Monthly Archives: September 2012

Unedited Letter to the Editor: New Paltz, NY Measles Case

Some of you may have heard of a recent case of measles being reported at a Mountain Laurel Waldorf School in New Paltz, NY.

It’s been in the news (WSJ, Poughkeepsie Journal, The Daily Freeman– three cheers for The Daily Freeman for linking to the CDC site to give readers more info about measles, and The Times-Herald Record).

I heard about it several days before it was reported in the news because it hit frighteningly close to home.  My mother is a school nurse in New York state.  She was amongst the first wave of health professionals warned by the Health Department that this was going on in a school only an hour from her school.  She called me right away.  Why?  Because kids we love attend that school.

I’m sure many read stories out outbreaks of whooping cough (aka pertussis) or measles and think, “Oh, that’s far away.  It will never happen to me/my town/my family.”

Well, it can, and if vaccination rates continue to drop, it’s all the more likely, it will.

So how close to home is it for me?  I have family members who are students at that school.  Children who hold, hug, and kiss my unvaccinated infant (because he’s too young).  Kids who play with my daughter, who has yet to get her second MMR vaccination (because she’s too young).  Kids who have a baby brother at home who may not have been vaccinated yet, since he just turned 1.*  Students who have now been exposed to the measles are kids that I love and care about- kids who have routine contact with an unvaccinated sibling and unvaccinated or under-vaccinated cousins.

This is why vaccination is so important!  I pray that these kids are not among the small percentage of vaccinated kids who do not mount a sufficient immune response.  I pray that they didn’t bring this home to their mom and dad and baby brother.  I pray that at pick-up/drop-off their baby brother wasn’t inadvertently exposed.  I am relieved that we haven’t seen them since school started and I can be sure they didn’t exposed my kids to measles.

Their school, the Mountain Laurel Waldorf School, per Health Department protocol, had to tell more than half (!!) of the students not to come to school because they were not sufficiently vaccinated against measles.  That low rate of vaccination is staggering.  It gives me a pit in my stomach.  The CDC is aiming for more than 95% of kids to be vaccinated to prevent an outbreak of measles (source).  A 95% vaccination rate to protect our children and this school has less than 50%?!!?  Why?  Why take this risk?  This school was/is courting an outbreak of vaccine-preventable illness.

The public was notified about this case of measles last Friday, the 21st.  The Dutchess County Health Department “advises residents who have visited the school since Sept. 10 or has had contact with anyone from the school they should make sure they are up to date on their vaccinations.” (source) The incubation period (before which an infected individual will not show symptoms of infection) is up to 18 days (source).  Whether this is an isolated case (which I certainly hope it is) or whether this will be a measles outbreak remains to be seen.

The local Times-Herald Record reported on the measles case earlier this week.  Much to my disgust, it contained a significant factual error, and missed a great opportunity to educate its readership on the importance of vaccines and the risk of declining vaccination rates.  Not to mention, pointing out the lies and shortcuts parents use to get out of vaccinating their children, thereby putting all of us at risk.

What did J Horrigan of the Time-Herald Record get wrong?  Or was it Dr. Carol Smith the Commission of the Ulster Country Health Department who was wrong?  I don’t know, but it prompted me to write a letter to the editor.

The letters to the editor of the Times-Herald Record can only be 200 words long, and I had much more to say.  So, I whittled the essence down to 200 words and sent it off.  The unedited letter to the editor, I publish here.

Letter to the Editor of the Times-Herald Record:

I am writing to bring your attention to an error that appeared in the article published on Tuesday, 9/25/12 entitled “Officials monitor New Paltz school for measles.

In the article, reporter J. Horrigan wrote, “According to [the Ulster County Health Commissioner Carol Smith], children who are vaccinated against measles cannot be infected by the disease.”

Either Dr. Smith was misquoted or she is completely misinformed.

No vaccine is 100% effective.  The measles vaccine has an efficacy rate of approximately 95% according to the CDC (source).

