Ups and Downs: Rotavirus

After a wonderful week with my parents, brother, sis-in-law and niece, we have had a bit of a setback. My Googliagnosis (def’n: diagnosis made via extensive research at the university of Google) is rotavirus.

Both boys have been hit. They are just fine during the day and a big laundry-inducing mess at night. This is day 4 for Lil C and Day 1 for Lil D.

I feel lucky that the boys are old enough to understand what is going on and for their bodies to withstand the virus’ onslaught. I could see this would be devastating for an infant (and their parents). I was up till 4 am alternating between cleaning, comforting (though they seem to be less distressed than I am), and worrying.

Right now the boys are revelling in unmonitored and untimed cartoon watching.

I wish the rotavirus vaccine were recommended when these guys were babies. If you’re wondering why they didn’t get it before our trip, they are too old for it now.

The rotavirus vaccine is a liquid administered orally to infants. It became part of the Ontario vaccine schedule in May 2011.

Rotavirus kills 500,000 infants and young children per year worldwide, most in the developing world.

Since Saturday I have done at least ten loads of laundry with bleach. I have washed my hands hundreds of times and administered middle of the night showers a few times. The boys have been sipping filtered water all day long.

I cannot imagine trying to manage this without a good source of clean, safe, potable water.

The Bill and Melinda Gates Foundation began a rotavirus immunization program in Nicaragua (among other countries) in 2006. We are currently living only a few hours from Nicaragua. This program has had a tremendous impact.

Here are two slide shows that show that impact:

Protecting Children from Rotavirus, One Vaccine at a Time

Tracing One Rotavirus Vaccine’s Winding Path through Nicaragua

I optimistically look forward to a better night tonight and finally a first day of school for Lil C tomorrow. This was Lil D’s first day yesterday… though there was no second day today.

First day in a uniform (need to get navy shorts)- mom likes it!

Lil C’s sick day yesterday; he cried big tears when we told him he still isn’t well enough to go to school today.

And something I find amusing:

The folder that Lil D’s school gave him

Find our adventure now at FamilyFreedomProject.com or find my health and medical freelance writer site at LiisaVexler.com.

Tico Tuesday: Travel Health and Basketball

We’ve made some good progress on our preparations, some fun stuff and some must-do stuff.

Travel Health:

Last week our family paid a visit to the travel health clinic to get the low-down on how to keep ourselves healthy in Central America. Before that day I had not a hint of anxiety about this trip. Now I may have a little twinge.

The thing is, we have been to our soon-to-be adopted town three times before and I’ve never been worried… so why now?

It may be the length of our stay and thus the increased exposure to health risks that is bothering me… but I’m not sure.

Vaccines can protect us from (as of last Thursday) the following local threats:

• Hep A & B (not Derek for the B); since the boys will be in school with other kids Hep B was recommended
• Typhoid Fever
• Influenza (seasonal) – not that weird new one I read about yesterday
• Tetanus, diptheria, pertussis

Vaccines cannot protect us from:

• Dengue fever which exists throughout Central America: We need to protect ourselves from mosquitos two hours after sunrise and two hours before sunset – DEET 25% for adults and 10% for children. Herbal repellent can work but needs to be reapplied every 20 minutes. We need to wear all unscented products, wear light coloured clothing and long pants/sleeves if possible (last one not likely).
• Foodborne stomach issues: we have a “just in case” prescription for anti-biotics for very bad cases of this. On our past three visits this has been bearable, and much better than any trips to the Dominican Republic or Mexico. We never stayed in a resort and still ate salads and fresh fruit wherever we went.

At the end of the visit, after some tears, maybe a little screaming, some sugar and some interesting discussion about the photos of children around the world on the wall, my children came away knowing how lucky they are to have the protection they do.

The Unicef gift catalogue came last week and now Lil D is interested in purchasing the polio and measles vaccine packs as gifts.

