the safety of the current vaccine schedule.  See also this.  And this.
  11. NPR article on a recent sting operation that found that some of the online journals will actually publish fake science for a fee.
  12. NYT article on the online world of "Fake Academia" (studies that appear reliable but are not)
  13. Interview with Dr. Paul Offit, Chief of the Division of Infectious Diseases at Children's Hospital of Philadelphia and co-inventor of the Rotovirus vaccine, credited with saving hundreds of lives daily.
  14. Excellent explanation of what vaccines are, what they're made of, and how they work, given by experts interviewed by Real Simple Magazine.
  15. Many states are falling below vaccination levels considered to provide herd immunity.  
  16. Video on the dangers of under-vaccination.
  17. Two articles (this and this) discussing studies that have found that delaying vaccines increases your child's chance of having an adverse reaction (but note that all but ultra, ultra rare adverse vaccine reactions are fairly benign).  
  18. On the lack of profit margins because vaccines are so expensive to produce.
  19. Discussion of potential legal ramifications for failing to vaccinate your child.
  20. More on the fake science used in the past to propagate the damaging - indeed, deadly - myth that vaccines cause autism.  If you've stumbled across any work by Mark or David Geier, you need to read this.
  21. Pakistan polio outbreak puts global eradication at risk - "Health teams in Pakistan have been attacked repeatedly since the Taliban denounced vaccines as a western plot to sterilize Muslims and imposed bans on [them] in 2012 ... dozens of children, many of them under the age of 2, have been crippled by this disease in the past six months." 
  22. On vaccine package inserts:  "Inserts are a problematic source of information for a number of reasons. They are legal documents, not scientific documents. They do not include science done after the insert was approved. They include ingredients, but do not show you that you are already exposed to those ingredients naturally and how tiny the amounts in vaccines are. They have to report on every adverse event that allegedly happens after a vaccine, whether or not causally related. In short, they are usually more misleading than useful, and my experience is that most readers get them wrong. My favorite was the anti-vaccine proponent who insisted that the vaccine insert said a child cannot eat fruit and vegetables for six weeks after getting the vaccine."
  23. Brand new study this past summer:  "The Number of Antigens in Early Childhood Vaccines and Neuropsychological Outcomes at Ages 7-10 Years."         
  24. Want to be "educated" on vaccines (and all these citations aren't enough)?  Well, "A new report found that parents wishing to exempt their children from required vaccinations due to personal beliefs should first be educated on immunization, the Colorado Department of Public Health said . . .  The stakeholder report was led by three partner organizations, the Colorado Children’s Immunization Coalition, the Colorado Department of Public Health and Environment and the Keystone Center, a neutral, third-party facilitator. The report studied the state’s personal belief exemption policy in an effort to update the policy."  Full article here.
  25. On whether we were magically saved from all these diseases right at the same time vaccines came out, but not from the vaccines themselves.  (Yes, that really is a common allegation).  
  26. The whooping cough vaccine does not increase your chance of getting whooping cough, see this and this.          
  27. Excellent explanation of herd immunity and fantastic information on each of the vaccines by an immunologist who is also a mom, here.   
  28. In-depth discussion of the Hep-B vaccine.      
  29. Statistics on 2014 measles, showing that almost all victims were unvaccinated or of unknown vaccination status (89% - versus 10% of the vaccinated). 
  30. Yet another study finding no link between the MMR vaccine and autism.  
  31. But what about all the "vaccine injury"stories I've heard on the internet and from my neighbor's second cousin once removed?  Read more on those here.        
  32. Excellent explanation of whether the current vaccine schedule is "too much, too soon."                           

Sunday, September 8, 2013

My Humbling Experience Raising a "Challenging" Toddler.

Ouch.  Just typing the title of this entry is a little painful for me.  Not because I'm sad that I have a "challenging" child.  I love every part of my son including his passion and yes, even his strong, strong will (95% of the time).  No, it makes me cringe because I know what so many people are thinking when I say it.  I know, because I had all those thoughts myself before my sweet baby boy turned one year old.

I'd hear the word "challenging" and I'd think "Ugh, more modern-day parents who naively think they can just talk to their child about why something is wrong and presto, the child will never do it again!"  Or I'd think "Oh here we go, another 'feeling-validator.'  If that's not working out for you, maybe you need to try something effective!"  When I'd see kids misbehaving whose parents used the word "Please" ("Please stop that") I'd really roll my eyes.  "Why don't you just tell your kid right up front that behaving is optional, I mean that IS what 'please' means!!!"  And whenever the trying toddler was a boy - which, let's be honest, wasn't infrequent - my judgment was harshest.  "Aaaarrrgh the 'boys-will-be-boys' crowd... perpetuating sexist double standards by letting their boys get away with everything, and raising playground bullies for the rest of us to deal with!"

