Sunday, September 30, 2007

Just in case you were wondering

No, we don't do stat paternity tests. It doesn't matter if you're from out of state. Would you like to see the baby? She looks just like you.

Actually, we don't do paternity tests at all. Here's the card. Contact them. They'll tell you how it's done. Yes, the doc will write a scrip if you need one. The company will tell you how much they charge.

No, medical assistance doesn't pay for paternity testing, but hey, the test is cheaper than child support unless the baby-momma has correctly ID'd you. In that case, you might as well skip the test and just pay up. Would you like to see the baby? She looks just like you.

If you really don't want to pay for the test, Maury Povich is recruiting maybe-daddies for his television show. Probably other shows are too. No, I won't be watching.

Sunday, September 16, 2007


Dr. Rob's 10 Reasons to NOT Like Pediatrics reminded me of a time when my older children were very small. It was item #10 if you're wondering.

My middle (then youngest) son was 15 months old at the time. He'd been up at about 2am looking for someone to play with. He didn't whine. He didn't cry. He was very cheerful. HOWEVER, this was a child who made a practice of sleeping through the night while cutting 4 teeth at a time. He NEVER complained about anything.

That and he'd been sleeping through the night since he was 2 days old. Really. Usually 12-14 hours.

So I did what any self-respecting mom would do.

I called the pediatrician and made an appointment to have him examined.

"Dr. Spock's office, how may I help you?"

"My 15 month old was awake last night. I think something is wrong with him."

"Was he crying?"


"Was he tugging on his ear?"

"No. In fact he was quite cheerful. But this isn't normal for him. Something is wrong."

"You want the doctor to examine your 15 month old because he was up once during the night last night?"

"That's right. Oh, and his brother (of the many ear infections) says his ears hurt, so I'd like to bring them both in."

(audible sigh) "Can you come at 11:30?"

"Sure. We'll be there."

For the record: his brother had bilateral otitis media - and so did he. According to the pediatrician, his ears looked much worse. He was the reason I bought an otoscope (ear-looker thingy) and why the pediatrician educated me in the proper use of it.

Prior to the otoscope, the first ear infection was the only one I caught before the poor kid had pus dripping from his ear canal. He NEVER complained. I got in the habit of checking his ears any time he had a sniffle. A year or so after I bought the "ear-looker thingy" he did ask me to "play check ears" - sure enough, the eardrum was ready to burst again. That was the closest the kid ever came to actually complaining about an ear infection.

That first incident was also the last time the office staff questioned my reasoning for wanting to bring a child in to be seen.

Sunday, September 09, 2007

It's mine and you can't have any

By way of Navelgazing Midwife. It's one of the funniest breastmilk stories I've read in a long time.

Warning. If you're the least bit squeamish about breastfeeding, just don't go there.

Driver's Ed

It was many years ago, but some things you don't forget.

My driver's ed instructor was full of useful bits of information:

Buckle your seat belt

He was right, of course. I've only crash-tested one seat belt, but the only damage to me was a bruise where my medic-alert tag got caught under the seat belt. Now the first thing I do after buckling up is find the damn thing and make sure it's ON TOP of the seat belt. Makes one hell of a bruise if you don't.

When parallel parking, back up until the back of your rear passenger door (or equivalent spot in a 2-door) just passes the rear bumper of the car in front of your space before cutting your rear wheels toward the curb (front wheels away). Start turning your steering wheel back the other way shortly before BEFORE your front bumper passes the rear bumper of the other car.

Works. I back in, pull up a little and am perfectly parked every time.

Don't run over ANYTHING, not even a paper bag. There could be a human head in it.

Colorful way of making sure I don't run over paper bags. Can't do it - not even 30+ years later.

If you're on a 2-lane road and someone is coming at you head-on, brake and stay in your own lane. Don't pull to the left or to the right, because the driver who is in the wrong lane will choose one of those most of the time.

I don't know where he got his statistics, but the only opportunity I had to test his theory, the other driver passed me at very high speed on my right - yes, going the opposite direction. I don't want another opportunity. NEVER.

Monday, September 03, 2007


I don't know whether this bird belongs to a neighbor, escaped from an area wildlife preserve, or has been surviving on his own with the one leg. We've seen lots of raptors around here, but this is the first time I've seen one in the bird bath.

Yes, those are thistle feeders in the background for the many finches who visit our yard. You can't see the "squirrel proof" sunflower seed feeder nearby. We haven't seen any evidence, but I wonder if this one-legged visitor has been snacking at our bird feeders - and not the seeds.

