KatieCouricBodyCount.com

In case you missed it (I never do), here’s the opening line to Katie Couric’s syndicated talk show last week:

(spooky voice, eerie music) The HPV vaccine is considered a life-saving cancer preventer… but is it a potentially deadly dose for girls?

Ugh.

I used roll my eyes at such irresponsible attempts at sensationalism, but I can’t anymore, not after Jenny McCarthy took to daytime TV to spout her unproven theories blaming autism on vaccines. Like Katie Couric, the TV shows that invited Jenny McCarthy (‘Larry King Live,’ ‘The Doctors’), supported the topic under the innocent banner of a ‘conversation.’

The problem, however, is when in one corner you have two teary eyed mothers (or the pretty, charismatic Jenny McCarthy), and in the other, a scientist giving objective data, science loses EVERY TIME.

The consequences of losing these talk-show ‘conversations,’ unfortunately, are not inconsequential. We are still reeling from the effects of Jenny McCarthy’s media campaign, in which kids unnecessarily got sick, and important dollars were diverted from meaningful autism research.

For the record, we are talking about a medicine that prevents cancer. For all the research, money, and media attention that go towards cancer research and treatment, nothing comes close to the holy grail of medicine, that is prevention.

Here’s the boring objective stuff. HPV isn’t just an unsightly wart. Annually, it is estimate to cause1:

  • 2,100 vulvar cancers,
  • 500 vaginal cancers,
  • 600 penile cancers,
  • 2,800 anal cancers in women,
  • 1,500 anal cancers in men,
  • 1,700 oropharyngeal cancers in women, and
  • 6,700 oropharyngeal cancers in men

And, by the way, its safe: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm?s_cid=mm6229a4_e

As a whole, we pediatricians were embarrassingly silent as we watched Jenny McCarthy’s deadly escapade unfold. I don’t think we will let that happen again. Katie Couric, what you did is shameful and dangerous. I hope you use your platform as a respected journalist to refocus the image you created for the HPV vaccine. If not, you may see yourself the recipient of a similar dubious honor, as seen here:

http://www.jennymccarthybodycount.com

 

  1. http://www.cdc.gov/std/HPV/STDFact-HPV.htm

Enough anecdotes. The truth about kids and guns

Media loves social experiments.  It’s the driving theme for a lot of shows, from “Let’s Make a Deal,” to the thought provoking, “What Would You Do?”

Tonight (Friday, 1/31/14) on ABC’s 20/20, hosted by Diane Sawyer, an experiment is conducted in which young children are exposed to “gun safety” programs, then observed via hidden camera to see how they would react to discovering a real gun. Their goal is to dramatically reveal the often unrealistic parental expectations of their child around guns.

Here is the preview: http://abcnews.go.com/US/video/young-guns-diane-sawyer-special-21694484

I always try my best to take the findings from a television show with a heavy grain of salt. After all drama, and often sensationalism, is usually the name of the game. This program, however, is actually a replica of a study published in the respected medical journal Pediatrics back in 2001.

The background was a survey of 400 parents, who were asked if their child (age 4-12) could determine the difference between a toy and real gun, and how they would then behave with the guns. Three-fourths (74%) believed their child could tell the difference between a real gun and a toy. 74% also believed they would leave the gun alone, or tell an adult.

The experiment consisted of watching 2-3 children play for 15 minutes in a room where a real, unloaded gun was placed in one drawer, and toy guns in another (they were not told to look into the drawers). 75% of the kids found the real gun. Of these, 80% handled the gun, and 50% pulled the trigger. 90% of the kids who handled the gun, and 95% that had pulled the trigger, later revealed that they had received some sort of gun-safety training. It didn’t matter whether the child was from a gun-owning family, or whether the child had remarked earlier that he or she was ‘interested’ in guns.

Absolutely, I think it reasonable to consider the results from tonight as “made for TV;” however the results from this study are not. Please remember  to teach your child: STOP! Don’t touch. Leave the area. Tell an adult.

