Let Me Level With You- Two New Videos

Two new videos have been added to the “Let Me Level With You” series!

Hepatitis B

So many parents have questions about hepatitis B and what the real risks are. Here’s the info on who is really at risk for hep B and why.

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Prenatal Testing

Prenatal testing seems simple on the surface. You get a test, it tells you if your baby has a birth defect or not.

Except that it doesn’t actually work that way.

In so many ways, prenatal testing has more in common with a roulette wheel or game of craps than a diagnostic procedure. This video has the most important things you need to know about prenatal testing like false positives, false negatives, perinatal hospice care, and quality life:

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Are Mandatory School Vaccine Laws Actually Helping?

I’m not talking about rates of vaccine exemptions here. Oh no. People like talking about vaccine exemption rates because it distracts them from the bigger issues of school vaccinations.

I’m talking about epidemiology.

The idea behind mandatory school vaccinations is to prevent diseases from spreading among children in a crowded setting. But required school vaccinations- especially for certain diseases- don’t necessarily solve the issue of transmission or serious outcomes. For example:

Measles/mumps/rubella/chickenpox

These are diseases that are generally mild in elementary school age children. I’ve written an extremely detailed post about measles, so I won’t regurgitate it here. (You can read it of you want references from the CDC and medical journals about how measles affects people of varying health and ages.) Long story short, measles is actually much more deadly in adults than children. Mumps is rarely deadly, however it can cause an infection of the testicles in teenage boys and men- though sterility is extremely rare. Rubella is generally a mild disease for children and contracting it in childhood confers lifelong immunity. But if a woman in her first trimester of pregnancy catches it, it can cause a condition called congenital rubella syndrome, causing the baby to be born with conditions like blindness, deafness or mental impairments. Chickenpox (varicella) is also much more severe in teens and adults. If a pregnant woman catches chickenpox, it might (in rare instances) cause birth defects. Also of note, in Great Britain, the National Health Service don’t recommend vaccinate for chickenpox on a regular basis because low circulation of the varicella virus can increase shingles in older adults.

Pertussis

I have also written a big post on pertussis/parapertussis as well and the relationship between vaccination and the adaptation of the bacteria. That’s where you can find all the nitty-gritty details and academic references on this subject. We are facing a growing crisis with asymptomatic transmission of pertussis. And even as more and more people are being vaccinated for pertussis, the rates keep climbing. See the CDC’s nice little chart here. Parapertussis is on the rise and pertussis vaccines are ineffective against it. So even if your kid’s whole class gets that ice cream party from 100% vaccine coverage, it won’t stop whooping cough. (But at least the kids got an ice cream party, right?)

Influenza

This one isn’t technically a school vaccine, though Ohio, New Jersey, Connecticut and Rhode Island require it for day care. The idea is probably to prevent transmission of the influenza virus to babies and toddlers since they (along with the elderly and the immunocompromised) are at the highest risk for complications. But you can’t actually achieve herd immunity with the flu vaccine because it’s only 40%-60% effective and herd immunity requires that 80%- 90% of a population be immune. And unfortunately the flu vaccine is less effective for children under 2 and adults over the age 65. Some studies measure flu vaccine effectiveness by how often people go to the hospital for flu- not necessarily in reduced cases of flu. In these types of studies, the flu vaccine is considered successful if you don’t get hospitalized for the flu after getting a flu shot. You may still get the flu, you may still pass the flu, but we long as you aren’t hospitalized for it, the vaccine can be counted as effective.

Hepatitis B*

Hepatitis B is primarily spread through injection drug use, sexual contact and maternal to child transmission during birth or the first few years of life. Child-to-child transmission is certainly possible, but it doesn’t happen very often.  (Just like hepatitis B from health care procedures is possible but doesn’t happen very often.) The age group at highest risk for HBV are adults who are opioid drug users and men who have sex with men. If we talk about Hepatitis B among children, teens are the most at risk with kids ages 15-19 having the highest rate of HBV infection. After that, it’s a pretty close tie between kids ages 10-14 and infants ages 0-4. That’s because 15-19 year olds are most likely to be participating in high risk behaviors with 10-14 year olds following behind. Kids ages 0-4 are mostly the maternal transmission cases where the mother passes the disease to the baby during birth or during the first few years of life. Kids ages 5-9 are the least likely to get hepatitis B because they aren’t sexually active, using drugs and aren’t in as close of contact with their mothers as infants.

