Monday, June 16, 2008

Payless Friend Jennifer asks Loaded Questions

Jennifer left a comment asking my thoughts on vaccines. We met at the grocery store when we both had our kids in slings, 2 years ago, and we recently ran into each other at the park so I gave her my blog address, and here we are.

First of all, Jennifer, I hope you guys are feeling better. Stomach bugs suck. I've used acidophilus before, especially after taking a round of antibiotics, and it's good stuff. You can get milk that's fortified with it, and that's sometimes easier to get down kiddos than a pill. Especially when you're sick, too, and you don't feel up to making smoothies. Milk can make stomach bugs worse, though, so I would save it until after the puking phase.

As for vaccines, well, I have a lot of opinions (I have a lot of opinions about everything). I went to school to be a special ed teacher, and I really believe that we're seeing an increase in autism diagnoses because we're getting better at identifying autism spectrum disorders - particularly relatively mild ones like Asperger's Syndrome. Special ed has only been law since the 1970s, and in the beginning it was just for kids with obvious disabilities. Now we've refined our teaching techniques and our diagnostic techniques, and we can identify and treat kids who would've just seemed "different" or at the low-achievement end of the class 20 or 30 years ago.

If the mercury in the MMR truly caused problems in some kids, it's a moot point now because they removed it from most vaccines several years ago. If you're concerned, it's a simple thing to ask your doctor to use the thimerosal free versions of the flu vaccine (the only one that I'm aware of that still contains thimerosal). I don't personally believe in getting flu shots - mainly because they vaccinate for last year's flu, which you're probably not going to get this year - but many people who are more educated than myself disagree. My kids have had flu shots, in the past, but it's not something I plan to do again.

The most recent research I've seen suggests that the vaccines combined with a genetic predisposition in some children can cause autism. The jury, though, is still completely out. The trouble with doing any online research is that a lot of the websites that are talking about this issue have their own agenda, and it's hard to find unbiased information. Stick with the big guys, like the CDC, the FDA, and the AAP. I think it's important to have a conversation with your doctor (and hopefully you trust your doctor!) about your concerns.

Of course, real vaccine opponents will say that the CDC, the FDA, and the AAP are part of the conspiracy, but there's really no reasoning with those folks, anyway. (Just because I'm paranoid, doesn't mean that they're not out to get me...)

The vaccines that really bother me are the ones they give at birth. Having a bunch of shots and eye gunk doesn't seem like a gentle way to welcome a tiny, helpless infant into the cold, cruel world. I opted out of the Vitamin K shot when both my kids were born, as well as the eye drops and the hepatitis B shot. I told the doctor, "She's not allowed to have unprotected sex or use IV drugs until she's at least 6 months old, so we can hold off on Hep B."

I also was absolutely certain that I didn't have any STDs, which is why they use the eye gunk (which can sting or cause other temporary discomfort - being unable to see clearly, etc.). I understand that other women may be "absolutely certain" and may have, unknowingly, caught something from a straying partner, so I understand why these are "mandatory" but the people who made the laws didn't know me or BJ, and didn't know our marriage or our situation. Our doctor agreed that we're "low risk" (BJ is more likely to cut off his own feet than sleep around), so he didn't give me any grief about that decision.

The vitamin K shot is to promote clotting. Knowing our medical history, and the fact that neither of our families has ever had a baby who had a brain bleed due to this rare clotting disorder, I didn't feel that it was necessary. Again, I understand why they would make it mandatory (because not everyone knows her medical history, etc.) but I felt that, in our case, it was unnecessary. There is an excellent discussion of the Vitamin K shot here. Since I wasn't on any medications when I was pregnant, and since I planned to breastfeed, I didn't feel that the benefits of the Vitamin K shot outweighed the risks for our family.

The thing about the vaccines that still bugs me is that it seems like a lot to hit a tiny, developing immune system with at once. At some appointments the kids have been vaccinated for 10 different illnesses (usually they get 3 or 4 shots, and those shots are combined vaccines, like the MMR or the DTaP that vaccinate for more than one illness). I have given serious thought to spacing the vaccines out over a longer period of time.

However, the problem with doing that it results in more shots and more doctor appointments. If you don't do combination vaccines, you're going to have 3 sticks for Measles, Mumps, and Rubella instead of just one - and you have to have them a couple times to get full coverage. If you add it all up, that's a lot of needle sticks. No one enjoys shots. The fewer the better, IMHO.

