Archive for June 2010

Monthly Archive

If It Were My Child: No MMRV Shot

A study published in Pediatrics today confirms a slightly elevated risk in febrile seizures in children who receive the combo MMRV (Measles-Mumps-Rubella-Varicella) shot between 1 and 2 years of age. If it were my child, I would NOT get the combo MMRV shot, even if the elevated risk of seizure is extremely low. The American Academy of Pediatrics will likely recommend the same. None of us ever want our child to be put at increased risk. Or to be part of a statistic.

This study found children receiving the combo MMRV had double the risk of febrile seizure compared with those children who got the MMR and Varicella (Chicken Pox) shots individually. Data shows 1 in 2300 children could have a febrile seizure after the combo shot. So, like journalist Madonna Behen reported today, I do not recommend the combo.

From the way I see it, both as a mom and as a pediatrician, if the risk is increased, it is meaningful. And, because children who get the 2 shots separately are equally protected against Measles, Mumps, Rubella, and Chicken Pox (Varicella) I recommend the safer route of 2 shots. Read full post »

A Sigh Breath: More Than A Metaphor

It’s been a thunderous week. I’ve swept through emotions like a teenager. People who know me, know what these weeks look like. Not unstable, just exuberant.

I consider my emotions a strength. I know they help me empathize and advocate for my patients. I count on my ability to feel and connect with others to define and paint my life’s landscape. Without this raw, and sometimes outrageous emotion, I wouldn’t be happy and I wouldn’t be able to care for my patients and my family like I do.

So a week all over the map. Mountain ranges of emotion peaked between panic, hope, celebration, connection, distance, activation, and then plain old, tired. Feeling celebrated and understood by my peers (thank you), and then alone in caring for children in clinic. It can feel so good to see patients. I’m so fortunate to be able to solve problems and answer questions. But then, it can be isolating somehow, too. Being singularly responsible for answers at times is something I am well trained to do. But it doesn’t always leave me feeling whole. Read full post »

Dreaming of Being A Big Boy

F watching the big boys play ball.

With the World Cup capturing the attention of most of us on the globe, I trust there are kids scattered around the entire planet dreaming. Doesn’t matter on what continent you plant your feet, or which game you call your own, at one point or another, we all dream of being in the “bigs”…

Dropper, Syringe or Cap? Dosing Liquid Medications

Here’s a quick video about dosing liquid medications for infants and children. Some tips on how to avoid giving the incorrect dose. Measuring liquid medications & vitamins for children demands having the proper tools–which we don’t always have. It seems, 12 minutes after I come home with medications, I lose that pesky cap…
So take a look at the video and see if it helps. For me it was a great reminder to organize the medicine cabinet again. And possibly the kitchen counters…

Latitude: 47 Degrees

Today is Monday and my g-calendar says, “Vancouver.” That’s where I am supposed to be for the better part, of the longest day, of the year. My latitude however, remains at 47 degrees. And I trust, like so many others, this day isn’t turning out as planned.

Reasons for the change of location include: the realities surrounding my being a mom, tonight’s swim lesson, a long leg cast, colon cancer, the necessity for using logic, and a dog who sneezed. And because of all of this, if written, the epitaph of this particular day will likely be something like: Latitude for the summer solstice, the day Wendy Sue found her calculated position and knew that leaving was the wrong thing to do.

Being practical when you’re a parent is so alarmingly necessary. One of the quintessential truths no one tells you at the baby shower. It feels good to do the right thing, it’s just wholly inconvenient when you’re desperately trying to make space for some sociability and connection to your friends. It’s back to the grown-up stuff I write about, that being caught in a generational sandwich thing. Read full post »

Answer Key: Measuring Medications For Children

Pop Quiz time up. If you haven’t taken the quiz, scroll back two blog posts. If you have, check your work below.

To be clear, dosing for children isn’t about memorizing conversions. Don’t feel bad if you didn’t know these. Rather, getting your kids the proper meds requires being given or searching out, the proper tools for the prescription that is written. When you lose the cap to the bottle, or the syringe, or the dropper that comes with the medication, it’s worth getting another equivalent bottle with the proper dropper-cap-syringe. That is what the FDA warning for Vitamin D was all about.

As a parent you’re not alone in having difficulty converting and dosing liquid medication. A Cornell University study published early this year found that measuring a dose of liquid medicine was far more complicated than it seemed. When asked to measure out 5 cc (a teaspoon) of liquid medication using a medium sized spoon, subjects under-dosed by about 8%. When using a large spoon, they over-did the dose by over 10%. So, guessing really isn’t the right thing to do when giving your children medication. Using a teaspoon from the silverware drawer, not the right thing, either. Got to find the proper syringe, dropper, or dispensing cup when giving medications to children. In a pinch, it’s okay to use your measuring spoon…

The quiz takers did wonderfully, but even a few doctors hesitated on their answers. We all can learn and re-learn how to dose and dispense medication… Read full post »

Extra Credit?

