Can you catch the flu from the flu vaccine?

Long time no write!  4 kiddos... at this rate I'm probably posting like once a month but we'll see... maybe it'll get better as I get my act together.  

Well, here's a topic that I'm sure will cause a lot of controversy and buzz but I feel I need to at least give my two cents as a primary care giver and mother of four.  So it's getting to be flu season and this question of whether you can get the flu from the flu shot always comes up.  Many adamantly believe they got sick from the shot in the past.  I do not doubt they got sick... but there are two reasons that are possible:   

1. mistaking side effect symptoms of the vaccine to be flu symptoms
2. coincidence in timing (takes 2 weeks for the shot to be in effect and probably already got exposed to the flu and would have been sick anyway)

I tell my patients this... if you are getting symptoms because of a dead virus... imagine how sick you'd be if it were alive!  Scientifically, it is impossible to be infected and get the flu from a virus that is dead.  Now if you get the flu mist (no needle kind) then you are being injected with a weakened version that has been engineered so the parts that make people sick are removed.

Here are some links to articles if you want to read in more detail:

• 10 Flu Myths by Harvard Health
• 13 Flu Myths by WebMD
• Misconceptions About Seasonal Flu and Flu Vaccine

So what are the symptoms if you get the flu?  Note... these symptoms can last typically 2-4 weeks and if you get infected with the actual virus, expect to get these symptoms.  How fast you beat it depends on your immune system

• Fever/chills
• Sore throat and cough
• Stuffy or runny nose
• Fatigue and malaise
• Body aches and headaches
• Nausea/vomiting and/or diarrhea (usually in children)

Compare that with the side effects most commonly associated with the flu shot.  Note... these symptoms last typically 1-2 days and not everyone gets all these symptoms

• Soreness at site of injection
• Redness at site of injection
• Fatigue
• Mild fever

So I realize that not everyone will be convinced and there will always be those who hold very strongly to their beliefs.  That's fine.  To be honest, it is draining sometimes in the middle of a busy work day to go through trying to explain this logic from a scientific point of view... especially when the waiting room is full of patients, it is much simpler to just skip the remarks and leave each patient to the fate of their choosing.  However, since I believe in this logic... and I believe there is more good than harm in getting this shot, I give it to all my kids every year.  Therefore, I feel it is the right thing to do to at least offer my two cents of why I would vaccinate if it were me, my child, my mom, my grandma etc.

Of course the vaccine is not for everyone (for example if you have an egg allergy or if your immune system is particularly weak)... so you should talk to your doctor in detail about whether it is right for you.  But if you are healthy with no particular health issues, then the benefits of the vaccine, in my opinion far outweighs the potential disadvantages.

Hospice

This weekend, I’m flying out to Houston to visit my ninety-seven year old grandmother.   Granted, it is not a great time to fly right now with all the crazy things going on in the news… but this trip was planned a while back and it may be the last time I get to spend time with my grandma.  She now has end stage dementia and I feel it may be time to introduce the idea of hospice to the extended family.  I am approaching this topic with some hesitation because I realize there may be a lot of misconceptions and fear associated with hospice.

So the basic 101 about hospice that I hope to convey include:

-    -  most patients could probably benefit from being put on hospice a lot sooner than the family realizes

-    -  just because a patient is on hospice, doesn’t necessarily mean that death is days or even weeks away

o   in fact, some perk up and improve so much from the extra attention, they may even get disqualified from continued service

-       

  -  goal is comfort for the patient and support for the family

o   to make the patient as comfortable as possible with as much dignity as possible… so that the days can be spent hassle-free without a lot of extraordinary measures and invasive procedures

o   to give family and caregivers support, encouragement, and a resource from professionals with tremendous experience with end of life issues

It will be challenging to convey all this with a language and cultural barrier, but we’ll see how it goes.

In the meanwhile, I hope to spend some quality time just being with my grandmother.  Simple things like the sound of ones voice or the feel of ones hand… can go a long way in communicating love and offering comfort.  I also hope to give some relief and provide emotional and physical support to my aging aunt who is the primary caregiver… and the same to my other aunt who carries a lot of the logistical and physical responsibilities associated with the care.

