the pulse

H1N1 (Swine Flu): To Vaccinate or Not To Vaccinate

2009-10-14T05:45:00.000-07:00

A week or so ago, our friends at StrollerTraffic.com came to us with their readers' most pressing questions about the new H1N1 vaccine. Seems their inbox (like ours) has been overflowing with questions, confusion, and dare we say, a little bit of panic.
Being on their panel of experts, we of course were happy to field the most frequently asked questions, break down the facts, explain some of the issues and controversies surrounding the vaccine, and hopefully talk a couple of readers down off the ledge so they could make a sound, educated decision about whether to vaccinate or not to vaccinate.
Here, the full unedited version of "Worth a Shot? H1N1 (Swine Flu) Vaccine Update", originally written for and published by StrollerTraffic.com.
(Disclaimer, it's a bit long...but we think, worth the read...So fill up your coffee cup, put up your feet, break it down into 2 parts if you have to, and enjoy!):

WHEN WILL THE VACCINE BE AVAILABLE?
The first 7 million doses of H1N1 vaccine began shipping the week of October 5. Another estimated 60-195 million doses are anticipated to ship over the next few months in weekly batches. Currently we have no information as to the where the rollout of the doses will occur. The best strategy is to watch your local news and keep abreast of notices posted or sent by your health care provider.

ARE THEY ANTICIPATING ENOUGH TO MEET DEMAND? WHO ARE THE PRIORITY RECIPIENTS?
Hopefully, yes -- especially as it pertains to high risk individuals. The first groups who will be targeted for immunization are the following:

Household members/caregivers of babies under 6 months of age
Children 6 months - 4 years of age
Children 5 years - 18 years of age with high risk health conditions (asthma, lung disease, sickle cell anemia, heart disease, chronic kidney disease, immune compromise, chronic asprin therapy, blood diseases, neuromuscular diseases, diabetes, and HIV)
Pregnant women
Adults with high risk health conditions
Health care workers
Very obese individuals (BMI >35)
Elderly living in nursing homes & assisted living facilities

IS THERE ANYONE WHO THE VACCINE IS NOT RECOMMENDED FOR?
For individuals with severe egg allergy, or history of anaphylaxis to egg or any components of the vaccines, immunization is not recommended. In addition, individuals with a history of Guillain-Barre Syndrome shouls not receive the influenza vaccine.

WHAT ARE THE DIFFERENCES AMONG THE 4 VERSIONS OF THE VACCINE?
Currently 4 manufacturers have been producing H1N1 vaccine. Three are producing shots, and one is producing a nasal spray.

CSL Brand: FDA-approved for individuals 18 years of age or older
Novartis Brand: FDA-approved for people 4 years of age or older. There are 2 forms of this shot:
1: Multi-dose vials -- using thimerosal as a preservative
2: Pre-filled single-dose syringes -- thimerosal used in the manufacturing process but extracted before final production

Sanofi Brand: FDA-approved for children 6 months of age or older. There are 2 forms of this shot.
1: Multi-dose vials -- thimerosal-free
2: Pre-filled single-dose syringes -- thimerosal-free
Medimmune: FDA-approved nasal spray for individuals 2 years of age to 49 years.

The SAME stringent manufacturing standards and processes used for the production of regular seasonal influenza vaccine apply to the H1N1 vaccine as well.

WHAT SHOULD I KNOW ABOUT THE VACCINE IN NASAL SPRAY FORM AND HOW DO I CHOOSE BETWEEN THE SHOT AND THE NASAL SPRAY FORM?
The mist form of H1N1 vaccine is very similar to Flumist - the vaccine used for seasonal flu protection. It is a live-attenuated vaccine, and is thimerosal-free. It is FDA approved for healthy people 2-49 years of age. Two doses are needed for kids under 10 (given a month apart), and one dose for kids 10 years of age or older.
If your child does not have a history of asthma, recent wheezing, or a high-risk health condition, the mist form of the H1N1 vaccine is a non-painful option for your child. The downside might be a day or two of sore throat, sniffles and/or a low-grade fever. Live virus preparations typically activate a different arm of the immune system and may result in more prolonged immunity. The H1N1 pandemic vaccine in mist form is free, however your health care provider will likely charge an administrative fee to cover the cost of staff time, disposal of syringes, and administrative time necessary to obtain the vaccine.
Certain individuals SHOULD NOT receive the mist form of H1N1 vaccine. They include:

Individuals with severe/anaphylactic reaction to egg or components of the vaccine (gentamicin, gelatin or arginine)
Pregnant women
People with asthma or active wheezing; children under 5 years of age with recurrent wheezing
People with immune deficiencies
People with underlying medical conditions that may be aggravated by live vaccine (always check with your health care provider)
Children under 2 years of age
People with extremely stuffy, congested noses (as absorption of the vaccine may not occur)
Children or adolescents on chronic aspirin therapy

SHOULD I WORRY IF MY CHILD CAN ONLY GET A FLU SHOT THAT USES THIMEROSAL PRESERVATIVE?
No. Priority for thimerosal-free vaccine will be given to pregnant women and children. However, if the only flu vaccine available for administration is one in which thimerosal was either used in manufacturing or a tiny amount in the final product, it is still a good idea to get the vaccine.
Thimerosal is a preservative that has been used since the 1930's to prevent contamination isn some multi-dose vials of vaccines (preservatives are not required for vaccines in single-dose vials). Thimerosal contains approximately 49% ethylmercury, not to be confused with Methlymercury (found in sushi and large pelagic fish such as halibut, swordfish and tuna). The kidneys excrete thimerosal very effectively, while methylmerciry is fat-soluble and more likely to be absorbed by its host.

There is no convincing evidence of harm caused by the low doses of thimerosal in vaccines, except for minor reactions like redness and swelling at the injection site. However, in July 1999 the Public Health Service (pHS0 agencies, the American Academy of Pediatrics (AAP) and vaccine manufacturers agreed that thimerosal should be reduced or eliminated in vaccines as a precautionary measure.
Thimerosal-free influenza vaccines are available, but in limited quantities (availability will improve as manufacturing capabilities are expanded). Priority for thimerosal-free vaccine will be given to pregnant women and children. However, if the only flu vaccine available for administraion is one in which thimerosal was either used in manufacturing or a tiny amount in the final product, it is still a good idea to get the vaccine. To date, there is still not any substantial proof that thimerosal is harmful in any way.

ARE THERE ANY CONTROVERSIES AROUND THE VACCINE, ITS INGREDIENTS, ETC?
The H1N1 vaccine does NOT contain any aluminum or other adjuvants (products that increase a body's response to a vaccine). Other countries have used adjuvants since 1997 but the US manufacturers have never done this. As a result all H1N1 vaccine (in all forms) is adjuvant-free. This has been a source of debate because using an adjuvant makes it easier to create more vaccine to meet demand.
Many parents have come to use with concerns that the H1N1 vaccine may cause Guillain-Barre Syndrome (GBS). Certainly on the internet this concern is a hot topic. It's worth a little extra reading on the CDC website to set the record straight.

IS IT A ONE DOSE SHOT OR IS A BOOSTER REQUIRED?
H1N1 vaccine has slightly different ground rules* than regular seasonal flu vaccine. Think of the first dose as "priming" the immune system, and the second one as "activating" the child's immunity. One dose will NOT protect a child 6 months of age through 9 years.
*Normally, regular seasonal flu vaccine requires 2 doses the FIRST YEAR it is given for children under 9 years or age, and then once yearly after that.)

ARE THERE ANY POSSIBLE SIDE EFFECTS CAUSED BY THE VACCINE?
Typical reactions to the H1N1 vaccine are anticipated to be the same as those experienced with regular seasonal flu vaccine. For the shots, these include possible pain/soreness at the injection site, muscle ache, headache, low grade fever (usually for a day or two), fainting (usually in adolescents) and rarely allergy to one of the components of the vaccine. For the nasal mist preparations (since they have low levels of the live virus) nasal congestion and stuffiness are fairly common for a few days after administration, in addition to possible low grade fever, muscle aches and fatigue.

HOW HAS THE VACCINE DONE IN CLINICAL TRIALS?
Two different 2009 H1N1 influenza vaccines have been enrolled in clinical trials as of July 2009 -- one made by Sanofi Pasteur in Swiftwater, PA and the other by CSL Limited in Melbourne, Australia. Initial review of the data involving more than 500 healthy adult volunteers showed both vaccines to be safe and effective. Because of these positive results, clinical trials began on children on August 18, 2009 using the Sanofi H1N1 vaccine.
The pediatric trials have involved eleven medical centers nationwide, and more than 1200 children between the ages of 6 months to 17 years have been given the vaccine. Preliminary results published 9/21/09 showed that an effective immune response was seen in the majority of 10-17 year old eight to ten days after receiving the vaccine. Younger children generally had a weaker early response to the vaccine.
Current ongoing studies are addressing whether there is a dose:response relationship with the vaccine - i.e. is giving more of the vaccine going to yield better or longer immunity? In addition, the effectiveness of combining seasonal influenza vaccine with the 2009 H1N1 vaccine is also being examined. Data will be updated as it comes in from the National Institutes of Alelrgy and Infectious Diseases (NIAID) and from the National Institute of Health (NIH).

SHOULD MY CHILD GET BOTH THE SEASONAL FLU VACCINE AND THE H1N1 VACCINE?
Yes, it's a good idea to protect your child from all threatening strains of flu this year. Most health care providers already started administering regular seasonal flu vaccine early in September. Unfortunately, full production and shipments of vaccine to all health care entities were held in order to produce H1N1 vaccine. As a result, your health care provider may be awaiting shipment of more regular seasonal flu vaccine (especially preservative-free formulations) -- and all any of us can do is wait patiently for the remainder.
Both seasonal flu shots and H1N1 shots can be given on the same date and if a repeat dose is needed, those doses can be given together as well. The only tricky part here is that a child cannot receive protection from two MIST preparations on the same day. So a parent has the prerogative to opt for one shot/one mist. If you only want your child to receive flu protection in mist form exclusively, you must separate all those doses by 4 weeks -- thus stretching out immunization over 4 months and possibly delaying the timely administration of second doses, if required.
Also, keep in mind that if your child has had any other live virus vaccine (ie MMR, Chicken Pox or Rotavirus vaccine) within the last month, you should wait FOUR weeks after that vaccine before administering any flu vaccine.