However, children who contract hepatitis B are more likely become chronic carriers and develop liver cancer than adults who contract hepatitis B. So the idea behind vaccinating elementary school children for hepatitis B is to reduce the likelihood of child-to-child transmission- though the risk of becoming a chronic carrier seems to be highest among infants and children ages 1-5.

This is an interesting issue for most of the United States though because hepatitis B risk is relatively low in the US. 0.1%-0.5% of the population in the US are infected with the hepatitis B virus, in comparison to places like the Mediterranean where about 5% of the population is infected with hepatitis B virus and in many Eastern European countries, 8% or more of the population is infected.

Now countries that have sky-high rates of hepatitis B have much stronger requirements for hepatitis B vaccination. But in many countries like France, the UK, Denmark and Norway where hepatitis B infection rates are similar to the US, hepatitis B vaccination is focused on those children who are most at risk. Our American vaccine schedule for hepatitis B is more like that of high risk  countries like Greece, Slovenia, Slovakia, Hungary and Romania where hepatitis B is much more common. Within the US, our practice of requiring hepatitis B vaccination for elementary school children may not have a big impact on hepatitis B transmission- especially since child-to-child transmission in schools and day care centers since it is quite rare.

*Of course, not all of this applies to West Virginia which is seeing a dramatic increase in hepatitis B due to its high rates of injection drug use, though their rates have not yet approached that of the Mediterranean and Eastern Europe… Yet.

 

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Let Me Level With You About…Ultrasound

Sonograms are everywhere for expectant parents!

But there are some things you need to know about keeping your baby safe.

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30 Minutes A Day To Overcoming Dyslexia*

*My son CJ doesn’t have a “technical” diagnosis for dyslexia. When I saw that his younger brother was grasping concepts like sounds and quantities easily and that CJ was still writing his letters and numbers backwards and upside down, I looked up dyslexia. He fit almost every symptom: difficulty matching sounds and letters, unable to sound out words, lots of difficulty with reading, trouble remembering sequences, unable to rhyme words, using context clues to figure out words, reversing and inverting letters in words, etc. I also suspect my brother may have had undiagnosed dyslexia when he was a kid. (We went to public school.) Like most parents, getting a trained specialist for an evaluation is not something we can do very easily. When I found that he fit so many of the symptoms, I just started finding out everything I could about dyslexia to tailor a curriculum to his needs. Onwards…

CJ is seven right now and on a traditional school system schedule, he would be in second grade. We have homeschooled him from the start and last year I started to really focus on more formalized reading and writing based work for him. Before this we had done a lot of learning games and some reading and writing practice. Schooling sessions quickly became a battle. I’d ask him to read simple three letter words and I may as well have asked him to read the Klingon paq’batlh. (This is when I hit my homeschooling crisis moment- “My child is failing because I am a terrible teacher!!! I am a walking example of the education apocalypse that is predicted when parents homeschool their children!!!)

klingon alphabet

I see letters and numbers. He sees a bunch of unintelligible squiggles.

As I began to understand that CJ’s brain just wasn’t wired on a traditional school schedule, I became a little more patient during his lesson time. But I felt like I was fighting a losing battle. This past summer I was giving him first grade level work and he couldn’t do it. He needed a ton of coaching to get through his workbook pages. (Apparently I’m not alone in this experience. One popular homeschooling site for parents with dyslexia had an article called “What To Do When Teaching Reading Takes All Day”.)

One day after cleaning up the school supplies, I saw my four year old’s Pre-K workbook and an idea hit me: Get CJ to do all the pages in the Pre-K workbook.

Unorthodox, yes. But I knew he could do it fairly easily. (The great thing is that he didn’t really know that he was doing Pre-K work. He couldn’t read yet and he doesn’t really understand the concept of grades in schools. So his ego didn’t seem much affected. Which is good because he likes to be in charge.)

30 Minutes A Day to Overcoming Dyslexic Symptoms

We did two 15 minute sessions 6 days a week in the Pre-K book. We started back in August and he was done after a few weeks around the beginning of September. The thing I noticed is that he was becoming more familiar with sequences, lines and writing, quantities and the sounds that letters make. So far, so good.

We moved up to the Kindergarten level book and I am thrilled to say that with the same 30 minutes a day, he raced through the workbook in about 6 weeks! Now he can sound out words, rhyme like a poet, do simple addition and subtraction, finish patterns, spell, and read and write short words. He just started first grade level reading, phonics and math.

