an inconvenient truth?

For a while now it's been getting worse. Parents asking about immunizations, are they necessary, what diseases are they preventing, how effective are they, and #1 on the hit parade - what's my opinion on immunizations and autism? Anyone who knows me knows that my opinions are usually pretty wordy to say the least, so I'm going to have to come up with a concise statement on this subject in general and this question in particular. It's not going to be easy, but I'm going to try to "flesh it out" here on the blog and compile my thoughts and put them into manageable piles.

Al Gore gets credit or crap for a lot of stuff, but he certainly is the poster child for global warming. And global warming is a good example of the effect of media/internet hype on a controversial topic. A subject where both sides have impressive information and both can wow you with their glitz and glamorous proponents. Admittedly, the vaccine controversy doesn't have quite the red carpet support as global warming but lately Jenny McCarthy has been one of the more visible celebrity faces of the vaccine/autism question, and Doug Flutie before her was one of the first, though since he appealed to guys, his effect was not as profound. In our media saturated and influenced culture, science takes a back seat to celebrity. "Don't confuse me with the facts" is a phrase I hear (and use) often. Gut feeling and quasi common sense have replaced data and expert opinion. I'm not immune to this, as I've alluded to above.

It has been said that the louder and longer one says something the more people will believe it's true. Especially if the ones saying it are pretty, famous, pretty famous, or wealthy (that never hurts).  Take evolution as an example. You might think, evolution? That's a done deal, right? We learned it in school, it is understood that it is true, except by some wacky fringe element. Well, go back 150 years and that's not the case. Even 100 years. Evolution was the global warming of the early 20th century, and Charles Darwin was Al Gore. Or something like that. Consider, if you believe in biblical Creation, by God, in 6 days or 6 million years, or if you believe in intelligent design even, the "lite" version of Creation, you are bombarded by conflicting information daily, even hourly, and you even may fall prey to this at times. I use "survival of the fittest" as a metaphor quite often, and "natural selection" rolls off my tongue like any other solid method of reasoning out some line of thinking. We are creatures of our culture, and like it or not, it influences us at many levels.

So, we buy a hybrid to decrease our "carbon footprint" despite the people who tell us that the factories that make the batteries that make our cars "green"  are emitting more pollutants than the semi that just passed you on the highway. Tradeoffs are a given in our world.

Unfortunately, the question of vaccines affects children, and that means it affects me. Global warming means I bought a Prius and had less guilt. Giving vaccines with the possibility that they cause autism or other problems is a difficult thing. Not giving vaccines with the possibility that the diseases prevented will reoccur and cause untold agony? A less likely evil? As long as most people still vaccinate their kids? The concept of "herd" immunity. Where it is said that if most of the "herd" is immune to a particular disease, the rest benefits from this protection.

So...global warming, evolution, vaccines cause autism. Which is true? Which is just media hype? Are these questions with absolute answers of yes or no? In the case of evolution, I am a strong believer in Creation by God in however long He decided to take to do it, He says 6 days and a day off on the 7th, so I'm going with that. Slam dunk yes. Global warming? Vaccines? I'm less certain that there is a black "yes" and a white "no" on either topic. Unfortunately, most of the "easy" yes and no questions have been settled - not always the same for everyone, but they're settled in the minds of the people. Are we affecting our environment with carbon fuels and pollution? But does the good outweigh the bad? Does the ability to travel by car or plane make our lives easier and is the tradeoff worth it? Is technology worth it? Are we giving our kids chances that previous generations didn't have by vaccinating against killer diseases? Are we causing problems that are worse by preventing unlikely but deadly infections? There are few people still alive who have experienced polio firsthand,  but even someone my age, in medicine, remembers Hemophilus influenza, type B. The ten or more days in the hospital on IV antibiotics. The great possibility of deafness if the child survived. 