AFTER WHAT DATE IS IT TOO LATE TO GET THE VACCINE?
Peak flu season varies across the US -- on the East Coast and Northern regions flu season peaks around the holidays, whereas on the West Coast and Southern regions, often it peaks as late as February. Unfortunately, since H1N1 novel strain seems to know no "season" (having surged in the Spring, quieted a bit in summer, now ramping up again) anytime is appropriate, but the earlier the better. What we have yet to know is whether we will need to have to repeat inoculations more than once yearly, given the propensity of H1N1 to occur year round (as typical influenza vaccines last generate only 4-6 months of immunity).

For regular updates on H1N1 and its vaccine, we suggest you visit the CDC Website regularly, and/or follow @CDCflu on twitter.

To read the edited version of this article, "Worth a Shot? H1N1 (Swine Flu) Vaccine Update" visit StrollerTraffic.com and their health and safety section.

Diary of a Doc: Dr. JJ on a Mission -- Headed to Medellin

2009-07-06T19:31:00.000-07:00

Hi everyone...greetings from the Bogota airport! We are waiting for our flight to Medellin, Carmen's hometown. Our 3 days in Bogota sped by, fueled by jet lag and an itinerary that forced us to fall in love with this crowded metropolis. Bogota itself is very green on the periphery, where roses grow in regimented hothouses, visible from the air and country roads. Yesterday we trekked to 2 salt mines where we were awestruck as cathedrals of salt were carved into their walls, and estuaries of salinated water are piped to distant factories to supply salt for industry and consumption. Today we went to the Museo Del Oro, where again, we were slackjawed viewing amazing artifacts, all in pure gold, tracing the history of Colombia from BC to AD. The intricacy of the workmanship and the symbolism were aptly explained by our hero, our tour guide Freddy.

Meals here are so different than the U.S. ...everyone stokes up on breakfast, and the main meal is lunch -- usually around 2pm and most often a 3-hour affair. Today we had an early lunch (noon) at Pescara di Jaramillo -- felt like Miami with marlins on the walls and ceilings regaled with sails. The main choice for most of the folks at the table was a whole fried fish (I'll post pics later), but Don Shaul chose the best ceviche I have ever sampled, and my grilled crab claws and octopus were amazing.

Imagine the face on the poor agent at Avianca when 18 showed up for check-in (today is #2 flight in 7 total legs for this trip!). Now sitting in the lounge enjoying some pretty yummy local snacks called Achiras (kind of like puffy parmesan cheezits) while waiting for our plane to Medellin. It's a half-hour flight and literally scrapes the tops of the Andes enroute...so as we fly in the light of day, hopefully there will be enough sun to take some awesome pictures...

On this leg we visit many of the medical schools and hospitals, and deliver trauma and CPR mannequins to several departments, teach how to put in interosseous lines, and deliver some toys to hospitalized kids. We will consult with the local docs on what they need and want to learn. It will be the beginning of the medical journey we are all yearning to take here. Carmen and Consuelo have been amazing hosts so far, and our accommodations and meals have been first class...not what most of Colombia enjoys daily, but nonetheless providing necessary comfort for this nervous introduction to Colombia.

The company of our traveling companions is wonderful. There have been very few times over the last several years that we have been able to share a conversation without interruption or getting paged, so having in-depth discussions about everything from medicine to kids is wonderful. The kids (ranging in age from 9-19) have been fabulous so far, all bonding on different levels, nary a whine or complaint.
So on day 3, we are ready to start our real journey!

More to come...
xo - JJ

Diary of a Doc: Dr. JJ on a Mission - Colombia Day 2

2009-07-04T07:03:00.000-07:00

Day 2, Bogota....a big hiking day, down literally into the salt mines that feed all the industry and provide salt for most of this part of the world. Into 2 of them are built actual cathedrals, where tourists abound, but weddings, funerals and baptisms occur, and also Halloween parties and receptions...every single inch of wall and floor is salt...then to Andres Carnes de Res - the craziest restaurant I've ever seen!

There are so many cars in Bogota that every person's license plate restricts them to driving 2 days/week. Motorcycles are exempt, but riders must wear their licenses on their backs (for security purposes so assassins could be identified. Yikes!)

Entry gates to the farms take on many bizarre shapes and forms.

This is the monument outside the Zipa salt cathedral, where miners work year round excavating 300 acres of underground salt mines...and have built not one, but two salt cathedrals.

Entry to the tunnel, where we hike down a steep 1000 ft drop, pretty much in the dark, with slippery salt floors (they are black -- and only turn white when water is added).

One of the 14 stations of the cross...this particular salt cross is 10 ft tall and weighs upwards of 3 tons.

The salt dome that heralds the entrance to the cathedral -- polished, perfect...looks like the night sky.

A small chapel within, with sandstone sculptures of the birth of Christ in Bethlehem.

A recreation in salt of the Michaelangelo ceiling at the Sistine Chapel. In this frieze, God's hand is 3 times larger than man's. Man has no eyes as he is imperfect.

Overlooking the town of Zipa, site of the first salt cathedral.

A beautiful old woman carting her goods in the small town of the 2nd cathedral.

Entrance to this salt cathedral is supported by Eucalyptus that forms the structural integrity inside. It takes 100 years for it to petrify, harden and become fully encrusted with salt.

This is a reflecting pool, over 100 meters long, 10 feet deep, and thought to have healing powers more powerful than Lourdes.

We turned a corner and gasped at this artist's 2 ton heart sculpture...lit from the front with a small red light and glowing eerily but beautifully.

Stalagtites abounded...looked like frozen icicles. They bend because of the wind in the caves and grow 1 cm /yr. These were all about 200 cm long!

This cow was there when we started our tour
...and still in the exact same place when we finished.

And to top off the day, lunch at the CRAZIEST restaurant -- Andres Carne de Res. At the street you are greeted with so much eye candy, sculptures, stuff hanging from trees and public art...you know something good is inside...

Another vaca, next to a bottle cap-filled heart...he flanks the front door.

Inside...enlarge the pic and play Where's Waldo :-)...in every corner a surprise and discovery. The restaurant has 300 tables that hold 8 people each....it's wild!

At the end of the hallway in the co-ed bathrooms...Ken will never be the same....in the Men's-only room were a pair of breasts at eye level above each urinal...Bucca di Beppo can't even come close to this place!

Pull on the leather arm and the door opens...

More adventures to come...Tomorrow off to Medellin and the top of the Andes....
Happy Independence Day to all! Stay tuned for another post from Mission Colombia!

xo - JJ

Diary of a Doc: Dr. JJ on a Misson...a Medical Mission -- Columbia, Day 1 pics

2009-07-02T18:04:00.000-07:00

So excited to show you the pics from yesterday's first day...Here goes!

July 1: first day in Bogota after a redeye from LAX -- all 18 of us arrived in one piece, and never stopped touring all day. Got a little woozy at 10,000 feet at the Monserrat Cathedral, but otherwise hung in...early to bed...more adventures today (pics and today's diary coming soon!)...will try to post daily. xo - JJ

Bogota is very hilly - feels like Old San Juan. CRAZY drivers and no rules...lots of car repair shops!

The streets are as colorful as the people.

We visited the Interior Minister's palace (Palacio di San Carlos) where I fell in love with this mirror (it's 6 feet in diameter!). Do you think they would notice if I "borrowed" it for my living room? Just kidding.

One of the many private courtyards. That'll work.

Old Cathedral. Have you ever seen a more beautiful brilliant blue sky?

In the public square...another friendly alpaca awaits his photo op. (And we just had ponies!)

The ultimate smiling vendor. Chalupa anyone?

The group with the palace guard (yes, they ALL look like they're 15 years old).

Enroute to Monserrat Cathedral -- there is a lovely waterfall with the icon of Bogota on the right -- while you await the tram that takes you on a harrowing 2000 foot vertical rise...you are calmed by this vision.

And then you board...

and go up...

and up...to view this city of 7 million.

And at the top, our group on the steps of the Cathedral in the pouring rain, out of breath and a bit headachey with the sudden rise in altitude...but eager to see the ornate chapel within...

Then back to the hotel after a long lunch at Casa Vieja where we ate corn cakes called arepas - with chimmichurri, amazing empanadas, potato soup, incredible steak, and the local beer - Club Colombia - which was EXCELLENT! Nighty night until tomorrow...

Diary of a Doc: Dr. JJ on a Mission...a Medical Mission -- Colombia, Pt 1

2009-07-01T16:33:00.000-07:00

In this Diary of a Doc, we catch up with Dr. JJ on a medical mission to Colombia. Unsure exactly what to expect, yet incredibly excited, the group of 18 landed in Colombia this morning and hit the ground running. Headed up by Dr. Carmen Botero (yep...THAT Botero!), the group of doctors, doctors' children (many quite accomplished in their own right) and contributing guests begin their trip in Bogota, absorbing the sites, sounds and culture of the capital city before heading to Medellin, Cali, Cartagena, back to Bogota and home to the U.S.

Here, Part 1 of Dr. JJ's travel diary:

"Funny I was stressing that I had 2 suitcases, Carmen had 12! And 14 huge boxes…needless to say after arriving in Bogota...getting out of the airport involved going through several gauntlets…but so amazing that a couple of the porters knew and recognized Carmen and treated us with ultimate respect.

