Married to Medicine

Married to Medicine

Tuesday, January 28, 2014

If you're following this blog by email...

If you're following this blog by email, first of all:

Hello!  Thank you *so much* for following!  It's both humbling and exciting to know that people are reading my writing... I hope I can keep it interesting, even as I attempt to keep this blog true to its original purpose of documenting my family's life (and recipes).

Anyway, if you are following by email, I just wanted to invite you to "like" my new Facebook page, "Married to Medicine Blog."  I'm experimenting with having a page because:

  1. It's a pain in the butt to "comment" on Blogger posts; I'd love to see more comments and what I'd really love is to see discussions.  This "former" lawyer loves and needs discussions!
  2. There are lots of things I'd love to share with my readers beyond my own blog entries.  For example, my friend Dani's amazing series on what drew her to home birth and what turned her away.  Seriously - if you have any interest in childbirth you won't be able to put this down; and
  3. Along those lines, I'd love for my readers to share things with me.  Whether it's a good debunking of pseudoscience, a good food find, or anything else fascinating (like this), post it!
  4. I have no clue how many people follow me by email.  It could be 5 or it could be 500.  It's very strange to write a post and have no idea if your audience is just a few close friends or if it's pretty broad.  I'd love to get a better idea.

So consider this your invitation to "like" my Facebook page.  No pressure of course!  Just experimenting over here.  And a huge thanks again to all of you who do follow by email.  This blog has been a really neat outlet for me during some slightly rough spouse-in-medical-training times!


Thursday, January 23, 2014

THE BEST (and EASY!) Sticky Pecan Rolls

My husband and I are big brunch people, and we love to try new recipes.  But there is one recipe (well, two actually) that we keep going back to - it's now to the point where we just can't have brunch without these.  Sticky, sweet, and savory my MIL's "Sticky Pecan Rolls" are seriously to die for.  Give them a try - they're easy to make and I promise you, they'll change your life.

Sticky Pecan Rolls

On the first day, you'll make a ball of dough and refrigerate it overnight:

For the ball of dough
1 pkg (1 tbsp) active dry yeast
1 cup warm water
1/4 cup sugar
1 tsp salt
2 tbsp butter softened
1 egg
3 1/4 - 3 1/2 cups flour

Dissolve the yeast in the warm water in your mixer bowl - wait a few minutes to make sure it foams to ensure the yeast is active.  Stir in 1/4 cup white sugar, salt, 2 tbsp butter, egg, and 2 cups flour.  Beat until smooth.  Work in remaining flour until dough is easy to handle.  Place in greased bowl.  Cover surface of dough with some shortening or butter so it doesn't dry out.  Cover with lid, cling wrap, or whatever you have.  Refrigerate overnight or up to 5 days.

On the second day, you'll roll out the dough, sprinkle the filling, roll it up, slice it, and bake it:

For the topping
1 stick butter, softened
3/4 cup packed brown sugar
1.5 tbsp corn syrup (baking section of store)
2/3 cup pecan bits

For the filling
1/2 stick butter, melted
3/4 cup sugar
3 tsp cinnamon

Stir together all the topping ingredients except the nuts.  Spread in the bottom of a 9x13 pan.  Sprinkle the nuts on.

Combine the sugar and cinnamon for the filling.  Roll the dough out on a lightly floured surface so it's roughly a 15" x 9" rectangle.  Spread it with the butter.  Sprinkle it with the cinnamon-sugar.  Roll it up the long, skinny way.  Slice into 15 one-inch slices.  Place slices on top of "topping layer" in pan - no need to grease the pan.  Cover with a wet cloth and let rise in a warm place until double (up to 90 minutes).  Bake at 375 for 20-25 minutes.  Immediately invert on tray (take a cookie tray, cover the top of the pan, and flip the whole thing).

Dough is easy to roll, and your rectangle doesn't have to be perfect.
Slices of the roll sitting in the "topping" ready to rise.
Just before rising.
Risen and baked!
Inverted onto cookie tray.
Ready to pull apart individual rolls and chow down!
Chewy, sweet, savory perfection!

Thursday, January 16, 2014

Five Mommy Myths I Believed.

Looking back at the start of my motherhood journey, I could have saved myself some stress by doing a little fact-checking.  Even though I'd cross-examined plenty of witnesses during my lawyering years, I started motherhood out pretty much believing everything I heard or read from other moms.  See, to a new mom (or at least to this new mom), experienced moms are like gods.  (Or goddesses).    