This less than 100% efficacy rate is why it is so crucial for everyone to be vaccinated- it protects those for whom the vaccine did not produce sufficient immunity, those who are too young to be vaccinated, and those who, for legitimate health reasons, cannot be vaccinated.  This phenomenon is called “herd immunity.”  For more detail on “herd immunity” and the consequences of vaccine efficacy, see the CDC website.

It is frightening that over 50% of the students at the Mountain Laurel Waldorf School attended by the infected child are not current on their vaccinations.  There is a clear lack of understanding of the need for vaccination in this community.  It is disturbing that when faced with keeping their children out of school for 21 days, the parents of 27 children chose to vaccinate them.

Clearly most, if not all, of these children were attending school under the religious exemption allowed by New York State law.  Presumably it was not the medical exemption available to children for whom vaccination is medically contraindicated, for that would not have changed so rapidly for 27 students.  Thus, it must have been under the religious exemption which is allowable when “parent, parents or guardian objects to their child’s immunization due to sincere and genuine religious beliefs which prohibit the immunization of their child.”(source).

How sincere and genuine were these beliefs that they would be tossed aside so parents would not have to arrange child care for 21 days?  Was there a mass religious conversion amongst the Mountain Laurel PTA or were these parents lying when they submitted a signed statement indicating that vaccination was a violation of their religious beliefs?

As a parent and as a scientist, I think it is crucial for correct information to be disseminated when it comes to such crucial public health threats as measles and vaccination.  Given the dangerously low vaccination rates at the Mountain Laurel Waldorf School, there is a clear need in your community for accurate information on life-saving vaccines.  This is not the time to spread misinformation due to a lack of diligence on the part of the reporters.  A simple search of the Centers for Disease Control website (or Google for that matter) would have turned up this accurate information.

I ask that you contact Dr. Smith to clarify her statements on this, and that you print a correction.  It would also be beneficial for your readership if you provided some legitimate and reliable information sources- such as the CDCWHO, etc.

Sincerely,

Momma, PhD.**

 
So, there you have it.  My unedited letter to the editor.
————————
For more info, see the Ulster County Health Department’s Measles Outbreak Fact Sheet

*For info on the CDC recommended dosing schedule for the MMR vaccine, see here.

**I used my real name in the correspondence, but am using my Momma, PhD here on the blog.

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Happy Anniversary: Better than last year

Today Mac and I celebrate out 4th wedding anniversary.  We’re going out to dinner at a restaurant near our house that we’ve been wanting to try since it opened a little over a year ago.  I’m hoping it lives up to our expectations!

Last year I posted about our anniversary here.  However, there was something significant that I glanced over.

I mentioned “other craziness/worry that just made me appreciate my husband and our marriage even more.”  Well, I’m happy to say that this year, the cause of the craziness/worry, an embryonic Nemo back then, will be spending the evening with his grandma.

Last year at this time I was about 7 weeks pregnant with Nemo.  Last year, our anniversary was scary and frightening and stressful.

I had had my first prenatal visit on Monday the 26th.  I mentioned to the midwife that I had noticed a few instances of spotting over the previous week or two.  It was very minor, but it was worrying me a little.  She suggested that they run some blood work to see how things looked.  Otherwise, there wasn’t much to do- being only 7 weeks, they didn’t do an ultrasound or anything.

I hadn’t told Mac about the spotting (considering one of the instances happened when we were out for the day, without Mabel, celebrating our anniversary) because I didn’t want him to worry.  Looking back, I think that was a mistake.

The day after that first appointment, our 3rd wedding anniversary, the midwife’s office called me at work.  It was not good news.  My progesterone (the “pregnancy hormone“) levels were extremely low.  For comparison, normal range is 9 to 47 ng/ml, with an average being about 25ng/ml at 7 weeks pregnant (source).  My blood work showed my progesterone level was 6ng/ml.  Very low.

The midwife then said, “Before we begin to supplement your progesterone, we need to make sure it’s a viable pregnancy.”  Right there my heart skipped a beat.  I knew it meant there was a chance I was having a miscarriage or what I thought was a pregnancy was a blighted ovum.

The midwife gave me the contact info for a local radiology center that could conduct the ultrasound, since the midwife in the practice who did them wasn’t in the office that day to do it.

