Simple Things That Make Me Happy

As many of you know, I have been in a little bit of a funk lately. I'm out of it now thankfully, but it got me thinking about the simple things I do almost every day that make me smile. Here is the most recent.

When I first moved into my house, I immediately tore out all of the iceplant on the hillside in front of my house, and replanted it in a Tuscan/ Califonia themed, water conscious garden. I chose every plant myself for its shape, color, smell etc. It occupied me for months. I spent special attention choosing the rosebushes that line my stairs. The one that is on the landing was the hardest. It took me forever to find it, but when I finally did, it was chosen for not only the color of the flowers, but the smell of the roses. (Yep, I can get obsessed that way.) As I walk down those stairs everyday, before my first cup of coffee, I stop and smell the roses and I smile. It is a simple act, but it connects me. It grounds me in a fundamental way.

The best smelling roses ever.



The other roses along the stairwell.

How Safe is Your Home Birth?

Last night I read my friend Jessica's post on a home birth turned tragedy, and immediately replied that I'd weigh in on it today.    The tragedy, the death of a baby born in an unassisted, unmonitored home birth.  So, here I am.

As a neonatologist, my profession, my passion is taking care of critically ill babies, most of whom would not survive without medical assistance.  I live in the world of the <1% of births that go really wrong. Approximately 10% of babies require some assistance at birth, included in that number is the ever increasing percentage of preterm births. And yet still many argue that we are "medicalizing" a process that is natural and  has occurred without medical assistance for thousands of years.  True, but for those same thousands of years there was generally a midwife or some trained person who assisted the the delivery.  Further, for those same thousands of years childbirth was the number one cause of death for women and babies.  Like I said, I live in the world of 1%.  I have seen crazy things.  There is one case that is burned into my mind of a home birth where the mom refused to listen to the midwife and her husband and go to the hospital when things started to go wrong.  After the woman passed out, the midwife drove her to the hospital, the baby was delivered, saved, but left neurologically devastated because of waiting too long.  A few hours earlier, they might have had a healthy baby.  The list is long and bad things happen even under the best of care, but wouldn't you want a chance to intervene if things start to go wrong, a chance for the baby and the mom.

 Reading the article about this woman in Australia it is clear that her labor was not going as planned, that she had to have an emergency c-section for her first child makes it even less safe for her to be completely unmonitored and unassisted. That she labored for 5 days, something no physician or midwife would allow, especially with the risk of uterine rupture after a prior c-section.  That the baby is dead is a tragedy.  Could medical intervention definitely have changed the outcome, no.  However, it would have given this baby a chance.  

Just like riding a bike

I'm one week into having committed to this triathalon thing and the training has begun.  As I said before, I'm confident I can handle the swim.  The run will be rough because it is last, and 4 miles is pretty much the longest I've run.  So I definitely have to work up my running tolerance...  However, I haven't been on a bike in years.

So, phase 1 of triathalon training is to get comfortable riding a rode bike.  A friend from work lent me a Bianchi rode bike.  I had to get new pedals for it last weekend because I'm not quite ready to have my shoes clipped into the bike pedals.  Maybe that will come.  Then I had to start riding the bike.  People always use the phrase "just like riding  a bike" to describe something that should be rote muscle memory.  Something you haven't done in years, but that comes back to you immediately when you try again.  I am here to tell you IT ISN'T QUITE THAT EASY.  It is going to take some work for me to get really comfortable on this bike.  So, that is phase 1 of triathalon training.  Oh yeah, and to continue to build up my cardio toleranace.  On that note off to the gym I go. 

Are Hospitals promoting Health?

I put this post up on facebook from work the other night when I discovered that the food that I had brought to be my evening snack was bad.  It was simple-  "I'm in trouble, I'm at work, I'm hungry and my hummus is bad.  What will I eat?".  This was after spending 2 hours at the gym earlier in the day which always leaves me somewhat hyperphagic and after recommitting to my healthy eating habits.  So, there I sat HUNGRY with just plain celery to eat.   As I munched away on my celery I pondered my possibilities to get something solid to eat and got some hilarious comments from my friends.  The sad reality is that at 8 pmon a weeknight while stuck in the hospital, my options are limited. There is a  McDonalds in the hospital open 24 hours, but I won't eat there. The cafeteria has almost nothing by processed overly salted food I wont' eat and if it were a weekend it wouldn't even be open at all.  I found an old banana in my desk drawer and some trail mix.  

So there you have it my options were McDonalds v. processed cafeteria food v. old food leftovers in my desk drawer.  Fortunately, the food in my drawer wasn't bad so I ate that. However, it really is a sad commentary that at an institution that is supposed to be promoting health there is nothing healthy to eat.  In an era when childhood obesity is an evergrowing problem, The only place to buy food from at on certain hours and on the weekends at a large freestanding Childrens Hospital is McDonalds.  Is the hospital really promoting health?  And it is not unique to this hospital. I have worked at several children's hospitals in the country and most of them have a McDonalds because of the link to Ronald McDonald houses, and most of them primarily serve unhealthy, fried food in the cafeteria.  As leaders in pediatric healthcare shouldn't we be promoting healthy lifestyles? I don't get it.  As I lay in my bed hungry that night this thought plagued me.  

Tonight when I came to work I packed plenty of healthy food and made sure it was all still good.

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.

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.

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.