Yeah.  That was me.  And yeah, obviously I jinxed myself big time.  Parenting is one of those things that really makes you believe in a Higher Power, because it's just a little too fitting that everybody gets their comeuppance, in whatever form(s) it takes.  And if you didn't get it just yet and you're still on your first kid, wait for it... double-whammy headed your way.  In that sense it's very humanizing.  It tears us all down, which pulls us all together.

My comeuppance comes about twice a week these days, down from every single day when he was a one-year old, in the form of a public tantrum.  And by every single day I mean it was every single time we got in the car seat, lots of times when we got out of the car seat, every single time we left every single park, every single time we left the house!  Pediatricians everywhere would have marveled at how long I kept my son rear-facing - I had to because it would have been physically impossible to wrestle him into a front-facing car seat, especially uber-pregnant.  Yup, name any place in town and I've been in the heated center of a huge public scene there ... or fifty.  The playground.  The mall.  The Children's Museum.  The airport.  Panera.  The doctor's office.  The beach - sandiest, most disastrous scene EVER.  The pool.  The post office.  The grocery store.  I am pretty sure the entire town knows my son's name:  "Matthew honey, I'm sorry but we have to go home now.  Matthew, do not run away from Mommy.  Matthew.  Matthew!!!"

Of course there are reasons behind these tantrums.  For one thing, if you've ever met my husband you'll know what I have on my hands here.  Can you imagine commuting 50-90 minutes each way on pubic transit when you're a medical resident working 90-100 hours a week?  Can you imagine a 50 minute bike commute twice a day, year-round in Boston weather?  Can you imagine voluntarily signing up for all that when you used to pay the same in rent but live right next door to the hospital??  The man is unstoppable.  So is his son.

For another thing, my son is tired almost all the time.  He stays up late knowing it increases his chances of seeing daddy, then gets up early when he hears his sister babbling in the living room.  He's excitable and he adores these two... who can regret that?  But it means that by late-morning he's a goner.  He'll nap until after 5:00 if I let him and he is a bear to wake up two hours in, which I try to do.

Yes, there are reasons.  And none of them are the reasons I assumed of so many others in my situation. And for the record, none of them are the other assumption-reasons either.  My son not only isn't "acting out" because we're "not strict enough," but he's also not acting out because we're (a) too strict; (b) spanking him; (c) not spanking him; (d) berating him; or (e) neglecting him.  It's not because I had an epidural folks, or even because we sleep-trained (my mom did too... my brothers and I didn't have these tantrums).  No, it really just is who he is, as a toddler.  I'm thankful for our pediatrician, Co-Chief of Pediatrics at MGH.  He said both his sons were the same as toddlers - that he felt like he'd put in a full day's work with his oldest son before he even walked out the door.  He says there's a whole range of "compliance" in toddlers that results simply from different personalities, all still normal and healthy.  He also said that parents of "less-compliant" ("challenging") toddlers let their toddlers get away with things other parents never would because they're forced to be choosier with their battles.  And that parents with compliant toddlers won't ever understand (read:  Not Judge).  Yeah, I know.  Because if I'd had only compliant children, I'd still be judging.

For the record, because I know I'll get suggestions, I've tried it all - from counting down the minutes to "foreshadowing the day," on and on.  I have had an enormous amount of success with "1-2-3 Magic."  My son hates nothing more than time-outs; his behavioral issues don't involve violence toward other kids or anything other than not getting to do exactly what he wants to do for however long he wants to do it (he does come from two control-freak parents).  The counting has been great because it gives him a structured opportunity to change his behavior before receiving a consequence he really doesn't want.  It has avoided countless meltdowns and it might single-handedly be responsible for taking us from every day episodes to twice a week.  But it only works when my son is still able to logically reason.  Once he's gone, he's gone.

Same for "How to Talk so Kids Will Listen, and Listen So Kids Will Talk."  The first chapter is brilliant.  I think it might actually be all you need... for many other kids and for a significantly happier marriage - seriously.  But for my son, validating his feelings only works once in awhile.  Most of the time I just get a transient pause until he realizes he doesn't care if I empathize or agree with his feelings... he cares that we're still leaving the park.  And he cares about it passionately.  My current M.O. is to start with the feeling validation and when that fails, count.  When that fails, I usually have to manage a way to haul him off against his will because like I said, the problem is usually that he won't leave a place.  When the problem is something else my choices are to (a) "pick my battle" (i.e., ignore behavior that I would prefer he didn't do) or (b) fight my battle, which will mean leaving completely in a big scene and going home.  That, folks, is why you'll see:

(a) My child laying down on the dirty floor while I'm waiting in line for something that needs to be accomplished;

(b) My child playing with the grocery belt divider pole thingey all throughout the store.  For me it's an accomplishment that he now gives it back when we're done;

(c) My child, running all over Panera while I try to bus our dishes;

(d) My child, with crazy-long hair, because I've already tried and failed twice at getting his haircut - not because he's scared, but just because he doesn't want it cut;

(e) My child, doing any number of other things that would cause a lot of people to think I'm a lax mother but don't qualify as "dangerous" or completely disruptive to others.