Ali Namazie, his wife Giselle (an internist), their 2 girls, Don Shaul & Shirley Suda and their 2 boys, a premed Junior from Masters University, Sister Colleen Settles (an ordained minister and Dominican Nun from Kalamazoo, who ROCKS by the way...), Carmen, her son Omar, assistant Consuelo, Howie and Ellen Reinstein, their adorable daughter Mikaela (a special ed teacher in Oakland), and Mark Koenig, Providence international mission expert compose our contingency.

Air quality in Bogota is horrible – from the air it is so green it looks like a massive golf course with Andes Mountains attached…once on the street, no traffic lanes, CROWDED buses, rogue ambulances and scooters, innumerable car repair shops (wonder why?), cows and horses on mere spits of land between lots of cinderblock buildings…and at the height of the city, modern construction, business people looking like they are out of central casting, our hotel, and 18 hungry and tired travelers awaiting our first stop at 10am this am – the State Palace – where we will have a private diplomatic tour...(stay tuned for pics!)

Since the food on the plane was inedible (but oh, the wine was good), off to a quick breakfast and then the days’ tour…..

Kind of cool that the hotel conserves it's resources – you have to put your key in a slot (a slot they don’t tell you about, btw) in order to turn on any lights in the room. For this tired traveler it took a few minutes…but the internet connection is good…and so far so are we…..

Until next post....

Xo, JJ"

Diary of a Doc: Dr. JJ -- 1109 Days & Counting

2009-06-17T17:15:00.000-07:00

Oh boy, the summer is really flying by! It seems like just yesterday I heard "Mom, I am so glad to be home, and can't wait to be here for 3 months!" Now the drums are thumping in the direction of Ann Arbor as Max is "home"sick for school and can't wait to get back! In the meantime, he is truly enjoying his job (and believe me, a job is hard to come by for these kids returning from college), and this week his comrades from the UC schools returned to a bit of fanfare from their buddies.
Our refrigerator staples are lasting a bit longer, as Max is eating out a bit more, and while home, is trying sincerely to eat well and get a little exercise. His dad and I wish his socks and dirty laundry would exercise their way into the basket located directly in the line of fire of his bed! But aside from the expected messes, late nights, and groggy mornings, we both are enjoying the unfolding stories that continue to come our way, and the (mostly) pleasant banter we have reestablished day to day. Some of you have had "Max sightings" as he borrows my car every Tuesday, accompanies me to the hospital to make rounds in the morning, and then picks me up in the afternoon.
He caught me off guard this week, when I was having a "moment" of feeling overwhelmed, hugged me tight, and told me he really didn't get how hard I worked until he stared at the wall in my office with diplomas & certificates, etc. He sincerely told me how proud of me he was....and of course, in moments like those, there is total absolution for all dirty socks and stinky laundry, late nights, overdue bank accounts and half-eaten food in the fridge. It's so interesting that as Bruce and I made this adjustment to an empty nest, the definition of who we were morphed. Although I will always be "Max's mom" whether he is far or near, it's only when he is here, in the flesh, that I feel I can be the 3-D mom.
Ahh, it's good to be mom...

Sun-Proofing Your Child's Skin: Dr. JJ's guest blog as seen on Huffington Post

2009-05-20T09:33:00.001-07:00

This month marks the beginning of beach vacations, pool parties and outdoor BBQs, which means it's a crucial time to keep your child's skin protected from the sun's harmful UV rays. May's National Skin Cancer Awareness Month reminds us all to practice sun safety -- not just during the year's hottest months, but year round. A parent has good reason to engage in sun protection early on: One blistering sunburn from unprotected sun exposure as a child can possibly double the risk of melanoma (the most serious form of skin cancer) later in life. And one in 55 people will be diagnosed with melanoma during their lifetime, according to The Skin Cancer Foundation.

In spite of these sobering statistics, most of us -- more than 66 percent -- don't use sun protection regularly. But if we help the youngest members of the family start off on the right track, and as parents we begin to practice what we preach, our children will be more likely to make a habit out of protecting themselves.

To find out how, click here to read more from Dr. JJ's guest blog on Huffington Post.

Diary of a Doc: Dr. JJ -- 1149 Days and Counting

2009-05-19T19:17:00.000-07:00

So my son, Max, is home from college in all is glory -- 3 stuffed duffle bags (gotta give him credit...at least he did his laundry before coming home. His clothes were wrinkled, but CLEAN!), 1 backpack, 1 computer case...aching for a haircut and an In N' Out burger. It took almost a whole school year for Bruce and I to get into some sort of established rhythm and routine with the nest being mostly empty, and Max's return has thrown a wrench (quite happily I might add) into daily life. He has taken up temporary squatting rights on the sofa, as his bed is still sandwiched between our office desks and the wall (I am none too happy that my home office is still not ready), a bookcase is serving as his closet in the dining room, and the refrigerator is suddenly much emptier as Max returns to home cooking. I learned yesterday while shopping in the market with him that A1 Steak Sauce is his savior at school -- drowning out all unsavory tastes and rescuing the hopelessly boring food served in the dining hall (at University of Michigan)...ugh! We'll have none of that this summer. Already the energy in the house is different, as a smattering of his local friends are starting to stop by (eyeing him jealously as their school terms aren't over for another month) to eat, visit and reconnect. I give Max credit in that the first day after arrival , after getting a decent haircut , he was on the move looking for a summer job (or two). He wants to get his feet wet in law or entertainment, and also wants to make a little $$, whether babysitting, working in the mall, tutoring or whatever...
He is pretty motivated without a kickstart from us! Some things haven't changed, however -- the smell of the young man pervades the household (those feet! Ugh!), the tabletops now littered with the detritus of a good snack, and the reality that mom gets a few extra bear hugs a day. I am in heaven (when I'm not cooking!).

Diary of a Doc: Dr. Diane -- Reflections on Becoming an MD and a Mom

2009-05-10T15:11:00.000-07:00

I often get asked "How do you do it? Being a mom of 2, pediatrician and co-founder of MD MOMS?". I find myself wondering why the question was posed, as it suggests that I'm managing an insurmountable feat of some kind. I'd imagine I'm not all that different from most career moms out there. It comes from the delicate, not always controllable, but somehow effective balancing act of just doing the best I can, in roles that really fuse together and become one. A role that is shaped by life but one that I hope would be an adequate model for my kids to observe and learn from.

Having fled Vietnam during the height of the war at the age of 10 and immigrating to the US, I've experienced what it means to start anew in a very different land and culture. I have memories of a more privileged life in Vietnam, with nannies, tutors and chauffeurs. Yet my more intense recollections were of my efforts to assimilate into being a 5th grader in America. I learned that my pajamas are not to be worn at school, that holding my sister's hands while we walked home from school was seen as 'too intimate', and that you can actually refer to your teachers by their first name without any reprimand. It wasn't always easy, but we worked hard
to assimilate and excel.
As life went on, I began to recognize that my motivation stems from observing my parents' sacrifices to rebuild their lives from scratch for the benefit of their children. Therefore, I strived to take advantage of every blessed opportunity afforded to me by excelling in academics. I entered UC Davis medical school after attending UCSD and graduated from my pediatrics residency without any breaks for travel or real work/life experiences.
I got married after internship and became pregnant at around the second year of residency, and by the time I joined my first pediatric practice, I was a mother with 2 kids under the age of 4 (gulp).

It's often said that having children makes you a better pediatrician. While I think that is certainly true, personally, I feel that my experiences in my practice have taught me to be a better mom. As I struggle with a tragic diagnosis, or a difficult situation, I've become better at putting life into perspective and have tried to "not sweat the small stuff" at home. Through my children's young years, I worked full time, but as they have grown beyond after-school care, I've cut back my hours at the office. My husband is a physician also, so the whirlwind of both medical schedules and the academic schedules of 2 children left us with a short window of quality time in the evenings (often filled with homework) certainly not conducive to a relaxing bedtime routine!
Now my hours at the office coincide with their school time, and I'm a ready presence for them when they return from school. Oftentimes, homework time is a perfect time for me to work on my homework: MD Moms projects.

I wouldn't go so far as to say that life is easy, but I know first hand that it could be a lot tougher! Though my children are far removed from the first generation immigrant experience, I hope that they will strive to do the best they can with whatever life floats their way. And if they ever do find themselves having challenges with multitasking, I will remind them to do what I do and "not sweat the small stuff"!

Happy Mother's Day to all of you!!

Diary of a Doc: Dr. JJ -- On Being an MD Mom and Striking the Balance Between the Two

2009-05-09T17:18:00.000-07:00

While perusing one of our favorite sections of the NY Times, the Well blog, we were understandably drawn to an entry called "Doctoring and Mothering", along with a moving companion article by Dr. Pauline Chen, "Bringing Out the Mother in All of Us". It gave us a moment to reflect on our own lives, as women, MDs, moms and, of course, as the MD Moms. We can certainly all relate to the challenge of striking that perfect work/life balance, and we'd without a doubt be zillionaires if we had the magic formula.
At the end of her blog, Tara Parker-Pope posed these questions to her readers, "Are you a doctor juggling the challenges of patient care and family care? Is the balancing act faced by doctors any different than what every working parent experiences?"
Here, Dr. JJ weighs in with her very personal perspective:

My opportunity to become physician, wife and mother all occurred within such a narrow window I didn’t think twice. I entered med school at age 30, married later that year, and delivered my son 9 months before graduation. During residency at CHLA my little guy was our class mascot - an ever present cherub brought to visit by his dad (the defacto mother as well), and discovering McDonalds (on campus in the hospital) a bit too early in his life.
The reality of what impact my training and lifestyle had on my young son came one day, when I picked him up from pre-school. I was dressed in my usual sweats (never wore scrubs outside of the hospital). His teacher laughingly remarked what an imagination my son had when asked what his mother did for a living. He replied “She’s the doctor at McDonald’s!” She thought he was just imaginative - I set her straight.
I knew from the get-go that both pediatric medicine and raising a child would dovetail nicely, but would require sacrificing time away from home. For us the quality of the time remaining together certainly overshadowed the quantity. I was always of the mindset that to be a great physician meant working fulltime and being there for my patients unconditionally. For me a doctor-patient relationship is strained when the doctor is not a present force the majority of the time. The learning curve for the physician is also diminished when the responsibility for the patient is handed over to others.
My husband worked from home in order to care for our son, and it was clear that I had to be the breadwinner for us to successfully manage our obligations. In the early stages of building my practice I made the conscious choice to NOT work part-time, to NOT ask for time off for small events (and saved my requests for the times that really mattered) , despite the glares from my part-time female colleagues. Was I any less a mother? I don’t think so. Did I become a better physician as a result? Yes. Was it worth it? Definitely.
With one child, certainly, this “balance” is more manageable. What challenged us greatly was the addition of parenting my mom for 5 years, as she had developed Alzheimer’s at an early age. Our best-laid plans cracked and the challenge of parenting/care-giving became too much as my mom’s dementia worsened and her health declined. Our marriage became strained as my mother’s needs grew, and there weren’t enough hours in the day to really tend to everyone’s needs. We moved mom into an assisted living facility which helped restore balance at home, but certainly made it impossible to consider cutting back hours and spending more time at home during my son’s middle school/high school years.
I wanted so desperately to process this stage of his life and make sure I had done enough to prepare him to be an intact, emotional responsible young adult. I started writing about him, his successes, failures, accomplishments, looked at his learning curve, his friendships, his insights. By the time he graduated I was convinced that his dad and I had really done a reasonably good job of preparing him for real life, despite the topsy turvy nature of our family life.
Now my darling son is 18, having finished his freshman year of college. I am still plugging away, and although I have missed many, many of his daily feats and events through the years, his dad has always been there. We have a very special bond despite the time away from home. He has a very happy mom, as I have been able to achieve my dream of being a pediatrician (albeit later than planned), having a tremendous kid, and an intact marriage. It certainly hasn’t been easy, but I would do it again!
Happy Mother’s Day to all of you women docs out there! You rock! ..And roll with the punches!

Swine Flu (H1N1): Part 2 - Q&A and FAQs

2009-05-06T12:12:00.000-07:00

With the second swine flu-related death in the U.S. (first of a U.S. citizen) occurring yesterday, we decided it was a perfect opportunity to post Part 2 of our swine flu update. We chatted with Tara Mandy, publisher of StollerTraffic.com, an online resource and weekly e-newsletter for city moms with kids under 3. Tara came to us for some tips and perspective (OK...and to help talk her and her readers off the ledge) and we were, of course, happy to oblige!
Here, we answer some of her and her readers' most pressing questions:

Are babies and toddlers more or less susceptible to Swine Flu (H1N1)?
Babies and toddlers who are below school aged, are less likely to be exposed to social situations, which would then expose them to swine flu. However, if infants and toddlers do become infected with Influenza, they are more likely to have a more severe or prolonged illness which can be associated with more complications.

Are there special considerations for pregnant women?
Pregnant women are deemed to be in the high-risk group, if again, we take our experiences from past influenza pandemics. They should take precautions to reduce their risks of contracting swine flu. These actions include frequent hand washing, covering coughs, avoiding contact with ill people and reducing unnecessary social activities in crowded settings. If a pregnant woman has swine flu, she can be treated with antiviral therapy, though these drugs have not been formally tested for use in pregnancy. Past experiences with Tamiflu and Relenza have shown them to be safe and effective in pregnancy with no observed ill effects seen in their newborns.

When should you call your pediatrician?
If your child has a sudden onset of fever along with a sore throat, cough, headache or body aches, call your pediatrician. Reports seem to indicate that the swine flu presents with an acute onset of high fever, and a rapid progression of the other symptoms. If you bring your child within a day or two of fever onset, anti-viral therapy is more likely to be effective. Most health care providers are equipped to diagnose flu in their offices. If your doctor suspects your child has influenza, he/she may perform a wash of your child's nasal secretions and submit it to your local public health department for analysis by the CDC.

When should you NOT call your pediatrician?
If you basically feel like you have the common cold or stomach flu virus -- both are common at this time of year. Do not call your doctor to obtain anti-viral therapy "just in case". This important therapy is reserved for those truly in need. Do not call your doctor if your child has NO symptoms and you have NOT travelled to a high risk area or had contact with a person suspected of having H1N1 (swine) flu.

What are Tamiflu and Relenza?
Tamiflu (oseltamivir) and Relenza (Zanmivir) are both FDA approved anti-flu antivirals that have been used to treat Influenza in the past and are deemed to be effective against the current swine influenza A virus (H1N1). They work best if started within 48 hours from the onset of flu symptoms.

What's the difference between the two?
Tamiflu is approved for treatment in patients 1 year of age or older. It is available in liquid or pill form and should be taken twice a day for 5 days for active flu. During pandemic conditions, there are dosage recommendations extending down to 3 months of age.
Relenza is for treatment of patients who are 7 years or older. It is also for preventative treatment for patients 5 years or older. It is taken twice a day for 5 days and inhaled directly into the lungs.

Are Tamiful and Relenza "okay" for babies/toddlers? Nursing moms? Pregnant women?
FDA approval of these antivirals are as per the ages described above. However during epidemics, Tamiflu can be used for children down to 3 months of age under the Emergency Use Authorization clause (EUA). Nursing moms and pregnant women can be treated with both Tamiflu and Relenza.

Is there a shortage of either one?
The U.S. Government has a stockpile of these antivirals, but judicious use of these medications is recommended, and we don't want to risk developing viral resistance to the drugs. That means that these medications should not be used daily "just in case" for prevention. They are to be used only in the vent of H1N1 illness and for household contacts of flu victims.

What are the downsides of taking Tamiflu or Relenza as a preventative?
Taking either drug in a preventative regimen is indicated only under certain specific circumstances. Essentially, these medications are recommended for the very young, or very old or those with chronic underlying illnesses who have been exposed to suspected or confirmed swine flu. These include household contacts, school contact or travel contacts to high-risk areas.
Tamiflu has side effects that may include nausea, vomiting, abdominal pain, seizures or behavior changes.
Relenza may cause breathing problems, especially in patients with underlying lung disease or asthma. It may also cause seizures, confusion or abnormal behavior.

Are there any other preventative measures worth considering?
Definitely. Here are some practical tips (mentioned in our previous swine flu post, but worth reiterating):

Avoid who are ill and thrive with those who are well
STAY HOME IF SICK and don't return to work, school or daycare until well and fever free for at least 24 hours
WASH HANDS WASH HANDS WASH HANDS when coming in from school, outside or work and before putting anything in your mouth
If you are coughing, cough into your sleeve or tissue. Wash hands frequently throughout the day.
Don't share food or drinks with others. Secretion exchange is a common route of infection.
Don't ask for trouble by traveling to high risk areas
Call your pediatrician if your child has true flu symptoms so that they can diagnose and treat early (within 24-36 hours of onset of fever). True flu symptoms include fever (usually over 101-103), chills, headache, sore throat, runny eyes and nose, cough and aches. Influenza A symptoms tend to hit a bit harder, so symptoms recognition is usually obvious
When new strains of flu emerge, such as H1N1, it takes 4-6 months to develop an appropriate vaccine to cover that strain. Already efforts are in place to develop a vaccine against H1N1, in addition to other new strains of influenza that have attacked worldwide.

Again, we can't emphasize enough the power of STAYING HOME IF YOU ARE ILL, so that the freedom to move about and attend schools, events, travel and activities of daily living is maintained for those who are healthy.

Should I keep my baby/toddler under any sort of quarantine if I live in a city where swine flu has been confirmed?
It's always easier to prevent illness than to diagnose and treat it, however, it is reasonable to move about your community and do the things you need to do if you have reasonable control over whom you come in contact with. For example, a day long jaunt to a large indoor play place may not be advised if you have H1N1 in your community. But a birthday party in your home attended by healthy, asymptomatic children is reasonable. This is the time when communities need to work together to preserve public health, so keep attuned to the advisories delivered by your local health departments.

While we would advise against unnecessary crowded or social contacts, obviously if you live in a densely populated urban area like New York City, staying locked in your home and not using public transportation is not always practical.

The most critical advice we can offer as pediatricians is that we all do our part to stay healthy and prevent unnecessary spread of germs. This means STAY HOME if you feel sick and wash your hands (and your children's' hands)...A LOT...especially after you come in from the outdoors or a social situation.

We must remember that the total number of cases of confirmed swine flu in the US really amounts to a relative handful (as of 5/6, 642 cases nationwide), and that with the support of our medical and public health communities, we are equipped to handle this situation. We must also keep in perspective that the case described in the US have been mild to moderate in severity (aside from the tragic exceptions in the case of 2 recent deaths in Texas), and that local communities affected are reacting appropriately and outcomes have been good so far.

Any thoughts or insight you can provide to help explain the 2 recent deaths (and help calm any panic)?
Very young children and the elderly are more at risk for dying to getting really sick from the flu. Approximately 36,000 Americans die every year form the influenza virus. Of this number, in 2007-2008, 83 were children. So deaths in this age group represent a minority, albeit a tragic one. While we would never ever want to minimize the grief that the families of these families are experiencing, 2 deaths from swine flu, relative to the total average number of deaths from flu every year, is not a cause for public panic.

Our recommendation is that we use this tragedy as an opportunity to reemphasize to parents the critical importance of vaccinating your kids from influenza every year* (hence this year's recommendation from the AAP that ALL children between the ages of 6mo and 18yrs be vaccinated with the flu vaccine!).
*Important note: this vaccine does not protect against this particular strain, however the medical community is working quickly on developing a specific swine flu vaccine.

Like we said, remember that flu from Influenza claims the lives of 36,000 Americans yearly (most often in the elderly and very young) and infects millions of Americans every winter -- and the great majority survive and thrive.
We said it in our last post (so forgive the redundancy) but we'll say it again: It is still too early to tell how severe this now prolonged flu season will be, but remember that summer is coming, and the flu virus tends to want with warm weather. Keeping this in mind, we anticipate a short outbreak, with the help of Mother Nature. Some of the hysteria thankfully seems to have waned a bit, but we still want to emphasize that we all use common sense, be sensible, stay calm, and WASH your hands!