The other difference I’ve noticed is that he’s become more confident and takes more initiative. He’s started doing some of his worksheets independently and is getting the answers right. He’s still writing his letters backwards, but he knows the names, sounds and how to use them to spell. A couple of weeks ago, he read Hop on Pop out loud to his dad and brother with minimal help. Score!

Why Is It Working?

I’m not a learning specialist, but my guess is that since dyslexia is a neurobiological disorder that affects the parts of the brain involved in language processing, getting a stronger grounding in phonics, reading and writing has helped him build the pathways in his brain to be a more effective reader and writer.My current hypothesis is that people with dyslexia may need extra strong base in language before moving on to more advanced reading and writing.

I know that people with dyslexia are often auditory learners, but I want CJ to be able to confidently navigate a world that relies heavily on reading and writing. He doesn’t need to be a professor of Russian literature, but I want him to be able to read and write well enough to handle the mountain of bureaucratic paperwork he will inherit at 18 when he has to start taking responsibility for his own medical care. I also don’t want him to be limited in his career options from an inability to read and write well.

Other Things to Note About This Experiment

We’ve also had him using an app called ABC Mouse.com every day. This has introduced him to some second grade level work, though he often needs help with some of the more advanced math and grammar. (However, one of the gifts of being a busy mother of three/ MPH student/ breastfeeding educator/ childbirth educator in training is that I can’t always rush over and help him immediately. There have been so many times he has said that he has a hard math or reading game that he can’t do himself and by the time I’m able to get over to him, he has it figured it out.)

The workbooks we have been using are based on Common Core. You can buy them on Amazon. We’ve used School Zone’s Big Workbooks and supplemental work books as well and Thinking Kids workbooks as well. I don’t if any one work book is better than another, I think it’s the extra reinforcement of those base level skills.

We also feel lucky that we didn’t come into this with the baggage of public school. Public school is like public transportation- it’s necessary to have it as an option, but it’s not an ideal solution for everyone. Most schools are not able to provide the resources necessary to diagnose dyslexia and help kids with it. CJ hadn’t had the experience of being the kid in class who doesn’t understand things, so we were able to avoid some of the frustration associated with that. I think half of the difficulty with dyslexia is trying to fit kids with different brains onto a schedule that doesn’t work for them or their teachers.

Seeing how he struggled to count, finish patterns, sequence events and assess quantities for a while, I suspect that he may also have a learning disability called dyscalculia as well.

And so, our exhilarating adventure in homeschooling with dyslexic symptoms continues!

 

 

Utah’s Juvenile Type 2 Diabetes Problem

Utah actually has a higher than average rate of juvenile type 2 diabetes.

This started as an assignment for one of my public health classes, but I’m sharing it here as we head into the sugariest time of the year. Utah’s issues with obesity and diabetes are nowhere near what they are in other places (the Southern states), but it is growing.

The paper is here: https://docs.google.com/document/d/10qh0b476zUFKDv41O0RkvXaGoCA6-xZyAC1dGfn-qnM/edit?usp=sharing

The Good, the Bad and the Utterly Useless of the Affordable Care Act- In 5 Minutes

Contrary to what you may have heard, the United States does not have universal health care. The ACA is well-intentioned, but there is no way it can revolutionize the health of Americans:

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Breastfeeding Advice from the Midwife of Auschwitz

Stanislawa-LeszczynskaUnless you’re really into World War II history  or you have been keeping up on the latest individuals to be beatified by the Catholic Church, you may not have heard of Stanislawa Lecysynska.

She didn’t attempt to assassinate anyone. She didn’t win any battles. She didn’t blow up any munitions factories or bridges. She didn’t find out any crucial bits of military intelligence. She never even wrote a book about her experiences. In fact, she rarely talked of her time as a midwife in Auschwitz.

But that’s OK. Because a lot of the mothers who knew her have told us about her- and even a couple of the babies she saved.

The Midwife of Auschwitz

Stanislawa Lecysynska was a midwife in Poland before the war. She was imprisoned in Auschwitz when she was suspected of collaborating with the Resistance. When the camp officers found out she was a midwife, they put her in charge of delivering babies for pregnant prisoners and killing the newborns. She delivered over 3,000 babies during her time in Auschwitz, but she refused to kill any of them- even when the infamous Dr. Mengele threatened to kill her for refusing to comply.