Most of these experienced moms are well-intentioned; they believe what they heard or read somewhere and are just passing it along to be helpful.  Or perhaps they did "verify" their information... but they were looking at a non-scientific, biased source.  Either way, there are quite a few Mommy Myths floating around out there that simply aren't true.  Here are five of them:    

1.  Getting an epidural increases your chance of having a c-section.  

I give myself a pass for having believed this one because it does seem to make a lot of sense.  If you're able to get up and walk around throughout labor, and try out different pushing positions, wouldn't that make your pushes stronger?  Or wouldn't an epidural make them weaker?  Or something?

As it turns out, there is no dispute that once you hit 4 cm dilation, an epidural doesn't increase your chance of having a c-section.  Here's a brief overview of the "gold standard" on this topic, a 124-page meta analysis (meaning, a study of studies - in this case, a study of 38 other studies).  It came out in December of 2011 and was provided to me by a friend who holds an MD and a PhD in anesthesiology; I wish I could provide you with the full text but I'd be infringing copyright.  My friend's career will be anesthesiology research and Harvard wanted him for residency, and he's a super nice guy.  And he was looking into this for his pregnant wife - who did get an epidural - that makes him my gold standard.

It is also not clear that epidurals have any impact on your chance of successful breastfeeding, which makes sense since the medication goes into your spinal fluid, not your blood stream - I was on an epidural for 18 hours with my first and he was not groggy and nursed just fine.  But this topic is probably too nebulous to really be a complete "myth."  

Please see my own comment to this post, below; I am not arguing that there is no benefit whatsoever to not getting an epidural, I am simply dispelling the myth that you increase your chance of a c-section by doing so; you don't.  

2.  You must have a supply issue if [insert any number of things].

You must have a supply issue if (a) your child loses interest in nursing before turning two (or three... or thirty); (b) your child starts sleeping through the night (better wake up anyway ... and pump!); (c) Your boobs feel flat; (d) you don't get much when you pump; (e) your child ever cries ...

Nope.  The truth is that the only way to tell you have a supply issue is if your baby stops gaining or starts losing weight.  With both my babies I went through phases of being positive I had major supply issues... my breasts felt totally flat, I only got 1-2 ounces when I pumped (even if it was time for a feeding), and my child was only nursing 1-3 minutes per side, 3-4x/day, and not at night.  But thanks to KellyMom I just kept on keeping on and I nursed both babies, waxing and waning (probably depending on their growth spurts) until about 15 months.  At that point they lost interest.  Even in the morning, which was the only time of day it actually was clear that I had some milk.

It's strange to me that many of the people who so strongly believe that almost all moms are capable of exclusively breastfeeding their babies are also hyper-obsessive about supply maintenance... 

3.  Inductions should be avoided at all costs; your OB is only trying to up her chances of a lucrative c-section!  

When I got to be 38 weeks along and my OB wanted to schedule an induction for 41 weeks, I knew just where to go for some "real" medical advice:  My local mommy list serve, of course!  I asked, and I read the archives, and it didn't take me long to find plenty of threads amounting to "I learned in my 'natural childbirth' class that you should almost never allow induction" and "my midwife says inducing before 42 weeks increases your chance of c-section" etc.  Now there was one comment by a mom saying that she pushed her OB to wait until 42 weeks and it backfired, since by then her baby was too big to deliver vaginally.  But I discounted her opinion since everybody knows that the size of the baby doesn't matter, duh!

But seriously, I was completely distraught; did I need to find a new OB or switch to a midwife this late in the game?  Would my insurance even cover that??  It's humorous in retrospect but it was downright miserable at the time.  Thankfully my (physician) husband was able to research the issue for me... and find that induction at 41 weeks does not increase your chance of c-section like earlier inductions do - and in fact, it's safer than waiting!  This is presumably because having a macrosomic baby (8 lbs 13 ounces or more) actually does double your chance of a c-section - along with other complications - and your baby is only getting bigger the longer he cooks.  I never did need that induction, but when my OB told me she was impressed that my macrosomic son came out vaginally (he was 9 lbs 10 oz, 99th/100th percentile head ... and I'm 5'3" and petite; he was delivered with forceps assistance) I secretly thought she was just saying that to pad my ego or something.  Because at that point, I still knew that "the size of the baby doesn't matter."

You can click here for a list of 124 peer-reviewed studies on Fetal Macrosomia.  Or click here for an excellent article by a renowned obstetrician that will probably clear up some other misconceptions you might have, too.  If you've seen "The Business of Being Born," click here and here

Actually, size does matter.  This was me somewhere around 40 weeks with my first.
(Please, I beg you:  Ignore the shoes).