Swine Flu (aka H1N1): Part 1 - Our Perspective

2009-04-29T19:12:00.000-07:00

With the media and government putting us all on the edge of our seats worrying about a possible pandemic of swine flu, it's important to have basic factual information and a realistic perspective about what is happening as questions and fears grow with every news report. While we know this blog entry is going to be a bit lengthy, we decided this was not the time to edit. We are choosing to fully explain the situation in a very straightforward manner, with as much information we have at this point, and answer some of the most common concerns we've addressed in our pediatric practices.

Simply speaking, Swine Flu (H1N1) is just a new, unexpected strain of influenza A. We are all familiar with the concept of new strains of flu -- it's why we need to revaccinate every year to keep up with changes in the makeup of of flu viruses. But since Swine Flu only comes around once or twice a century, most humans have no acquired or natural immunity. Swine Flu strains are typically not included in flu vaccines, and thus more people may be susceptible to illness in a pandemic situation (though this is not at this point classified as a 'pandemic').

The good news is that, unlike many strains of influenza that are not responsive to therapy, this Swine Flu strain, H1N1, is TREATABLE with Tamiflu or Relenza. In the last year our practice alone has treated 390 cases of documented influenza. Some, but not all, patients received Tamiflu, but many were treated conservatively with rest, fluids, supportive care and staying out of work, school or daycare until symptoms resolved. We had no children hospitalized due to the flu, and had good outcomes, even with just supportive care as treatment.

Because the US Government has stockpiled Tamiflu, should H1N1 become a problem in our communities, we anticipate ample supplies to treat this strain of the flu.

We continue to remind families that the best way to stay healthy and avoid flu risk is to:

Avoid those who are ill and thrive with those who are well
STAY HOME IF SICK and don't return to work, school or daycare until well and fever free for at least 24 hours
WASH HANDS, WASH HANDS, WASH HANDS when coming in from school, outside or work and before putting anything in your mouth
If you are coughing, cough into your sleeve or tissue. Wash hands frequently throughout the day
Don't share food or drinks with others. Secretion exchange is a common route of infection.
Don't ask for trouble by traveling to high risk areas
Call your pediatrician if your child has true flu symptoms so that they can diagnose and treat early (with 24-36 hours of onset of fever). True flu symptoms include fever (usually over 101-103), chills, headache, sore throat, runny eyes, cough and bodyaches. Influenza A symptoms tend to hit a bit harder, so symptom recognition is usually obvious.

When new strains of flu emerge, such as H1N1, it takes 4-6 months to develop an appropriate vaccine to cover that strain. Already efforts are in place to develop a vaccine agains H1N1, in addition to other new strains of influenza that have attacked worldwide.

We must remember that the total number of confirmed cases of Swine Flu in the US (109 as of the morning of 4/30/09) really amounts to a handful, and that, with the support of our medical and public health communities, we are equipped to handle this situation. We must also keep in mind that flu claims the lives of 36,000 Americans yearly (most often in the elderly and very young) and infects millions of Americans every winter -- and the great majority survive and thrive. It is still too early to tell how severe this now prolonges flu season will be, but remember that summer is coming and the flu virus tends to wane with warm weather. We anticipate a short outbreak with the help of Mother Nature. So hang in there -- and continue to be calm and sensible!

Stay tuned for Part 2: a Q&A with Tara Mandy, publisher of StrollerTraffic.com. Tara has been fielding a ton of questions from concerned parents, so she came to us for answers. We'll share them with you in our next blog posting...

AAP Considering Update: Rear-Facing Carseats Until Age 2

2009-04-23T11:48:00.001-07:00

In case you haven't heard, the American Academy of Pediatrics is considering changing their carseat policy in 2010 to recommend REAR-FACING carseats for ALL children up to the age of TWO YEARS. Not official at this point (though that implication is making the rounds...even to our offices!).
Even if little feet touch the seat, injury rates and severity have been shown to decrease dramatically with kids in the rear-facing position. In fact, according to research, toddlers between the ages of 12 and 23 months who ride rear-facing in a car seat are more than FIVE times safer than toddlers in that same age group who ride forward-facing in a car seat.
We're thinking it's a great idea to turn your tots back to rear-facing -- for their health and safety. Your sanity may suffer a little bit, but safety comes first!

We want to know what you think. How do you feel about this potential recommendation? Will you turn your kids back to the rear-facing position?

The Great Vaccine Debate

2009-03-31T07:30:00.000-07:00

A GREAT discussion about vaccines is on our friend Ari Brown's website at http://www.windsorpeak.com/baby411/Vaccine.pdf

It is so hard to sort out fact from fiction in this age of vaccine fears. Dr. Brown has kindly allowed us to access this excerpt from her book Baby 411. We hope you read it and pass it along. We couldn't have said it better ourselves!
No matter which side of the vaccine debate you are on, make sure you have open and frank dialogue with your pediatrician. Open communication is key, and you can work together to devise a plan of action that both of you are comfortable with.

By the way, if you don't already have a copy of Dr. Brown's book Baby 411...run, don't walk...buy it. It's a must-have for any parent, and could save you a trip or two to our office!

Diary of a Doc: Dr JJ -- 1186 Days and Counting

2009-03-31T07:21:00.000-07:00

First of all, I want to thank you all for your good wishes for DOD. He’s hanging in at home and gathering a little strength, day by day. As for the boy, he trekked to Chicago last weekend, riding shotgun with a librarian from Flint, for a national backgammon tournament. Backgammon shares a space in his heart with poker, but somehow the former seems more legitimate in mom’s mind (no seedy, smoky, sunglass-clad, shifty-eyed visuals in my brain). Having never set foot on the streets of “ChiTown” (except for his layovers in the airport), Max now understands why everyone LOVES Chicago (except in the deep of Winter). Here he was, kid from the BIG City, calling mom in absolute wonder at the gorgeous architecture, river through the City, admiring the vibrancy and beauty of this incredible jewel in the middle of the US! The tournament was held out in the ‘burbs, and Max quickly was humbled (and his scratched together entry fees and buy ins quickly gone) by the finesse and skill held by those many years senior to him. He didn’t mind being excluded early – as that gave him time to meet his heroes of this “sport,” garner some knowledge, and most importantly, stand back and realize that winning at this level requires years and years of practice, dedication, and, as he realized, many losses on the way to victory. His mind set zoomed from the fantasy of winning (as a young neophyte) to the reality of realizing that true dedication, humbling losses and resilient persistence are the qualities of someone who succeeds. I hope that he will apply this experience, and these lessons to his life on campus, and his life on this planet. I already started to see a hint of it when he was not hired as a campus tour guide (a plum paid position), and set about to try again in the fall (with no anger, angst, or assigning blame)……now let’s hope he finds a job this summer as he returns home April 29 for 3 months!

Baby Silk Honored with 2 Major Awards!

2009-03-21T09:05:00.000-07:00

What a week we've had! We learned, in the span of 2 days, that our Baby Silk line was honored with not one, but TWO very exciting awards!
Our Babysafe Sunscreen Towelettes were honored last week with the prestigious NAPPA Gold Award (the National Parenting Publications Awards' highest honor) and our Soothing Bottom Relief Diaper Rash Cream and Gentle All-Over Clean Cleansing Towelettes each won a PTPA (Parent Tested Parent Approved) Award!
Having one product recognized like this is an honor...but three? Wow. Just wow!
The NAPPA seal is one that is recognized by parents everywhere and is a great mark of credibility for consumers and retailers alike.
The PTPA award is exciting because it was bestowed upon us by parents themselves. What more could we ask for?
So THANK YOU NAPPA...THANK YOU PTPA...and most especially, THANK YOU parents. It is for you and your kids that we do what we do, both as pediatricians and as the makers of Baby Silk. We are honored to have become a part of your lives!

Diary of a Doc: Dr. JJ -- 1212 Days and Counting

2009-03-19T18:04:00.000-07:00

Well, where have the last several weeks gone?? Real life has stepped in the way of late -- as plans for a week away took a hairpin turn back to Los Angeles! My father-in-law was admitted to the ICU at Cedars, and by last Sunday, we seriously thought we were going to lose him. That said, for Max it was an automatic decision to return home instead of trying to feign enjoyment in NYC while grandpa (or DOD, Dear Old Dad, as we call him) was fighting for every breath. So Max (and his friend Lorin) returned home Tuesday, immediately sailing into DOD's room, and actually finding him a bit improved (as he had made no progress for 9 days prior). As the other grandkids gathered 'round as well, I think DOD decided he couldn't throw in the towel, and started to fight all week -- inspired by the young who sat at his side daily. I think Max (and Bruce and I) heard more funny (and secret) stories from Grandpa this week than we had heard in the last 20 years. It was as if he had unlocked more of his legacy and made sure it was verbally given to the kids. What a great gift! Although an emotionally draining few weeks, Max and Lorin left yesterday knowing that DOD was being transferred to a regular room, and against all odds would make it home.
As the kids' adventure got derailed, we made sure (with the kindness and generosity of friends) that they returned to Michigan with a few memories -- innumerable rides on The Simpson's at Universal Studios (thanks Janice!), a Laker's game (thanks Rex & Val!), and a day on the firing range in Tujunga (where Lorin looked like Annie Oakley, and shot more like a pro than a novice). The kids helped Bruce and I refocus and settle down, as initially every phone ring made us both jump, thinking we were going to hear the worst.
The kids returned to a HUGE storm just in time, and today we return to a regular life -- with its completely unexpected twists and turns...
We are grateful to all those who have returned DOD to us, and thank our friends and family for all their support and love.

