I have given transfusions to children of Jehovah's Witness children. Virtually all of the parents consented tacitly by not opposing the court orders we obtained in order to give the transfusions. I never felt bad about that until I visited a web site which refers to JW teaching on the subject as "moronic"
That made me more uncomfortable than you might think, given that I believe they are misinterpreting the scripture.
Why?
Because I can see a battle coming. If ever there is any successful treatment from embryonic stem cell research, I would refuse that treatment. I would refuse to allow my child to have that treatment - even if it meant that my child would almost certainly die. I believe very strongly that life begins at conception and that destroying embryos for research purposes is a great moral evil.
I still think that the Jehovah's Witnesses are misinterpreting the scripture. If a child's life is in danger, and if we can get a court order for a transfusion, I'll still give it. I will have a great deal more sympathy for those parents, though.
Wednesday, August 15, 2007
Saturday, August 11, 2007
Religious beliefs in the NICU - Jehovah's Witnesses
My first experience as a NICU nurse with a Jehovah's Witness family was in the 1970's. The baby had severe hydrops fetalis because his mother was Rh negative and had developed antibodies to the baby's Rh positive blood. This sensitization very likely occurred prior to the introduction of Rhogam.
The baby was so critically ill and so unlikely to survive that our neonatologist opted not to request a court order to permit him to transfuse the baby. He felt that it would cause unnecessary pain for the family without any benefit to the baby.
Since then, I've had the opportunity to discuss blood transfusion with several families who are Jehovah's Witnesses. Their responses vary.
The very young moms who have been raised in the faith tend to say, "I can't give consent, but you can get a court order, can't you?" Not always the case, but they often have to balance their concern for the baby with their relationship with relatives.
The physician's answer is always the same. "We'll try to avoid transfusing your baby, but we can get a court order if needed." Care for those babies isn't significantly different than for our other preemies. We try to avoid transfusions in all of them if we can. The one difference is that the babies for whom we need a court order get an appointed guardian who has to approve any transfusions. It's not simply left up to the physician once the court order is in place. The guardian, who is generally a hospital administrator, has to be convinced of the need. I've only seen one transfusion refused, but the guardians take their responsibility very seriously.
Older Jehovah's Witness families don't always have the hard-line belief that all transfusions are prohibited for all members of the faith. Some believe very strongly that transfusion is always wrong. Others believe that it would be wrong for them to have a transfusion, but that their baby is not yet in a position to make that choice. They, like our appointed guardians, want to be convinced that each transfusion is actually needed, but they will sign the consent form themselves. Retaining control is probably an important part of choosing that path.
While doing some background reading for this post, I discovered a web site titled Associated Jehovah's Witnesses for Reform on Blood. The site says that they have members who are or have been elders or members of Hospital Liaison Committees. They disagree with stated positions of the Watchtower on the use of blood and blood products and say that they hope to educate Jehovah's Witnesses on what they call inconsistencies in doctrine.
I don't share the Jehovah's Witness belief that it is a sin to use blood or blood products, but I do appreciate the technological advances that have resulted from medical and surgical attempts to minimize or avoid transfusions. Transfusions save lives, but they're not free of risk.
The baby was so critically ill and so unlikely to survive that our neonatologist opted not to request a court order to permit him to transfuse the baby. He felt that it would cause unnecessary pain for the family without any benefit to the baby.
Since then, I've had the opportunity to discuss blood transfusion with several families who are Jehovah's Witnesses. Their responses vary.
The very young moms who have been raised in the faith tend to say, "I can't give consent, but you can get a court order, can't you?" Not always the case, but they often have to balance their concern for the baby with their relationship with relatives.
The physician's answer is always the same. "We'll try to avoid transfusing your baby, but we can get a court order if needed." Care for those babies isn't significantly different than for our other preemies. We try to avoid transfusions in all of them if we can. The one difference is that the babies for whom we need a court order get an appointed guardian who has to approve any transfusions. It's not simply left up to the physician once the court order is in place. The guardian, who is generally a hospital administrator, has to be convinced of the need. I've only seen one transfusion refused, but the guardians take their responsibility very seriously.