By all accounts, Stanislawa was a woman of great hope and compassion. All the pregnant women in the camp called her “Mother” because she gave the best care she could to every mother and baby- Jewish or Christian. Women described her as going hours without sleep to attend to laboring mothers and doing everything she could to keep babies alive for as long as possible. She had a deep conviction that if a baby was born alive, it was meant to live.

She delivered babies in the most hellish environment imaginable- and yet she never stopped caring for her mothers and babies. Some accounts describe the German doctors of being incredulous that she never lost a mother or baby to labor complications- despite the abysmal resources she had to deal with. It’s little wonder that she has been beatified by the Catholic Church (the first step towards sainthood).

Saving Babies Through Breastfeeding

Infant formula was not available in concentration camps. Mothers who weren’t able to make enough milk turned to other prisoners who were lactating to feed their babies. One of these babies, Barbara Puc, lived out the first two years of her life in Auschwitz. When her mother was unable to breastfeed her, another woman who had just lost her baby offered to wet-nurse baby Barbara, saving her life. One Auschwitz inmate, Maria Saloman described how Stanislawa found two women to wet nurse her baby who ended up living to adulthood.

Kazimera Bogdanska was unable to breastfeed her little girl at first, but Stanislawa encouraged her to keep putting the baby to the empty breast in hopes that it would eventually stimulate lactation. When the camp was liberated, Kazimera was able to see a doctor who encouraged her to follow the midwife’s advice.

“Mother [Stanislawa Lecysynska] was right,” says Kazimera, “How lucky I was that I believed her. When liberty came in January 1945 and I was taken to a real hospital (since I had typhoid fever) the doctor allowed me to continue to give my child my breast devoid of milk. After some time milk returned. My daughter began to gain weight. . . . She started to become round and rosy cheeked. . . . Mother’s wisdom and faith saved my only child.” 

I just think it’s beautiful advice for any mother who is struggling with breastfeeding. Even when you feel like nothing is happening, even if you have to supplement or get donor milk for a time, keep putting the baby to the breast. It might stimulate the glands.

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Let Me Level With You About…Electronic Fetal Monitoring

Ah, American maternity care. High tech, low results.

Here is the video:

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Can I Consume It While I’m Breastfeeding?

The answer is yes… and no… and maybe under certain conditions…

In no particular order, here are some of the most commonly questioned substances and the verdict on each one:

madmenpregnancysmoking

Yes, neither Betty nor Francine breastfed, but you get the idea. 

Tobacco

No.

Obviously, no one should smoke. Ever. But there are certain risks associated with breastfeeding and smoking. Heavy smokers (20+ cigarettes a day) increase the likelihood of passing nicotine to the baby. The half-life of nicotine (the amount of time it takes for it to be eliminated from the body) is 95 minutes, so even smoking before a feeding can pass nicotine to the baby. Smoking increases the risk of SIDS and respiratory problems for the baby. Studies have found that breastfed babies of smokers were more likely to have episodes of colicky crying and fussiness than breastfed babies of non-smokers.

Also, smoking and breastfeeding is associated with early weaning, lowered milk production, and inhibition of the milk ejection (“let-down”) reflex. And it lowers prolactin levels- crucial to milk production. According to Thomas Hale, Ph D, author of Mother’s Milk and Medications (the go-to book when you have questions about how stuff in your milk affects your baby), smoking cessation aids are generally less hazardous to the baby than continued smoking.

Alcohol (in Moderation)

Yes.

Drinking occasionally is fine if you’re breastfeeding. The Mayo Clinic is pretty stiff on the subject and their article generally discourages drinking and breastfeeding. And truthfully, not drinking while you are breastfeeding eliminates any chance of alcohol being passed to the baby.

However, research shows that 1-2 drinks generally doesn’t pose any risk to the baby. Thomas Hale says that mothers can return to breastfeeding after ingesting alcohol as soon as they feel neurologically normal. Many health professionals recommend keeping alcohol intake to 1-2 drinks a week while breastfeeding.

What about “pump and dump”? You can pump after drinking, but it won’t take the

jane the virgin pump and dump

I’m a huge Jane the Virgin fan, but this was yet another example of inaccurate breastfeeding information the show propagated. <Sigh>. The other big one was here.

alcohol content out of the milk any faster. However, if you’re away from your baby for a few hours and need to keep your milk supply up or relieve engorgement, by all means pump it and dump it. (FYI, Jane the Virgin didn’t need to drag her whole electric breast pump with for a night on the town with her best friend. She could have taken a small hand pump or even hand expressed milk to maintain supply and relieve engorgement.)