He wouldn't have to. There is certainly enough road kill around here - mostly squirrels, with the occasional raccoon or 'possum, to keep him well fed.

Sunday, September 02, 2007

Pediatric Grand Rounds

The Labor Day Weekend edition is up at Unintelligent Design. Thanks to Dr. Clark Bartram for keeping this going!

Byler Babies arrive

Karoline Byler, of Wesley Chapel, Florida, can finally take a deep breath. Her babies were delivered Saturday, September 1, between 9:00 and 9:03 pm at Bayfront Medical Center in St. Petersburg, Florida. They were taken through the connecting tunnel to adjacent All Children's Hospital. The 2 hospitals have been planning for months and there's a video linked from the All Children's web site that describes the plans. The hospitals have managed many sets of multiples - including quintuplets, so they are understandably confident of their ability to manage the Byler babies.

From the All Children's Web site:

Names and birth weights for the five boys and one girl are as follows:

Brady Christopher - 2 lbs., 8 oz.
Eli Benjamin - 3 lbs
Ryan Patrick - 3 lbs
Jackson Robert - 2 lbs., 10 oz.
Charlie Craig - 2 lbs., 5 oz.
Mackenzie Margaret - 2 lbs., 9 oz.

They describe the babies condition as stable, except for Ryan Patrick who is "receiving airway support" and in serious condition. To me, that means something short of a ventilator because that would generally be described as critical condition. The babies were born at 29 weeks, 4 days gestation. There are certainly risks for these babies, but at 29+ weeks and having come through delivery with apparently no major complications, statistics are in their favor.

The family, with an eye to supporting these 6 additions to their family, has signed an exclusivity contract with Inside Edition reportedly worth $12,000, so you'll have to watch their broadcast if you want to see pictures of the babies today. As the reporters in the video I linked above said, that will buy a lot of diapers.


I should have anticipated this.
2 of the Byler babies are now in critical condition and 2 others in serious condition. It's quite common for 29 week preemies to have some respiratory issues and I hope that's all that's going on here.

We call that initial period when the baby does so well the "honeymoon" and it last about 24 hours. The babies start running into problems with inadequate surfactant production after that.

If that's the issue, the 2 who are in critical condition probably had to have a breathing tube placed so they could receive surfactants. They'd be kept on the ventilator for a period afterwards. The time frame would depend on how quickly they recover. The 2 in serious condition may need respiratory support short of a ventilator. They may recover without needing a ventilator, or they may need some surfactant replacement within the next day or so themselves.

Saturday, September 01, 2007

Breastfeeding - a personal choice

It is well documented that breastfeeding provides many health advantages for moms and babies. The incidence of upper respiratory infections is lower. The incidence of severe allergies, asthma, and type 1 (insulin dependent) diabetes is lower. The incidence of sudden infant death syndrome is lower. Moms who breastfeed even have a lower incidence of breast cancer. There's a myth that the baby weight comes off faster. Many women find that it helps. I didn't find that to be true - and many women don't.

In the US, where we have access to clean water, refrigeration, and infant formula that is virtually always safe if stored properly (there have been a few alarming -- even lethal, but rare -- exceptions), women can choose to feed formula without fear of the risks found in third world countries. They should be informed of the benefits they are giving up. They should be supported with good breastfeeding education and workplace accommodations, but I don't believe in badgering women who choose not to breastfeed.

Some moms have medical reasons for choosing formula. Those vary from a need to take medication not compatible with breastfeeding to breast surgery which interferes with milk production and let-down. In rare circumstances, the baby may have a genetic disorder which makes breastfeeding impossible, due to special dietary requirements.

Some women have psychological reasons. For example, women who were molested as children may find it difficult to even consider breastfeeding. Some women have work schedules which will not accommodate breastfeeding or even pumping. Some have tried with a previous infant and for one reason or another found it too discouraging to even try again. Some women wish to share the closeness of feeding times with the baby's father or other relatives.

Whether or not I agree with their reasons, I don't badger. I educate about options - like partial breastfeeding. I help them research medications to be certain that they have the latest information. If they wish, I can refer them to our social worker for help with other issues. I make sure that they know WIC provides food for breastfeeding moms in addition to formula for babies. Under the right circumstances, I'll even offer them a pump to help deal with engorgement.

In the end, I support their choice. Moms have a hard enough time without people trying to make them feel guilty about one more thing.

Yes, I wish everyone could breastfeed, but that isn't ever going to happen. Moms need to educate themselves and make the best choices for themselves and their babies - and nobody should jump to conclusions or behave in a hostile manner regardless of the way a particular baby is being fed.