Basketball:

My sweet husband Derek is a HUGE basketball fan. Up until last week, upon waking each morning he would check his iPhone before his feet hit the ground to see if the NBA lockout had ended (and boy is he happy it has!)

Well, Derek has been searching high and low on the Tamarindo websites for basketball and soccer programs for the boys, as well as some men’s basketball for himself. Through much search and much emailing, he has found soccer, and two full covered basketball courts, one with weekly pick-up.

He emailed the guy who organizes the pick-up run asking about the existence of kids’ programs. The funny guy emailed back something to the effect of,

“That’s a great idea Derek! Thanks for volunteering for the new Saturday morning kids’ basketball program.”

First Derek asked me if this was a misunderstanding or if the guy was a joker. I suggested that he was indeed being funny. However, Derek didn’t think it was funny. He thought it was great. He has now recruited that joker to help him get a basketball program for kids going in January…

If you’re you’ve got a basketball fan in your family and are planning a trip to Tamarindo or really anywhere in Guanacaste, let me know and I’ll hook you up with some hoops!

Here’s our to-do list progress for this week:

For Ottawa

• Organize home insurance as rental property (still waiting for quote)
• Purge our household contents; feeling the urge to pare down (solid wood crib, well-loved Step 2 playhouse and plastic piknik table are the next items…)
• Pack up house for renters; rubbermaid bins and wardrobe boxes on my shopping list this week
• Make contact list, instruction list for renters
• Pack for our trip – I bought 3 MEC duffle bags (so reasonably-priced!) as lightweight luggage for our clothing
• Get worksheets for Lil D from teacher
• Redirect mail to my parents’ house
• Inform security company of renter
• Modify cable, internet, phone services for renter

For Tamarindo (our Costa Rican town)

• Stock up on Cdn pharmaceuticals including DEET-containing products
• Second visit to travel clinic for last two shots for boys
• Doctor – Lil D annual physical (booked for early Dec)
• Buy new linens for CR
• Rebook renters of our condo in March for another unit in our building; we don’t want to back up and leave for that week.
• Plan trip in March to renew tourist visas – looking like Nicaragua (Panama would require anti-malarials)

So, with all this list-making, you can see that the holidays are not really on my radar. I am outsourcing that to extended family this year. I’m hoping that even the kids’ gift-opening can be done outside our home to minimize clean up. I hope everyone else’s preparations are going well. It’s hard to imagine Christmas and Hannukah are in 4 weeks…

Vaccine Overdose: What the Reaction Means (or Finding the Silver Lining)

If you have been reading this blog for a while, you may know that I am pro-immunization. I believe immunization is the safest, most cost-effective way to protect my children (and yours) and keep them healthy. So, writing this post has been an interesting exercise in telling it like it is.

In November, I took Lil C and Lil D to our family doc’s office for their annual influenza immunizations. Lil D was also due for his DTaP-IPV 4-6 year old booster (the shot that protects against diphtheria, tetanus, pertussis, and polio; between 4 and 6 years of age, the immunity gained from the earlier shots begins to wane).

The boys were not looking forward to this experience and they got each other more and more worked up to the point where they were both crying, begging and pleading for me to take them home.

The experienced, but not particularly helpful nurse left the exam room to go prepare the three syringes. As she left, I was getting Lil D ready.  But when she came back, I had Lil C sitting with me on the exam table. She was visibly harried and curtly instructed me how to hold him tight.

I did.

And she injected him. With the booster shot that was meant for Lil D. Not the influenza immunization that was meant for Lil C.

The second after she did it, I knew she had made a mistake. I asked her. She confirmed. She felt terrible. I felt nauseous. Lil C and Lil D were screaming.

The nurse went and got the doctor. She assured me that it would be okay and helped me to get the influenza shots into the 2 boys and the booster that was meant for Lil D into his arm. It took all I had to let them do this. But the thought of the anxiety that another visit would cause was too much to bear.

I gave the boys chocolate before and after their shots. They were both in their undershirts with snot and tears streaming down the faces running together with the melted chocolate around their mouthes. They looked like little street urchins.

