The website is launched!!!! March 13, 2009

For those of you looking for my blog, you will now find it on my WEBSITE!!!!  I have waited a long time to get this up and running and I am thrilled with it!  Some editing still needs to take place but I can’t wait for all of you to go there and explore the site.

For blogs that are personal, like the ones about Spanx or the kids, I have started a series of blogs on my Live + Share page called DrMolly’s Musings.  On that same page you will find recipes, family fun outings and green living tips.  You too can add to the storehouse and even post a topic or question.  Looking for a good place for you child to take karate?  Post it!  Have a great family friendly recipe?  Post it!  Have a great parenting tip or cleaning tip or green living tip?  Post it!  The more you add, the richer the site will be.  

For my more medically oriented blogs, you will navigate to the Health + Wellness section of the site and you can choose blogs based on keywords to read (like constipation or sexuality or allergies) or just peruse the titles and read those you are interested in. 

On each page, just below the picture, is ‘Need a medical answer now?’ and if you click on that, it takes you to the University of Michigan Mott Children’s Hospital online encyclopedia of all childhood symptoms, illness, and medical problems.  This searchable data base is a superb and reliable source of information for you!

Enjoy the new site, post your questions and recipes and family fun and green living ideas and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com 

The final word on pertussis for now March 5, 2009

Over the last two weeks in my office I have seen four cases of pertussis, or whooping cough. One of the four children had received no vaccines, but the other three were fully vaccinated and still young enough (between the ages of 7-10) that their immunity from the vaccine should still be in full effect. In August, I had four other cases of whooping cough with the same distribution of vaccinated to unvaccinated kids, which has now caused me to worry more about any child who comes in with significant cough.

Most kids get the DTaP vaccine during infancy and boosters at around 12-18 months, 4-5 years and 11-12 years. Teenagers and adults should get the vaccine as well every ten years or so since immunity will wane and they will be at greater risk contracting the illness if exposed. The “P” of the vaccine protects against pertussis, also known as the whooping cough. The problem is that the vaccine isn’t perfect and about 12-20% of the kids that get the vaccine won’t develop adequate immunity to whooping cough. Back when virtually everyone got the vaccine, this wasn’t such a big deal because even those folks who didn’t respond were protected in a way by the fact that the illness was much less prevalent because everyone else was immune. Now with more parents opting to delay or not give vaccines, we are seeing a real uptick in the incidence of whooping cough in children.

Pertussis in one of the most contagious illnesses around. According to Dr. Basim Asmar, chief of the Division of Infectious Disease at Children’s Hospital of Michigan, almost all people who are not immune to whooping cough who are exposed to it will get it. That means those 12 percent-20 percent of vaccinated kids are doomed to illness if they get exposed as are all unvaccinated people and anyone older whose immunity has diminished over time.

The illess is spread through droplets coughed in your face and then inhaled. If your child has been exposed to the whooping cough, it takes about seven-10 days for the symptoms of illness to appear. the The illness can be averted if antibiotics are taken during this incubation period. The bacteria can’t live for any length of time on surfaces or clothing, so you needn’t worry about toys and clothing but rather just direct exposure to the child in who is infected.

Given the fact that the incidence is on the rise, what should a parent look for? Pertussis initially looks like a mild cold with some cough. It has less runny nose than the winter viruses and fever is not that common with it. After a week or two ,the cough begins to get dramatically worse and is associated with severe coughing jags day and night. The cough can be severe enough to cause vomiting, broken blood vessels in the white of the eye and on the skin around the eyes, a loud intake of air after the jag (the “whoop”) and even cracked ribs from coughing. This severe coughing phase can last two-four weeks followed by another month or so of slow, gradual recovery with diminishing cough and fatigue.

As bad as this all sounds, it can be worse. Infants, especially under 6 months of age, can stop breathing as a result of the illness and up to 5 percent of the smallest infants will die as a result. People of any age can develop pneumonia as a complication, which you might imagine makes the coughing even worse. Many people end up hospitalized for dehydration because eating and drinking can trigger severe coughing and vomiting, while others end up in the hospital for supplemental oxygen. It is one bad illness.