Suffice it to say, this generation has not suffered the effects of the infectious diseases endured by the previous ages. The proponents of vaccines can show graphs of the prevalence of a disease and the controversy over vaccine and the inverse relationship between the two - i.e., if the disease is common, there is little controversy over the vaccination, and if the disease is seen as historical, the vaccine side effects become the subject of controversy, not the disease. Though I don't want to see it, if a measles outbreak occurs, the whole autism/MMR vaccine issue will be a moot point for a while. But we do need to revisit the issue of vaccines and side effects and whether the good outweighs the bad. There are few people without obvious agendas who are taking sides on this question. That is a huge problem - those with personal involvement weigh in on their particular side and then facts take a back seat to emotion, or at least "spun" facts. Statistics can be "spun" to make anyone's point.

Are we causing harm to our children by immunizing them against diseases that most people have never seen? 

To those who are totally in favor of vaccines, for all diseases, in every kid, at any time, the picture portrayed is of a world where the diseases prevented by immunization are lurking just outside the door, waiting for us to let our guard down and let them back in to kill and maim our beloved children in minutes.

To those who believe that vaccines have caused more problems than solutions, the picture is a world where things would be fine if doctors and vaccines and medicines didn't exist and if people would just eat right and exercise, things would be fine.

OK - neither one is right, which takes me back to the earlier comment about no "black and white" answer.

I find myself sitting on the fence. In terms of diseases, I've experienced HIB meningitis personally and professionally. When I say that the worry caused by a phone call about a child with a fever is much less now that it was 20 years ago, it is an understatement. To say the least. I have put the early years of practice behind me. When, after a 2 A.M. phone call about a child with a fever, my wife would say "do you think it could be meningitis?". And I couldn't sleep after that. That's pretty much gone. As gone as something that used to happen but hasn't happened in a long time can be gone. I wouldn't wish it back in a million years.

So...some doctor can say the same about diphtheria, tetanus, polio, measles, etc. 

We are a society of convenience. We vaccinate against chickenpox because it costs the mother a week off of work and that costs a lot. Of course, there is the justification of MRSA and the secondary infection of the chickenpox lesions that could cause worse problems than just the itchy rash. We would like to see rotavirus disappear. My first rotavirus experience was a funny episode in my first year of med school where my roommate got it and couldn't decide whether to sit on the toilet and throw up in the bathtub or sit on the tub to evacuate his bowels there and vomit in the toilet. It was a one or two day thing. And still is for most kids. But it can mean hospitalization and for God's sake, that's an inconvenience to say the least. Kids in Africa die of rotavirus, but here in the US of A, that shouldn't happen. So we immunize to save lives and to save jobs and lifestyles. Where do we draw the line? 

Reading history, I find that smallpox may have been the deciding factor in the conquering of the New World. We have been taught that it was guns or education or desire or something purposeful or controllable that helped Europe conquer the Americas, but as I read history, it was smallpox. Or some other infectious disease/s. 

So...I'm in favor of immunization. I can be tolerant of parents wanting to spread out the vaccines over a longer period of time, while laughing at the fact that the multiple ingredient vaccines that today's parents are scared of were created to meet consumer demand from 15-20 years ago. 

We; doctors, scientists, researchers, should review the data, devoid of emotion and secondary gain, and come up with a reasonable approach to achieve the necessary coverage for children for diseases that are still present and active, and propose this with acquiescence to those opposed, and win them over with our data and dry information and not with bullying and laws and requirements.

And those who are opposed should look beyond their own personal experience to the big picture and the possibility that they were the victims of cruel fate or divine providence,  or maybe to the power of the almighty dollar and the whims of drug companies.

No one is right. No one is wrong. It's not clear, at least in my mind, like the evolution controversy is clear. God created this world.

But we should begin to face the problem of vaccines and autism with the idea that both sides have reasonable, defensible ideas and data. That there is no one right answer to the question. That both sides together, with cooperation and collaboration, may come up with a safe and effective plan. However, until both sides can discuss the issue without emotion and personal baggage, without millions of dollars helping to decide the outcome, this seems an unlikely dream.