Diary of a Doc: Dr. JJ -- 1240 Days & Counting

2009-01-30T16:37:00.000-08:00

Our intrepid Max, fully outfitted in khaki green Northface expedition parka and LL Bean subzero boots continues to love the freezing cold, ice storms, snow and subzero temperatures that define the heart of winter in Michigan. Spring break for the Wolverines comes the third week of February -- as the kids are likely to be in the depths of seasonal affective disorder, dreading short days and long nights, and tired of the daily slog through snow drifts to get to class, the prospect of a little fun for a week keeps them warm with hope.
Max's first inclination was to return home for some R&R. However, knowing that we would force him out on the trail of identifying employment for summer dashed his dreams of sleeping in, eating trays of food lovingly prepared by mom, and the prospect of doing nothing. Skip to Plan B -- a trip to Mount Rushmore, by bus, enduring 36 hours in a smelly seat with perfect strangers. Good enough? NO! Skip to Plan C -- a quick trip to New York to visit the United Nations, see a Broadway show, take in the Museums before they are impassable in the Spring, a return to Ellis Island to caress the inscribed names of his great grandparents -- you bet! With the kind offer of a friend to stay in her apartment while there, Max will trek to the bigger city to take inn a little culture, a lot of history, and while not really having a chance to defrost, enjoy the vibrancy that is Manhattan.
It will be a little late to see Conan, but no less thrilling.
So what does Mom do? Put away the trays (ready to be laden with home cooked food), forget about fluffing up the pillows, put herself back in the office to work, and mope a bit...all part of the necessary process of emancipation and detachment that both parent and young people experience at this stage of life! So much of the college experience comes from not what is conveyed in the classroom, but rather the coping, resourcefulness and creativity that comes from striking out on one's own, problem solving, living within a budget and surging forward steadily into real adulthood.
Yeah, I'm moping a bit, but inside, I am totally proud!

Health & Safety Tip: Are you keeping your New Year's Stay-Healthy Resolutions?

2009-01-22T09:37:00.000-08:00

Well, we're 22 days in to the New Year and it's awe-inspiring to think how much change we've all been surrounded by of late! With all this excitement, it's sometimes easy to forget the promises we made to ourselves at the top of the year, so we thought we'd check in and see how your progress is going on your New Year's resolutions. We know how difficult it is to keep them, however well-intended they may be. So we're sharing our favorite stay-healthy resolutions that are actually easy to keep (and easy to pick up again any time of year)!

"I resolve to use sunsreen on my family every day."
We know, we know..."But it's January! And we're not at the beach!" Believe it or not, harmful UV rays don't just make their appearance Memorial Day through Labor Day. Exposure to UV rays adds up all year round. The most effective way to prevent skin cancer (aside from staying out of the sun) is to use sunscreen 365 days a year. Our favorite (though we know we're biased) is the Babysafe Sunscreen Towelettes SPF 30+. These indispensable sunscreen wipes are so easy to pop in the pocket of your winter coat and have a perfect amount of sunscreen to cover any exposed areas like face, ears & back of the hands -- any time of year.
"I resolve to wash my hands...a lot!"
In our pediatric practices we are constantly bombarded with nasty germs, yet we rarely get sick. Our most tried & trued stay-healthy secret is surprisingly simple: We wash our hands constantly! Hand washing is the most effective (and easiest) way to prevent the spread of germs that cause colds, the flu, and several gastrointestinal disorders. Help your kids get in the habit early by teaching by example. Make it fun and lather up to a rousing rendition of the ABCs! If you don't have soap and water handy, go ahead and use a great multipurpose alcohol-free wipe or all-natural hand sanitizer.
"I resolve to adhere to the 30-second rule."
Did you know the most effective way to maintain your and your baby's precious moisture barrier is to smooth on a moisture balm within about 30 seconds of patting dry? We like to call it the "30-second rule", and it's one of our favorite techniques to recommend to parents of children with eczema and dryness. Especially as the temperature continues to drop and winter dryness threatens even normally supple skin, we suggest at least a once-daily dose of moisture balm. A note to parents of children with very dry skin or eczema: One key to successfully treating these conditions is REPEATED application throughout the day.
"I resolve to up the antioxidant ante."
Antioxidants protect us (and our babies) on the inside and out, aiding in skin repair and strengthening blood vessels. Blueberries are our top "superfood" choice for little ones (they're packed with antioxidants, phytoflavinoids, Vitamin C and potassium!) and a recent British study even showed that an antioxidant-rich Mediterranean diet may even prevent allergic rhinitis and asthma symptoms in youngsters. When it comes to the outside, be sure to look for antioxidants like Vitamin E, Avocado Oil, Grapeseed Extract and Olive Squalane to protect baby's uniquely delicate skin from environment damage.

These resolutions we know we can keep... Now if only somebody would make it easier for us to stop eating chocolate and start jogging!

Diary of a Doc: Dr. JJ

2009-01-19T19:44:00.000-08:00

A year and a half ago, I started to blog about my son in my practice newsletter - counting down the 400 days he had at home until his graduation from High School. Was he ready to go forth into the big world of college? Had we given him the right tools?
He successfully completed his journey and started as a freshman at the University of Michigan in September. Yet another countdown started, as I blog about his progress in college, our progress as empty nesters, and reflections of the life he faces currently. Enjoy as we pick up on this week's entry, and check back every Friday as we update our countdown...

1257 Days and Counting...

Brrrrr.....it's cold in Ann Arbor - freezing temps are hitting the entire Midwest and Northeast. From the comfort of our tropical climate, we shudder at the thought of even a 40 degree morning in LA - and yet thousands of our kids trudge bravely through several feet of snow, ice and slush to go to class, grab a hot chocolate, nourish in the dining hall, or just go to work! Max related that the other night, in the midst of an almost-blizzard, the fire alarms went off in his dorm, the kids trudged downward and outside, dreading the cold, and beleagured at the hour. What did they face at the front door - an army of energetic colleagues from the dorm across the way - and a pile of thousands of pre-made snowballs at the ready! The battle was on, the freezing temps didn't matter, as the proud warriors engaged in a contest that none of us could or would survive at our age. This is just one example of how our perspective changes with youth. Seriously, aside from a brief weather report from Max, I have not heard ONE complaint from him about the cold. His daily description is "It's so beautiful mom", and "thanks for the great coat and boots - 'cause I'm not cold."....and here I am this week, dreading a trip to NY, Boston and Providence next Friday - imagining that upon leaving the safe confines of a warm airport terminal, that I will IMMEDIATELY turn into a human popsicle and never recover! Of course the very mention of my anxiety arouses huge guffaws from my son, and a reminder from him that I have a little natural insulation to help me through such ordeals - oy!

The kids are gearing up for a celebration of hope on Tuesday as the inauguration and its' personal significance to Max and his friends is truly huge. I hope that we all stop and pause on Tuesday and realize the signficance of this very day. Think about the millions who will happily stand in the cold, ice, and snow to witness history, to revere freedom, and to support our country and its new president. Take the opportunity to share this event with your children, as it will generate such a variety of discussion points - both from the past and present. Whatever your politics, it is incumbent upon all of us to link together in mutual support in order to survive these tough economic and political times...

Have a great week - and enjoy this historic moment!

2008-11-19T09:42:00.000-08:00

It’s that time of year, the holidays are upon us, and travel reaches a fever pitch at the end of November. Here are a few tried and true tips for safe and sane travel with your young ones:

Stay healthy on the go! Before you travel, make sure your children’s vaccinations are up to date, including flu vaccine (have your pediatrician guide you) – especially since nothing stops people from traveling to loved ones during the holidays – not even colds or flu!

Arrive early at the airport. If it is naptime, find a quiet corner for your child to nap while awaiting your flight. A rested child is a better traveler.

Always pack comfort items for your baby or tot . A lovey, pacifier or blanket are essential. For older children - a couple of favorite books, a favorite packable toy or a stuffed fuzzy friend are always a welcome companion.

Remember to also pack some light snacks for your tots or older children. Babies will do well with nursing or sucking on a bottle during take offs and landings as this will reduce discomfort associated with middle ear pressure changes.

Sample-size your routine! Current regulations permit a maximum size of 3oz bottles of creams, lotions, or gels as carry-on items. Baby Silk...To Go! is a perfect carry-on choice: 1oz tubes containing diaper rash cream and liquid powder, together with 2oz bottles containing hair &body wash and moisture balm are TSA-approved for carry-ons and make for an easy pass through at the security gate. (Don’t forget to also bring your Babysafe Sunscreen Towelettes!) We suggest you check www.tsa.gov the day prior to departure for the most updated security information, to avoid unnecessary delays at the security checkpoint.

Children like to be comfortable traveling, too! Their softest PJs are better choices than their most fussy outfit! Save that for your destination. If you’re also traveling with a toddler, be sure to keep their shoes on when walking around a plane – unexpected injuries can be prevented.

If you are changing time zones, keep your child on his “home” time schedule until you arrive at your destination. Once at your destination, expect that for every hour time change you experience, your child will need a day to adjust …on the return leg, the same occurs. Try your best to remember regular naps and a consistent place for your child to sleep. Ironically, keeping a baby up and missing naps usually results in very sleepless nights.

Whether you are traveling near or far, or not at all, we wish you a happy, healthy and loving time with family and friends this holiday season!

October is Breast Cancer Awareness Month

2008-10-01T05:47:00.000-07:00

Philanthropy is an essential core value of ours, both in our personal and professional lives as pediatricians and through MD Moms. As physicians, women and mothers we are committed to raising awareness when it comes to both child and family health.
As you may or may not know, October is Breast Cancer Awareness Month. While we love that there is a month of the year dedicated to awareness, we hope it will just be a kickoff to what is an entire year, and lifetime, of action.

It is nearly impossible to encounter a family that has not been touched by this dreadful disease in some way. For some of us it is our mothers or fathers, our sisters, our aunts, our grandmothers. For others it is a best friend, a friend of a friend, an acquaintance.
Many of you reading this have bravely fought and gloriously triumphed over a most devastating diagnosis. Too many women (and men) have not.
One more mother, one more grandparent, one more individual dying from breast cancer is one treasured person too many.

