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Zika, Dengue And Mosquitoes: Info For Women And Men Who Want Babies

zika cdc infographic

Image c/o CDC

 

Zika virus scares continue to worry expecting parents and pregnant moms. In addition, we’re now just learning about a state of emergency in the big island of Hawaii because of the rising cases of Dengue virus, a virus also transmitted by mosquitoes. Shifting lifestyle advice for growing families will continue as researchers and public health officials learn more. We should expect that the recommendations for travel will change and evolve this summer. As of today, news reports from Brazil coupled with public health officials new knowledge and evolving medical research from around The Americas has clarified a number of things for pregnant moms and families thinking about having babies. Some things we DO know:

  • What is Zika: Zika virus is predominately spread by mosquitoes. It is a virus causing joint aches, red eyes, rash and overall yuck feelings in about 1 in 5 people who get it. Typically the virus causes mild symptoms and goes away on its own even in the minority of people who have symptoms. The virus typically clears the blood stream a week after symptoms show up but we know it can remain for longer periods in other bodily fluids (urine, semen). Zika has been around for decades but warmer climate and travel has spread the mosquitoes and the virus around the world. Then it caused a massive outbreak in Brazil (over a million people estimated to have had the virus). During the same period a surge in cases of birth defects worried health officials about a possible connection of serious side effects from the virus during fetal development.
  • zika map voxWhere is Zika: Outbreaks of Zika have been reported in over 30 countries, including some cases (not outbreaks) in the United States. Zika is often found in small pockets of countries who have reported cases (costal areas, low-lying areas with standing water) and not ubiquitously throughout the entire landscape. It’s not a risk everywhere you go in Central America but it has touched every country. Further, even though we expect to have cases of Zika in most parts of the US over the upcoming months, you’re simply not likely to get Zika in most parts of the United States for a few reasons: mosquitoes that carry and transmit Zika typically only live in the gulf coast and Southeastern US, our measures to control mosquitoes in the US are effective, and many of us who live in warm climates where mosquitoes live spend the majority of the day in air-conditioning and have access to repellent if outside.OUTBREAKS ARE NOT EXPECTED here in the US but we certainly have no guarantee. Here is a nice infographic from Vox depicting the distribution of mosquitoes who can potentially transmit Zika in the US.
  • Birth defects from Zika: The long-term effects from Zika remain unknown, however there are serious concerns about Zika virus and the association of a constellation of symptoms on developing babies, specifically life-altering brain and neurologic changes (microcephaly and developmental delays & changes in the eye). More evidence connecting Zika as the culprit has unfolded in recent weeks. Zika has been found in the brains of babies with microcephaly, it’s been found in the placenta of women who have miscarried, and it’s been found in affected babies eyes. These findings don’t yet prove a cause-and-effect relationship between Zika and these defects but it is more data to construct the case. It is unknown exactly how Zika could cause such devastating changes to a developing baby (for example, researchers cannot yet prove that it’s the virus itself versus our own immune response to the virus that causes devastating side effects in developing babies).

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7 Quick Tips For Healthy Mouths

oral health 1

Valentine’s Day this weekend….Even if you think it’s a card-store holiday chances are your children LOVE it. So power on Super Mama & Super Papa and learn something that makes it worth it. The American Dental Association declared February National Children’s Dental Health Month (I’m thinking because of the holiday and all those sugar hearts). This may have to do with candy…..but please read on even if you DON’T have a sweet tooth. Setting a good example and teaching children from an early age how to take care of their teeth is worth all of our time. It’s something I’m STILL working on as a parent. This matters because tooth decay is the most common chronic disease in kids age 6-11 and adolescents age 12-19. Additionally, at least 20% of children ages 5-11 have at least one untreated decayed tooth. Flossing and brushing 2 times a day changes the odds. Boom.