Marijuana

Marijuana Yes - No , Marijuana leaf , cannabis , cannabis leaf

That Red “X” is the answer.

No.

Here is my big post on marijuana and pregnancy for those of you who didn’t catch the controversy the first time around. Don’t use marijuana while pregnant and don’t use it while you’re breastfeeding either. Here’s why…

Marijuana smoke contains the same chemicals as tobacco smoke with the same risks to lung health for both the mother and baby. (American Lung Association, 2015).  Any chemicals that the mother takes in through smoking marijuana are passed to the baby, just like smoking tobacco products. THC also passes to the baby during breastfeeding and it stays in the body longer than many substances. THC is stored in body fat, which means it actually stays in your body (and your baby’s body) for much longer than alcohol. Because THC stays in the body for long periods of time, you can’t consume marijuana and then breastfeed after a couple of hours and not pass THC to your baby. So “pump and dump” won’t work. 

What about edibles and vaping? No and no. Edibles and vape pens still contain THC and that THC will pass to your baby. And while some research shows that vape pens result in lower tar, some of the newest research suggests that there might be a chemical trade-off in the form of toxic ammonia levels in the lungs from vaping.  The effects of THC from marijuana edibles will actually last longer than the effects of THC from smoking marijuana.

Caffeine (In Moderation)

Yes.

Don’t over-do it on the Starbucks or energy drinks, but other than that a couple of cups of coffee or cola are usually OK. (Chocolate is A-OK.) The amount of caffeine that ends up in a mother’s breastmilk is 1% of what she actually consumes. Babies younger than six months may take up to 80 hours to process caffeine, but in small amounts that’s usually OK. By about six months, babies can usually process caffeine in about 2-3 hours. It’s important to factor all caffeine sources into your caffeine consumption equation, so remember that even some OTC medications can contain caffeine. And if your baby seems especially fussy, alert or wakeful, consider that he might be a little more caffeine sensitive.

Medications/antibiotics/OTC drugs

Mostly OK.

The majority of medications are actually safe for breastfeeding. Most doctors do not get information about medications and breastfeeding from actual research on a particular drug and lactation, but from package inserts of a book called The Physician’s Desk Reference Both of theses resources come from pharmaceutical companies and may include out of date and/or incomplete information or disclaimers meant to cover the manufacturer’s collective @$$. One of the big medical treatments that is incompatible is chemotherapy because it uses radiopharmaceuticals. Sudafed can cause a drop in supply for some women, though it’s not generally harmful to the baby.

But other than that, pain relievers, anti-depressants, anti-anxiety drugs, cough medicines and many other types of medications are actually safe to take while breastfeeding. I do advise all expectant mothers to understand their options for pain medications that might be used during or after labor so they can make a choice that will cause fewer breastfeeding difficulties. (That’s why I included a section on it all my breastfeeding classes.)

Make sure to check out any supplements you are thinking about taking. Certain herbs can decrease milk supply or pass to the baby in harmful amounts, though culinary herbs and some herbal teas like chamomile are usually fine. Large amounts of certain candies, teas, cough drops, etc. might cause a drop in supply for some moms, but everyone is different.

Dairy/wheat/soy/peanuts/other potential allergens

Mostly OK.

If your baby isn’t displaying any signs of gastrointestinal upset or colic symptoms related to certain foods, you don’t need to avoid any foods. It might be a good idea to be cautious and avoid certain foods if there is a family history of food allergies on either parent’s side though. If your baby seems to be especially fussy, at different intervals, it might be time to keep a food diary and see if there is any pattern related to certain potentially allergenic foods. What about peanuts? Well, the latest information seems to indicate that exposure to peanuts through breastmilk may actually decrease the risk of peanut allergies. So go ahead and have that peanut butter cup. =)

Why Vitamin K Prophylaxis?

Hardly a week goes by that I don’t find someone asking about vitamin K prophylaxis. Most people have heard that newborns are just naturally deficient in vitamin K and without vitamin K supplementation their baby will get seriously ill. Of course, this is another one of those stories full of a few half-truths and many outright lies. This video was quite the merry chase of research as I dug around in a 100 year old medical journals and an 80 year old doctoral thesis to find out how a condition called hemorrhagic disease of the newborn came to be known as vitamin K deficient bleeding and how breastfeeding relates to it.

Here it is on Vimeo.

And here it is on YouTube.

Enjoy!