Sunday, November 28th, 2009

Counting to 30 by the end of kindergarten is a math standard. Some kids enjoy counting, sometimes to the extreme. Victor will proudly display his counting prowess to 100 over and over and over again. I am so proud but if I hear it one more time I think I’m gonna scream, but I don’t because I am his mommy and it is my job to listen.

Oliver had more trouble with counting, forgetting what comes next especially once we were into double digits. However, I found the best tool available for $1.99 – an advent calendar! Yes, you remember them from your childhood. Little windows with the numbers 1 through 25 scattered in random order, each one hiding a tiny chocolate (because chocolate is a great motivator for both young and old!). Each day you can look through the previously opened windows and review the numbers that you have counted so far. Opening the little cardboard shutters is also a good fine motor skill (and I am all about sneaking that in whenever possible).

It’s fun, it involves Christmas, and there is a reward system in place. You can find advent calendars at just about any grocery story. There are more expensive ones, but why spend the money when $1.99 can do the job just as well?

Now the advent calendar only gets you 24 days, buy if your kindergartner (or pre-schooler) can count to 24 by the end of December you are almost there with 6 months left in the school year.

While we patiently wait for Tuesday when we can begin, Oliver sits and stares at the calendar (maybe looking real hard will make the chocolate teleport through the cardboard?). When I tell him there are 25 days until Christmas I hear his little voice count from 1-24 without any help, and then, bolstered by his success he carries on to 30.  I stop what I am doing, because I am his mommy and it is my job to listen.

Thanksgiving always means a lot of work. The prep. The cooking. Cajoling the boys to the table. The after meal movie (Fantastic Mr. Fox, and by the way we laughed out loud!). The clean up that seems to last for 3 freakin’ days (how does a family of 4 make such a mess?).  And then the finale Charlie Brown’s Thanksgiving.

While loading the dishwasher late last night, for quite possibly the 6 th time in less than 24 hours (and no Tony, I can’t use fewer dishes), I realized it was all worth it for the memories. I don’t have a lot of happy childhood holiday memories (and certainly nothing involving my mom dissolving into hysterics, or at least not the good kind of hysterics). But I can change that for my boys.

So here’s to hoping that Victor remembers waving his turkey leg around like King Henry the VIII and Oliver cherishes those moments in the kitchen when I squirted ReadiWhip directly from the can into his mouth over, and over, and over again.  Because I sure do and for me, it was the best Thanksgiving ever.

When H1N1 emerged this spring I will admit that I panicked. Oliver, with his scarred lungs and damaged heart, has suffered terribly with respiratory illnesses that cause colds for us healthy people. Twice he has been hospitalized with influenza pneumonia and twice we were very lucky.

I have long been obsessed with hand sanitizer (dates back to my infectious diseases fellowship when a shook hands with some who I realized afterwards had active secondary syphilis on his hands, a story in of itself), so I doubled my efforts. I think my husband thought I was drinking the stuff because we were going through it so quickly. However, despite my cleanliness I caught H1N1. Yup, in the first wave. Clearly hand hygiene only gets you so far. It was horrible. 6 days in bed that felt  like and eternity of sweats and muscle pains so bad I felt as if I had been on the losing end of a match with Mike Tyson. But that feeling paled in comparison to my worry about Oliver. He took Tamiflu as prophylaxis and we all held our breaths, hoped, and prayed. We were lucky.

My kids were among the first in line for H1N1 vaccination. Victor could get the nasal spray, but Oliver, because of his bad lungs, could not. His screams of “I HATE SHOTS” were no doubt heard throughout greater San Francisco.

What has amazed me most about this flu season is the misinformation. The claims that the H1N1 vaccine is somehow different and “less safe” than the typical season influenza. The claims that the flu “isn’t so bad.” And then of course, the claims that the flu vaccine causes autism and any number of untold human miseries.

I have thought a lot about the people who propagate these harmful untruths. How do they benefit? Perhaps they are looking for a unifying factor on which to lay the blame for their health problems? Some of course have built their business empire around  these harmful ideas.

I know what it is like to have children with serious medical issues, but I do not believe there was a bogeyman lurking in the shadows with a poisoned stick. Prematurity, like autism, is multifactorial and studies have show that vaccination is not one of those factors.