I want to place myself squarely in the middle of this controversy. I see the need, and I see the concern. I'm not smart enough to know everything about everything. I will continue to encourage complete vaccination for every child while respecting the decisions of those parents who do not want to immunize or who want to delay or spread out vaccination. It's uncomfortable up here on the fence.

addiction

It's probably the new "energy drink" phenomenon that really caught my attention, but other than being a legal addiction, caffeine is a great example of the concept of addiction itself. One can put many other things in the same boat, like meth, cocaine, heroine, prescription pain killers, narcotic cough syrups, money, attention, the list goes on. When one is addicted to something, they have to have that thing, and once they get it, they want more. I remember when Mountain Dew had the most caffeine of any drink, now it's hardly comparable to Monster and Red Bull. I have even heard of water with caffeine in it, and if you made coffee with it, you increased the caffeine content.

So what's the big deal? Sure, some of the list above are illegal, some bad for you but legal, like caffeine, and some allegedly good for you, like money, or attention. Who ever heard of anybody younger than mid 50's dreaming of a smaller house? Fewer clothes? Less to do? I've spent my life wanting more, more money, more fame, more house, more car, more everything. And once I get what used to seem like "more", it becomes the norm and I again want "more". That's addiction. The bar keeps getting higher, what once was considered satisfactory just no longer makes the grade. So...what about attention? That's not bad, is it?

Consider your first child. That child got a level of attention that you won't be able to provide for any subsequent children. And is it enough? Is that child ready to share that attention when #2 comes along? Or is that child asking for more attention? The level you previously provided is not enough anymore. Always more. As humans, we must be built this way. So what's my point? Other than to tell you not to get into illegal or harmful addictions? 

I want you to look at reality, accept the fact that with your kids, whatever level of attention you currently provide won't be enough for them in a year. No matter how much you give. No matter how big a deal you make of how well he colors in the lines or she recites her abc's, they will each want more attention and recognition than you gave previously. It's human nature. So start low! When they're babies, meet their needs. Feed, change, burp. Hold them and look at them and count their toes and fingers, but only because you want to. When you find yourself holding the child because if you don't he or she will scream and cry, you're witnessing addiction at one of its earliest levels. So start low. Don't neglect, I'm absolutely not saying that. But don't overcelebrate early success, because you're always going to have to top your last celebration or "you don't like it, daddy?". Once again, I'm not speaking of meeting needs. I'm talking about that basic human right as far as the liberal educators are concerned, "building self esteem". Be very careful here. Self esteem is built in. That's why the 2nd great commandment according to Jesus is "love your neighbor as yourself". He didn't tell us we had to love ourselves. That's a given. Back to your kids - rip off the "my child is an honor student at..." bumper sticker, peel off the  cheesy baseball icons or cheer icons with your kids' names beneath them on the back window of your SUV. For whom do you do this? Do the kids say, "mom, you don't have my name on the back of your Escalade and that hurts my self esteem"? No! To tell the truth, they are likely embarrassed that you've messed up a perfectly good - though overpriced and a gas hog, with 4 more seats than you have people to put in them - vehicle (I digress, sorry, hard to not run down rabbit holes). Do you need to go to all their games? From the time they're 3 and chasing butterflies instead of pop flies? NO! Hell, no! You're creating an addiction. In you and in them. You're setting their expectations for your attendance and attention so high that by the time it really matters, you'll be the rabid dad who comes out of the stands to tackle the coach because your kid didn't play enough or hit the kid who hit your kid in the football game. You are getting them addicted to you being there all the time. OK, if it's fun for you, just like holding the baby in the illustration above, that's different. But I'm talking about the mandatory attendance at anything your kid does anytime, anywhere, because somewhere you've been convinced that to NOT attend all those events you will crush that fragile thing labelled as self esteem and your kid is going to be the next "troubled youth" who shoots up a school or a mall. Stop now, before it's too late. 