After laboring at home for 15 hours overnight, I looooOOOooved me some epidural!
I just want to thank my OB, the hospital staff, and the scientists who made my birth as unnatural as possible.
They saved my baby's life and my own life, and saved me from what would have been unimaginable pain.
With my #2 I got past a 9 before they got my epidural in... it was a breeze.
And seriously - check out his head - he was 6 weeks in this pic, his head not all that much smaller than ours!!

4.  If you're doing it right, nursing shouldn't hurt.

Being the ever-diligent, slightly-crunchy mom that I was, I obviously signed up for a breastfeeding prep course taught by a Certified Lactation Consultant ("CLC").  Adorably, my husband even came with.  There, I learned that breastfeeding was nothing but dreamy - unless you were doing it wrong.  No problem, how could I possibly do it wrong after learning about something so "natural" for three solid hours ... to the tune of $70.00??

Fast-forward to the birth of my son.  Nursing in the hospital was pain free and my milk came in right away.  My son was a great nurser and the only problem was getting myself positioned in a way that wasn't excruciatingly painful to the nether-regions that delivered him.  All the nurses were so impressed, one even told me that "my problems [with delivering a huge baby] were ending, right when all the problems usually begin."

Then I got home.  And holy MOLY did it start to hurt.  It hurt so badly that I walked around for days - weeks even - in a nursing tank with the flap pulled down.  I even answered the door that way, it was so second-nature to me (thank God it was a female neighbor).  People:  I flashed my father-in-law.  There were lotions and soothies and "airing out" and everything else I could possibly think of or get my hands on.  I called pretty much every other mom I knew, even though I am a professed phone-hater.  The worst part was, I lost a lot of the intense bliss I was otherwise feeling and a lot of the family time I'd have had on my husband's 2-week paternity leave (which was pretty much the last time I ever saw him awake until residency was over) frantically trying to figure out "what I was doing wrong" - because I was so worried that I was sabotaging my nursing.  I watched youtube videos, I googled, I emailed, I even drove to a friend's house to show her my nipples, and I went all over town to "nurse teach-ins" with CLCs.  At the nurse "teach-ins" all I got was further confirmation that it shouldn't hurt, and the suggestion that my son was likely tongue-tied ... so I had better set up a private consult, stat!

I was on the verge of caving even though we could not afford a private consult at the time when I thankfully asked my son's pediatrician about it.  In under 10 seconds he gave me the best advice I'd yet received.  He said "I really think there's too much 'dogma' out there about nursing; The proof is in the pudding, and he's clearly getting plenty of milk."  Then my own OB gave me a script for APNO (a prescription nipple ointment for nursing - that was never once mentioned in my $70 CLC class) and it rocked my world.  As it turns out, I was doing it right all along - it just still hurt like a mother!  (no pun intended).  And it hurt even more with my second born!  Maybe because she was born tiny (6 lbs 10 oz) and gained weight at lightening speed?  The postpartum hospital nurses and the hospital CLC were all scratching their heads about why my nipples were so torn up.  I nursed through all the pain and nasty scabbing, and some thrush, and eventually it all came along.  I've always had really sensitive skin.

My experience made me really skeptical of some CLCs:  Pay lots of money to learn about nursing, learn that it shouldn't hurt, when it hurts, be told to pay more money for a private consult.  I have no doubt that there are amazing CLCs out there doing a world of good for new moms, but my particular experience seemed kind of like a racket.  And my dad told me that over the course of his (40-year) career as a pediatrician, he's found the lactation world a bit "trendy."  For example, he said tongue tie is the current hot ticket, whereas it was all but unheard of until recently - and so now he's gets lots of patients who have been told their child has or might have a tongue-tie, where that's clearly not the case.

And so yeah, vulgarity aside I pretty much completely agree with this Jezebel article:  Far from blissful, nursing is often excruciating.  Physically, mentally, and emotionally.

5.  Any of this really matters.  

It's really easy as a new mom to get all wrapped up in the first few parenting choices we make.  You're overwhelmed with the newness of being responsible for another human being, and you want to get it right.  Plus, there's an enticing sense of "safety" in every decision you can convince yourself is monumental.  "Well, I don't have to worry about obesity/ADHD/allergies because I did X, and 'studies' show that X blah blah blah blah blah."