Doing my best to keep myself composed, I took the scrap of paper with the phone number, picked up my cell phone and car keys, and went out to my car.  Nobody at work knew I was pregnant and I couldn’t have that kind of conversation in a shared office.

First, I called the radiology center, told them it was urgent and asked when they could see me that day.  They had a 3:30pm appointment.

Once I hung up with them, I knew I had to call Mac.  I was nearly in tears just thinking about having to make the phone call.  He was totally unaware that anything was going on. I hadn’t told him about the spotting, I hadn’t told him about having the blood drawn.  As far as he knew, everything was fine.

I called him, a tremor in my voice and said, “The midwife’s office called.  They are sending me for an ultrasound.  They think I might be having a miscarriage.  I had some spotting, they did some blood work and they need the ultrasound to confirm that the pregnancy is viable.  My appointment is for 3:30pm.”  It all tumbled out.

His first response was, “What time do I pick you up?”  What else we discussed is hazy in my mind. I know I was crying.  I felt scared at the loss of the pregnancy and I felt guilty for having kept him in the dark.

I then scrambled and called my mom.  She knew I was pregnant, but also unaware of the concerns.  She was great.  She accepted my brief explanation, didn’t ask any questions and then scrambled to get coverage at work so she could come watch Mabel.

I composed myself and went back into my office.  I sat down and started Googling/PubMed searching and reading all that I could about miscarriage, low progesterone, blighted ova, chemical pregnancies, etc.  In my searching I found info on misdiagnosed miscarriages.  Women, particularly those with a ‘tipped uterus’ reported being misdiagnosed as miscarrying.  Transvaginal ultrasounds (the only ones capable of seeing an embryo in the early stages of pregnancy) with a tipped uterus apparently resulted in miscalculated gestational ages- indicating that an embryo wasn’t growing normally, was measuring small, and likely there was a miscarriage in progress.  I tucked that info into my brain.

At 1:30pm Mac with Mabel, my mom, and I all convened in the parking lot at my work. I didn’t even tell anyone I was leaving, I just walked out. My mom took Mabel home, and Mac and I went to the radiology center.

We waited FOREVER- over an hour- to be called back.  It was miserable.  Then they called me back.

The technician began the scan and looked for a long time.  The longer she looked, the more my hope faded.  She said, “Here’s the embryo.  It’s measuring about 5 weeks.  That’s too early to see a heartbeat.  Maybe your dates are wrong?”

I knew my dates weren’t wrong.  I’m a scientist for Christ’s sake.  I was charting.  This was a wanted and planned for pregnancy.  My dates were right.  I had a positive pregnancy test in my hand over 3 weeks ago!  There was no way that I was only 5 weeks along now.  Something was wrong.

Outwardly, I was stoic.  I just laid on the table holding Mac’s hand.  I didn’t look at him.  I couldn’t look at him.  I felt so guilty for keeping him in the dark.  For letting him go along thinking everything was fine.  Then calling him a few hours ago to tell him everything wasn’t fine, that I might be having a miscarriage.

Inwardly, I thought to myself, “Maybe I have a tipped uterus.  Maybe that’s why her measurements are wrong.  It will be hard to wait, not knowing, but I’ll insist on coming back in a week to see if the embryo is still growing.”

Then, the technician, God bless her, said, “You know what, scootch down, make your hands into fists, and put them under your but.  I think your uterus is tipped.  Let me just try to get a better angle.”

I felt a glimmer of how and did as she instructed.  It took several minutes.  I knew she was trying very hard to find us conclusive answers.

After what felt like an eternity she said, “Oh!  I see a heartbeat! Right there.”

I couldn’t even look.  I didn’t even turn my head.  I had too many tears in my eyes to see the screen anyway.  I just reached out and clenched Mac’s hand and said a prayer of thanksgiving.  (I’m getting teary-eyed just thinking about it now.)

She recalculated her measurements.  The embryo was still measuring behind where it should have been, giving my charting, but it was less than a week off, and given the tipped uterus and the trouble she was having getting a good view/good measurements, it was good news.  The heartbeat was definitely good news.