Realize that the level of attention that you give your child now, whether for reading a certain number of books or peeing in the pot or showing up at the soccer game or making good grades or being in the school musical or drawing a picture that got chosen to be shown in the mall with a bazillion other pictures that look like 3rd graders drew them, will set the level of expectation for the future of attention in your child's life. So, set the bar low. Love your kids. Don't worship them. Be with your kids, but not always at an "event". Have dinner together, skip soccer practice, show your child that you treasure the time with him or her more than the commitment you made for him or her. Relax. Enjoy your children. I'm not telling you to neglect or fail to notice accomplishments. But only to the level that those accomplishments deserve. Making the honor roll in middle school doesn't deserve a bumper sticker. In fact, have you ever seen a bumper sticker that says "my kid got into Harvard"? NO. You celebrate more personally and less publicly, more appropriate for the level of accomplishment. I think something of this thought is in my "birthday party" blog from a while back. Just remember, you are growing a kid who someday will expect a medal for showing up to work everyday if you reward the normal, expected things in life. Show some restraint. Just because everybody else on the block is touting their kid's accomplishments, you don't have to. Your kids will know that you love them by your attention in the areas that matter, and by your attendance at things like - baths, bedtime prayers, dinner, church, impromptu fishing trips to the neighborhood pond, Braum's runs after dinner "just because" - that's what they'll remember. 

Save something for the big stuff later. Don't throw all your good pitches too early in the game. Remember, they will always want more, so if you start low, you can peak at the right time.

surfing

OK, I'm going to get "religious" on you for a minute. I want to try to tie together the concept of trials and tribulations in life as Jesus speaks of them, and the troubles we have with our kids, and make a point. Wish me luck. For excellent spiritual advice and discussion, please see my wife's blog at feedingthespirit.blogspot.com. 

My wife references Oswald Chambers a lot. I read his devotional, My Utmost for His Highest, almost every day. He's got some cool insight into how God works. I like it, maybe you will, too. In Bible Study Fellowship, we are studying Matthew, and this week there's a part where Jesus tells the disciples that things aren't going to be easy, and that they will have to drink His cup, too, and that it's going to be tough, but for all the tough stuff they endure, it will be worth it both here on earth and definitely in heaven, where eternal life is the prize. He tells them not to be surprised when trials come.

So...trials and troubles don't sound fun, do they? But, basically, no pain, no gain. 

How do we handle them? How are we supposed to handle them? Are the answers to these two questions the same? I doubt it. I know it's not that way for me. 

Here's where Oswald Chambers comes in with a quite hip (for the 1910's) analogy that I think illustrates the point and the correct handling of trials and tribulations. He references the verse in Romans where Paul says "in all these things, we are more than conquerors through Him that loved us". Oswald then goes on to say that "the surf that distresses the ordinary swimmer produces in the [surfer] the super-joy of going clean through it". So, picture Hawaii and the big waves and you don't see people swimming and splashing around at the beach, you see the surfers paddling out and waiting for the best, the biggest, wave they can find to ride in as far and as fast as they can. Never having been there, I'm just guessing, but I'm thinking that swimming in that kind of surf is dangerous to say the least. In fact, people probably drown all the time there. But they travel there to surf.  The waves that would drown a swimmer are the exact things that make it fun for the surfer. 

So...the waves are the trials and tribulations. The swimmer is the person who tries to plow through the surf on his own strength and he drowns. The surfer is the one who sees the problems as opportunities that can provide fun (rejoicing) if one has the Holy Spirit (surfboard).  I really like that metaphor. It hits me where I live. When I'm swallowing a lot of water trying to swim, I try to conjure this idea up in my mind, rise above it with God's help, and surf. This is probably what I mean when I say parents should be "detached" from their kids' lives some of the time. If all you see are waves one after another, and all you're trying to do is swim, you're going to drown. So surf! If it weren't for the waves, you wouldn't know what it was like when the waves were quiet. You might even (gulp) wish for some waves!