Leaving my four children behind on this short weekend trip is not easy.  I am forced to rely on other caregivers to manage the day to day logistics and needs of my kids.  At the same time, I look forward to sleeping in!  I admit I am a “control-freak” and often feel the need to call or text multiple times a day just to find out what is going on and whether things are smooth.   It so happens that my phone developed an issue and I cannot currently make calls or receive calls and texts on the cellular network.  I am sitting here on the plane typing this hoping to fix the problem the minute I land.  I realize that at the end of the day, even if things are not going as smooth as I like back home… what can I do?  Maybe not having contact for a while can be a good lesson for me to let go and let be.  Oh… let’s see if I can do that.

So back to my earlier comment about it being a crazy time to fly… at least on this flight from Philly… no one seems to be acutely ill or overly worried about contracting anything =)

Enterovirus D68

I've been meaning to blog for a while now... and although it is near midnight I feel compelled to jot down a few thoughts.
Crazy things in the news lately... and since so many patients are asking... let's talk about it!  Here is a quick 101 on the Enterovirus D68...

What is it?
The enterovirus is a virus that typically causes cold like symptoms around autumn.  This particular strain, D68 seems to cause more severe respiratory symptoms especially in kids with asthma leading to more hospitalizations and even death.

What are the symptoms?
Starts off as typical cold symptoms like cough, runny nose, sneezing, body and muscle aches.  It can lead to more severe symptoms like wheezing and difficulty breathing.  There are 9 cases in Denver so far where patients with the virus developed paralysis-like symptoms.

Who gets it?
Anybody can get it but this particular virus is causing more critically ill children requiring intensive care.  Spreads from respiratory secretions from cough, sneeze etc.

How do you treat it?
The basic treatment is supportive care and treating the symptoms.  There are no current antiviral treatments for this virus.

How do you prevent it?
There is no vaccine yet for this virus.  Protective measures include:  

• Need to wash often with soap and water for at least 20 seconds.
• Avoid touching eyes, nose, mouth with unwashed hands.
• Avoid close contact with those who are sick.
• Cover cough and sneezes with sleeve (not your hand)
• Clean and disinfect frequently touched surfaces often
• Stay home if sick

These all sound great but getting preschool age children to do them can be a real challenge.  Usually if one of my kids get sick... they all eventually get sick!

101 on Ebola

Perhaps you have been reading about Ebola in the news.  In my opinion, the scariest thing about Ebola is the fatality rate (up to 90%) and the fact that there is still no definitive treatment nor vaccine for it.  Don't want to create unnecessary worry but I believe having some understanding is key in prevention of spread.

So what is it?
It is a disease caused by a virus and used to be called Ebola hemorrhagic fever.

What are the symptoms?

• sudden onset of fever
• intense weakness
• muscle pain
• headache
• sore throat
• vomiting
• diarrhea
• rash
• impaired liver and kidney function
• sometimes internal and external bleeding

How do you get it?

transmitted originally from wild animals then human spread by:

• blood
• secretions
• organs
• other bodily fluids

How do you treat?

often requires intensive support.  There is yet no definitive drug treatment.

How do you prevent?

Since there is no vaccine yet, best way to avoid spread in humans is by raising awareness.  Avoiding close contact with infected or suspected infected persons is key.  Health care workers have to implement extra precautions with protective garments and other measures.

Can read more about it here at the WHO website.

The two Americans who got infected with Ebola both worked as missionaries in Africa treating patients infected with the virus.  This tugs at my heart because doing missions played a key role in my decision to become a physician.  Here is an article by CMDA about Dr Kent Brantly, one of the Americans who is infected with Ebola.  After reading the article this verse keeps echoing in my head...

"For me, to live is Christ and to die is gain."  - Philippians 1:21

Sunscreens and Kids

Been crazy busy... I've been finding no time to post!  Summer is flying by.  Here is a short blog to get some info out  Caution and avoid if possible when using spray sunscreen on kids!  See this link.