But the truth is that ten years from now we'll hardly remember or care about fleeting things like whether we birthed vaginally (well, unless we're still peeing when we cough) or even whether we nursed.  By then, we'll have made approximately 1.3 billion other parenting decisions; parenting is decision-making, it's hundreds of mostly small decisions day by day and hour by hour, and even minute by minute, that add up to your relationship with your child.

This isn't to say that you shouldn't be proud of the struggles and sacrifices made for your baby, whatever they may be; I am, and you should be too.  But if you do find that new-mom stress is getting to you, it might help to envision that fast-forward button for some perspective.  Ask yourself whether you ever suspected that the success of an adult you admire was due in any part to having been born vaginally.  Query whether you've ever watched someone accept an award and thought "That's totally because his mother nursed him the full twelve months."  And if your grown son needs therapy one day, do you think it will have anything to do with exactly when and how you introduced solids - or even whether you circumcised?  These baby-days might seem the be-all, end-all but in reality they fade quickly as our children grow and develop.  At that point, it becomes obvious what really matters:  How we raise our children and how we love them - in other words, how we parent (not how we birth).  The memories we make with them.  How we function as a family.  And who we are - who we model for our children to be.

This super boring video shows all you need to be an amazing mom:  Love.  That's it.

Thursday, January 9, 2014

Why The Press Shouldn't Be Your Source For Medical Advice

Perhaps you read the Huffington Post article "Why The Press Shouldn't Dismiss Vaccine Skeptics" by Lawrence Solomon.  In it, Mr. Solomon concludes with the worthy (if not lofty) goal that we should spend a lot of research dollars "identifying vulnerable populations" so that "all can be confident when vaccines are administered."  (Lofty I say, because study after study has shown that vaccinated children are at no higher risk for autism than are unvaccinated children, and severe vaccine reactions - or reports alleging the same - remain almost entirely without causal verification and number fewer than one per million for most childhood vaccines).

The rest of his article drops a few names, and attributes a few out-of-context quotations.  For example, he claims that Dr. Diane Harper, one of the lead developers of Gardasil, "believes [the vaccine] is less effective than the common pap smear, and that it may harm more children than it helps."  He doesn't link to any transcript of her saying any such thing, and as far as I can tell from Snopes there's a pretty good reason for that [Correction:  Since I first published this entry, he changed his hyperlink to direct to an article by a known anti-vaxxer who seems to parrot the debunked statements].  Let's look at what Dr. Harper actually says about the vaccine versus what Mr. Solomon says she "believes."  It's classic anti-vaxx twisting:

According to Snopes, and to another more in-depth discussion here, Dr. Harper has said:  "Cervarix is an excellent choice for both screened and unscreened populations due to its long-lasting protection, its broad protection for at least five oncogenic [read: cancer-causing] HPV types, the potential to use only one dose for the same level of protection, and its safety."  She did speculate that cervical cancer screening may be just as effective in preventing cervical cancer, and she expressed concern that vaccinated women would fail to use other protection and/or to follow-up with annual pap smears, which would remain important for detecting rarer strains of HPV not covered by the vaccine.  She finally went on to recommend expanding the guidelines for HPV vaccines for older women (in other words, using it more often).  And yes, there is continued confusion over Dr. Harper's views on the effectiveness of the vaccine 5+ years after it is administered (because current research shows that it is highly effective longer-term - see the link and the comments section).

Hmmm.  A pretty far cry.  Any innocent reader who didn't dig beyond Mr. Solomon's article would walk away thinking "The very creator of the HPV vaccine doesn't think it's the most effective option and thinks it may harm more children than it helps.  Guess I won't be using that!"  In reality, Dr. Harper's statements have been a ringing endorsement of the vaccine.  Plus, anyone with a little medical knowledge will tell you that even if pap smears are highly effective at detecting precancerous cervical cells, they cannot be done to detect and prevent the oral, penile, or anal cancers also caused by HPV.  Oral HPV-acquired head and neck cancers are fast becoming a major concern; when my husband did his head-and-neck cancer rotation back in 2006, already about half the patients were tobacco users and half had oral HPV-acquired cancer.  To say nothing of the idea that perhaps preventing HPV in the first place is more appealing than acquiring it and catching precancerous cells at one's annual pap smear - and continuing to spread it.

That twisting alone made me highly suspicious of the article and its author.  That's why I want to share with you the exchange I had with him in the comments section.

Commenter A:  When 97 scientists say these vaccines are better than no vaccines, and 3 scientists say no to vaccines, I don't think we need balanced reporting or respect for the no-side. They are simply wrong with potentially dangerous effects.