We expect things to be easy. We sure hope they're going to be easy. We get a baby and that baby should be perfectly healthy at all times and present no problems to us, and maybe an hour goes by and something goes wrong. The baby spits up, has a stuffy nose, is constipated, has a rash, breathes funny. And you haven't even left the hospital with your newborn! Then there are ear infections, colds, stomach bugs, strep throat, 5th disease, shots, fussiness, biting, temper tantrums, defiant behaviors, the list is endless. We should not be surprised at these problems. In fact, if we are "surfers" we should really be looking for the next wave, and in my experience, if you're looking for a wave, one doesn't usually come! Reverse psychology! The last shall be first and all that stuff that Jesus talked about. 

My point? Don't be surprised when bad things happen. They're going to happen. If they didn't, you wouldn't be able to enjoy things when they're going well. You wouldn't know any difference. Sort of like a "Twilight Zone" episode where the guy died and thought he'd gone to heaven because he got everything he wanted right away and always won when he gambled and always got the girl he wanted, then he found out it was really hell. With no down, up can't be appreciated, with no sound, silence can't be enjoyed, etc.

So, surf! You don't have to enjoy your kid being sick, just realize that you're in Hawaii (it's a metaphor!) and there are going to be waves and you should expect them and you've got the Holy Spirit to help you surf, so detach from those waves, stand on them and ride! You might find that when things are going great, you get kind of bored. Maybe, maybe not.

Last point: waves are going to come. Don't be surprised or overwhelmed by them. In fact, if you do it right, you might be surprised at your attitude when your kid doesn't have as many problems you thought they would. Not that you look forward to problems, but in a way, you really do. And in the same vein, you enjoy the lack of problems that would overwhelm you, and you might even be able to help people who are trying to swim and about to drown!

stating the obvious

just got a "news flash" from some pediatric journal: caregivers should not "pre-chew" the food for a child because they could get aids from it. wow, glad they told me that one. i'm going to have to put up a sign or something to make sure my patients aren't doing this. forget that food grinder, that blender, do it the "natural" way and chew it for them! oh, and you shouldn't do it especially if you have any open sores in your mouth. please! i've heard many stupid things that parents have done, but this takes the cake. at least there's a reason not to do it now, besides the fact that it's disgusting and i can't even imagine being on either end of that activity! sorry, just had to share that with you.

seems there needs to be a statement to tell people not to do stupid stuff, like the coffee may be hot, and don't put this plastic bag over your head, or don't stick this knife in your eye, or don't swallow this little bag of sand in your medicine bottle, and on and on. one hopes that people who can actually read the warning labels (or can interpret the symbols on the warnings that are supposed to tell people who can't read not to do the stupid stuff) should have the common sense not to do those things, and that the warnings would be unnecessary, but no. sort of like the statement on the airline safety handouts that say "if you can't read this, ask someone to read it to you"...well, if you can't read, how do you know to ask?

i tell parents not to tell the older siblings of a new baby not to do something they haven't already done, like "you can't carry the baby", and things like that, because to do so might give the child the idea. so, if attorneys are responsible for these warnings, and we are a society of idiots, as it seems, is it better to tell us not to do these stupid things or should they not mention them in hopes we won't think of them ourselves? time will tell.

letters vs. words

We have become increasingly comfortable in recent years in the area of assigning acronyms to diseases and disorders or viruses and bacteria. This makes them easier to refer to and maybe less scary. Or are they less scary? Is something we can't pronounce or understand more or less scary than the letters that represent it? Is the IRS more or less scary because we have relegated it to the status of acronym? I should actually change the word from acronym to initialism. Acronyms are supposed to actually spell a word that can be pronounced, like NOW for the National Organization of Women, etc., whereas initialisms are things like IRS which take some or all of the initials of something and make it a common phrase or almost a word. I looked that up, are you impressed?