If you are like me... it's so much easier to spray than it is to keep wiggly giggly kids still and apply lotion sunscreen.  However, we are reserving sprays for beach time only now...

Have a great rest of the summer!  Come on weather... we need more sun...

Our Experience with Au Pairs

So for the past four years around this time, we welcome a new member to our family.  This time I'm not talking about a new baby!  Working part-time hours as a family doc and caring for four kids six and under would be a much more challenging task without the help of our live-in au pair.  July is when we started our contract and we're now on our fourth.

I had written an entry about why we were considering going with an au pair for childcare back in 2011.  All those reasons are still true... the cross cultural experience, availability, and finances... however, it became much more than that.

Granted, it is difficult initially transitioning and getting to know and live with someone new every year.  We're in the process of getting to know our new au pair right now.  There is much adjustment from their end to a different culture, way of thinking and caring for young kids while we adjust to another personality.  However, overall our experience has been very positive and rewarding.  Thankfully, our kids have taken to all our different au pairs and they often refer to our previous au pairs with much fondness and love.

Our past au pairs have each brought something different to our family with the varying talents and personalities they have.  Our kids have learned a lot of the Chinese language because of their interactions with them.  My oldest, especially, is very fluent in mandarin Chinese because of them.

Last month, we threw a reunion and 'goodbye' party for our au pairs.  All three au pairs from previous years were here!

We are excited to see what this year will bring with our current au pair.  It is no easy task to help care for our four young children but we hope the experience can be fun and rewarding for both parties.

Little Kids and All-You-Can-Eat Buffets

Recently I had a good laugh reading this circulating blog about people at the beach either with kids versus without kids.  Got me thinking there are many things that fall into this category... including eating at buffets!

We just got back from a trip out to Lancaster.  Those of you who've been out there will know what a smorgasbord is.  Well, we went to a huge smorgasbord for dinner the first night at Shady Maple.  There is no way you can walk out of a all-you-can-eat place like this feeling hungry shortly after... unless you have little kids!  Well, maybe if you have one or two and if they are older... different story.  But I have four and my oldest is six years old... so no wonder I was still hungry looking for ramen noodles about two hours after we got back to our vacation rental and the kids were finally sleeping!

Seriously... the first ten minutes was just taking each kid to the bathroom to potty and wash hands.  Then while one adult is watching the baby the other is getting the kids' food one or two plates at a time.  Now once the kids are all sitting and eating... my turn to get food!  However, after like two bites, this kid needs a drink... that kid wants more mac n cheese... the other one wants some soup.  It is just non-stop back and forth to the HUGE buffet spread.  Uh-oh... need more napkins... dropped a fork... need to potty again... ready for ice cream!  I think I burned more calories just running back and forth from the table to the buffet spread than I actually ate that night.  And if it weren't for eating dinner with other adults, I'd probably not get to eat at all.  I get why some folks just prefer the sit down and just serve me places!

Happy Father's Day!

Shout out to all the dads out there... especially you, Joseph Kim!  You are awesome.  It takes great sacrifice, character, and perseverance to be a good father...


I can only manage a link to Dove's dad commercial this year... made me tear... 
https://www.youtube.com/user/dovemencareus
OK... trying to catch up on sleep... but have a few things I plan to write about this week...

Family Medicine

I’m returning home from a conference for continuing medical education.  Schooling never ends for a doc.  It’s a good thing because as medical advances are made, standard of care and treatments change with new research and discoveries.  Practices based in tradition are challenged to see if there is real evidence to support their continued use.

So anyways, as I sat in a room full of family medicine physicians reviewing basic dermatology issues often seen in primary care, I was struck with many thoughts… thus prompting this post.

It takes an average of 3 to 6 months to get my patients in to see a dermatologist.  Everyday, at least 30% of my patients come to see me for dermatology related issues.  The better I am at recognizing and treating various rashes and recognizing skin cancer, the more I can help my patients save time and money.  In fact, it probably helps overall health care costs for the country.