The other problem with deviating from the recommended immunization schedule is that you have to be very, very proactive about making sure that your child eventually gets all of the vaccines that she should. Doctors are super busy, and it would be so easy to give a shot too many, or too few, times if you deviate from the schedule that they typically use. Our doctor's group recently switched to paperless charting, and we've watched them struggle as they learned the new, less intuitive, computer system. It would be so easy to give a child the wrong shots if you go "off list," and that concerns me. I'm not saying it's impossible to keep track of what they need, when, and modify the schedule to suit your own preferences... But if you're going to do that, you need to be extremely educated on what they need, when, and on what they've had already. Many of the vaccines need to be given more than once. You have to make sure that you're giving them at the right intervals. Otherwise you could end up with a kid who isn't truly immune, or who accidentally got the shots too close together or too far apart, or who got too many doses of one vaccine or another.

Also, the recommended schedule has been used thousands of times. There is a lot of data to show that, for most kids, it works. If you use a DIY (do it yourself) schedule, your kid is the only data point to show whether or not it's effective. Seems to me that there's risk, there. For example, the pneumococcal vaccine (pneumonia) is given 5 times before 6 years of age. They get it at 2, 4, 6, and 12 months, and then some kids get it between 2 and 6 years (if they're high risk). If you don't get all 4 of those shots, you're not covered. Let's say you decide that a 6 month old or younger is too little for shots, so you get them at your 9, 12, 15, and 18 month well baby visits instead. That may be fine, and it may work just as well, but where's the data showing that it works? How many other parents have used that schedule? Did their kids get pneumonia at higher rates, or lower rates, than the kids who got it on the recommended schedule? There may not be data that's available or reliable. On the other hand, just about every kid you know has gotten his or her shots on the recommended schedule - that's a lot of data. Do you see my point? I, personally, don't feel that it's worth the risk. Close friends of mine disagree, and I know that they're getting their child shots on a modified schedule that they came up with on their own. It's hard to find a doctor, in some areas, who will go along with this, too. That's another practical concern.

If we only had one kid, it would be a lot more do-able, I think, to modify the schedule. But with two small children who are both still getting shots, I can't keep track of it all. I know that you have a lot of kids, Jennifer, and that you live in a small town. Because it's a lot to keep track of (who has had what) and because it might be harder to find a cooperative doctor where you are, I would recommend that you go with the recommended vaccine schedule.

I think it's the responsibility of every parent to do their homework and to know what their kids are being exposed to when they get their shots. I also think that most parents are unprepared to correctly find, read, and interpret the data that's available. And I know that a lot of the most recent data is unavailable to the average parent. For these reasons, I think that the best thing any parent can do is to find a doctor that you trust, and to continue to see the same doctor throughout your kids' childhood to the greatest extent possible. Having a doctor that you have a relationship with is proven to increase the quality of your medical care. I truly believe that having a longterm relationship with a good doctor is one of the best things you can do for your kids' health.

We see a family doctor (Joel Mulder, for those who are local) and we LOVE him. We've been seeing him ever since fall of '04. He treats all four of us, and he knows us in a way that a doctor at a "doc in a box" type clinic never could. He is the only doctor who has ever treated our kids. He's known them both since before they were born. We don't always agree on every little thing, but I can put my trust and faith in him, knowing that he's a good man, that he's a great doctor, and that he has a longitudinal view of our family's health. He knows me, too, and he listens to me (which is HUGE - I've been to a lot of doctors who didn't listen). He knows that if I call and say, "Hey, BJ's having trouble sleeping and we need something, but he doesn't have time to come in this week..." that we're not going to get drugs and sell them on ebay - that we're trustworthy enough for him to recommend or prescribe something over the phone. It's also handy when we all have the same bug - we can make back to back appointments and have everyone seen and treated in one outing, rather than having to drag the kids all over town to my doctor, BJ's doctor, and their doctor.

OMG, I have to get this day on the road. We've got MG's first gymnastics class at noon, and I am not even dressed... YIKES! I hope I answered your questions.
Feel free to comment and we'll continue this conversation later...

And Jennifer - it was GREAT to hear from you! Made my day!!


Rob Monroe said...

Very good response to such a loaded question. You and I think very much alike. :o)

That being said, tomorrow we go to get Abby her 12 month shots. Advice on how to calm her....MOTHER? through the process?

Kidding, no need to do a blog post for me. :o)

Jenn said...

Funny, you are talking about this today as I'm on my way here in a few minutes to get Brody his 4 month ones, and posted a couple pics of when he got his 2 month ones and was not a happy boy!