What's funny is now that I know that, the whole MRSA thing has really got me going! What do you call an initialism (MRSA) that people, usually on the news, have begun to pronounce as a word, like MeRSA, or MaRSA, when the 'e' or 'a' is nonexistent, not just silent? You call it an attention-getter, a catch phrase, a buzz word, a lead-in, a hype...One would conclude from watching the news (another acronym, by the by) that if you don't die from the flu this year you're bound to succumb to MeRSA or RSV or AIDS. The FDA is making a new PI for the old AD's and NSAID's because of AE's noted in RS's of UD. I made most of that up, but it's jargon for the fact that the FDA is "re-looking" at old drugs based on retrospective studies of usage data. The news talking head doesn't know that, he or she just knows the initials and leaves the rest to you to decipher.

So, is methicillin resistant staphylococcus aureus more or less scary than MRSA? Would Kelly Ogle be able to repeatedly say the "non-initialism" and therefore it would be the problem that it is vs. the BREAKING NEWS STORY it has become?

The lay (nonmedical) public's understanding of microbiology is pretty minimal, and if I wasn't a doctor, mine would be, too, I'm sure. But THE FLU is a virus (not, "I hope it's just a virus and not THE FLU."). RSV, initialized from respiratory syncytial virus, is also a virus, obviously, hence the name and the 'v' on the end of the initialism. Viruses are myriad - there's a gazillion of them, more or less. From the common cold (rhinovirus most often) to the stomach "flu" (another misconception - "I thought he had the flu, but he wasn't throwing up", the real live influenza virus isn't known for causing vomiting as much as high fever, body aches, sore throat, cough, so stomach "flu" is a misnomer, but the most famous in kids is rotavirus, another, famous on cruise ships, is the Norwalk virus), some are petty and to be endured until they go away, while others, like herpes simplex, to quote Eddie Murphy, you keep "like luggage". Then there are the scary viruses, like HIV, an initialism for human immunodeficiency virus, which causes AIDS, an acronym for acquired immunodeficiency syndrome. It can kill you. Some are more in the middle, like hepatitis A, which you get and get over, not to be confused with hepatitis B, which again is like luggage, and even like HIV, can kill. 

One must not only differentiate between viruses and bacteria, but between diseases and their causes. AIDS is the disease caused by HIV. Hepatitis is a liver disease caused by a few different viruses, typically, but can be caused by drugs and other toxins that are not infectious agents. Pneumonia is a lung infection and can be caused by viruses or bacteria. We typically think of it as a bacterial infection and in this case the public lack of knowledge is fed by the medical community's consistent use of antibiotics for pneumonia and bronchitis while studies continue to show that most cases are caused by viruses and no antibiotic treatment is needed. I'm guilty here, too, but hey, how do we know? To find out specific causes takes a lot of time and a decent amount of money, and the public hears pneumonia and has an expectation of at least an antibiotic, hopefully a shot, and if grandma hears about it, she thinks it means hospitals and possible death.

So, pneumonia isn't one thing, nor is hepatitis. RSV is one thing, a virus, but it causes several other things, like bronchiolitis, bronchitis, pneumonia, pneumonitis, ear infections, etc. MRSA is technically one thing, or a group of similar things. 

To further clarify (?), viruses are viruses, and bacteria are bacteria. There don't seem to be as many famous bacteria as viruses lately, but MRSA is an exception. Maybe E. coli is another. There are bunches of bacteria, too, but some of them are good and play a part in our health, whereas viruses are pretty much always a nuisance if not a problem, though most of us have had exposure to way more viruses than we know. Point: there aren't any "good" viruses, only ones that don't cause problems, where there are some "good" bacteria, like probiotics, which actually help us. I may get corrected for saying there are no good viruses, maybe I just can't think of any.