This applies to other fields as well… such as ortho, cardiology, endocrinology, etc.  So this is a shameless plug for medical students to consider entering this field.  Minus all the paperwork stuff that we get bogged down with… I find it extremely rewarding.  It is never boring and there is such a variety of things we do everyday…  like taking skin biopsies, suturing wound closures, incising and draining abscesses, injecting cortisone into joint spaces, or just being there to listen when someone is having an emotional personal life crisis!  In fact, psychiatry is the other field that I find very difficult to get my patients in to see.

There is so much to know to be a competent primary care physician but it also takes a calm, warm bedside manner.  This is often challenging in the midst of pressures to see more patients in less and less time.  Whether the recent healthcare law changes will affect the quality of care given is for a whole other post.

So I worry when I read things about more mid-level providers (nurse practitioners and physician assistants) taking over the role of primary care physicians.  Nothing against mid-levels, I’m sure there are many very competent folks out there… but the amount of time spent in schooling and the type of schooling is just different.  Why are there so few US medical student graduates going into primary care?  Well that is for another post as well, but it is all sadly related to money.  Our dermatology and psychiatry colleagues make twice or sometimes even more the amount the salary of an average primary care physician and medical school debt is medical school debt.

Well, if I had to do it again, I would not change fields.  For my type of personality, I like having the variety of things I come across everyday.   And unlike our emergency room colleagues (who also make about twice the salary) I also like the potential to cultivate relationships with my patients.

So for what it is worth, I love family medicine!  I think there is a very important role family docs can play in helping patients achieve overall good health without breaking the bank.

Fever

Last night, my two and a half year old woke up in the middle of the night crying.  This is unusual for him because he usually sleeps from 7p to 7a.  Going in there, he tearfully cries, "mommy, I'm sick".  Poor kid felt hot.  Moms just know when their child has a fever... no need for thermometer.. you are in skin contact with these kids almost all the time so when their skin feels hot, you know.  I tried to measure it to be scientific and to prove to daddy that this warrants tylenol but E would not let me.  But daddy trusted my judgement, so we just gave him tylenol.  In fact, I had to get up four hours later because he was crying and was all hot again.  Then this morning, he woke up before his usual wake time crying and hard to console.  He was so loud I was worried he would wake up the other three kids.  I had just finished nursing little L and had just put him down again for another short nap hoping to sleep a little more till it was time to get up.  Nope.. not this morning.  So what actually worked was laying next to my little buddy and just soothing him with "shhhhhhh".  He eventually stopped sobbing... stuck his thumb in his mouth... and layed back down again.  I actually love moments like these... just laying there soothing my baby and knowing that just my presence was all that he needs.  After a while, I told him I was going to go back to my big bed.  "Ok, mommy...  I love you, mommy."  Melts my heart...  now to keep the others from getting sick!

So few things on fever...

• not a fever unless over 100.4 degrees
• fevers are actually a sign that the immune system is working
• lower fevers with tylenol or motrin mainly for comfort
• need to find source of fever if persistent... can be viral, strep, ear infection, etc.
• rule of thumb is if fever persists despite tylenol, motrin call your doctor for further evaluation

Cradle Cap in Babies

Yay!  We have just passed the cradle cap stage... but thought I'd throw in a few things about it since two of my kids had it pretty severely and I don't think I've blogged about it yet...

What is it?
Scaly flakes that covers the scalp that can thicken into yellow crusty patches.  It can also be around the ears, eyelids, or around the nose.  Sometimes it can itch.

Who gets it?
Babies.  It usually starts by 3 months and resolves on its own by 6 months or so

Why does it happen?
No clear cause is known.  Some believe it is due to hormones that cross the placenta from mom to baby before birth.  It is not due to poor hygiene.

How do you treat it?
It will resolve on its own.  However, washing with mild shampoo can loosen the scales.  There are some oily cradle cap shampoos out there that some have found useful.  Combing the flakes with a baby comb after shampooing helps to remove the scales.

As always, when in doubt or if severe and persistent, see your physician!

Full Plate

Hope all had a wonderful Easter weekend!

Wow... everyday I feel like I'm playing catchup... who has time to blog?