And then Lil C’s arm swelled and got red and itchy.

We watched him for a few minutes and it seemed to get a bit better. I took the boys home. I was seething inside but trying to remain calm and nurturing for the boys.

Lil D told me he will not be like that next time he gets a shot because it wasn’t that bad.

Lil C got lots of cuddles and some ibuprofen. He woke up that night with a sore arm and got more analgesic.

Forty-eight hours later, this is what his arm looked like.

Overdosed arm

Healthy arm (with band aid from flu shot)

The morning after I took these photos, we had an appointment with the allergist for testing (since his brother, Lil D, has nut allergies). I asked the allergist to take a look at his arm; how convenient that I would get see a specialist in reactions! He said it would go away and that I should consider that this was a sign that he still had immunity to the antigens in the vaccine and his body recognized that.

We also learned that Lil C does not have any allergies to nuts and that in fact, he should eat them so that he doesn’t develop a sensitivity down the road. This presents some logistical issues since we have a nut-free home, but it is a relief in many ways.

Ultimately, no long-term or even medium-term physical harm came to Lil C, though I do wonder how he will be next year at flu shot time.

But, I am still angry with that nurse. She did so many things wrong beyond her blatant error. She did nothing to ease our anxiety on that visit. In fact, I would say she heightened it with her own anxiety.  I had come prepared with many tools but she did not give me the time or the assistance to use them (iPad, sugar in the form of chocolate, cuddles).

She needs some serious re-education in vaccine administration, from safety, through to pain-free administration techniques.

I am planning on sending some of the following resources to my physician’s office with a candid letter:

http://www.sickkids.ca/pdfs/Learning/32833-CMAJ%20HELPinKIDS%202010%20Appendix%202%20clinician%20tool.pdf

http://www.aboutkidshealth.ca/En/News/Video/Pages/Video-Help-Eliminate-Pain-in-Kids.aspx

http://www.toronto.ca/health/immunization_children/howtoreducepain.htm

This experience will have no effect on my belief in vaccines.  In fact, it underscores my understanding of the process and the importance of having well-trained medical personnel to make the experience easier for families.

Silver-lining:  I know Lil C is immune to diphtheria, tetanus, whooping-cough and polio.  Yay!

Lessons learned:

1) Don’t take both children for shots at the same time; they work each other up.

2) Act as an extra check for the health-care provider; slow them down and check that they are administering the right procedure/medication.

Find me today at LiisaVexler.com or FamilyFreedomProject.com.

It’s That (sniff) Time of (cough) Year (wheeze) Again

I just checked the stats on my blog and noticed an increase in the immunization-related search terms that bring people here.  I also noticed that the post I wrote about reducing pain in childhood immunization has gotten a lot of play lately.   And that reminded me (a little late), it’s inFLUenza season again!

Time to get immunized.  I actually got my shot at a doctor’s visit in late October.  But the kids – the kids!  I must get them there.  Luckily, Friday is a PD Day.  Oh what fun we will have getting passport photos and influenza immunizations.

Finola wrote about her husband’s bout with influenza earlier this month.  It’s not fun.  And it’s even worse for children and the elderly, populations that figure prominently in my current day-to-day life.

I’m not willing to risk it.

So consider this a public service announcement.  Get immunized.

For information on immunization in your area of Canada, go to Immunize.Ca.

In the US, try the CDC‘s info on influenza.

Have you had your flu shot yet this year?  Did the lack of hype compared to last year’s media frenzy surrounding H1N1 influenza make you feel like you don’t need to get immunized, or like me, almost forget about it?

Celebrating Immunization

In celebration of National Immunization Awareness Week, I thought I would write about my work and why this job will stay with me, even after I leave my paid position in a couple of months.

Let’s begin at the beginning.

