Thursday, May 29, 2008
Hidden benefits
Wednesday, May 28, 2008
What's up
As I mentioned, yesterday we all went to the new parents/newborn class that Andrea and Emmett normally attend alone. The class is for 0-3 month-olds and is headed by a midwife/RN-in-training who we had for one of our pre-birth classes and who we really like a lot. The format is a bunch of people and their kids sitting around in a circle for an hour with each parent or set of parents introducing themselves and their little one and asking a question of the leader or the group. It was good to get to hear what others are going through, and it really made me feel like we have a pretty cooperative kid so far. We have a friend whose pediatrician appointments have at least a part which is a group meeting like this, and I think that this approach is extremely valuable as when Andrea and I see our pediatrician it seems like we can't remember all of the questions we have in the weeks between appointments (plus it gives parents a chance to look at other parents/kids and feel like things aren't so bad).
The other big event in the last day or so was Emmett had his first erection this afternoon...or at least first that either of us have spotted (Andrea saw it, I didn't...I was at work for this event, too, and I guess she didn't snap a picture---that would be good for his baby book). I think that this was a little unexpected and surprising for Andrea to come across. It is good to know that Emmett, unlike so many other male children, will get to know and celebrate the anniversary of this momentous event (sure, there were probably others hiding under diapers, but this first in-the-open one must count for something).
What shots E got
Anyway, we spent far too long in the office with the doctor trying to convince me that this is a good vaccine and worth the risks (aluminum in the blood, seizures), and me feeling that this is a bad vaccine for the risks, for supporting bad medicine and science, and for its measured effects. Well, in the end Emmett only got polio, and I have decided that I will do a lot more research on this disease to see if we will end up giving him the shot (this is a good stall in some ways as waiting a couple of weeks puts a full month between shots with aluminum rather than the 2week/6week spread that the doctor had advocated for).
It is very unfortunate that there is so little scientific data on what is going on with this disease. This Dallas study seems the only of its kind, and in talking to a pediatrician who was at the new parents group that Andrea and Emmett normally attend without me (and which I got to attend because of the doctor's appointment getting me out of work), I learned that UCSF is now finally analyzing each invasive case of pneumococcal to determine what strains are causing the trouble. Without this kind of information the doctors are prescribing this vaccine blindly and without fully understanding the ramifications of its widespread use.
Anyway, this is the scorecard for those keeping count: the American Academy of Pediatrics says that by 2.5 months Emmett should have had the HepB twice, HIB, Pc, DTaP, Rotovirus, and Polio vaccines. Dr. Sears has DTaP and Rotovirus only with HIB and Pc at 3 months. Emmett has had HIB, DTaP, and Polio, so we are kind of in an intermediate position at present.
Luckily I have heard that immunization is that last hard decision we have to make before Emmett graduates high school.
Monday, May 26, 2008
Over the river and through the woods
This was our longest trip to date by any mode of travel, and Emmett used the trip to remind us that he likes riding in the car even less than his father does. To provide views into the multi-faceted child that is Emmett, I thought I would post a short video of Emmett expressing his feelings on car travel while traveling home from Oregon. This video is intended to be juxtaposed against this morning's video of Emmett's vocalizations. The astute video viewer might notice when comparing the two videos that there are slight differences in tone and frequency of vocalizations between the two. In order to prevent calls to Child Protective Services I preface this video by saying that I had been trying to calm him for some time previous (I was in the backseat with him while Andrea drove) and succeeded shortly after this. I figured that recording 30 seconds of Emmett's outburst is important both for posterity and for those who might be led to believe, via this blog, that Emmett is all smiles all of the time.
Speaking of happy, tomorrow is vaccination #2. Emmett is scheduled to receive the polio and pneumococcus (Pc) vaccines. Andrea and I decided that we would do the polio (Dr. Sears recommends it at 9 months, but the vaccine has very few side effects and as we are skipping a number of the early ones he recommends we figured we could slip it in here---I should say that we are not excited about the fact that it is made of monkey parts, but if Emmett is going to have any chance at the presidency we should give him this as the days of the press keeping the secret of a polio-stricken president are surely in the past). I am leaning toward Emmett not getting the Pc tomorrow for reasons I will elaborate below. Those who don't find their interests piqued by vaccine talk should walk away now.