My oldest is in the swing of elementary school. Conversations about friends and school and life has gotten so much more in depth lately. What a tremendous privilege and responsibility to guide her during this precious stage of growth and maturity.

My second is largely over her terribly independent and defiant stage and is back to being sweet and huggable. When the two of girls are together, they are non-stop chattering away. Every now and then we have to step in and sort out hurt feelings.

Big brother E is pretty hilarious with the things he says these days. He totally likes to copy his sisters. He seems to admire and follow along with the oldest but battles fiercely with the second. He is always banging on something with this toy or that... and fighting imaginary bad guys. Of all my kids, this kid is accident prone! Scraped knee here... banged up head there... cut lip... oh I'm just waiting for the stitches and broken bones!

Little L is my cute cuddly little man who has developed quite the chuckle. Poop has gotten more smelly as we've introduced real foods into his diet. Only issue is sleep, little buddy... mommy needs sleep!

Juggling when this one eats and that one needs to sit on the potty... this one has a sore thumb... that one needs homework help... I'm blogging here but I still need to make the lunches for tomorrow... print out pictures for another's homework project... piles and piles of laundry... figure out when my helpers need to come help... Ack! My plate is just full right now... but it's a good full.

4 Months Old

L is four months old.  The time is flying by.  I am so in love with my little meaty cutie patootie!

Every time, I get him in the morning, he breaks into a huge smile for me.  Sometimes, if he has been crying, he will smile with tears still glistening in his eyes.  He definitely loves attention and is so easily consoled.  Just smile at him.  Before a bath, when I pull on the sleeves to take his arm out of his clothes, he cackles out loud.  Often, I hear him cooing to himself and blowing raspberries.  He has discovered his hands and loves to suck voraciously.  He has excellent head control and can lift his head pretty high during tummy time.  The newborn baby swaddle no longer holds him, his two arms usually break lose.  He can turn 360 degrees if placed on a mat and it is probably just a matter of time before he starts rolling over.

Sleep pattern has improved some at night but we’re still waking up once or twice.  I expect him to sleep through the night by 6 months because my third started sleeping through the night by 9 months, my second by 12 months, while my first took 15 months!   Eventually, they all learn to sleep all night… at least most kids do with a few set backs.

We’ll probably introduce rice cereal and oatmeal soon.  However, I’m not looking forward to smelly poop that comes with introduction of real food…

Of all my kids, this one has definitely been the most mellow.  He is fairly low maintenance… and the best napper of them all.  Maybe he learned to be this way with all the chaos and physical and emotional demands of his older siblings… but surely it must also be his personality.

Babies and Sound Machines

Long time no blog!  ...or facebook for that matter.  Life has been busy as usual but I've just been crashing at night. 

Speaking of sleep... there has been recent news regarding the use of sound machines and whether it is harmful to baby’s hearing.  The theory is that the noise level may be too loud for infants because they are more sensitive to sound due to their smaller ear canals.  So there is potential harm to the child's hearing if there is prolonged exposure.

Now, we have a sound machine in each of our kids’ rooms and even bring it with us when we travel!  We’ve found that sound machines do help with the quality of our kids’ sleep and sleep is highly treasured in this household.  So what to do with this new information?

I like Dr Karp's response to this recent news.  To boil it all down, these are the take away points I came away with:

• Make sure sound machine is not too close to baby’s ears… as far away as possible
• Make sure the volume is not cranked up.. maybe make it as soft as possible
• Use the machine for as short duration as possible... some say turn off after kid is asleep

Bottom line... use with caution and if not really noticing a significant difference in kids’ sleep, may be time to put it away.

3 Month Stage

L is out of the newborn stage!  I'm mourning each stage as it passes now since I know he is my last...

So at 3 months, L is much more alert and aware of his surroundings than before.  He has gotten the social smile down pat.  If you so much as catches his eye even for a second, he will break out into a huge smile and start cooing.  It melts my heart every time, and I end up spending the next few minutes just cooing back and smothering him with kisses.