IndyPedsDoc

@IndyPedsDoc

An email from our lactation consultant (a must read for breastfeeding parents)

Dear Sarah and Dr. G,

I am confident with some time both of you will work into breastfeeding success. Don’t give up and Be patient, both of you are learning and he needs some time to forget about his early days in the hospital (the separation from you both, constant NICU stimulation, tests, and bottle feedings).  He needs time to be at home, bonding with you both.  In this (stay at home), quiet,, no testing, atmosphere he will begin to relax and fit into that wonderful baby routine of eat,sleep, poop, pee and best of all being loved and touched gently.   Scheduling is ok right now keeping your breast happy with milk release by pumping or nursing, and making sure Henry  is fed by the 3rd hour.    Remember to time the next feeding from the moment his tummy is full.   It takes about 10 min after a feeding, and gentle burp for babies to slip into that deep sleep so they can be  placed in a crib without waking up.  That’s your goal.  Happy breasts, happy baby, happy Mommy, happy daddy.

Tips:
> Try natural methods to increase your milk supply.   Diet, fluid intake, eat two servings of oatmeal a day, Pumping on a comfortably high setting with the larger flange 27mm.  Your breasts need a good 2 1/2 hour break between feedings or pumping sessions to replenish milk volumes.

>  Rest:   This is so important to your whole well being.  You can rest with baby skin to skin between feedings, as long as you do not drift into sleep.
Pump before feeding; Give the milk and baby to Daddy for food and bonding,  while you take your meds and go to bed for a good 3 hours.

>  Breastfeeding:  Choose your times to attempt a feeding at the breast, or when doing skin to skin bonding, his little brief latch on moments are good practice   sessions.  Let him explore your breasts and nipples and learn.
If pumping before a feeding: do this 20 min prior to even waking Henry ..  Pump both or one to collect 15 -20 mm per breast.   Wake Henry
Burp him, change his diaper, and bring him to your breast.  Cuddle and bond first, watch for his rooting, and see if he will latch to your bare Wet nipple.  If he
refuses, or fusses,  give him the fresh milk you just pumped,  once he takes that milk.  Then bring him back to your nipple, hopefully to continue his feeding.
You may use the shield as directed.  Apply wet, massage the breast, bringing a puddle of milk into the shield, so he gets instant reward when he sucks.
Massage your breasts as you pump and as you nurse Henry.  This keeps milk moving toward your nipple, for removal.

>  Use the tips provided in the engorgement phase management hand out.  Switch it up to make it work for you.

>  Clean pump parts, bottles, nipples, paci, shield, with hot soapy water, hot rinse and paper towel dry.  Dish washers can harbor bacteria.

Sarah,  Now that you are home with Henry,  Keep visitors to a minimum, stay in your PJ’s, Do a lot of skin to skin bonding with Henry,  Dr. G- this means you too. curl up next to Sarah and Henry in bed for some important gentle bonding time.  When it is time for sleep, Henry goes to his crib.    Both of you Sleep when baby sleeps.  Maternal Fatigue can disrupt milk production, and prompt frustration (tears).  Sarah, You have everything you need to feed your baby.  Working into nursing at the breast needs patients, practice, and confidence.   All of which you have.  You can do it.  You’re both such loving parents.  Keep me posted.  I will check with you tomorrow.

Our lactation consultant and Henry:

Carla and Henry

When it comes to guns and kids, leave your politics at the door

Perusing social media, I strayed upon this blog article posted by a friend, summarizing “something bad could always happen.” Here, a mom left her 12 year old in the car while running in to a bank. Tragically, the mother was then killed by a bank robber, while the 12 year old was unharmed. This, of course, was on the heels of recent arrests for parents that unknowingly left their children in their cars. Her point? Voicing out against laws* that infringe on our autonomy (maximum freedom, minimum government), she argues:

“There is risk in everything in life. Punishing parents who make rational decisions just because something bad couldhappen is not going to change that. Something bad could always happen.”

This popular argument always seems to come up when defending guns in the home with children.

A couple of examples:

pic1 blog

And here (in response to same article):

blog pic2

So we’re missing the point.

‘Que sera, sera’ is certainly a fun Instagram #yolo, but it makes for really lousy parenting. Yep, something bad could always happen, and accidents do happen. We accept this, and do our best to weight and minimize these risks wherever possible. Bike helmets, seatbelts, fences around pools, etc. This is ok. This is parenting. Guns are no exception. Leaving you kid in the car unattended is no exception.

Instead, some seem to suggest it’s fine to ignore risk, because ‘something bad could always happen.’ In reality, though, I think they are ignoring risk because it gets in the way of their politics. This is really selfish, and it’s jeopardizing the safety of children. And for what? The right for an adult to keep a gun in the house with children? An opportunity to decry a state law infringing personal autonomy? When it comes to protecting the lives and safety of children, we need to keep our politics to ourselves. It’s distorting our perception of risk, which isn’t fair to our kids.