So here are the facts. Plain and simple:

• 171 children have died so far in 2009 from H1N1. This is much higher than typically seen from season influenza, so H1N1 is an epidemic.
• The seasonal flu vaccine is very effective at reducing death and hospitalization from seasonal influenza and the antibody response from the H1N1 vaccine seems as robust. So, there is every reason to believe that the H1N1 vaccine will be as effective.
• The nasal spray (flu mist) is as good as the shot; however, if your child has asthma or chronic lung disease it can irritate the airways because it is a live virus. Kids with lung problems must have the shot.
• The H1N1 vaccine is made the same way as the seasonal flu vaccine. Think of them like raspberry pie and blackberry pie. Exact same ingredients made the same way, just different berries.
• H1N1 is not some trumped up government conspiracy. People die from the flu all the time. Influenza, both season and H1N1, is a very serious infection.
• The flu vaccines, both season and H1N1, are very safe. People who are trying to tell you otherwise are have an agenda that does NOT include the welfare of your children.

It is true that many people will not get sick from influenza. Viruses don’t infect every single person, but the risk of complications with H1N1 infection are higher. I think this graph from the CDC of pediatric deaths due to influenza that compares the last 3 flu seasons to this year says it all (pink and yellow are H1N1 and green and blue are seasonal flu).

Play-Doh is one of the best (and cheapest) occupational therapy tools around. Squeezing and squishing works on strength and pinching and rolling into cool shapes helps with coordination. There are also untold numbers of Play-Doh tools that double as great OT tools. Especially good for hand strength are the presses (they look like garlic or cookie presses). Dig around your kitchen drawers for cookie cutters and other small kitchen tools, because kids love working with kitchen stuff (I guess the bloom falls off that rose around the age of 10).

I have always thought it is best to work on strength first. There are two reasons. One, it is easier than coordination as it involves fewer nervous system pathways and everyone is encouraged by success. If you can do something you are more likely to want to do it. It is also easier to build on success (probably one of my top 5 rules).

The other reason to work on strength is stronger muscles are easier to control, so coordination tasks will become less of a challenge. Think of strength and coordination as a screen door and a glass door, you have to open the screen door first to get in the house.

Play-Doh is also a good warm up tool.  Just like we stretch (or are supposed to stretch) before going for a run, a few minutes with Play-Doh can limber up little fingers for other activities.

So do Play-Doh a lot. Keep your child interested by making cool creatures you have liberated from the darkest corners of your imagination. Snakes, snowmen, spiders – anything goes! If you are laughing, having fun, and engaged in the activity your child will want to copy.

Mine certainly do.

By the way, your kids don’t have to know Play-Doh is therapy, you are just the coolest mom or dad for letting it get all over the house!

The first few days in the neonatal intensive care unit (NICU) were so strange.  Being an OB/GYN seemed like a lifetime ago.  Even though I had visited this place so many times before, checking on babies that I had delivered, I just didn’t know what to do.  I felt like an outsider with my nose pressed up against the glass.  In addition I was sick from a serious infection, incredibly sore from the surgery, and weak from almost four weeks of strict bed rest, never mind the storm of hormones and emotions.  In a fog of pain, sorrow, and hopelessness I traipsed back and forth from my room to the NICU trying not to look at the overjoyed new parents with their healthy babies.  I was the only girl at the prom without a date watching from the shadows of the gym.

Before things went wrong I had mapped out scenes from our future.  I think every parent does. Whether it is your baby’s first smile, how you will look pushing your baby in a stroller, or taking your child to their first day of school.  I suspect the image is different for everyone.  I had an image of being wheeled by my beaming husband to the front doors of the hospital clutching three baby boys.  Heads would turn and everyone would say, “Triplets!”  I have always liked to watch this imagined scene unfold.

As I am an OB/GYN I see it a lot.  The father or partner nervously sprints to the car and as the mother passes by cradling her precious bundle, almost everyone smiles and remarks on the baby.  It is hard not to get caught up in the excitement of a newborn.  The mothers are like beauty pageant winners, clutching a baby instead of roses, their faces beaming with excitement as they glide through the hallways as if they were taking their first turn on the stage before an adoring crowd.  I really wanted that wheelchair ride.

No one looks at the mother without a baby.  We are the invisible.

I had come to hospital pregnant with three boys and I now had two, who had a tenuous grasp on life at best.  Even as a doctor, I do not think that I grasped the gravity of the situation until I actually left the building.  The sound of the car door closing was like punctuation for all that pent-up emotion and I began to sob.  I have never felt so utterly devastated.  I was crying for our son who died, for our boys who might not live, and for all the dreams that had vanished.

A mother should never have to leave the hospital without her baby.