I can’t explain the relief I felt.  I don’t think it’s possible to comprehend just how attached you are to your pregnancy until you are faced with losing it. I knew that the embryo wasn’t a baby, yet, but I wanted it to become one, and I realized I would have been heartbroken if it hadn’t of been viable.

As soon as the appointment was over, I called the midwife’s office and they called a prescription for Prometrium into my local pharmacy for me to start on that very night.  Then I called my mom and let her know that her prayers were answered.

That was how we spent our anniversary last year, Mac and I.  This year promises to be so much better.

________________________

Follow-up:

A few days later (I think it was Thursday or Friday) the midwife’s office gave me another near panic attack when they called with the retest of my progesterone levels after starting on the Prometrium.  They hadn’t gone up at all, and they said I needed an ultrasound to confirm viability.  The fear came flooding back.  This time I went to their office, alone.  When I mentioned the scan I had on Tuesday, and how the tech had said my uterus was tipped, the midwife looked confused.  Apparently they hadn’t gotten around to putting the results from the radiology center into my chart!  That midwife (one of several in the practice) didn’t know the viability had already been confirmed when she saw my blood work and said to bring me in!   So, the midwife did an exam and actually, manually un-tipped it (!) and could see everything just fine.  She measured and said the embryo looked fine and was measuring normal growth compared to Tuesday. I was simultaneously angry at them, and relieved by the results.

I stayed on the Prometrium through my first trimester, even upped the dosage, but my progesterone levels never got above 12.  Thankfully Nemo was fine.  He developed right on track.  By the time of my Nuchal Translucency scan (about 12 weeks) he was measuring right according to my dates.

Thinking back, it was so frightening.  I am so blessed it worked out the way it did.  My heart breaks for the parents whose stories don’t have the happy ending.

___________________________

ETA: A follow-up post with more science, and more emotions regarding this experience is here.

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Wordless-ish Wednesday: Mystic Aquarium

Been sitting on these photos for a long time!  So here they are as a Wordless-ish Wednesday.

Mabel REALLY enjoyed the aquarium and I was really impressed how willing she was to touch all the different creatures in the touch tanks.  She was a little scared by the Belugas that came right up to the glass, made eye contact, and “spoke” through the glass.

PS- We were able to get discounted admission!  A friend who lives in Connecticut was kind enough to borrow her local library’s admission discount pass.  Another option was showing a Big Y saver card, but we got a larger discount with the library pass.  We met friends at the aquarium and they are a military family (USAF) and their military ID qualified them for a generous reduction of the admission price.   So check your local library (always a good idea since they often have passes for a local museums, zoos, etc. in their area) and the aquarium’s site for info on discounts.

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Children and funerals

Saw this article in the New York Times yesterday:  Letting Children Share in Grief.  The part of the article that really resonated with me is below.

TRYING to protect children from the pain of the death of a relative can actually make matters worse, some experts say. Children pick up “on the message the adults give verbally and nonverbally to ‘not go there,’ ” said Patti Anewalt, a grief counselor at Hospice and Community Care. “As a result, kids are extremely anxious.”

But America has since become a “mourning avoidant” culture, he added, in part because many 40- and 50-year-olds still have living parents. And that longevity, he wrote in an e-mail, has “resulted in a tendency to overprotect children from the realities of grief and loss.” Indeed, death is such a foreign concept to some families, he said, that he has been told, “We just don’t do death.” (Source:  Catherine Saint Louis, NYT)

In her nearly three years Mabel has already attended several funerals and memorials.  My high school friend’s father’s memorial service; her great-grandfather’s wake, funeral mass, and burial; my aunt’s memorial service; the wake for an aunt’s father; her great-grandmother’s memorial service.

Maybe it’s the Irish Catholic way of doing things, but kids are always there.  Even in the midst of tragedy, it seems kids can provide a wonderful emotional release- laughter at their antics, reminders that life will go on.