 

*This particular case, by the way, I’m pretty sure isn’t illegal. Most laws, in the states that do have laws, pertain to children under 7, and usually only under certain dangerous situations. See here for your state’s law. http://www.kidsandcars.org/state-laws.html

Musings on Measles

For some reason, there are more kids with peanut allergies than beforemeasles.

Peanut allergy, which can cause life-threatening anaphylaxis, is very serious. The community, in response, has adjusted their way of life to protect this minority, knowing the impact even a tiny particle of peanut can have on those that are allergic. We now have peanut free schools, peanut free airplanes, peanut free Halloween. Perhaps begrudgingly, but always understandably, we did this to protect those that can’t always protect themselves.

And now, according to this report in the journal Pediatrics,  we are seeing ‘pockets’ of communities where the decision to not vaccinate is more prevalent than most of the United States. Without vaccination rates somewhere in the 90% range, the community loses the powerful effect of ‘herd’ immunity, where even the unvaccinated are unlikely to get a potentially life threatening disease.

There are kids with cancer and autoimmune diseases that can’t receive vaccines because they are immunosuppressed. There are children under 4 that are incompletely immunized. In the midst of this growing measles outbreak, how does the community respond to protect these kids? Is your right not to vaccinate your child, the same as my right to eat peanuts next to a child with a peanut allergy? I would never do that, by the way.

I’m struggling with this one. Can someone help me out?

Why you (Yes, you) still need the flu shot

Why you (Yes, you) still need the flu shot.

  1. 45% > 0%.

Before every Flu season, a group of scientists, smarter than me and with hard to pronounce titles, meet up to try to figure out which strains of the flu will be rearing its ugly head. I honestly don’t know exactly how they do it, but suffice to say it’s more sophisticated than drawing a name from a hat or throwing darts at a board. Usually they do a good job. So far, this year they didn’t. In particular, they did not predict a “rogue” strain of flu H3N2 which seems to be wreaking the most havoc (about 45% of the H3 strains), and is not included in the vaccine. Rats! The good news: the vaccine does provide protection against some of our most popular, and deadly, strains which can pop up as quickly as this H3N2 strain. Remember “swine flu?” We got you covered.

  1. You can get sick. Real sick.

Last year, the flu caused an estimated 400,000 individuals to get sick. Annually, about 20,000 die. Who can get sick from the flu? Anyone. Yes, the elderly, very young, and those with chronic diseases like asthma, seem to get hit the hardest. But, I’ve also watched healthy teenagers die in the pediatric ICU from the flu. So far 11 children have died this season, the number will certainly climb into 100’s, like every other year.

  1. You can get others sick.

Christmas season is the season of charity and giving. But don’t give the gift of flu. That’s mean, and down-right Grinch-y.  My Pediatric Unit at Hendricks Regional Hospital is currently full of sick children and infants with the flu, some of them too young to receive the vaccine. By protecting yourself, you are protecting your community, which includes the most vulnerable.

  1. You can’t get the flu from the flu shot.

Let’s stop with this nonsense. The flu “shot” only contains part of the virus to help your body develop a natural immunity. This means creating an immune response that sometimes involves soreness around the injection shot, mild body aches, and low-grade fevers. Unlike the flu, these side-effects are well tolerated, and compared to the actual flu, will not hospitalize you or make you miss even a day of work. The nasal spray contains weakened strains that also will not cause true influenza infection, but you may short-lived mild symptoms. Again, ask anyone who has had the flu, this isn’t it. Finally, immunity takes a few weeks to develop, so it is possible to get infected after vaccination, but before immunity develops fully.

  1. It’s not too late!

As mentioned before, several viruses circulate every season, which lasts until spring time. Get vaccinated, protect yourself, your friends, and your community.

 

Merry Christmas and Happy Holidays!!!

Dr. Tony GiaQuinta, MD FAAP

The Cold Never Bothered Me Anyway

I read somewhere last week that you can get frostbite in as little as 10 minutes with a wind-chill of -60F.

By the way, that’s 10 minutes, not 10 seconds. Yeah, it was cold last week (cold enough to do this awesome trick), but I don’t think we got anywhere near -60F. christmas-story-5

So when dropping off my two-year old at daycare, it’s with curiosity, and a bit of judgment, that I see kids piling out of cars looking like Randy from A Christmas Story.