He is also much stronger now and is breaking out of the newborn swaddle wrap.  The wrap works so well in keeping their arms from flailing all over the place.  Now, he likes to stretch and suck on his hands when given the opportunity.

That football hold where I could just hold the baby with the crook of one arm... no more... getting bigger and heavier and longer...

Stool still smells relatively "not stinky" at this stage since diet still consists of only breastmilk... no solid foods yet.  Once solids get introduced is when the poop starts smelling like real poop!

So other than a lot of kicking in the air and arms flailing, there is still fairly minimal movement.  No danger yet of finding baby in a different place after putting him down.  However, one should never leave baby unattended... especially on high surfaces.  Any day now, he may roll over!  My oldest first rolled at 4 months so gotta be on the watch for it.

Now is also the time to transition from sleeping most of the day to developing a more scheduled sleep pattern.  Eventually, we'll fall into one morning nap, one afternoon nap, maybe a short late afternoon nap, and then a 12 hour night stretch from 7p to 7a... hopefully soon??  We'll see...

Two and a half Toddler Stage

Stealing a quick moment to blog!  At this rate.. I'm posting once a month...

So what to write about... I've been meaning to write a little blurb about my two and a half year old since I've already written one for the newborn and my two older girls.

This is a crazy fun age.  Lots of new words and discoveries!  This includes discovering the power to say "no" and not comply with mommy and daddy's every wish.  I find my toddler especially likes to exert his control during meal times.  Though this may be frustrating to say the least... it is supposed to be a phase.  For the most part, my boy is actually a pretty decent eater but for those of you out there who are struggling with getting the calories in, remember you can count total calories per day and not necessarily jam it all in during the usual breakfast, lunch, dinner times.  I actually wrote a previous blog on this topic when my second child was going through this stage.  You can click on the link here to read it.

So in addition to the power of saying "no" is the yearning for independence and doing everything by themselves.  This actually does crack me up most of the time, though there are moments when I just want to pull out my hair.  So here are a few examples... I'd put E on the booster seat at meal times...  he will climb back down and then climb back up himself.  Same thing with washing his hands... if I by accident place him on the step stool to wash his hands... he will climb back down the stool and climb back up it before he is willing to wash his hands... by himself.  He will try to put his shoes on for 5 minutes or so before giving up and asking for help.  If I help him before he asks me for help... sometimes we get the loose jelly melt down on the floor.  Sigh.  So getting to places on time requires factoring in extra 20 minutes or so to just get out the door dressed... then to the car... then into the carseat and then buckled!  Fun times...

My boy loves to copy his two older sisters in everything they say and do right now.  We're often trying to remind the older ones to be a good example so he can copy good things.  Unfortunately, most of the time he is copying them with things like... waving utensils madly in the air during meal times... screaming certain phrases and laughing hysterically... He even wants his hair in a ponytail!  Right now the thing to do in the car is to sing "let it go" and "love is an open door"... on the top of their lungs...

My toddler boy is certainly a little more active and accident prone than my girls at this same age.  This may be a personality thing and not just a gender thing... but E is totally into choo choo trains and such.  Already, he is wiggling out of my smooches and embraces.  In fact, the only way I get him to come over and give me a kiss is by getting my girls to do it first.  I'd call out, "who wants to give mommy a kiss?!"  My girls would usually run over and smother me with their hugs and kisses.  E will see them and run over, too.  Sigh... they grow too fast...

Sleep Deprived Moms

Happy Belated New Year... and almost Chinese New Year!  It has been forever since I've blogged... all because I usually blog at night and I've been desperately trying to catch sleep whenever I can...

Slowly but surely, I will sleep through the night again!  We've improved to waking up only 2-3 times at night now... for a while there I was waking up every 1-2 hours.  Ah... the joys of sleep conditioning... I think I prefer that term over "training".

So anyways... just wanted to throw in a short blurb here about sleep deprivation and moms.  There are so many ways that lack of sleep adversely affects one's health.  Personally, I find myself more short tempered and irritable and more vulnerable to sickness.  Here is an interesting article by Web MD on Moms and Sleep Deprivation.  So on that note... good night!