When little D was born, I was anxious.  About everything.  My anxieties were mostly the common anxieties of a first time mom:  Was he eating enough, pooping enough, sleeping enough, looking around enough?   And what was that little red spot on his body; would he survive the stuffy nose he got at  3 weeks, and that irritation from the diaper, what should I do about that?  All of these anxieties were grounds for extensive Google searches.

At the time, in 2005, autism awareness was increasing, with a campaign on DirectTV which, before you got to your TV guide, gave you signs of autism to look for in your child.   In my anxious state, I would screen Little D daily for these signs.  Also around the same time, a connection between vaccines and autism was being touted by celebrities in the media.

It stands to reason then, that the impending 2 month well baby check where Little D would receive his first set of vaccines, was cause for concern to me.  I talked with friends, I ruminated, I Googled, and then, I asked my family physician about immunization. She is the expert I trust to fix us when we are not healthy, so why wouldn’t I ask her about immunization, a way to prevent future visits with her?

My first question about vaccines was about the connection with autism.  Dr. G. was unequivocal in her response and pointed me directly to the research.  She said to me, “you work in health research (I did at the time), read the literature”.  She gave me key words to search in PubMed, and off I went.

A few hours later, I was convinced.

1.  The proposed connection with autism had not been replicated.  The proposed association was extremely weak and the temporal relationship was not proven (i.e. the babies showed some signs before they were vaccinated with the vaccine in question).

2.  I would be protecting my baby from terrible diseases some of which, thanks to vaccines, are largely absent from our community, but which reappear from time to time, and are only a plane ride away.

2.  I would be protecting my baby’s aging great-grandparents, and our friends’ newborn babies whose immune systems were compromised or who were not yet fully immunized.

3.  I would be protecting others in my community for whom immunization was not an option or who had compromised immune systems.

I understand that it can be scary and uncomfortable to have your baby injected with a needle (or four).  I understand that we all fear the unknown.  But to me, the fear of a sick child, trumps all that discomfort and anxiety.

At 4 months of age, Little D came down with pneumonia.  Whether that pneumonia was one that we are immunized against is unknown, but I can tell you that those hours in the ER were not fun.  I would do anything to prevent that from happening again.

This year’s National Immunization Awareness Week’s theme is Vaccines Save Lives.  Just 100 years ago, many children did not reach their fifth birthday because of infectious diseases.

I saw this firsthand a year ago, when my husband’s Nanny R. died.

Nanny R. was in a wheelchair due to post-polio syndrome.  At her funeral in the oldest cemetery in our city, I noticed her mother’s gravestone (my husband’s great-grandmother).  It was a family gravestone which listed her name, and 2 of her children, ages 2 and 12, both of whom succumbed to what are now vaccine-preventable diseases.  In that one immediate family, there were 3 children who either perished or were severely disabled.

As we walked back to the front of the cemetery, I couldn’t help but focus on all the gravestones marking the little buried bodies of infants and children in the first part of the 20th century.  Again, my eyes were opened to the value of vaccines.

So, here I am, just about five years after questioning vaccines, working as an immunization advocate and educator.

In two months, I will leave this position to go work for my little bosses at home, but I will not leave be able to leave behind advocacy for immunization.

Happy National Immunization Awareness Week.  Please make sure that you and your loved ones are protected.

To those of you who immunize, thank you for all the work you do.  I’m sure you don’t hear that enough (especially from the kids).

Great resources on immunization in Canada are available at immunize.ca.

Complete info on immunization available in Canada, Canadian Immunization Guide

Easy to read, evidence-based book, Your Child’s Best Shot

Reducing Pain during Childhood Immunization

I was invited to participate in a workshop yesterday in Toronto.  I was sitting beside a woman who I will call Anna.  She was there to tell the group her story:

When Anna was a child, she had a rare condition which took years to diagnose.  Through the process of diagnosis, she had many needles.  She remembers being physically restrained for the shots and tests.  Eventually her condition was diagnosed and she was able to go on with her life.  Around the age of 16, when she could refuse, she stopped having any sort of medical intervention which required a needle, no immunizations, no blood tests, no IVs.  Even if she was sick, she would suffer through it.