Older Jehovah's Witness families don't always have the hard-line belief that all transfusions are prohibited for all members of the faith. Some believe very strongly that transfusion is always wrong. Others believe that it would be wrong for them to have a transfusion, but that their baby is not yet in a position to make that choice. They, like our appointed guardians, want to be convinced that each transfusion is actually needed, but they will sign the consent form themselves. Retaining control is probably an important part of choosing that path.
While doing some background reading for this post, I discovered a web site titled Associated Jehovah's Witnesses for Reform on Blood. The site says that they have members who are or have been elders or members of Hospital Liaison Committees. They disagree with stated positions of the Watchtower on the use of blood and blood products and say that they hope to educate Jehovah's Witnesses on what they call inconsistencies in doctrine.
I don't share the Jehovah's Witness belief that it is a sin to use blood or blood products, but I do appreciate the technological advances that have resulted from medical and surgical attempts to minimize or avoid transfusions. Transfusions save lives, but they're not free of risk.
Thursday, August 09, 2007
And one more thing
I know the nurses who took care of my husband must have been glad to see us go home. He's a notoriously poor historian with a couple of significant allergies. He remembers the one about the shellfish, usually, and nearly always forgets to tell them about the peanuts. At least the peanut allergy isn't an issue until they start feeding him. Then he remembers and they ALWAYS want to know what else he's forgotten. Can't blame them.
He can't remember the name of the drug that made his platelet count drop to 30,000.
And neither of us thought it would be a problem to simply give them a list of his medications without a list of "not allergic, but do not give" meds. We were trying to figure out which medications he'd been given prior to discharge and which he might need to take when he got home. Plavix, check. Toprol, check. Aspirin, check. Zocor. Yes, he got Zetia and Lipitor.
"Wait. He got Lipitor? You can't give him Lipitor...."
and then I remembered we hadn't told them about the whacko liver function studies when he was taking Lipitor. And he'd referred every single one of them to me to review his medications and history -- well, everyone except the house doc who wrote the orders and the nurse who'd given him the Lipitor without telling him the name of the damn pill. He'd have remembered if he'd been told the name of the pill.
One isn't going to kill him, of course, but it is aggravating - both that we forgot and that he had a nurse who couldn't be bothered to tell my husband the names of the pills he was handing out.
I need to do a little training: "Yes, honey, you need to ask the name of EVERY SINGLE PILL. I don't care who is giving it to you. Don't put anything in your mouth until you know its name."
He can't remember the name of the drug that made his platelet count drop to 30,000.
And neither of us thought it would be a problem to simply give them a list of his medications without a list of "not allergic, but do not give" meds. We were trying to figure out which medications he'd been given prior to discharge and which he might need to take when he got home. Plavix, check. Toprol, check. Aspirin, check. Zocor. Yes, he got Zetia and Lipitor.
"Wait. He got Lipitor? You can't give him Lipitor...."
and then I remembered we hadn't told them about the whacko liver function studies when he was taking Lipitor. And he'd referred every single one of them to me to review his medications and history -- well, everyone except the house doc who wrote the orders and the nurse who'd given him the Lipitor without telling him the name of the damn pill. He'd have remembered if he'd been told the name of the pill.
One isn't going to kill him, of course, but it is aggravating - both that we forgot and that he had a nurse who couldn't be bothered to tell my husband the names of the pills he was handing out.
I need to do a little training: "Yes, honey, you need to ask the name of EVERY SINGLE PILL. I don't care who is giving it to you. Don't put anything in your mouth until you know its name."
Wednesday, August 08, 2007
Vaccine, Autism, and Statistical Nonsense
Since Med Journal Watch has comments turned off, I'm going to comment here.
He's right on nearly all his points, but he missed a BIG one.
The discussion of Autism related to the alleged prenatal exposure to Thimerosal from Rhogam requires a visit to the Rhogam web site
Since at least 2001, THERE IS NO THIMEROSAL IN RHOGAM. Scroll down. You'll find it.
Once again, statistical nonsense which totally ignores reality. Thimerosal must cause Autism, according to the anti-vaxers, so there must be thimerosal in Rhogam.
Even when there isn't.
Update: See Christian's comment. The only thing he missed was the date when the Rhogam (or similar product) was given. The study subjects were prior to the exclusion of Thimerosal.