7 Tips For Healthy Teeth:

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Women Who Want Babies: Alcohol And Advice

pregnant belly FASThere’s a swirl of media and pithy opinions that pertain to women of child-bearing age this week that have come off as fairly oppressive. You’ve heard the news — this is about Zika and this is also about alcohol. First, there’s a new report out of the Centers for Disease Control (CDC) that stitches truths about unplanned pregnancy, alcohol use in child-bearing years and offers advice that has lit women and the blogosphere aflame. The CDC’s goal is valiant: inform women about risks alcohol has on developing fetuses, remind the public that nearly 1/2 pregnancies are unplanned and remind women to make “good choices.” On top of this, women of child-bearing age have been told that not only can we not take a trip to Mexico or Central America while pregnant because of risks from Zika, we learned earlier this week that we can’t have unprotected sex with our partners while pregnant if there is any chance of an exposure to the virus. Women planning on getting pregnant should also take precautions. As a reminder, Zika is a somewhat silent infection (only 1 in 5 who get it have symptoms) so the risk criteria is just based on where you go and where you’re exposed. If we women get the Zika virus while we’re pregnant or at the time of delivery, our babies can have devastating side effects. So the threat can feel very real.

Ooofdah.

Something that has to be said: public health recommendations in keeping families healthy will at times differ for men and women. It’s just the way it’s gonna be because of our differing roles in making and raising children. Nonetheless, I’m here to say I think the advice and the news this past week has felt like a big ton of bricks. Advice has felt unrealistic, sexist, and oppressive by many even though it’s based in smart public health data. For the first time in my life I’m relieved that I’m not thinking about having another baby. I mean it’s just a lot to toss around. That being said: IT’S A WONDERFUL TIME to have a baby. Let me do my best to frame up the alcohol conversation as a mom, feminist, pediatrician and health advocate. The updated recommendations/precautions on Zika will be in my next post:

Pregnancy, Women Who Can Get Pregnant, And Alcohol:

In the report’s summation, it advises women who 1) ARE pregnant or who 2) are TRYING to become pregnant to refrain from drinking. Pretty standard. It’s group #3, the group that MIGHT become pregnant causing a bit of unease. The report recommends that women who MIGHT become pregnant (capable of becoming pregnant) unintentionally & who consume alcohol, to either refrain from drinking altogether or use contraception. This includes women of child-bearing age (15 to 44) who are drinking, having sex, and not using birth control – roughly 3.3 million based on the CDC report. According to a study in 2011, we learned that about half of all US pregnancies are unplanned and, even if planned, most women do not know they are pregnant until they are 4-6 weeks into the pregnancy. Read full post »

Flu Season Update & OTC Medicines

2016 flu KYOTCs

The flu season is in full swing across America although thankfully, influenza activity is mild in most states. If you click on this interactive US map you can see where your state fairs with ongoing influenza (hit “play” and you’ll see all weeks reported this season).

It’s certainly NOT too late for your family to get a flu shot  (or nasal spray) since that’s the best way to protect against severe complications from influenza. There is no cure for influenza (antibiotics don’t treat the virus), but there are over-the-counter (OTC) products that do help ease symptoms & side effects from viruses (including influenza) that cause cold symptoms. Some doctors are calling for a “symptomatic prescription pad” that would first suggest simple aids like humidifiers, drinking fluids, and OTC products before antibiotic use. No sense in using antibiotics if the infection you or your child has is from a virus like influenza or one of hundreds that cause the “common cold.”

It’s awful when our children are sick, especially when multiple symptoms like congestion, fever, body aches, sore throat or cough interfere with sleep. Salt in the wound for parents everywhere. Sleep disruption is normal during illness, especially cough and colds, and especially with infants and toddlers who are unaccustomed to moving mucus around while they sleep. So parents often turn to multi-symptom OTC products out of desperation! Sometimes these medicines really reduce symptoms that can make the whole family suffer but there are cautions we have to take.

First off, cough and cold medicines are not typically recommended in children under age 4 to 6 years of age.