Whooping cough can be tested for by taking a sample of snot from the back of the nose and sending it to a lab for a test called a pertussis PCR. It is much more sensitive than a culture and allows for a more rapid diagnosis, getting an answer in about two-three days.

So if your child has a coughing illness that is lasting more than a week and still getting worse, especially if he or she is not vaccinated, pertussis needs to be on the list for serious consideration. If the test comes back positive, your child will need to be put on a course of antibiotics to decrease the spread to others and the antibiotics may decrease the severity of the illness. Also, all of the people the child comes in contact with in the household need to be put on antibiotics as do other close contacts for prophylaxis. For example, if your child has had a sleep over during the illness, all of the other kids should be put on antibiotics in the hopes of preventing the illness.

Be aware of your risks, get your shots, and remember that even grown ups need em and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Masturbation in young kids….yep you read it right March 2, 2009

Your 5 year old son is constantly ‘adjusting’ his underwear.

Your 3 year old daughter is ‘riding’ the arm of the couch a lot lately.

Your 4 year old daughter seems to ‘dance’ in her car seat and wriggle her hips up against the clasp for the seat belt between her legs.

Your 6 year old son is complaining that when his penis gets big it hurts.

Your 7 year old daughter is ‘itching’ her private parts so much that you wonder if she has a yeast infection.

What all these children have in common is that they are masturbating. I know you are surprised but it is true. Virtually all children, both boys and girls, starting around the time of potty training discover themselves and let’s face it, it feels good. Because it feels good, the exploration continues and some children will find lots of ways to stimulate themselves.

I get a ton of questions from worried parents about this on a regular basis. I think it is a bit of a taboo topic for parents to discuss with each other and sheepishly or with great angst they bring it up with me. Most parents are worried that interest in masturbation at this age means they are going to have a ’sexpot’ as an older child but this is not the case. Masturbation before the hormones of puberty are contributing is not sexual. It just feels good. It feels good like scratching an itch feels good or having someone rub your back feels good. It isn’t sexual, just satisfying.

I advise parents who are worried that the child will do these behaviors in public that it is important to teach kids at this young age that private parts are private for a reason and if they want to touch them, they need to do so in a private place like the bathroom or the bedroom. Since kids don’t experience this as a sexual feeling (even though they may really enjoy it), the fact that this sort of ‘good feeling’ can’t be done in the kitchen or the classroom makes it that much more appealing for some. Often, parents will find the child will increase the behavior after the parent has drawn attention to it and consistency about the need to be in a private place is important.

Some kids start to ask more pointed questions about their bodies and yours during this time and others will even want to see the private parts of their peers through ‘playing doctor.’ This is a great opportunity for parents to talk frankly and openly with their kids about their bodies and how they differ from grown up bodies. It is a great opportunity to reinforce the rules about who can see private parts and who can’t, who can touch private parts and who cannot. It is also a great opportunity to lay the groundwork for later discussions about sex and sexuality. By talking openly, frankly, and without embarrassment about this, you will start a dialogue that is natural and comfortable and will serve you well as your child grows and matures.

Sometimes, our own past comes back to haunt us when our kids start to ask us questions or explore their bodies.  Perhaps you were told you were dirty as a child or maybe masturbation was punished in your household.  You may have chosen to be sexually active at an early age or had sexually traumatic experiences as a child or adolescent.  Sometimes we were never talked to at all about our bodies and later sexuality.  Any of these woud make it very difficult, uncomfortable and anxiety producing to talk to your kids about this natural, normal part of life.  I encourage you to talk to your partner or a mental health counselor to work through these feelings and not repeat the past mistakes with this generation of children.

Here are some good books to help open the discussion with your younger children (ages 3-8).