Pc can be pretty bad stuff, causing things like pneumonia, meningitis, etc., so somebody thought it to be a good candidate for a vaccine. The vaccine developed and in use gives immunity to 7 strains of Pc and has been very effective in reducing these strains since vaccination started around 2000. However, the first catch with this vaccine is that there are 90 known strains of Pc (7 of 90 is 7.8%, so the vaccine is 1.8% closer to total immunity than Emmett is to total visitation of all of the states in the USA...hmmm). The second, more important, catch is what has happened since that time. The photograph below is of a plot from a paper that I picked up tonight at UCSF which Dr. Sears references in his book (Pediatric Infectious Disease Journal 26, pp. 461-467, for those interested). The gray bars show the number of cases of Pc at a Dallas hospital which were infections of one of the seven strains in the vaccine, and the number has clearly decreased since the vaccination started in 2000 (good). The black bars, though, are the number of cases for Pc strands not in this group of 7 strains, and it is clearly going up with time. Take home message: we are improving with the 7 covered types, but are paying for them with the non-covered types. Worse yet, since the introduction of the vaccine there have been reports (cited in this article) of increasing anti-bacterial resistance of at least one of the non-covered types which is also rising in frequency. All this gives me pause as to whether the bunch-of-seven is the best vaccine approach to this problem and if we are not, perhaps, losing ground as a result.
It would be so great if we could make some sort of a numbers argument to decide if we should have Emmett get this vaccine. Estimates for the number of "severe" cases have a wide range of 400 to 60,000 per year in the US (pre-vaccine with the latter, and "severe" loosely defined), so with ~4,000,000 newborns each year in the US this gives probabilities in the range of 1 in 10,000 to 3 in 200---- however, seizures as a side effect occur with a frequency of about ~1 in 20,000....plus there is the presence (again) of aluminum with its semi-unknown side effects, so the numbers don't tell a whole lot.
Things we have working for us not getting the vaccine are the facts that it is much more prevalent in child-care facilities and with non-breastfed children, so our chances of occurrence should be a bit lower (how much??? who knows??). Right now I am leaning toward not getting the shot and I am hoping that we get a chance to talk with the doctor pre-poke (though I am pretty sure I know her opinion already). I will give the paper and Dr. Sears another read pre-appointment and will report back with our final decision. Also, I have a copy the paper if anyone wants some light reading.
The morning report
Tuesday, May 20, 2008
The indispensables, vol. 1
Monday, May 19, 2008
Sleep-challenged weekend
The next night, Saturday, would be more of the same, but would be even more painful as we stayed up well into Saturday Night Live as we had guests over (unheard of late night for us). By yesterday we were all dragging. I finally took Emmett for a walk to check out Bay to Breakers, which passes only a few blocks from our house. For those who don't know it is supposedly a race (there are runners at the front, I think, but you have to show up early to see them), but the primary attraction is the fact that thousands and thousands of people walk the course (from the Bay to the ocean) dressed in costume (or undressed)----it is basically a moving party through the city. Emmett wasn't sleeping so well on Sunday morning so I walked him over and the constant drone of loud voices and music served as perfect white noise and he slept in the Ergo carrier against my chest. It was a little worrying as there were drunk people all over the place and I didn't know when one was going to stagger into me, so I spent most of my time propped against a tree for defense.
Last night, he got back on a more reasonable sleep schedule and I feel a ton better. It seems that much more than anything else, our lives completely revolve around Emmett's sleep schedule and we spend a lot of time wondering what we should be doing to improve it or what we have done wrong when it goes astray. It is kind of funny, too, that Andrea and I both know that when he first starts to squirm at 2 AM any diaper change or the like that needs to take place will be easier if done immediately rather than waiting for him to wake up completely (which usually brings the tears, crying, and misery for all involved). Part of the waiting is hopes that it is just a squirm that he can go back to sleep with (rare), and the other part is hopes that the other person is going to get up (less rare). Yes, it is much easier to see the rational choice in the daytime.