In addition, we have to use our smarts with medicines that contain more than 1 ingredient that treat different symptoms. Being aware of the ingredients in the OTC product you’re using is very important because you don’t want to take another product that includes the same ingredients as another (doubling-up). This can happen if you give your child acetaminophen, for example, for fever and then give a cough and cold medicine with that same ingredient. Read full post »

Zika Virus And Pregnant Moms

mosquitoIt’s January, 2016. News stories have inspired significant anxiety about Zika virus. It’s a scary topic because news about the outbreaks are just unfolding and this affects an already anxious group, PREGNANT mamas and expecting families. I want to share with you real time information and data to try to alleviate anxiety and educate the best I can. I suspect with time some of this will change. I’ve curated the most common questions and answers directly from the Centers for Disease Control (CDC) below. The most alarming information coming from these outbreaks are the effects of Zika on pregnant women and their babies. First things first, Zika virus will only affect an unborn baby who is exposed to Zika in utero if mom is infected WHILE she is pregnant. Meaning, women not pregnant who get Zika can have Zika virus, clear the virus from her bloodstream (typically about 1 week after illness resolves) and not transmit Zika to future babies. If you are pregnant, there is no question it makes sense to think carefully about travel. That babymoon just can’t be the priority if it will put you at risk. Zika is potentially dangerous to a baby during any trimester or pregnancy or at the time of delivery.

Zika virus is unusual in a couple ways: only 20% of people who get it know it — meaning most people infected won’t develop any symptoms. Secondly, we don’t have a vaccine and we don’t yet have an anti-viral to protect pregnant moms and their babies from side effects. So, unlike infections caused by influenza and polio, or rubella or mumps, we have to change our social determinants of health — basically pregnant moms have to take precautions with where they go and how they expose themselves. I’ve found this CDC Q/A extremely helpful.

What Is Zika Virus Disease?

CDC: “Zika is a disease caused by Zika virus that is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week.”

Like mosquitoes all over the world, the mosquitoes that carry the virus and spread it to people breed in open ponds/pools of water. The ones that carry Zika tend to bite and infect primates and humans during the day. These little buggers can get the virus from an infected person and then bite another person and transmit it during outbreaks.

What Are The Symptoms Of Zika?

CDC: “About one in five people infected with Zika will get sick — symptoms from being ill. For people who get sick, the illness is usually mild. For this reason, many people might not realize they have been infected. The most common symptoms of Zika virus disease are fever, rash, joint pain, or conjunctivitis (red eyes). Symptoms typically begin 2 to 7 days after being bitten by an infected mosquito.”

Remember, 80% of people who get Zika won’t have any symptoms. So heading off to a country with an outbreak and coming home feeling fine doesn’t ensure you haven’t been exposed. This is key in protecting those at risk. We can’t make a lot of assumptions of who has it and who doesn’t.

How Is Zika Transmitted?

CDC: “Zika is primarily transmitted through the bite of infected Aedes mosquitoes. Aedes mosquitoes, which spread the virus, live in every Western hemisphere country but Canada and Chile. It can also be transmitted from a pregnant mother to her baby during pregnancy or around the time of birth. We do not know how often Zika is transmitted from mother to baby during pregnancy or around the time of birth.”

Research will likely evolve through these outbreaks. What we know is that unborn babies are at most risk for serious complications. They are dependent on their moms making great decisions during pregnancy. Holy moly, it’s always a lot of pressure but this sure is another one for us to bear.

More on who is at risk, what to do if you’re planning a trip to Mexico for a babymoon, and ways to prevent getting Zika:

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Yes To No Tobacco Until Age 21

Teen smokingHear me straight: we don’t want anyone addicted to tobacco products. No question it’s an ugly habit and a terribly complex addiction. Expensive, detrimental to health, so very ugly… So I’m all for WA State House Bill 2313 (SB 6157) supporting moving the purchase age of tobacco from 18 to 21. Yes I know you can vote and enlist in the military at 18, but inconvenient or not, teen brains are not fully developed by the time they enter college-age and the effects of nicotine and the trend towards lifelong addiction are seriously grim. Complain all you want that Washington would be a “nanny state” but the facts are clear: if you start smoking at a young age, odds are that you will still be smoking as an adult. We know that more than 80% of all adult smokers begin smoking before the age of 18; and more than 90% do so before leaving their teens. We need to get tobacco out of reach so we can stop addiction before it starts. This isn’t just about public health it’s also about the health care spending of your tax dollars.