Amazing You

What’s The Big Secret

And for older kids (9-12)

Body Science

For parents:

Speaking of Sex: What your child needs to know and when they need to know it

Remember for young kids its not about sex, talk openly with your kids, and don’t worry and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Whooping cough….again….. February 27, 2009

This week in my practice I have seen another two cases of pertussis, or the whooping cough, as it is more commonly known, and I feel the need to sound the alert.  One was in an unvaccinated infant and the other was a school aged child who had been vaccinated.  This illustrates two important things: that the disease is really still around (these are the seventh and eighth cases in my practice alone since August) and that vaccination, although important, is not fool proof. 

Both of the kids this week have severe wracking coughs, worse at night, which lasted days into weeks.  Both were quite sick and both were coughing so hard they threw up at times.  Lucky for them, neither ended up in the hospital. 

Pertussis usually starts out in an adult with a milder coughing illness that is then spread to younger, more vulnerable children.  Adults can get a vaccine too called tDaP (Adacel is the brand I carry in the office for the teenagers) and decrease the risk of getting this illness and spreading it to their children.  In some areas of the country, all pregnant women and their spouses are offered the vaccine during pregnancy or at the time of delivery…..something to think about…..

I wanted to let all of my families know that the DTaP vaccine is very protective against pertussis but isn’t foolproof.  Clearly having the vaccine makes it much less likely that you will contract the whooping cough, but as with all vaccines, there is a failure rate.  So even if your vaccinated child is severely coughing, be sure to think of the whooping cough. 

Try to stay healthy, grown ups need vaccines too, and don’t cough on anyone and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Another blow to the vaccines cause autism argument February 23, 2009

A special federal court on Thursday ruled against parents who claimed childhood vaccines had caused their children to develop autism. The “vaccine court” examined the evidence presented and concluded, “It was abundantly clear that the petitioners’ theories of causation were speculative and unpersuasive.”

Many families are confused with all of the information available on all ends of the spectrum. There are the Jenny McCarthys of the world who are convinced vaccines caused their child’s autism and will hear nothing else while others like Dr. Paul Offit are convinced vaccines have absolutely no effect on development or autism. Doctors like Bob Sears have written books describing “alternate schedules” that still provide for complete vaccination but at a slower pace. Web sites and organizations like Defeat Autism Now! contend that everything from diet to mercury to vaccines cause or contribute to autism. What is a parent to believe?

When I talk with parents about vaccines and their safety, I can see the tension and worry. There would be nothing more painful than knowing you caused your child harm. Because the popular culture wisdom is heavy in the camp that vaccines are potentially harmful it makes it even more difficult for parents to have confidence choosing to vaccinate their child.

Parents want only to help their children. Parents understand that sometimes doing what is right or best can be painful, for example, removing a bandage quickly, but if parents hear that removing bandages quickly can cause permanent tissue damage, even if it may not be true, they will think twice about doing it.

It is this dilemma that drives parents to question the safety of vaccines. We all can agree that vaccines are effective (they do prevent the diseases they are designed to prevent) but what is in question, in the media at least, is their safety.

What is even more distressing is that the article that put the association between the measles-mumps-rubella (MMR) vaccine and autism on the map is tainted. What has only recently come to light is that Dr. Andrew Wakefield apparently falsified much of the data. All but the original author recanted authorship when they became aware of Wakefield’s bias in data collection. The Times of London reports that although Wakefield reported data that the symptoms of autism appeared very soon after the vaccine was given, the actual data is different. This is very concerning and may result in disciplinary action.

So why are so many parents still reluctant to vaccinate? The reason is complex but boils down to these things: a feeling that the science is biased and tainted by the pharmaceutical industry, the fact that an alternate explanation for the cause of autism is yet to be found and the fear of doing harm to their child. In reality, the risk of contracting a disease that vaccines prevent is increasing while the supposed risk of vaccinating is decreasing.