Thursday, May 15, 2008
Cry, baby, cry
Last night Andrea talked me into trying this thing that she heard about through some other mothers called "dream feeding" or some other name along those lines. Basically what it is is a trick to get your kid to sleep more by putting a bottle in their mouth while they are asleep. They start eating without really waking, get their belly topped up, and as a result sleep longer without waking for hunger. It was about midnight last night when she tried to talk me into this (she can't do it because a mother is not supposed to feed by the bottle and breastfeed at the same time as it might confuse that young, 25th percentile head), and after a little consideration I figured I would give it a try (I was working on a talk for today---anything to get out of work). I snuck into the room, bottle in hand, and what do you know: that kid will eat while sleeping, and eat quite a lot. While feeding him I had these grand plans of to do a little "dream feeding" to Andrea to see what she thought of it (not believing it would work), but as I was thinking about this ploy I was reminded of a basketball trip in high school when Jay Garnier fell asleep with his mouth open and someone kept feeding him food which he would promptly chew up and swallow---so dream feeding is not just for kids. Luckily, for Andrea, she sleeps with her mouth shut. Oh, net result: Emmett didn't sleep any more than normal. Dream feeding gets zero stars for results but four stars for strangeness.
It was hot, hot, hot here in SF today. Andrea, Emmett and I just got back from a trip at dark to the store where we were all dressed in short pants and t-shirts. The city is really alive with many people on their stoops after dark, so Emmett has to have his white noise machine extra loud tonight.
I will do my best to post with pictures next time and avoid any topics that cause me to rant.
Monday, May 12, 2008
Shots for E
That is the short, fun part...here is the long, boring rant. Beware all ye who enter.
Andrea and I have known for some time, obviously, that this day was coming. I believe that I have mentioned it here before, but I have been reading Dr. Sears' "Vaccine Book" trying to educate myself as to what we should do. Yes, I do understand the argument that vaccines can be a good social policy and can actually eradicate disease (e.g. small pox, polio (mostly), etc.), but I feel that there has been a shift to immunize on diseases that probably do not need this level of attack: chicken pox, whooping cough, rotovirus. The result, I think, is that we have come to the point that immunizations are being developed and approved for second-tier (at best) diseases at rates that outpace long-term clinical trials for potentially problematic components (e.g. oft-quoted mercury, monkey cells, etc.), and as a result these new-found effects are casting doubt on immunization in general which we will most result in a resurgence of first-tier diseases once held at bay such as polio. Our pediatrician, who we still really like, said that further doubt is being cast on doctors as the populace is now starting to believe that doctors push so many immunizations so they can make more money, and she informed us that they at best break even on the shots. However, in the examination room was a poster alerting us that a pertussis (whooping cough) immunization is also available for adults, and this poster was provided as a "public service by Sanofi Pasteur" who just so happens to make a pertussis vaccination---the one the doctor's office uses. It is really hard to feel that our best interests are being kept in mind and that the vaccinations are truly necessary when our public service messages are provided by the person who pockets payment for their use.
Anyway, recommended by the American Academy of Pediatrics at the two month visit are HIB, Pc, DTaP, Rotovirus and Polio (four shots, one oral) with the same repeated at 4 and 6 months. Dr. Sears recommends what I see as a more reasonable schedule where things are spread out with two vaccines at one month intervals so as to lessen the vaccine load on the baby at any one time. Sears recommends DTaP and Rotovirus at the first visit. DTaP stands for Diphtheria, Tetanus, and Pertussis, and (get this) the only one that poses any real threat to an infant is the third. Can you get a shot of just the third, though? No, but Pertussis is serious enough that we opted to get this shot. One shot, three vaccines, two unnecessary (at least until older), but Sanofi Pasteur is looking out for us. Rotovirus is basically bad diarrhea (more EC practice!!!) and causes ~50 infants to die each year from it, which sounds serious, but they die of dehydration which means bad medical care (what does that say about our medical care if 50 children dehydrate each year from something that can be taken care of by inserting an IV). I went in thinking we didn't need it and our doctor agreed arguing that we are fortunate enough to have medical care that would insert an IV if this set in, so we were down to one.
At this point, however, the doctor threw me for a loop by saying that since we were only doing one vaccine we should add another, and I didn't come fully prepared for her recommendation: HIB (Haemophilus Influenzae Type B). HIB can lead to bad meningitis, so I was fine with him getting the shot under the one condition that it not also be a shot that has aluminum in it.