When my grandmother passed away, my cousin, who had given birth only 2 weeks prior was there, with her infant, though nobody would have faulted her if she had stayed home.  When my aunt passed away unexpectedly, we were all grief-stricken and beside ourselves; however, the little cousins still brought smiles to our faces as they toddled around.

I remember the first wake I attended as a kid old enough to realize what was happening.  My uncle’s father passed away.  We dressed up and went.  I remember seeing him laying in the casket- the kind and generous old German man who always had the kids into his small cottage for German chocolates every time we visited- it was upsetting.  It was also upsetting to see my uncle, a strong man, cry and weep.

Was it wrong for me to be there?  I don’t think so.  Not at all.  I watched my parents and learned the cultural rituals we participate in to mourn the dead, celebrate their lives, and most importantly comfort the ones they’ve left behind.  Some cultures you wail and throw yourself on the casket.  Others you are somber and quiet.  Mine? Everyone stands around and tells funny stories, uses humor to diffuse the sadness, then has a big party.  Everybody fights the urge to cry, tries to keep their sadness under wraps, and often laughs through the tears.

Mabel is way too young to realize what is happening when we go to wakes and funerals.  We don’t bring her up to the casket, we let her play with her cousins in the back of the room and entertain the mourners in need of the happy distraction.  Her hugs and kisses for her mourning loved ones aren’t any less comforting because she doesn’t know why they are upset.

She has little concept of death.  When she saw a dead snake squished on the road near our house, she suggested we take it to the vet.  I told her the vet couldn’t help.  The vet only helped living animals and the snake was dead.  When she asked what that meant, I just explained that it’s body was too broken, it didn’t work anymore, it couldn’t be fixed.  She was satisfied, although I’m sure we will revisit it.

I know there are some who disagree- who think it’s my job to protect her (and Nemo now that he is here) from the grief and sadness.  However, to them I say, when will it be time?  Should it be something she’s always known about and learned about as she grew, or something traumatic and sudden when the person who has passed away is too close to be ignored and hidden, when she will be unaware of the rituals to mourn and comfort?  You know, as I write it- it’s always traumatic in some way, it may always be a shock- but at least she can be as prepared as possible for the eventuality.

Hopefully it will be a very long time before she loses someone she loves dearly.  However, I know for certain it will happen.  I hope by then she will have navigated less upsetting losses and have the skills and emotional depth to ease the pain when it hits close to home.

How do you handle death with your children?

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My little fashion plate…

Mabel is in her second full week of preschool.  For the first day and the week after, I took a picture of her before we got in the car to go to school.

That first week her teacher said, “Well, we’ve got a little fashion plate!”  To which I laughed and nodded.  However, I’m the one that at most picks out and at least guides her choosing her outfits for school.

Here’s Mabel’s First Week of School Fashion Plate Montage:

Friday morning, Mabel actually said, “It’s time to take my picture!”  So, I obliged.

Here’s what we got:

The car was already running, and Taylor Swift’s “Never, Never, Never, Getting Back Together” was playing.  Mabel, being who she is, was overcome with the urge to dance- which resulted in this:

After I stopped filming and went to pick her up I said, “You threw a show!”  So, when we got to school, the first thing she said to the teacher was, “I threw a shoe!”

I’m sure the teacher thinks we are a family of weirdos.

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Baby-led weaning, Take 2!

I’ve written previously about baby-led weaning, what the science says, how it worked for us, what things we found helpful, etc.

Well, Nemo is 4 months old and DEFINITELY interested in food.  He’d been hanging out in his bouncy seat, on the floor, next to the table while we ate.  However, as he got older and more aware, he was protesting more and more at being excluded.  So, we pulled out Mabel’s old ‘high chair’ and put him in it at the table so he would be distracted by toys and let us eat in (relative) peace.  (Note:  We really like the ‘high chair’ which is in quotes because it’s not a stand alone.  It’s one that straps to a chair.  It’s the Fisher Price Space Saver. We like it because it takes up a lot less space and can recline a bit.  With the straps, tray, and shape of the seat, it works really well even for a baby that cannot sit up on his/her own yet. It also converts to a booster, so Mabel used it for a really long time.)