When I counsel parents who are considering delaying vaccines or not vaccinating at all, I discuss the science we have and the possible risks of contracting the illnesses the vaccines prevent. Some of these illnesses are more common than others and as a result my advice varies. For example, if a family is reluctant to vaccinate, I explain that since August, I have seen six cases of whooping cough (pertussis, the P portion of the DTaP) but polio is no longer seen in the United States, so although I still recommend following the routine schedule, if a family is going to opt to delay a vaccine, polio is the one.

Lots of doctors feel strongly that the science is so clear vaccines are safe that any parent who is opting not to vaccinate or to vaccinate on a different schedule is putting their child at such great risk they cannot continue to be the child’s doctor. I disagree. Although I, too, believe vaccines are safe and effective, I also understand the decision is that of the parents. My job is to provide the best data as we know it and in doing so, hope to have as many children vaccinated as possible.

My experience is that most parents want to vaccinate their child and feel safe and comfortable doing so. By hearing and addressing parents’ concerns, the chances of at least partial vaccination is more likely than taking a hard line, all-or-none approach.

Know the facts, talk to your doctor, and love your kids and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Do as I say, not as I do February 21, 2009

Ok, I have a confession to make…..tonight I made my kids finish their dinner even though it goes against every piece of advice I give parents about feeding their kids.  You see, I had told the kids at lunchtime that we would have Jet’s Pizza for dinner (our family fav) and then when we came home from riding and the hour-long drive in the blizzard, I was pooped and went upstairs and took a nap.  When I woke up around 530, Kevin had already put potatoes in the oven and so we had baked potatoes for dinner.  This is not the boys favorite you see and since they were eager to eat the pizza, their cries of stomach ache and lack of hunger didn’t ring true.  Soooo being the world’s best mom (and world reknowned pediatrician) I told them to eat up!  If they were hungry for pizza, they were just making excuses and to get a move on already!  The potato wasn’t going to evaporate after all! 

And so they did.  They slogged through the baked potato and drank their milk with continuing protests and finally they were done.  I did the dishes and while I was humming ‘Fabulous’ from High School Musical 2, Conall threw up.  Yep.  Super.  He almost made it to the toilet.  Almost.  After cleaning him up and the vomit strewn bathroom, all seemed well.  To be honest, a little part of me still wondered if he made himself throw up.  He has reflux so vomiting is pretty easy for him.  BAD MOM! 

Anyhoo, the rest of the evening went as usual and the boys got ready for bed.  Then about an hour after Declan went to sleep, he threw up too.  Everywhere.  All over his bed and room and him.  While he showered, we stripped the bed and cleaned the carpet and started the laundry and remade the bed.  He’s now asleep, as is Conall and no more vomiting has happened as of yet. 

I guess Conall wasn’t ‘working it’ after all.  Talk about mom-guilt!  This was almost as bad as the mom/doctor-guilt I felt after Declan fell out of the top bunk in the middle of the night when he was still sharing a room with Conall.  I went in, didn’t even turn on the light since Conall was still asleep, and despite Declan’s wails (he can be dramatic after all), I shoved an advil in his mouth, kissed him and told him to go back to sleep.  In the light of day the next morning, his mangled arm told a different story and off to the ER we went for his cast. 

Soooo even though I give GREAT advice, I don’t always follow it…..SUPER…..

Clean up vomit, believe your kids when they say they aren’t hungry (at least most of the time), and don’t serve potatoes for a month or so and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Busy week and single parenting February 19, 2009

As you all know, it is winter break for schools all over the area and I am not sure exactly if, because of the economy, fewer people than usual went out of town or if it is just a busy illness year but this week has been BUSY!  Between influenza, RSV, and strep throat, I have had a consistent and steady stream of at least 28 people every day with a near record breaking 38 on Monday!  What I am most pleased with though is how well the scheduling system has worked.  Although very, very busy, I have not been more than 20 minutes off my schedule yet!  Woo Hoo!  My staff is amazing and work hard to make the office run smoothly and since we are a good team it all goes well. 