During the month of October, we will be donating 15% of the web sales of Baby Silk on our site mdmoms.com to The Breast Cancer Research Foundation.
This global organization, founded by the extraordinary Evelyn Lauder fifteen years ago, is dedicated to finding a cure in our lifetime and we hope we can help make that goal a reality!

We hope you will be inspired by a person you know, or even one you don't, to join us, get involved, and take action to fight breast cancer.

Health Tip: How to Perform a Breast Self-Exam

2008-10-01T05:13:00.000-07:00

Get the facts.
Breast self-exam, as part of a 3-part program (including self-exam, mammograms and clinical breast exams every 3 years starting at age 20) can be an important element in the early detection of breast cancer. But how many of us really know how?

Here, a step-by-step guide on 3 different ways to perform a breast self-exam:
IN THE SHOWER

Put one hand behind your head, elbow facing upward

With the pads of your three middle fingers, move your hand over the entire breast area

Use right hand for left breast, left hand for right breast

Use one of the three following patterns to examine your breasts: 1)Circle: in a series of circles around your nipple, middle of breast, and outside perimeter of breast; 2) Up & Down: up and down in a zig zag pattern from top to bottom over the entire breast; or 3) Wedge: in a series of "wedges", working from the nipple outward in 8 or so sections

For consistency, be sure to examine the same way each time, using the pattern and technique recommended by your healthcare professional at your clinical breast exam. (The American Cancer society recommends the up & down pattern.) Check for lumps, knots or thickenings.

LYING DOWN

Place a pillow or towel under your right shoulder, with your right hand behind your head.

Using your left hand, follow the same technique (using one of the above patterns) as in the shower. Then lower your right arm slightly and with your left hand, check your right underarm.

Check for lumps, knots or thickenings.

Repeat on the other side, using your right hand to check the left breast and underarm.

IN FRONT OF A MIRROR

With your hands firmly pressing down on your hips, check for changes in shape, size or skin texture of your breasts. Then raise your arms overhead and check again. Be sure to note any swelling, redness or skin dimpling. Also be sure to check for any changes in your nipple or unusual discharge.

Be sure to perform a self-exam monthly (perhaps after your periods when your breasts are not full or tender) and report any changes or irregularities to your healthcare professional immediately.

An important note: This guide is not intended as a replacement for medical care. For a complete diagnosis and course of treatment, please see your doctor.

The Breast Cancer Research Foundation has a great resource in its Breast Cancer Basics Library. Be sure to check it out for video and articles about everything from more details on how to perform a self exam to understanding the stages of breast cancer.

The Magic Mommy Kiss, and the Baby Silk Babysafe Sunscreen Towelettes, Seen Round the World

2008-09-30T10:44:00.000-07:00

We’re not going to lie and say that it’s not unbelievably exciting (a dream, really) to wake up to photos of an A-list celebrity toting our products along with her most precious cargo (who, P.S., is definitely one of the most adorable tots in town). When we saw the pics of Jennifer Garner planting a big ‘ol magic mommy kiss on her darling Violet, while holding our Babysafe Sunscreen Towelettes, our “awwwwwws” turned to “WOOHOO!”s.

As founders of a company, in a celebrity-obsessed society, we couldn’t dream of a better caught-on-film moment. But as pediatricians, what REALLY excited us was seeing a mom diligent about sun safety…in almost-October!

“What a FABULOUS opportunity” we exclaimed, “to remind everyone that the sun’s harmful UV rays don’t take a vacation just because you came back from yours!”

So, here are a few tips and reminders to help us keep our kids protected, 365 days a year.

Just because it’s cool outside doesn’t mean UV rays aren’t present and harmful. The temperature may have dropped by a few degrees, but UV rays are still present! Sunscreen is just as much of a post-labor day must-have as it is in the Spring and Summer
Pack a lunch, pack a sunscreen single. Typically, daycares and schools don’t provide sunscreen for their students, yet kids spend considerable time outdoors (even in the winter). Recess, playtime, lunchtime, or school sports are all opportunities for UV exposure and an important time for sunscreen application.
Don’t forget about afterschool sports. Whether it’s big brother or sister on the field, or baby cheering them on from the stands, even that hour or two a couple times a week adds up to a significant amount of time exposed to UV rays. If you’ve applied sunscreen to your child before school, don’t forget to reapply prior to heading out to practice.
Baby it's cold outside! UV rays can be reflected off snow and other surfaces, so don’t forget to protect exposed areas with a broad spectrum sunscreen during winter sports or while perfecting your snow angel skills.

Dr JJ's Diary of a Doc: Allowing yourself a much needed 'Mom's Time Out'

2008-08-24T09:11:00.000-07:00

One of the great perks I enjoy, since I travel a lot as president of MD Moms, is taking advantage of the opportunity to meet great moms and Baby Silk customers in any city I wake up in. A few months ago I had the privilege (for the second year in a row) of being the “in house” pediatrician for Mommy and Baby week at the Greenhouse Spa in Dallas.

Certainly, a week at a high end spa is usually only the subject of dreams for most of us (including me), so seizing an opportunity like this (4 days of sublime treatments in the company of several moms and adorable babies) was a no-brainer…..

I met a great group of moms from all backgrounds and walks of life as well as a few speakers who brought their insights and expertise to this event. Two moms had 4 kids under kindergarten age (twins made the math “easy” for both of them – one was a stay at home mom, and the other was a fulltime attorney in Washington DC), one mom had a very young one month old, one was having a last hurrah before returning to her position as an aerospace engineer at NASA, another a single mom/prosecuting attorney who had lost her home in Hurricane Katrina, a store owner, a foundation head and 2 mompreneurs – one who manufactures organic baby food and the other, socially responsible dog products.

These are lucky women – auspiciously not because they could afford the week at the Greenhouse (although I’d be lying if I didn’t acknowledge that), but because they have taken the time, with the support of their families, to recognize that relaxation, revitalization, and recreation were important enough to stop real life for a few days, and treat themselves to some needed rest, some healthy food, a few naps made possible by the help of in-house helpers, and an opportunity to make some new friends.

How often do we, as mothers in particular, sacrifice things like a good haircut, a meal or coffee out with a friend, or worse yet, a needed doctor’s appointment or yearly mammogram, because we are just “too busy?”

How often do we say “no thank you” when a friend, relative or colleague offers to take our kids out, drive them to school or daycare, or just give us a break?

While martyrdom was popular in the dark ages, there should be no role for it in our lives. Allow yourselves to take the time to assign your partner to your child for an hour, light some candles, and soak in a bath. Say yes to your neighbor, let her watch your child, and go get your hair cut or nails polished.

Grab your young one, and curl up together for a nap, and defer a few errands or chores to just suspend yourself in rest for a few minutes. Despite the fact that most of us don’t have a big budget for a spa, we can easily create some “aaah” time as a priority. You will find, as I have this week, that the world does not stop and implode when you are gone for a few minutes or hours. These breaks are difficult to take, but allow us to refresh our bodies, minds, and spirits so that we become better mothers, better partners, and better people.

Dr. JJ's Diary of a Doc: 8/10/08

2008-08-10T16:21:00.000-07:00

It seems as though age is catching up with me – between my daily work in my pediatric practice, getting my son ready for his departure to the University of Michigan next week (Go Blue!), new construction in my office, and of course, serving as President of MD Moms, one would expect a grey-tinged person such as myself to stifle a few yawns………Believe it or not, I get enough sleep to prevent that from happening……………..UNTIL THIS WEEK!

Every four years my husband and family surrender and hand me over to my television set to live, eat and breathe the Olympic spirit. My issue this year is that the major network televising this marvelous event is broadcasting to the West Coast on tape delay – and you lucky folks on the East Coast get to view the games live! Why does that matter to me? Well, my TIVO broke long ago, I don’t have the necessary cable to watch a live feed, and I struggle to stay awake past my midnite bedtime to see history unfold once again.

After lifting my jaw off the floor (and my box of tear stained tissues) after the mind-bending opening ceremonies, I trudged, half asleep to bed with the knowledge that I would miss the torch being lit. I prided myself on my ability to stay awake, but swore under my breath when my neck hurt this morning from the odd yoga position I found myself in as I drifted off to sleep on my sofa.

I resolved to stay awake last night to see the pride of the University of Michigan, Michael Phelps, win his first gold and look to the stands for his mom, his inspiration. There went another box of tissue! However, with the intricacy of the opening ceremonies setting a high benchmark, do you think that the National Anthem could have been played correctly, and not awkwardly cut off at the end? Perhaps you all respond like I do at these medal ceremonies, silently mouthing the words and welling up in tears feeling the magnitude of the moment………and then our collective joy is cut short as the last stanza just drops off! Come on!

More importantly, I wanted to witness a more significant piece of history unfold – the debut of Dara Torres . She is a symbol of courage, talent, determination (OMG that 12 pack)! She is also a friend of the MD Moms, and her young Tessa wears our Baby Silk Babysafe Sunscreen Towelettes daily, while mom works out in Coral Gables. It angers me that the press speculates that her grueling schedule of workouts, and the transformation of her “middle aged” body is the result of doping. She has gone so far as to have her blood stored and frozen for any future analyses, to prove to the world, that greatness can come just with hard work and talent. She has something to prove, and serves as an inspiration to many individuals who feel that age is an impediment to accomplishment – especially in the realm of physical competition.

I never got to see Dara take the podium to win her Silver Medal last night…sleep overtook me and this morning I hope to find a rerun somewhere to recreate that moment….I anticipate that I will be yawning daily at work, quaffing more than my usual 2 coffees daily, and aiming home as soon as patients are out the door, to catch these moments of triumph and persistence, joy and disappointment, pride and pain, as these young (and middle aged) ambassadors of the world make us feel, for just a few days, that the worlds’ people could get along under one roof…..