My friend and colleague Dr. John Wiesman (WA Secretary of Health), gave a press conference this week on the new bill. Here are a few staggering excerpts from his speech:

Counting cigarettes, smokeless tobacco, and e-cigarettes together, in 2012, 12 out of every 100 10th graders used these products, and by 2014 that number had risen to 20 out of every 100. That’s a frightening 67%  jump in just 2 years!

Both cigarettes and e-cigarettes set kids up for a lifetime of addiction and poor health.

The most effective way to stop this trend is to stop our kids from smoking before they start.

Middle school, high school and college students are still undergoing significant brain development.

Nicotine exposure during this critical time appears to affect the structure and function of the brain and may lead to lasting cognitive and behavioral impairments.

If that’s not enough reasons to support this work, I don’t know what is. But, here’s one last piece of data that will hit you square in the wallet (ouch). Each year in Washington alone, we spend: Read full post »

TV Tip-Overs Are Real

One of the most horrific memories of my residency training was caring for a little girl after she sustained a life-threatening injury from a TV and dresser tip-over. When I met her she was unconscious, non-responsive, and simply gorgeous. She was just so little and there was so much suffering around her. These real stories harbor horror but also hope.

Injuries from tip-overs are worth talking about. Securing furniture or new TV’s (especially after the holidays) are those things that end up on the long, “Honey-Do” lists that we often push aside and that we often de-prioritize. No reason really except that the tragedy just seems so unlikely. Injuries to our children from tip-overs or children who visit our homes are entirely preventable. Statistics and quick tips for how to get it done tonight below.

The U.S. Consumer Product Safety Commission  recently released this video featuring mothers who have lost their children to a terrible, but preventable tragedy: a TV or furniture tip-over incident. It’s a horrifying thing to reflect on — almost too hot to hold in your thoughts. But these parents ring out with a true reminder of the importance of always anchoring your screens and furniture. Hashtag anchor it… #AnchorIt Read full post »

2015 Mama Doc Greatest Hits

I’m not thrilled to close out 2015 — there were special parts of this year I’m a little desperate to hold onto. Not certain I always feel this way, but on this final day of the year it’s true: there’s a tiny bit of me bracing for the flip on that clock. I somehow skipped an end-of-the year 2014 “Greatest Hits” (most read blog posts) post last year and am eager to bring the tradition back to life (here’s 2010, 2011, 2012, 2013)! Of course, 2015 had highs and lows. For me it included all sorts of mid-life-forty-year-old-woman-type thoughts about life and parenting. There’s wild hyperbole in the middle — recognizing profound hand-clutched-to-chest privilege like good health, good friends, unique opportunity and the immutable joy it is to raise little children. Yet in the middle zone of life, these momentous realities are often chased by the overwhelming epiphany that life is uniquely precious and finite. So much to contribute and so much also to learn and so much we all want to witness with our children. Every single day.

Over the year I had significant learning about communicating about health. I did dozens of interviews regarding the measles outbreak that stemmed in Disney, I’ve experienced heart breaking and continued stun at ongoing gun violence, I had a painful goodbye to my beloved dog, Luna, I’ve witnessed great suffering with illness in those I love and those I’ve cared for, and my ever present work-life balance quandary and curiosity toils on. But 2015 also had me soaring with things like The Supreme Court Of The United States voting 5-4 in majority to make gay marriage legal in all 50 states, quiet snowstorms, hikes in the mountains and hours running on trails here in Washington. I was able to continue to spread public health messages on national news outlets like NBC Nightly News, Al Jazeera, The Washington Post, The Today Show & NPR, and USA Today. I traveled to Australia late in the summer for a speaking engagement with my delicious 9 year-old and discovered how much I want to go back. I was an invited speaker at the NFID Influenza News Conference at the National Press Club in Washington D.C. to explain the seasonal launch of influenza vaccinations and I got to see healthy and sick children and their families in clinic nearly every week. I continued to learn and grow and partner with like-minded groups working to improve public health and messaging in pediatrics/parenting like The American Academy of Pediatrics, The CDC, The Washington State Department of Health, The Washington Dental Service Foundation, a new start-up called Mother.ly, and continued our ongoing partnership here with Know Your OTCs. In addition to my trip to Australia, this year I was lucky enough to learn and contribute to conferences and health systems in Iowa, Minnesota, Illinois, Washington, Colorado, California, Washington, D.C., North Carolina, and Maryland. Read full post »