What also made this week particularly challenging for me is that not only have the kids been off school but Kevin has been away at a conference for a couple of days.  For those of you that don’t know, Kevin has been an at-home parent since Mairen was born and although he has been out of town before, this was the first time I had the sole responsibility for both work (without other docs to lean on) and the kids while they are off school.  I was uptight about it early in the month, and as a result I decided to expand my lunch times for yesterday and today to be able to come home and be with the kids each day.  Mairen is in 8th grade and babysits a lot so I wasn’t uncomfortable leaving them at home but it is a big burden and responsibility for her to have to bear. 

What an experience these last two days have been!  I would dash to the hospital after getting the boys up and then head to the office from 9-1245 seeing patients, go home from 1-330 and return to the office until 530 or so.  Yesterday, the kids had signed up to partcipate in a Lego building contest at Baldwin Library in which they were to design and build a ‘green’ Lego creation.  So I raced home, swept up the kids and headed off.  The boys spent an hour or more building and Mairen perused the books and studied her words for the Scripps Howard spelling bee (she’s in the regionals this weekend).  The first mini crisis of sorts I had as a newly minted single working parent was when I realized that the event ended at 5 but I would have to leave at 320 and wouldn’t be back until 530!  Yikes!   Thinking on my feet I decided I would just take the kids with me to the office but then discovered the judging for the event was happening around 430 and awards to be given at 5 and Declan wanted to stay!  Conall agreed to come to work with me, even though he would miss the awards portion, but Mairen and Declan could not be budged.  Soooo they stayed.  It felt incredibly funny to leave the kids at the library without me there.  They are there all the time and the librarians know them by name but still….what kind of mom leaves her 4th and 8th graders at the library for a couple of hours alone?  Apparently I am that kind of mom. 

Soooo I went back to the office and at the end of the 2 hour marathon from 330 – 530 , I learned that I had a new set of twins to see at Royal Oak the next day.  This would normally fill me with glee but this time, it threw me for a loop.  I had to be at the office at 745 today for our first all office meeting with the staff and in order to round and get there in time, I would have to leave the house before 7.  The problem, of course is that I wouldn’t even see the kids in the morning if I did it that way so I had a flash of brilliance and decided to take the kids to The Red Coat Tavern for dinner and see the babies that night!  Stunningly brilliant, or so I thought. 

Now all of you two working parent or single parents out there, try not to laugh yourself silly…..but when we got to the restaurant, there was a 20 minute wait and my kids were already about to eat my hands off they were so hungry but I made us wait.  and wait.  and wait.  for a table.  The kids finally got their burgers and fish and onion rings (they really do have the BEST burgers and rings) and by the time we were done, it was nearly 7.  Bear in mind, the boys go to bed at 8 and they had been having a relatively stressful day since they were without an adult for so long so when I announced the possible plan of going to the hospital to round, there was a loud cry (literally and figuratively) of opposition from the kids and the plan was scrapped.   

While at dinner though, before the rounding debacle, I had this huge and strong sense of joy and accomplishment.  I was close to my kids in a way I don’t always have the opportunity to be and being completely responsible for all the decisions, big and small, was suprisingly liberating.  I felt as close to them as I ever had and couldn’t wait to come home today for my extended lunch and share our time together again.  Of course today, they were whiney and bored and annoyed with each other after having spent so much time alone…not Lord of the Flies mind you but  definitely not the idyllic picture I had painted for myself all morning at work.  Even with that, and the laundry, and the dishes, and the cleaning and the meal planning I loved today.  I loved the snuggling and scrabble.  I loved then coming home a couple of hours later and having the kids calmer than they would have otherwise been.  I loved feeling like I was close and connected to them.

Often my evenings after the boys are in bed are spent typing away this blog or the News blog and answering email and for a change last night, I didn’t even open the laptop.  Mairen and I watched ‘Prince Caspian’ (the second of the Narnia series) and just snuggled up together.   I still attended to my email by using my phone and I may do something like that one weeknight each week and spend more time with Mairen.  We both really enjoyed it and it was one of many ways I can say ‘Thank you’ and ‘I love you’ for all she is and does.