Mr. Solomon:  Can you point me to the survey or study that indicates a 97%-3% split among scientists? Was the question as black and white as you suggest or could a scientist have answered that some vaccines help some populations but not others?

Me:  Here's a study that shows that 97% of physicians vaccinate their own children:  (This study shows that 95+% of pediatricians polled in Switzerland - which included a 95% response rate among pediatricians there - vaccinate their own children, and that physicians are more likely than non-physicians to vaccinate still more for other diseases not included on the schedule, like Lymes Disease).

Mr. Solomon:  Thank you very much for this 2004 study, which I had not seen. It shows that pediatricians in Switzerland generally follow the recommended schedule, but not slavishly. And other physicians (non-pediatricians) are less likely to do so. 

In the case of vaccines that are not recommended by the authorities (the Swiss vaccinate much less than we do), the majority of pediatricians and non-pediatricians stay away from most of the vaccines.

Me:  Actually, that is not true. We have one extra Hep B and one extra PCV, and we vaccinate for Hep A. But the Swiss show 2 more IPVs and 1 more MMR. Did you see a vaccine "not recommended by the authorities" in Switzerland that we do vaccinate for other than Hep A? I didn't.

Mr. Solomon:  You'll find the World Health Organization's immunization schedules for every country here:

You'll see that the vaccination schedules for both Canada and the US are much longer than in Switzerland.

Me:  This is a good example of why non-physicians and non-scientists have difficulty assessing the vaccine situation. The tables above are confusing because of overlap; if you look carefully you will see that the only diseases we vaccinate for that they do not vaccinate for are:

(1) Rotavirus and Hep A, which are a concern for nations including significant migrant and inner-city poor populations - a good example of how, far from mindless and unmonitored, each nation accounts for its population when its experts come out with their best schedule; and

(2) They don't recommend the flu vaccine until the age of 65. Surely though, the current news in the U.S. is enough support for our schedule here.

The other differences are minor differences I already listed above. The Swiss actually give two different meningococcal vaccines whereas we give 1. We give 1 extra HPV but are considering reducing to 2 as more evidence emerges that 2 is safe. We give one more pneumoccocal. 

The point being that the study I provided shows that 95+% of pediatricians vaccinate their children. I don't know of a similar study done in the US but it seems anti-vaxxers are more likely to trust physicians of other nations anyway. Do you have a study showing anything otherwise? My father is nearing retirement as a physician/professor at UW-Madison and has seen tens of thousands of vaccinations. He has never once seen a dangerous reaction, and he hasn't seen HIB deaths since we started vaccinating for it.

So there you go.  Perhaps the press shouldn't dismiss vaccine skeptics.  But they should certainly do a better job of presenting their misleading, distorted, and in some cases simply false "information" as factual and objective.  The above exchange shows the classic twisting of anti-vaxx logic.  A study showing near unanimity in physicians supporting their nation's vaccine schedule that is nearly identical to ours - and is identical on the controversial vaccines - is made out to be a potential reason not to vaccinate.  And the fact that physicians are more likely than non-physicians to add still more vaccines (like the Tick-Borne Encephalitis vaccine) is twisted to somehow say something alarming about our own vaccine schedule.  It's almost amazing, really!

Here is an excellent response to the article, from the professor who runs "Informed Parents of Vaccinated Children" ("like" the Facebook page to get the most recent vaccine news coverage and studies in your Facebook feed ... or ask them your questions, she'll respectfully respond).

Asking questions about vaccine safety is both important and appropriate - and done by scientists and the public alike. That's not why anti-vaccine activists are dismissed. They're dismissed because they reject valid answers because of conspiracy theories. They're not interested in improving vaccine safety, but in getting rid of vaccines - based on false information and unsupported fears - without proposing an alternative to protect children from disease. They ignore the data. They resort to conspiracy theories and personal attacks.

When serious scientists point out real problems with vaccines, they are not dismissed - like the recent narcolepsy connected to H1N1 or the problems with the first rotavirus vaccine. When scientists or others misrepresent data, do flawed research, when others reject abundant data based on global conspiracy theories, they are appropriately marginalized and criticized.

Last, please note that Mr. Solomon's article cites with approval a research team funded by wealthy anti-vaccine foundations.  The papers produced by Chris Shaw and Lucija Tomljenovic have been rejected by mainstream scientists as remarkable for sloppy methods and weak non-scientific reasoning.  See the first comment below for more information and sources.

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