Monday, March 30, 2009

To vaccinate or not to Vaccinate

I read this article in the LA Times yesterday about vaccines and recent outbreaks of Measles in certain communities and it made me mad.  I well realize that parents on both sides of this argument feel very strongly.  So, this could get me in trouble, but I'm willing to take the risk.  The gist of the article is that in California there is a rising number of kindergartners who are getting vaccine exemptions  (essentially the parents saying we don't believe in vaccinating our kid).  They just have to sign a form and the kid can enter school unvaccinated.  This isn't such a problem if the majority of the other kids are vaccinated, but with as few as 5-10% unvaccinated kids you can get mini epidemics of diseases that are otherwise quite rare these days, ie measles, mumps, diptheria etc.  According to the LA times there have been several such measles outbreaks in the San Diego and the rate of unvaccinated kids is especially worrisome in several charter schools and non-catholic private schools.

OK, here is my take on this vaccine thing.  When I was a pediatric resident at the beginning of every year in clinic we reviewed the vaccine schedule, risks and benefits of all the vaccines and why we vaccinate against them.  As you can imagine being me, by the time we were third years my friend and I would joke that the reason to vaccinate against these diseases is because they can KILL.  Most of the diseases vaccinated against are things that kill people.  (OK recently we've added a few not so deadly disease to vaccinate against and I used to use this same argument to question if that was right).  But I digress the main issue at hand seems to largely be the Measles/Mumps/Rubella vaccine (MMR).  This one started to fall out of favor after an article linked it to autism.  The fallacy of that study is that autism typically becomes apparent around 15-18 months and almost every child gets the MMR at 12-15 months.  The two were temporally linked, nothing more.  The only study that really looked at vaccines and autism rates showed no difference.  So, my argument and what I used to advise people to do if they were really worried was just delay the shot until their child was already talking.  OK, so there is the mercury thing, but manufacturers have gotten into that and combined more shots and made more of the vaccines without the mercury contained preservative so that is pretty much a nonissue.  Of course, again, you can delay, space them out and make it even less of an issue if really worried.

So back to the diseases behind the vaccines, why care.  Let's start with measles since that was what the article was about.  Measles still exists in the US and is especially prevalent in certain European countries, not to mention less developed nations.  Measles isn't so bad for the average school age kid, but it is DEADLY for infants, and not good for the elderly or immunocompromised.  I took care of a 9 month old infant who had measles encephalitis as a resident.  The child spent two weeks essentially comatose.  She ultimately went home, but the long term effects are likely significant.  Hello this baby almost died, her parents were rightly infuriated and scared.

 How did she get it?  Her older sibling's friend wasn't vaccinated.  She came home from vacation with measles and before she got sick played at the vaccinated friends house.  Thereby exposing the unprotected child.  The child who was too young to get vaccinated even though her parents would have.  You see there is the problem.  It isn't just one kid.  It effects the community.  The LA times article had several similar vignettes of infants under 1 year of age being exposed to measles by unvaccinated friends of their older siblings.  The year before the measles vaccine was released-  ~500 people died from the measles and ~4500 kids had measles encephalitis.  Do I really need to say more?

OK, so now mumps.  Mumps doesn't seem so bad, right?  It used to be the biggest cause of male infertility.  That's right mumps infections in prepubescent or adolescent boys can leave them infertile.  How about Polio?  Now eradicated from the Western Hemisphere, but its long term effects were devastating.

I could go on, but I think I have said enough.  I guess my bias is obvious.  Please people vaccinate your kids.  If you're really worried, it isn't terrible to slow down the vaccinations, but please.  These are bad diseases.

Monday, March 23, 2009

Let the Insanity Begin

So, all of you who have read this know that I used to be a competitive swimmer. Serious emphasis on the used to be part, but as of late I have been swimming again. I have even tried to train to swim the 100 fly once again. My time is not so far off from what it used to be. I count that as one of my many blessings. Further, in my new found pursuit of health and fitness I have started to run. Nothing crazy, but I routinely run 2-3 miles, 2-3 days a week. I have never considered myself a runner, but nonetheless it isn't that hard. When I lived in DC, I used to bike. I would bike the 25 miles or so down the Potomac to Mt. Vernon and then take the subway back, at the time it was my escape. I loved it. So naturally, lately many friends have been asking when as a swimmer and now a runner, who used to bike would I do my first triathalon. My response, had been umm- never, but it got me thinking. Why not. I'm in good enough shape, a half mile swim is still a warm up to me, a 3 mile run something I do when I don't have time to work out. I can do this. So, I have officially agreed to do my first triathalon- 0.5 mile swim, 12 mile bike, 3 mile run. It is in August. I'm doing it with my trainer and friend, Jason.

Let the insanity begin. God knows where this one could lead.

Monday, March 9, 2009

Lost Hour

I love daylight savings time. That magical change in the clock that all of a sudden gives me sunlight when I get home from work. Really I do. However, yesterday I never quite seemed to recover form having lost an hour. I spent the whole day feeling behind schedule and wound up not getting everything in, then this morning 5:45 came terribly early. I know I'll be happy about this in a few days, but today I'm tired.

Friday, March 6, 2009


I am reading a beautifully written book now, Edgar Sawtelle. The author has the sort of mastery of language that I love and can't read fast enough, but don't want to end. The protagonist of the story is a child born without the ability to speak and the dog who decides his purpose is to be the boys protector. I'm half way through it and it is the kind of book that I know I'll be sad to finish, but it has me thinking about the power of words. The ability of language spoken and unspoken to provide support or cause pain, to share emotions, to transcend time, to inspire or to belittle.

As a physician I have worked to become aware of the ambiguity of language and have trained myself to speak as precisely as possible. I work towards perfecting the skills of delivering bad news with compassion but strength, but still there are times when I know that the words that are about to come out of my mouth are going to change a family's life forever and cause them nightmares and inordinate suffering. Yesterday was such a day. I fight my own personality which is to spread cheer and not cause pain by trying to not say such things, but sometimes you must, and I firmly believe that it is worse to withhold the information. However, the aftereffects of delivering such news are rough to bear witness to. I only hope that we (my coworkers and team) can also use our language spoken and unspoken to support too.