At the age of 31, in an ironic twist of fate, Anna discovered that to have children she would have to undergo in vitro fertilization which would need daily injections, as well as a battery of blood tests.  Anna wanted to have children more than she feared needles.  At the first blood test, she fell on the floor in a panic and the hospital’s crisis team was called in.  She was restrained and they took her blood (with her consent).

There is a happy ending.  Anna has two fully immunized children, ages 8 and 6, and now she goes first at influenza shot time.

So, here are a few questions for you to ponder:

Did you know that there are about 1 billion injections given to children annually worldwide (CDC, 2001)?

Did you know that the most commonly asked question by children in a doctor’s office is “Am I getting a needle today?”

Did you know that health professionals and parents, to this point, have done very little to manage the pain of children getting immunized? (Taddio et al., Pediatrics 2007)

We’ve always considered pain a necessary evil in childhood immunization.  We say “it will just hurt for a minute”.

But what if it doesn’t have to hurt, or at least not as much?

Research has shown that rubbing the arm or leg before injection, holding a child, injecting really quickly (without aspirating),  using the less painful brand of a vaccine, and doing the shot that hurts least first, work  to reduce pain(Taddio et al, 2009).

Research has shown that topical anesthetics (Emla patches), feeding sweetened water a couple of minutes beforehand, and breastfeeding during the immunization, work (Shah et al, 2009).

Research has shown that breathing exercises (in kids that could be blowing a windmill or blowing bubbles), distraction by the nurse or parent(same methods as previous suggestion), child-led distraction (video on an iPod or video game) work (Chambers et al. 2009).

At the workshop, we got to see videos of infants and children who had their shots with and without using these techniques.  The results were striking (and hard to watch for a parent).

So why do all immunizers not use these techniques? There could be less pain, less fear, more satisfaction and perhaps even more willingness to stay on schedule with vaccines.

One energetic young family practice nurse told us about how she has implemented these strategies in her clinic and the great success she is having.  Her enthusiasm was infectious.

Not one of my sons, but a cute child nonetheless, blowing bubbles

The group who hosted the workshop are about to publish what is known as an Evidence-based Clinical Practice Guideline so that immunizers will have this information and will hopefully be able to incorporate it into their busy practices.  But in the meantime, we, as parents, can take this info to our doctor’s and public health nurses, and use some of the strategies ourselves.

The next time my boys are due for vaccines, I will:

1) Bring juice for them to drink a couple of minutes before (this would be sugar in water for babies).

2)  Bring bubbles.

3)  Buy Emla patches at my local pharmacy and apply them 45 minutes before their appointment.

4)  Bring Derek’s iPhone cause the kids love playing with it.

5)  Hold them during the shot (I usually do this anyway).

6)  Ask the nurse to do it quickly and ask her not to aspirate first (if she does; I kinda remember that she doesn’t but I just want to be sure).

7)  If they are having multiple injections, I’ll make sure she uses the more painless one first (I’m pretty sure she already does this).

8)  Distract them with discussion about something unrelated to the moment.

9)  Rub the injection site for a couple of seconds before the shot.

A couple of interesting points about techniques that DO NOT work to reduce pain:

1)  Analgesics prior to immunization (Tylenol or ibuprofen).

2)  Reassurance from the parent.  It does not help to tell your child it will be over or they’ll be okay.  Apparently research has shown that this makes them more anxious.  I am definitely guilty of this.

These techniques also work for blood tests and IVs.

Do you have any other great tricks that work to distract your kids or reduce their pain during immunization, blood tests or other injections?

Find our family adventure now at FamilyFreedomProject.com or find my health and medical freelance writer site at LiisaVexler.com.

