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

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

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

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

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

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

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

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

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

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

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!