Once he was up and could see what was happening, he definitely wanted in on the action.  It started out with just a lick of a banana and now he’s slobbering apple sauce.

So far he has tried banana, pear, bread, and apple sauce.  He’s basically just licking it off our finger, sucking on it, or slobbering it all over himself, but that is to be expected.  If he manages to ingest a teaspoon work of something, it’s a lot.

It is quite hilarious to see the facial expressions that the different tastes and textured elicit.  Here’s an example:

Apple sauce! The “spoon” he’s holding is this one. (ETA: Just realized that spoon is ‘currently unavailable’ but this one looks similar.)

Right now, he’s basically still nursing/getting pumped milk, but he does seem to be enjoying the tastes.

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What if your ballot wasn’t a secret? Would it change your vote?

With all the political discourse going on in the US right now, many people are expressing similar sentiments.  Something along the lines of, “The ballot booth has a curtain for a reason!  Keep your opinions to yourself.”

As Americans, we seem to pride ourselves on the secret ballot.  I know why, it helps to minimize the chances that people will be pressured to vote in a particular way.  It’s supposed to help protect the integrity of the vote, ensure people vote their conscience.

However, I think there may be a significant downside.  Are people really closing that curtain and voting according to their conscience, or are they voting their selfishness?

What if the ballot wasn’t secret?  What if you had to admit to your fellow citizens how you voted?  What if you had to tell your fellow citizens that you voted against their best interests?

Would it change your vote?  Would you support a different candidate if you had to tell the person who was directly, adversely impacted by his policies?

Here’s a thought experiment- if your vote would differ, perhaps you should consider why.

What if you had to tell your neighbors that you voted to stop the unemployment checks that are the only thing standing between them and foreclosure?  Could you do it?  Would it change your vote?

What if you had to tell a little boy that his mom couldn’t get food  stamps anymore because welfare if for people who don’t take responsibility for themselves?  Could you do it?  Would it change your vote?

What if you had to look your pregnant friend in the eye and tell her, “If you develop a life-threatening complication, you will die because I voted to make it illegal for your doctor to perform an abortion to save your life.”  Could you do it?  Could you tell her that you would let her die along with her baby?  Would it change your vote?

Could you turn to her husband and say, “I voted to ensure that your wife and your child would die, rather than allow her to have an abortion.  Your other children will be motherless and you will be a widower.”  Could you do it?  Would it change your vote?

What if you had to break the news to the high school senior that she wouldn’t be able to go to college because you voted to defund her student financial aid?  Could you do it?  Would it change your vote?

What if you had to admit to your friend that you voted to repeal ‘Obamacare’ even though you know it’s the only way she is able to get health insurance for her chronic illness?  Could you do it?  Would it change your vote?

What if you had to tell the guy who repairs your car at the dealership that you’d rather the car company had gone bankrupt and put him out of a job?  Could you do it?  Would it change your vote?

What if you had to tell a kid that she was being deported because her parents brought her here illegally as a toddler?  Could you do it?  Would it change your vote?

For any of these scenarios, if you couldn’t tell your neighbors, that little boy, your pregnant friend and her family, the high school senior, your sick friend, your mechanic, or the little kid how you voted, if it would change your vote, maybe you should reflect on that.  Are you really, truly voting for the right person if you cannot own up to the policies he espouses?  If your candidate’s policies would hurt those around you, is he really the right candidate?  Could you stand publicly as his surrogate and acknowledge the direct impact his policies would have?

Would seeing people hurt by the implementation of your candidate’s policies keep you up at night?  If you had to know your sick friend would lose her health benefits, your pregnant friend might die and leave her husband and children, your struggling neighbor would be homeless, etc. would you lose sleep at night?

Now, what if you had to tell a millionaire that you voted to make him pay more taxes so others could get the services they need?  Could you do it?  Would it change your vote?  Would you lose sleep?

I’m going to vote in November as though my ballot were a matter of public record.  I’m going to cast my vote, turn and open the curtain, look my neighbors in the eye and know that I voted in their best interests.  I will not, I cannot vote otherwise, and neither should you.

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