Aluminum is being added to many vaccines to increase the efficacy (they say), but brilliantly they have never tested the long term effects of aluminum injected through muscle. Surely if it is in the shots it is safe, right---that mercury thing was just an accident. There have been studies that have shown that elevated levels of aluminum in infant's blood can cause long term learning problems, etc. at amounts/body mass levels lower than they inject with these shots, but zero studies looking at the effects of muscle introduction (questions like how fast does the aluminum in muscle get moved to blood, what densities in blood are reached, etc. remain unanswered). As there are some vaccines for which no aluminum-free options exist, Sears recommends not taking more than one aluminum-containing shot at a time...again, what seems to me a reasonable approach to minimize an unknown risk. I believe that we did this, but I will need to check as I left the brand list/aluminum content at work (you would think this would be on the packaging the doctor's office uses or that they would have easy access to the information...I thought that and I was wrong).
Side note: there are three DTaP immunizations of increasing amounts of aluminum, so one might make the easy choice of the lowest, but to throw the whole thing for a curve the one with the lowest aluminum also uses mercury (and you thought mercury was out of children's vaccines?!?). We took the next lowest (Daptacel by Sanofi Pasteur, which also has formaldehyde, a known carcinogen----so you literally get to chose your child's poison). Shots are fun!!!
This whole process had me really frustrated. We, as patients (or worse yet parents of patients) are supposed to make decisions between immunizations that have preservatives or other elements that are known to be harmful or even deadly and try to determine, without real scientific studies having been performed, which vaccine will give us the best chance of defense with the least risk. And what does it say about our FDA that potentially unnecessary immunizations are filled with components whose effects are not fully known (mercury in flu shots for example---mercury-free are becoming more prevalent but at least up to last year the average flu shot had mercury in it). Who are we to trust in making these decisions? Our pediatrician whose walls, pens, post-its, and booklets are decorated with "public service" notices or actual advertisements for the brands the doctors use asking us to assume that they will present an unbiased scientific opinion? The American Academy of Pediatrics, an organization of pediatricians whose offices are decorated in similar fashion? Who?
Sure, a free market is great but it is hard to go through this process and feel that the free market medicine solution is really taking us along the correct health track. In the free market system, what (besides one of their products catching the public attention by being shown to cause harm) is going to drive Sanofi Pasteur or GlaxoSmithKlein to invest in comprehensive testing or re-engineering a vaccine on which they are already making a bunch of money? Why invest in testing when post-it notes and clicker pens are much more fun?
Saturday, May 10, 2008
Saturday morning routine
Wednesday, May 7, 2008
Hard data
Tahoe fun

The other good thing has been that we are closer than normal to grandparents. We have seen Andrea’s parents who stayed with us our first night here and we saw my mom last night in traveling to
Thursday, May 1, 2008
And this is how it ends...
I feel like I haven't seen too much of Emmett in the last few days. I have been working long days as I try to get a paper ready for a conference in Tahoe next week (the whole fam is heading up). I am an amazingly inefficient writer, especially when it comes to those science paper things (I actually hand wrote the great majority of my dissertation and then transcribed it to the computer as I found that it was so much effort to go back and change handwritten sentences that I would actually make progress---the latest trick has been a few glasses of wine which get my science inhibitions turned down a little). Anyway, the result of my slow paper writing is that I keep arriving home after Emmett has gone to bed, and as he is sleeping the longer hours now it feels like I get zero interaction. Actually, last night he woke up at around 9 pretty cranky and I was secretly glad that he couldn't sleep as I got to hold him and try to settle him. The whole settling thing took about an hour and I tried every trick in the book, including one from Dr. Sears' big Baby book: the ol' "strip baby naked except diaper and put him on pop's bare chest" trick. Yep, didn't work at all. Not only that, I had to spend 10 minutes rewrapping both Emmett and myself with him screaming and flailing the whole time. Andrea came in mid-redressing and I believe all I said to her was "don't ask." I have to say, though, that it was pretty neat to feel how soft his skin is right next to mine. I change his diapers and clothes a lot, but the feel of baby skin on tough hands (well, relatively tough) is very different.