Why did it take so long? Gardasil approved by Health Canada for males age 9-26

This week, Health Canada approved the Gardasil (HPV or human papilloma virus) vaccine for boys and men ages 9 to 26.   I’m no sexual health anthropologist or women’s studies expert, but I have big red question marks in my head on why this wasn’t done at the same time it was approved for girls and women.  Yes, I realize that girls and women are the ones who get cervical cancer so it was a priority to approve this vaccine for them… but couldn’t the trials and the data have been done on both sexes at the same time?  Like for every other vaccine??  If I had the time, I would go and read the record of decisions on this from when the HPV vaccine was approved for women – maybe I will try to find the time right now.  I’m quite perplexed.

My boys are still too young for this vaccine, but they will certainly get it when they are eligible.  For the same reasons they get the other vaccines, to protect themselves (from nasty warts on their man parts – how absolutely disgusting to think about in my babies), and to protect their partners (also somewhat disturbing to think about for a 2 and 4 year old).

At any rate, this is really the logical follow-up to having the HPV vaccine recommended for girls and women in the same age group and I’m surprised it took so long.  Or maybe I’m not surprised.  Are you?

Totally Freaked Out…

… by this article from Toronto Life Magazine about “pure parenting”.  What a perfect topic for my first real post.

Do these people really exist?  I mean, I know they do cause I know people who are on the fringes of this, but really and truly, NEVER any store-bought bread?  Having the gall to ask people for a particular type of toy for a child’s birthday (if you don’t like it when you get it, take your own time to go exchange it)?  Fear of a rubber ducky leaching phthlates into bath water?  What would happen if it were in the bath water?  Is there any evidence that a minute trace of phthalate in the bath water is associated with any sort of condition?

And then there’s the vaccine issue… how it gets lumped in with the other neuroses in this article is so frustrating for me.  The parents in this article are described are doing everything they can to ensure their babies health but they don’t want to give them potentially life-saving vaccines?

My last big beef is the neurotic behaviour of the parents – those can be felt by children.  I’m convinced of that.  In my house, we’ve purposely started avoiding the phrase ” I worry about “when speaking to our older son D.   It sounds strange coming out of a 4 year old’s mouth and he has recently taken to saying it.  Hopefully the less he hears it from us, the less he’ll use it, or think it.

I’m all about moderation and balance (on most days).  In our house, here’s what we do for our children:

VACCINES:

• Both boys vaccinated on schedule for all recommended vaccines, even those that are not publicly funded (Hep A for vacations in the Caribbean and Central America and Meningicoccal Conjugate)

FOOD & FOOD STORAGE

• Generally the children eat nutritious foods, fruits, veg, whole grain, unprocessed, though purchased at the regular grocery store.
• Occasionally food is organic, but not always.
• On the weekend we eat out usually twice (usually one brunch and one dinner, though sometimes more).
• The boys like hamburgers and french fries (though not usually fast food) and sometimes ice cream.
• Metal water bottles
• Reusable lunch containers (except the odd ziplock bag when I just can’t fit it all in the lunchbag)

PERSONAL CARE PRODUCTS & CLOTHING

• Not usually organic though I love Little Twig Tangerine organic Baby Wash and Shampoo – the smell is heavenly; choices are usually based on convenience, availability or preference.
• Diapers and wipes – disposable… not a chance I would ever have selected cloth.  Thank goodness only a few months left (I hope).
• If the organic clothing is as cute as the conventional, then I’ll go for it; otherwise, forget it (I do the same for my own clothing).

TOYS

• We try to use good quality toys.  Turns out they are mostly wooden and that is my personal preference.  I hate cheap plastic and avoid the dollar store toys at all costs (except gifts!  We teach the boys to say thank you no matter what the gift).

CLEANING PRODUCTS

• While I try to avoid harsh chemicals, we live in a northern climate which means that germs are rampant for at least 5 months of the year when we are primarily indoors.  For that reason, I firmly believe in proper disinfection of commonly used surfaces.  We never spray around the children or near anything they might consume.

So, I know I have no readers as of yet, but if you do happen to read, I’d love to know what you do in your house, and what you think of the Toronto Life article…