Bacteria are things like streptococcus, which causes strep throat, but others with that first name can cause pneumonia, meningitis, flesh-eating diseases, etc. Staphylococcus is a bacterial first name, and here's a place for another clarification. Germs, viruses and bacteria, often have a first and last name, and some even have some letters and numbers after that. The strep of strep throat is different from the strep of meningitis and pneumonia, the first names are the same but the last name is different. Sort of the opposite of the way we are named here in the US and elsewhere. Strep is more like Smith or Jones, and the word after it tells which Smith or Jones you're talking about. 

Bacteria are killed by antibiotics, or antimicrobials, to be exact, because guns could be said to be antibiotics, since it means to be against living things. When we use antibiotics for a while, the bacteria get smart and some get resistant to that antibiotic. When a bacteria gets resistant, we switch to a different antibiotic, and on and on, until something like MRSA shows up, or some strains of tuberculosis, which are "multiple drug resistant", meaning they are not killed by the usual antibiotics, and we have to pick specific ones, and then...nothing works. Or so it seems, but God didn't create us to be wiped out by a bacteria so He made our immune systems so that we can kill most bacteria on our own given time and a decent immune system, but boy oh boy, having antibiotics to help sure has made things better for the most part, or so it seems. 

Viruses are not killed by antibiotics, in fact, they laugh at them. By using antibiotics in a viral infection, we have selected resistant bacteria to cause secondary infections, so that's why the first antibiotic your kid took for his "cold" didn't work and now you're on to the $100 one. 

Secondary bacterial infections, ones that occur on the tail end of a viral infection, are the problem which we, as physicians, face daily. "Yes, today my child has a "cold", but I know that tomorrow it will be an ear infection, can't we just put him on something now to keep that from happening?" I'd love to be able to do that, but the timing is of the essence. If I put him on an antibiotic before a bacteria has decided it wants to cause a secondary infection, then the antibiotic will kill all the bacteria it can, leaving perhaps, and increasingly commonly, one or more that aren't killed by that antibiotic. So, I've guaranteed that the first drug won't work. How do we know when to treat with an antibiotic? We don't, always. However, a good rule of thumb is that it is better to be a little late than a little early with an antibiotic. Let one settle in a bit, and let it get rid of its rival bacteria, then go in and kill it with an antibiotic.  It seems to be increasingly less common for a child to actually have a bacterial infection in the office. Moms are acutely aware of the early warning signs and perceive themselves as bad mothers if they are unable to anticipate an ear infection or strep throat and the child actually gets sick. This is a challenge daily. 

Viruses, at least some of them, can be treated, but they aren't really killed like some bacteria are killed by antibiotics, they are just kept from replicating or reproducing. So you've got whatever symptoms you've got for however long that particular viral generation lasts, then you get over it. Tamiflu, for instance, works that way with influenza A and B. If you've already got the flu virus, you can start it but you won't get well in a day, it will take a couple or more to let the virus die off and since it can't replicate, it's over at that point. You can also take tamiflu to keep from getting the flu if you've been exposed. Viral resistance to drugs happens, too, and they shift pretty quickly, making the little boogers hard to hit sometimes, hence the flu shot only working on 40% of the flu virus present in the US this year. 

To finish, don't be scared of bugs with initials. They are no more scary than when they had long names that were hard to pronounce. Conversely, they aren't tamed when they've been initialized either. Learn the difference between a virus and a bacteria, an initial infection and a secondary infection, and then you can make better choices as to when to take your child or yourself to the doctor and when and if an antibiotic is indicated. Antibiotics aren't all bad or all good, they are tools, and when used properly, work pretty well. When they become overused, whether by the physician or based on the demands of a patient (sometimes it's hard to separate the two, but healthcare is a consumer driven business to a great extent, and the customer has to leave satisfied...), bad things can happen. Remember, better to wait an extra day or so on an antibiotic than to start too early. There are few bacterial infections out there that are exceptions, like meningococcal meningitis, but 99.9% of the time, this caveat holds true.