Turn off the laptop once in a while, parent alone and juggle the challenges and joys, and eat a juicy burger with onion rings at The Red Coat Tavern and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Flu vaccine….its not too late! Supplies are limited! February 12, 2009

While cleaning the vaccine fridge at the office, I found a surprise.  Lucky for me, it didn’t smell bad or have a hazy blue mold growing on it!  It seems that we had put aside some flu vaccine for some kids who either never came to get it or who got it out of the regular stock but the one set aside remained.  SOOOOOOO, I have 6 doses of big kid flu vaccine (including one flumist) and 1 dose of under 36 months flu vaccine just begging to be had. 

Flu season is in full swing but we see a peak in both February and April in Michigan so its not too late!  Call and schedule your child (or yourself) for one of these few remaining flu vaccines!

Get your shot, wash your hands, and get lots of sleep and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

Getting closer to my first real vacation February 11, 2009

My family is planning a trip to Peru in April.  We are going for about 12 days and will visit Lima, Callao, Cusco and Machu Pichu.  About three weeks ago, I told Kevin that I wasn’t sure if I could go.  I had been trying to find coverage for the office, rounding and call and had been coming up short.  My usual coverage person was going away then too with her family and I contacted a couple of other pediatric ER docs I know and could only get three of the eight days covered.  I had begun talking with another doc who is unexpectedly in solo practice now about cross covering for each other but to be honest I didn’t want to have to owe her days if she covered for me.  The way it was going to work is that she would be in my office for the mornings on each of the days I was gone and in her own office in the afternoon and I would owe her eight office days and two weekends.  That way when she went out of town, I would work half days in her office and mine just as she would.  She’s a very good doc and a nice enough person but I didn’t want to owe anyone that much.  

Soooo back to the drawing board I went.  Lucky for me, I have been meeting with doctors who are possibly interested in working for me starting this summer and there are a couple that I really, really liked.  When we were talking, I discussed this time in April that I needed coverage for and one of the women is going to do it!  I am thrilled.  It will give her a chance to see what the office is like, give my staff and some of you a chance to meet her.  I am hoping that the other person that I am interested in will take me up on a couple of other days I have available for coverage so we can all try each other out.  NICE.  

Now I just have to figure out the rounding and the call…..any takers?

Be sure to take vacations, don’t leave without all your ducks in a row, and maybe, just maybe leave your phone at home when you go and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

It really is February February 9, 2009

February is usually a very busy month for me.  It is the height of the RSV and influenza seasons at the office, Declan, my father, father-in-law, two nephews, and two very close friends celebrate birthdays, and the kids have a week off of school.  This year Kevin is leaving town for a couple of days during the week the kids are off to attend a the ACA National Camp Conference for our home business CampRx and I am scrambling to figure out what the kids will do on those days.  For the first time I am feeling like I am doing a triathlon…..I love each part of the event and the thrill of the race but when I am swimming that last 100 meters, or biking the last mile, or running the final few feet I can’t help but think I must be crazy to have done this!  Of course when I finish the course, beaming and happy, I feel a huge sense of both relief and accomplishment.  I know that when March dawns I will share those same sentiments.   And after a day or two off, the biking and running and swimming will start all over again.

Declan had his friends’ party this weekend.  He’s in fourth grade and invited two girls and two boys to come out to dinner and to see Pink Panther 2 to celebrate his birthday.  Let me tell you, girls and boys are really on different planets at this age (and maybe all ages!).  The girls were very nice but seemed so old!  They were talking about Abercrombie and lip gloss while the boys were talking about passing gas and bakugan.  The really fun thing though is that despite the ocean of difference between them, they really did enjoy each other and had a terrific time.  Very nice!

Tonight I am trying to fend off a migraine….this isn’t the month for a migraine!

Find a little reason to smile even on the busiest day, enjoy the ride that is February, and get lots of sleep and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com