I know all you gunner-brown-nosers out there are looking for the extra credit question. I never believed in those. Although I will tell you that on my final exam while teaching 9th grade math and science in 1997, I asked this one extra credit question–the only question guaranteed to raise their grade:

“What was the huge message that was spelled out on the bulletin board in the back of the classroom?”

Mind you, the sentence had been hanging up the entire school year. A bunch of them turned around to look. I’d taken it down, of course. It was a huge message; the letters were about 12 inches high. But just one sentence.

You Are A Superstar!

If I remember correctly, only about 5-10 (out of 150+) students got it right. The unbelievable power of observation. Each student that answered correctly also instantly received the appropriate message…

But no, even if you are a superstar, still no extra credit for this quiz.

Pop Quiz: The Teaspoon, cc, & mL

Yesterday, the FDA put out a warning for parents regarding the risk of over-dose in infants receiving Vitamin D supplements. Seemingly scary, especially since nearly every infant is recommended vitamin D supplementation. But hold on a minute. As you likely know, I recommend giving 400IU (1 cc) of Vitamin D to all breast-fed and/or partially breast-fed infants every day. My blog posts about why and the research.

The FDA warning really gets to the heart of a bigger issue: how we understand dosing liquid medications as parents. So, let’s keep this warning in perspective. When you give Vitamin D to an infant (or your babysitter, nanny, or mother does), make sure you have a dropper with “1 cc” etched on the side. The warning is really rooted in how we use the tools we’re given to dose medications. This is a problem that crosses all education and socioeconomic lines. Particularly in the case of medications that can cause life threatening complications in an overdose situation. For example, when O was given pain medication for his broken leg last week in California, the Rx said: “Give 1/2 tsp every 6 hours.” But the pharmacist gave us a 5 cc syringe. Would you know what to do? The husband had to double check…

I was a middle school science teacher; in the spirit of safety (playing along?) please do the pop quiz below. Post your responses to the questions. Be bold. And as I told my 9th-grade science students in Oakland some 10+ years ago, if you think the test is easy, “Well, good for you.”

Answers will arrive later today with rationale & explanations of why I am forcing you to do this. Now, get out your #2…

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Pop Quiz: Conversions & Other Necessary Info For Giving Meds To Children

#1 How many cc are in a mL?

#2 How many mL in a teaspoon?

#3 Without looking it up, tell me how you’d give your child 1 1/2 teaspoons of medicine using a 5 cc syringe the pharmacist gave you?

#4 If the doctor told you to give your child 1 tsp of medicine, twice a day, for 10 days, and the pharmacist gave you 100 cc of medicine, will you have enough?

#5 Your pediatrician tells you to give your child 1/2 tsp of Children’s Motrin for pain. You loose the cap on the top of the bottle. You pull out a teaspoon from the silverware drawer. Filling up half way will likely work. Yes or No?

#6 Your pediatrician tells you to give your child 1/2 tsp of Children’s Motrin for pain. You loose the cap on the top of the bottle. You pull out a set of measuring spoons from the drawer. You pick the “1/2 teaspoon” spoon. Will this work?  Yes or No?

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Being On The Other Side

Over the past few weeks I’ve had ample opportunity to be on the other side. Not like some parents with chronically ill children or those with children who have suffered tragic illness. No, not like that; I am fortunate that hospitals aren’t a part of my family’s everyday (except for work). My children have had amazing fortune and I remain in awe of good health. Lately though, we’ve had some stumbles. Literally.

O broke his leg a week ago after falling from some play equipment while we were on a trip to California. Six days before that, he turned blue in his lips and mouth and we ended up in the ER for a 6 hour investigation. My mom finished a week of chemo this past weekend and we’ve got follow-up visits for nearly everyone. Two today, in fact. I’m still living a part of the generational sandwich. And we go to see doctors. Allowing ample opportunity for being on the other side.

When I tell others about my experiences in the ER with little O or with my mom at the cancer center, or going to the doctor for my own health care, people often point out how good it is for me. Enter broccoli with a side of brussel sprouts. People want doctors to go to the doctor. I get it.

Read full post »

The “Inherent Risk And Implied Immorality” of Distracted Driving

Distracted driving = drunk driving. All doctors in and out of primary care should be telling patients this. Oprah talks about it nearly every day. We should, too. We have the rare privilege of an often captive audience. Our patients come to us for advice.

Framing distracted driving with drunk driving conveys the “Inherent Risk and implied immorality” of the situation, wrote Dr Amy Ship in today’s New England Journal of Medicine.

She says, “more than 275 millionAmericans own cell phones, and 81% of them talk on those phoneswhile driving.” It’s time for primary care doctors to not only talk about the issue, but frame and explain the risk that distracted driving poses for patients.  In my world that is teenagers who are driving.  And then all the children who ride around in cars with drivers who are distracted.

In the editorial, Dr Ship uses a Youtube video for storytelling and education. It’s a brilliant use of new media. A little morsel for all of us to endure.

If you have a teenager, will you please show them this video? Graphic, real, and powerful, it tells the story of consequence. And what it looks like to suffer from risks taken while driving distracted. If we can put down the phone, maybe we can all learn how to drive again. Don’t some people say they wish they were 16 again? This may be our chance.