Are they worried about frostbite in those 10 seconds from the car to the door? Is it a fear that the cold causes the ‘cold?’ Is it plain old southern frigophobia?

Judge me all you want, but when my 2 year-old and I race across the parking lot, he may or may not have his coat on.

He definitely doesn’t have it on in the car.

You see, I feel very good about my son surviving the 10 seconds of cold from the parking lot to the door. I don’t feel very good about him surviving a car accident with his winter coat on in the car. Simple as that.

Here is a great video illustrating why. If you want to bundle your kids up like Randy outside of the car, be my guest, but I’ll tell you, my two-year-old and I have raced inside by then. Sure, expect a few mean looks from folks at the entrance of the supermarket etc. Just do as Taylor Swift does and shake it off. You’re being a good parent. More resources here.

Dr. Tony GiaQuinta, MD

@IndyPedsDoc

Co-Breastfeeding

My wife and I are expecting our second baby in a few months. Truthfully, I’ve probably been a little lax in my own mental preparation for taking care of two of these things.  A reality check came in the mail yesterday….

breast supplies

Oh yeah. Breastfeeding. Dear God.

A flood of memories comes pouring in. Countless little breast pump supplies needing scrubbing, breast pads as far as the eye can see, and….  AHH! Something squishy just touched my elbow!  Damn you rogue nipple shield! Really??? How can we be out of lanolin again?!?!

Buckle up, here we go!

I’ve discussed this before in my blog, but I wanted to take a second to remind all the dads, spouses, and significant others out there that breastfeeding is a team sport. I like to think of it as co-breastfeeding.

Relax bro, your nipples are safe. But you can help in other ways.

A new study in Pediatrics this month studied the impact of providing both parents with breastfeeding support information. At 12 weeks postpartum, significantly more moms in the intervention group were still breastfeeding, compared to a control group.1 Dads also felt more knowledgeable and helpful on the subject, and Moms felt more supported.

In our nursery at Hendricks Regional Hospital, I always make sure to make eye contact with both parents when talking and educating about breastfeeding, because I don’t want moms to feel like they are going it alone. It takes teamwork, and success can depend on it!

Again, read my earlier breastfeeding survival guide for dads to find ways you can help your amazing spouse/friend/girlfriend with this important endeavor. Attending a breastfeeding class as a couple, available at most hospitals, is a fantastic idea as well.

Good luck team! You’ll do great.

Dr. Tony GiaQuinta, MD

@IndyPedsDoc

 

  1. Abbass-Dick J. Coparenting Breastfeeding Support and Exclusive Breastfeeding: A Randomized Controlled Trial.Pediatrics. Vol 135. January 2015.

More Musings on Measles

Does this ring a bell for anyone?

“Texas Megachurch at Center of Measles Outbreak?”

This happened only about a year ago in September, 2013, when 21 members were infected, a majority of whom were unvaccinated children.  I remember at the time thinking it was a big deal. Yet, I haven’t heard it referenced at all in the midst of our current measles outbreak.

I’m guessing its omission is partly because an outbreak of 21 cases is chump change compared to the now 121 cases throughout 17 states, as of February 2015. But perhaps it highlights another issue at play: Why isn’t there much, if any, heat on the religious exemption for childhood vaccinations?

This isn’t the first time unvaccinated communities, in the name of religious exemption, have gotten themselves (and others) in trouble.

Turn back the clock way back to 1991, and some (not me… only in 2nd grade at the time) will remember the measles outbreak that infected more than 1400 people in Philadelphia, which included 9 dead children. About 33% of those infected belonged to one of two large churches, which emphasized prayer over medicine (and vaccines, for that matter).

Dr. Paul Offit, now an infectious disease specialist, witnessed the outbreak firsthand. He talks about his experience in this recentNew York Times article.  Since the disease has become so ‘out-of-sight, out-of mind’ to many, I’ll quote his experience:

“Children would come in, covered in rashes, squinting in the bright light (a side effect caused by eye irritation), struggling to breathe, and often dehydrated. It was like being in a war zone.”

200 kids came through his ER, 40 needing hospitalization, and with a handful of deaths.

It required this bucket of cold-water reality for something remarkable, and probably unthinkable for many of us: a court order to vaccinate children against their parents will.

So what would the ACLU (American Civil Liberties Union) have to say about that? Would they decry this sacrilege on individual freedom and the first amendment?

Nope. As Deborah Levy, of the Philadelphia ACLU chapter defaulted, “…parents don’t have the right to martyr their children.”