Wow, I started off on acronyms and ended up with a microbiology lesson. Sorry. LOL (I don't even know for sure what that initialism means!) but it's a pretty common one in the text business. Have you seen the commercial where the mom, grandma, and daughter are playing Scrabble and they're using initialisms from texting for words? PFF (pretty fricking funny).

obesity in children

Just finished reading an article that even an optimist like me can't find too many things good to say about. It reviews the literature on the role of the mother in a child's eating and the role of the child in eating and then the combination of the two. You can pretty much guess how it turned out. If it was all the mom, she could change, maybe. If it was all the kid, the kid could change or be changed. If it was all genetic, we're getting there. If it was all psychological, well...but it's all those things and more. It's the mom, it's the kid, it's the two of them together, it's the genes and the environment and whether the mother was overweight and whether they're poor or of low socioeconomic status. It's the grandma, surprise, and where she came from and whether she had plenty of food or not enough. It's the culture, it's where you grow up and the sizes of the kids around you. It's whether your kid tends to eat in the absence of hunger, something they've coined EAH, which I find amusing in our world of 3 and 4 letter confusion. I have EAH. Please forgive my obesity. I can't help it. I really do. I eat because it's time to eat more than because I'm hungry. I eat because there's food there to eat, often without regard to whether or not I'm hungry. My wife on the other hand forgets to eat. What's that? NEPH? Not eating in the presence of hunger? Maybe ADD of hunger? I just didn't pay attention to my hunger. That's never happened to me. 

My advice for parents for many years, learned from experts and observation, is that if you have healthy food around the house, present it at regular times and in measured quantities (another paper I just read says that kids don't want more of a snack if it's presented in a small quantity and they can't see the whole sack of cookies, etc. ) and don't get too wrapped up in whether or not your child ate or didn't eat, you will be less likely to have an overweight child. Or an underweight child. Detach from your child's eating except as it is your job to provide it. There are two good articles to read: one from Contemporary Pediatrics on "Mother Knows Best", vol. 25, no. 1, and one from Wondertime magazine, 3/08, on "natural selection", and no, it's not by Charles Darwin, it's by Catherine Newman. The "heady" one from Contemporary Peds is the more depressing of the two, basically coming to the conclusion that it's all a crapshoot and we have no answers for you, and the other is very funny and well-written and I think speaks to most moms who either are naturally relaxed and have some common sense and faith or who take their xanax regularly, saying that you know what's healthy and just because it's organic doesn't mean you can eat more of it and don't fall prey to the "green" advertising ploys out there that make you think there's a healthy ice cream or potato chip! Good reading. 

These, and many other, articles continue to make me aware that the more we know the less we understand, and I go back to Genesis where the tree of the knowledge of good and evil was the one we weren't supposed to take a bite of, but who in today's world wouldn't have done what Eve did way back then? I know I would have, at least if I'd gotten my lazy overweight butt over to it and the fruit wasn't too high up or too hard to pick or clean or cook or...

packing

OK, random thought while opening a package recently: most of life is packing "peanuts" and they are there to protect the real product inside. Many, if not most, of life's experiences are packing nuts. Newspaper. Those new air bladders that I suspect are cheaper since they keep showing up more and more. Actually, the air bladders pretty much make the metaphor more nebulous and unfortunately more realistic. Most of life is just air, a la Solomon in Ecclesiastes. Our package, our life, has but one precious content, our Savior, our faith in God, our worship of Him, and all the other stuff is just packing - nuts, newspaper, air, bubbles - either protecting that precious cargo or just obscuring it from view. The more room the actual contents of the package takes up, the less packing material is needed, right? Are we the kind of package I saw at Christmas this year where one keeps opening another and another box until the tiny box is finally opened at the end? Or are we open packages, showing the contents for the world to see our God and the faith we have in a way that they can touch and feel and not just hear and wonder if it's the real thing?

OK, that's my random thought of the day. Radical, maybe. Do I do it the way I've suggested? Probably not. I'm pretty much a big old air bladder with just that tiny nugget of faith inside, hidden from all but the most curious of observers, but it's there, trust me, it's there.