OK, so enough rambling……….grab a pen, write to NBC, appeal to them to give me some live feed on the West Coast so I can sleep! NOT!

Enjoy the Olympics! ...and GO DARA!

JJ Levenstein, MD, FAAP

President, MD Moms – makers of Baby Silk

Health & Safety Tip: Have Fun in the Sun...Safely!

2008-06-28T14:05:00.000-07:00

☼Summer time is for relaxing and having fun in the great outdoors. It’s also time to think about sun safety. The most common type of skin cancer in the US is caused by unprotected sun exposure (specifically UVA and UVB ultraviolet rays) in childhood and adolescence.

☼ Between 60% to 80% of sun exposure happens before we turn 18 years of age. That’s because children spend more time outdoors than most adults, especially in the summer.

☼ The majority of lifetime sun damage occurs before the age of 18, and did you know that just two or three blistering sunburns during childhood can DOUBLE the risk of skin cancer later in life? More than 90% of all skin cancers are caused by the sun, and yet less than 33% of adults, adolescents, and children routinely use sun protection.

☼UVA (the “AGING rays”) cause wrinkling, spotting and skin cancer by penetrating deep into skin. UVB (the “BURNING rays”) sizzle the top layer of skin and contribute to skin cancer risk.

Here are some practical tips to help reduce these risks:

Avoid direct sun exposure during the peak hours of the day, usually between 10AM to 4PM. Harmful UV radiation is maximal during this interval. Stay in the shade if possible. Reapply sunscreen at 2-4 hour intervals if your child is dry, at 1-2 hour intervals if swimming or wet.

Dress your child in UV infused clothing (Cabana Life and Wallaroo Hat Company are examples) or use an SPF rinse on tightly woven cotton clothing to raise the SPF value from 5 (regular cotton t-shirt) to spf 30 (we like SunGuard Laundry Aid).

Your child should wear sunglasses that offer 99-100% blockage from ultraviolet rays (check for ANSI rated UVA & UVB protection). Also, remember a hat with a wide brim that will shade the face and cover the ears.

Be more diligent about consistent sunscreen use around the water, sand and snow as they all reflect the sun’s rays, increasing the risk of sunburn. (Our Baby Silk Babysafe Sunscreen Towelette Singles are a convenient way to take sun protection on the go...no matter the locale or temperature!)

The American Academy of Pediatrics and the American Academy of Dermatology recommend that, if avoidance of sun exposure is not possible, babies - no matter how young - should be protected with a sunscreen that has at least a SPF15 and offers both UVA and UVB protection (broad spectrum.) In addition, due to the sensitivity of young children’s skin, the ideal sunscreen should be one containing Zinc Oxide and Titanium Dioxide (pure physical block ingredients). These two ingredients offer the safest protection with the least potential for skin irritation. Unlike a chemical block, which needs minimum 20 minutes absorption time to be fully effective, a physical block will work immediately upon application, as the sun’s rays are reflected from the barrier on top of the skin.

Use enough sunscreen for effective protection. One ounce (the size of a shot glass) is recommended per application. If a chemical sunscreen is used, apply it to your child’s face and body, wait 20 minutes and re-apply (so that any missed spots are covered, and areas that wear against clothing or sweat get double coverage). Reapply at 1-2 hour intervals if swimming or wet, and at 2-4 hour intervals all through the day. (Our Baby Silk Babysafe Sunscreen Towelettes have a premeasured dose of sunscreen to adequately cover the average 2-year old from head-to-toe.)

Always patch test any new topical product on a small area of skin on the extremities or trunk. Wash off or discontinue use if redness, itching or irritation occurs. Discard sunscreen that has passed its expiration date. A good rule of thumb is that, if it is more than 2 seasons old, it has lost its potency.

"Safe sun" doesn't have to be a contradiction in terms. Know your sun facts, be prepared ( a little Girl Scout motto that has stuck with us!), and HAVE FUN! Happy Summer!

As seen on Better.tv: Head Lice

2008-03-27T20:17:00.000-07:00

Head lice - yuck! Amazing how 2 little words can make you so...itchy! (Ever wonder where the term "lousy" came from? Now you know!)
There are many misconceptions about head lice that are simply not true. Head lice know no bounds (neither cultural nor socioeconomic) and are not a reflection of poor hygiene. Common to very popular belief, they do not jump from one head to another (don't look for any lice going for the pole vaulting gold in Beijing this Summer), and though they are incredibly disruptive and annoying, they are not dangerous. Here are a few tips on how to prevent, spot and treat head lice, and even some recommendations for a support team!

Remember...this advice does not constitute care...and the final call is with your pediatrician.

PREVENTION: lice can infest through DIRECT contact – so sharing hats, hair ornaments, caps, scarves and other adornments with others should be prevented. Lice can live on inanimate objects for a few hours, so even surfaces like movie theater seats/airline seats/car seats can be vehicles for spread – wearing a CAP to the movies (hair tucked under) might be a good strategy.

HOW TO RECOGNIZE: active lice are obvious – they are tiny, crawl, and hang out at the hairline under the nape of the neck, behind the ears, and hide in the depths of hair. Their eggs (called NITS) adhere pretty firmly to the hair shaft about 1/4" to 1/2" from the scalp. Nits are often mistaken for dandruff and vice versa. If you have a child with an ITCHY scalp AND see nits or live lice, your kid’s condition is obvious. Lice can also infest eyebrows and beards – anywhere there is a hairy hiding place.

TREATMENT: OTC: Many of the over the counter treatments are ineffective – partially due to some resistance that has developed with the lice themselves, but also because the MOST IMPORTANT STEP OF TREATMENT, which is to PICK OFF ALL THE NITS is hard to do. Lice combs may help, but the most tedious, yet effective way to cure an outbreak is to go through EVERY strand of hair and physically pick out the nits with your fingers. With boys, piece of cake – haircut, buzz ‘em, most don’t mind. With a child with luxurious locks, pin up 1 inch sections of all the hair, round up some magnifying dimestore glasses, a bright light, and a big bucket of patience and go through section by section.

Prescription treatments: there are 2 that we use pretty routinely – Elimite (permethrin – oil of chrysanthemum) and Ovide.

With Elimite, we saturate the dry hair/scalp and leave on for 8-12 hours, shampoo out, NIT PICK – and repeat in a week. Ovide (malathion, an insecticide) always works, but we restrict it’s use to older children.

ALTERNATIVE REMEDIES: From our good friends at DrGreene.com...

Most alternative treatments are untested, but early reports are promising. One method with widespread stories of success is the Vaseline (or mayonnaise) treatment. Cover the infested head liberally in Vaseline. Place a shower cap over the entire head for the night (or an eight-hour period). Then shampoo the Vaseline out of the hair. This treatment is reported to "smother" the lice. The downside of this method is that the Vaseline does not shampoo out of the hair easily -- in fact, it usually takes a week or so to get it all out. The upside is that it is not toxic, and from all reports, it seems to work. Washing the hair with dishwashing liquid, which has a degreasing agent in it, may help. I've smothered my own hair in mayonnaise (loved the smell), and it came out easily with Dove Ultra dishwashing liquid.
The Packard Children's Health Services Pediatric Hotline at Stanford is hailing another popular treatment. It uses regular shampoo and three ingredients that can be found at most health-food stores:
Shampoo (use an inexpensive brand such as Prell -- these seem to mix more easily with the oils).
3 tbsp olive oil.
1 tsp tea tree oil.
1 tsp rosemary or eucalyptus oil.
Add the oils to a small amount of shampoo and mix well. Work into hair and leave on for half an hour with a tight-fitting shower cap. This mixture has a strong smell. The fumes may burn the eyes, so don't lean forward. Wash hair two or three times to get the oil out. Repeat the procedure if necessary.
I'm hearing positive reports about this nontoxic treatment, though to my knowledge, no medical studies have been conducted to establish the efficacy or possible side effects of this treatment.
One of our readers suggested using a hot blow-dryer for 15 minutes, morning and evening, in conjunction with thorough nit combing. The heat helps to kill the nits and adult lice, but the combing is essential to the process. This type of treatment should not be combined with the over-the-counter treatment.

ENVIRONMENT: so anything that has touched infested scalps needs to be dealt with – sheets, hats need to be washed in hot water/dried on hot. If seat cushions/pillows/toys have been in contact with the lice, they can just be bagged up in large trash bags for 2 days (lice can’t live that long without a human host) and then tossed in the dryer for a few minutes to remove the nits (or vacuumed). All hair brushes/combs need to be soaked in boiling water.

WHO CAN HELP: There are several services out there that will NIT PICK for you – some come to your home, some are housed in salons. Check for a service in your area, but a few we like are:

Hair Fairies : http://hairfairies.com/

Lousy Nit Pickers : http://www.louseynitpickers.com/

The Hair Whisperers : http://www.liceremovalla.com/

Some will accept a prescription from your doctor, and some insurers will actually pay for delousing!

Good luck!

The Doctors are IN!

2008-03-05T17:06:00.000-08:00

Well, here we are, finally joining the blogosphere! If we haven't met, allow us to introduce ourselves...
We're the MD Moms - Dr. Diane Truong and Dr. JJ Levenstein. We are nationally recognized, board-certified pediatricians and moms. We were inspired by the needs of our patients and our own children to create Baby Silk, the first skincare line for babies developed by pediatrician-moms.
We are so proud to share our experience and expertise...both by providing babies and their parents with the most effective, gentle, modern and thoughtfully developed products on the market and also by giving real-life advice and support. (By the way, we try to speak English, not Doctor...)

In The Pulse, we'll be posting our monthly health and safety tips you may have seen on our site (and a lot that you haven't), answering your questions, addressing any hot topics, and welcoming a few of our friends and favorite experts as guest bloggers. From the country's most renowned sleep experts to The Baby Planners to some of the world's leading tastemakers and trendspotters....We know you have multi-faceted lives and we look forward to bringing you tips and topics that address each part of them!

Welcome...we can't wait to chat with you again soon!