Or, to get downright Libertarian, “the only purpose for which power can by rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.” That’s John Stuart Mill. On Liberty. Boom.

So what happened? Well, kids got vaccinated against their parents’ wishes, outbreak ended, and kids didn’t get sick.

I wish I could also report that we remembered the dangers of measles and other vaccine preventable illnesses, and when we beat measles into submission and eliminated it from this country in 2001, it stayed down. But that, of course, didn’t happen.

Which brings me back to the topic at hand. Currently, most people are hung up on states (currently 19) that allow personal belief or philosophical exemptions from vaccines. Some of them are thinking this wasn’t such a good idea (I’m looking at you, California). 

But what about the 48 states, sans Mississippi and West Virginia, that allow religious exemptions?  Look, freedom of religion and separation of church and state are foundational tenets for this country.  My parents have always instilled in me the importance of the right to believe (or not to believe), and the right to express one’s religion freely. But when the rubber hits the road, and kids are being harmed in the name of martyrdom, we begin to recognize there are more important rules at play.

Truly, I believe that with what we are witnessing in these last two months, mandating vaccinations for all children bears more attention and consideration.

-Tony GiaQuinta, MD FAAP

@IndyPedsDoc

Welcome to IndyPedsDoc!

My name is Tony GiaQuinta, and I love my job.

Tony 2

In 2009 I graduated form IU school of Medicine with a medical degree, and spent the next three years in Nashville at the Vanderbilt Children’s Hospital practicing to become a pediatrician.

I’ve always loved pediatrics. Kids motivate me. They give me energy. I can be having a really lousy day… the barometer is dropping, I have a headache, or a thirty hour pediatric shift ahead of me (of course, not allowed these days), and a be completely recharged by a smiling 6 month old eating his hand and talking non-sense. It’s truly a reciprocol relationship. I make them feel better, they help me feel better.

Don’t get me wrong, I like adults too, and in fact, rely on them to do my job effectively. Specifically, my relationship with parents is a critical bond that helps me communicate, treat, and prevent pediatric illness. But treating kids is my passion, allowing me sleep soundly at night and wake up energized in the morning.

After studying since I was a fetus (or seems like), with 4 years of undergraduate training, 4 years of medical school training, 3 years of residency, 4 certifying examinations (including my Pediatric Boards, still pending the results), and a heap of student debt, I have finally started my venture as a licenced pediatrician, capable of making treatment decisions and dolling out pediatric advice on my own. Liberating! A little frightening… but I have confidence in my training and work ethic that I will be a really great doctor. Not a good one. A great one. Cocky? Mmmm… I don’t think so. Kids are too important to have a mediocre pediatrician. You want a great one, and I worked really hard to be just that. Don’t worry, I promise I am still humble and will always admit when I am in over my head or just plain don’t know. I’m thinking this is ok for a doctor to admit, and that even great doctors don’t know everything.

I accepted my first job with Hendricks Regional Hospital taking care of their sick Pediatric population, newborn nursery, and special care nursery. It’s a fantastic job… interesting, exciting, busy, but still lets me spend time with my families and patients for them to ask questions and get the answers they deserve.

But more importantly, my job does not have me working the 80 hours/week that I have grown accustomed to over the past three years during residency! I have time. With a baby on the way, I am sure, some of this precious resource will be diverted. But, over the last three months, I have really cherished these moments talking with other parents and educating them about the field I love.

I focused these efforts initially using my Twitter account @IndyPedsDoc, and garning a few followers (thanks to my sister and wife for getting my name out). Admittedly, most of the posts are ‘re-tweets’ or quotes from other sources, with me adding my own spin on the title.

But I have more to say! Hence, this blog. We’ll see how this evolves, but for now, I am intending to focus this time on advertising current pediatric trends, research, and knowledge and occasionally mixing in my own thoughts and opinion. I really hope that what I post has relevance specifically towards issues that are confusing, controversial, or unknown to my followers. I am also motivated by Dads (being a male myself), and hope for this to be a resource that they can feel comfortable looking towards…although I think I only have 1-2 male followers on my IndyPedsDoc twitter account. It’s a work in progress.

Most of all, I hope this to be helpful. A few friends (now parents) have already begun texting me pictures of their kids’ rashes etc asking for my advice, and always apologetic to be taking my time.

To this, I always reply, that it is an honor to be entrusted with taking care of your loved one, and as mentioned above, I love my job.

Tony GiaQuinta