He refuses to walk to the car with us.   
If we pick him up, he thrashes and yells "I WANT  TO WALK!!!!!!"  As in, the whole way back even if it's many blocks.  If we set him down he throws himself to the ground.  Either way, we look like bad parents.
And when I'm the only parent around, with another baby to transport... disaster!!
Anyway, it's all been hugely humbling.  Until becoming a parent myself, I assumed personality was about 90% nurture, 10% nature... HA.  It's been said that our children teach us more than we ever teach them.  Let me second, and third, and millionth that statement.  I went from judging parents in my situation, to feeling rattled and humiliated daily, to - finally - truly not caring what others thought no matter how big and loud the scene, once I regained confidence in my parenting as the episodes decreased in frequency.  And especially once Matthew's language took off so I could see the loving, sweet, generous, happy, and passionate little boy and big brother he is.  I wouldn't trade him for the world.  And in retrospect, I wouldn't trade the humiliation and failure either.  An ounce of pain is good for a pound of empathy.  And no matter how hard I try, I cannot control and mold every aspect of my life into my definition of "perfection."  I'm rolling with this card, wrestling with it, and just trying to keep in mind that I'll someday long to have all these days back.  Even the very hardest ones.

Loves dandelions.  Melts my heart daily by adoring, playing with, and watching out for his sister (more proof here).
Heart of gold, will of steel.

Update 12/7/13 -
It has come to my attention that people are reading this post and armchair-diagnosing my son with autism, because of my vaccine post.  My son doesn't have autism, but I would love him just the same if he did.  This post represents his difficult stage, 1y3m - 2y2m.  He's a piece of cake now, and SO sweet!  All kids go through more and less challenging phases.  Here's a video of him at 2y8m; he's now 3y3m and hasn't had one of his epic tantrums since he turned 3.  If I had to name the one thing that helped us the most, it was the book "1-2-3 Magic."  But it also just took time, language acquisition, and a less urgent need for naps.

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Friday, September 6, 2013

Tomato ***Ecstasy***. And I Don't Even Like Tomatoes!!!!!

Shout-out to a former karate pal, now chef Christina and her amazing blog for introducing me to what is definitely among my top 10 favorite recipes of all time:  Slow Oven-Roasted Heirloom Tomatoes.  A lot of the recipes on her drool-worthy blog are too advanced for a novice-with-two-kids-under-three like me, but this one caught my eye because it looked super easy.  And because I've always wondered about the very best thing to do with the gorgeous heirloom tomatoes at our local farm stand.

Folks, this is it.  Holy cow.  I mean her blog lists suggestions for what to do with these babies after you've roasted them, but no matter;  everything not immediately frozen for winter was gobbled down like candy.  And I mean I don't even like tomatoes.  But these... these are essentially caramelized.  They're warm with chewy, sometimes crispy edges and soft middles, and they will cause an utter explosion of flavor in your mouth.  I mean this will forevermore be a late-summer staple for us, a key part of my quest to mark my children's childhoods with seasonal food-associated memories.  Give them a try, I implore you!!  Capture some of summer's strongest flavors, and freeze some for the winter - if you can resist eating them all!

Summer's Glory.

So Simple, So Easy!!

Yes, please!!!

Slow Oven-Roasted Heirloom Tomatoes


4-6 Heirloom Tomatoes
1/4 cup Olive Oil
1 tsp. Garlic Powder
1.5 tsp. Oregano
1/2 tsp. Salt
Fresh Cracked Pepper
Optional:  Basil to sprinkle*
Optional:  Balsamic Vinegar to drizzle*

** Her recipe said you could add other herbs or what have you, so I added these.  I don't know what the result is without them.
** I used "LiteHouse" freeze-dried basil.  I think that was great - it soaked up more of the vinegar, oil, and herbs.  Also, it's just a great way to have semi-fresh basil always on hand for salads, for those of us blasphemers.  Find it in the refrigerated area of your grocery store's produce section.


Preheat oven to 250.  Cover a cookie sheet with aluminum foil for easier cleaning.  Core and slice heirloom tomatoes about 1/2 inch thick - thicker for more tomato flavor; thinner for a more chewy and caramelized experience.

Mix together olive oil, garlic powder, oregano, and salt.  Spoon over sliced tomatoes - it's okay if it's not perfect.  Sprinkle with cracked pepper and basil, drizzle with balsamic vinegar.

Bake for 2 - 2.5 hours.  This recipe is very forgiving; all that happens if you leave them in too long is they become smaller and chewier.  Fine by me.  The finished-product pics I have are of a batch that got overdone.  They might have been the most delicious yet.

Alternative Uses:

  • Serve bruschetta-style over toasted, buttered or olive-oiled rounds.
  • Add to sauces.
  • Add to sandwiches - check out the BLT on Focaccia on Christina's blog.
  • Stuff inside Pillsbury Crescent rolls.
  • Toss with couscous and feta, pine nuts, raisins, etc.
  • Add to pasta salad.
  • Bribery.
  • Substitute for therapy.