It Was Never A Dress: Raising Boys And Girls To See Things Differently

Mamas are superheroes in disguise ❤️

A photo posted by The Glow (@theglowdotcom) on

Last night, around dinnertime the doorbell rang. When I opened it to find a clipboard-clad solicitor obviously looking for donations or a signature, earnestly I wasn’t thrilled. But she had me at hello when she said, “I’m here to work for equal pay and equal rights to health care.” After we talked for a few minutes, my little boy curiously also appeared at the door and asked what we were discussing. We explained and he stayed quiet. But later in the evening he said to me unprompted, “it sure made sense” that women and men were paid the same amount of money for the same job.

Then this morning I stumbled upon this cartoon on instagram. Hidden truths re-imagined in the pant suit! Something about this felt exceedingly timely with 2015 being a time where a woman is a front-running candidate for President of The United States, girls now report more than anything else they’d like to grow up to a doctor, and a time where we’re still working hard to chip away at supporting women and men equally in the workplace as they raise families. As we raise our little girls to feel unencumbered and as we raise our little boys to feel the just the same, I couldn’t help but feel the thrill from this “superhero” re-design. I say we share it with our children…also consider these 3 articles today:

3 Things To Read While Raising Girls And Boys To Value Each Other Equally:

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Parenting In 2015

My little love in the snow yesterday. Part of my #worklifebetter life hack!

My little love in the snow yesterday. Part of my #worklifebetter life hack!

Time capsule entry. Although I suppose every parent since creation felt that the time in which they were raising their children was somehow novel, I’m moved by our 21st-century digital connection to share a transparent take on being a mom and pediatrician today. It’s the end of 2015 and overwhelmingly, I think many of us are stretched thin. And although our children are more-than-ever-before extraordinary, somethings gotta give.

First things first, as a perhaps totally-exhausted-working-full-time-emotionally-laden-at-baseline mom trying to find center, I keep reaching for poetry from Mary Oliver. Here she sets me flying in a portion of her poem, Spring Azures:

Sometimes the great bones of my life feel so heavy,

and all the tricks my body knows–

the opposable thumbs, the kneecaps,

               and the mind clicking and clicking– 

                                                                                                                         don’t seem enough to carry me through this world

                                                                        and I think: how I would like

                                                                         to have wings–

                                                                         blue ones–

                                                                          ribbons of flame.

Oh, how our minds always seem to be clicking and clicking and clicking and clicking…and those blue wings, the ones of flames? Yes, please sign me up.

A friend, a few years ago referred to their spouse as having a “busy brain” and I’ve thought on it since. Don’t all parents? Or is that the 2015 talking?

The 2015 realities aren’t surprising to any of us: the earnest tether to a smartphone, the wild ease to immediately compress and access news from the entire globe, the immense pressure to have a career wed to the impressive surge in being asked to be wildly productive everywhere (at home, at work, at volunteering, at exercising, at being present). The heavy burden of being told to elegantly role-model (hello, parenthood), the urgency we feel to then perfect raising children, all the advice (!!) out there floating around and intentionally pushed our way in social networks. And then the never-ending stream of in-arm’s-reach science of what we know to be good for us (sleep, flossing, daily exercise, leafy greens, friendship, “balance”, a job with purpose, BPA-free) and what we know even more is bad for us (sleep deprivation, unemployment, stress, smoking, divorce, bad cholesterol, processed meat, sedentary days). I mean…. Read full post »