I haven't been able to access the full text of the study yet. I'll keep trying, but I did a little investigation of the researchers. Christian, of Med Journal Watch, is quite right to be suspicious. The researchers definitely have a dog in this fight. Dr. Mark Geier is a paid professional witness in anti-vaccine trials. He has had his testimony stricken on at least one occasion because he did not have the necessary credentials to be an expert witness in that case.
Additionally, Dr. Mark Geier has been cited for attempting to breach confidentiality and had a different study suspended for that reason.
For some very interesting information on the Geiers, see this post on the Neurodiversity Weblog.
As an Rh negative mother of a young adult with ADHD (too old to have gotten prenatal thimerosal), I'd be interested in research that truly shows a higher incidence of any type of developmental issue in children of Rh negative women. The study population was only 53 and it truly was not a prospective study in the way I understand prospective studies. Further research would be interesting, but I'd want it done by someone who doesn't have anything to gain other than knowledge.
He's right on nearly all his points, but he missed a BIG one.
The discussion of Autism related to the alleged prenatal exposure to Thimerosal from Rhogam requires a visit to the Rhogam web site
Since at least 2001, THERE IS NO THIMEROSAL IN RHOGAM. Scroll down. You'll find it.
Once again, statistical nonsense which totally ignores reality. Thimerosal must cause Autism, according to the anti-vaxers, so there must be thimerosal in Rhogam.
Even when there isn't.
Update: See Christian's comment. The only thing he missed was the date when the Rhogam (or similar product) was given. The study subjects were prior to the exclusion of Thimerosal.
I haven't been able to access the full text of the study yet. I'll keep trying, but I did a little investigation of the researchers. Christian, of Med Journal Watch, is quite right to be suspicious. The researchers definitely have a dog in this fight. Dr. Mark Geier is a paid professional witness in anti-vaccine trials. He has had his testimony stricken on at least one occasion because he did not have the necessary credentials to be an expert witness in that case.
Additionally, Dr. Mark Geier has been cited for attempting to breach confidentiality and had a different study suspended for that reason.
For some very interesting information on the Geiers, see this post on the Neurodiversity Weblog.
As an Rh negative mother of a young adult with ADHD (too old to have gotten prenatal thimerosal), I'd be interested in research that truly shows a higher incidence of any type of developmental issue in children of Rh negative women. The study population was only 53 and it truly was not a prospective study in the way I understand prospective studies. Further research would be interesting, but I'd want it done by someone who doesn't have anything to gain other than knowledge.
Making a difference
Abbie Armstrong comes from a family with a tradition of changing lives. She's carrying on the tradition - even before she graduates from nursing school.
While still in high school, she was invited to fill an empty seat at a fundraising dinner. The dinner was to benefit the people of the island of Sumba, a small island in Indonesia. No, I never heard of it before I read the story either.
The pictures Abbie saw at that dinner weren't the pretty tourist pictures on the first link. They were the pictures of the indigenous people of the island. The people who have very little in the way of health care - and often not much in the way of clean water or protection from malaria.
Abbie's life was changed forever that night. She decided that she must visit Sumba - and it was arranged. She decided that she could not go empty-handed, so she invited friends and family to donate money, not knowing how it would be spent before she left home. The rest of her story is truly inspirational. Abbie's life has been changed, but not only her life. Read the article to see how one person can make a difference - if they are willing to make the effort.
While still in high school, she was invited to fill an empty seat at a fundraising dinner. The dinner was to benefit the people of the island of Sumba, a small island in Indonesia. No, I never heard of it before I read the story either.
The pictures Abbie saw at that dinner weren't the pretty tourist pictures on the first link. They were the pictures of the indigenous people of the island. The people who have very little in the way of health care - and often not much in the way of clean water or protection from malaria.
Abbie's life was changed forever that night. She decided that she must visit Sumba - and it was arranged. She decided that she could not go empty-handed, so she invited friends and family to donate money, not knowing how it would be spent before she left home. The rest of her story is truly inspirational. Abbie's life has been changed, but not only her life. Read the article to see how one person can make a difference - if they are willing to make the effort.
Tuesday, August 07, 2007
Surviving childhood -- your children's
My friend Pippa, of Pippa Said is having a little trouble with her youngest child. Said child likes to play in the street. And is being encouraged by the older siblings. Pippa could use some advice. Mine would be along the lines of "Have a glass of wine."
Drinking won't help, of course, but when your kids act like that, the neighbors already believe that you do. I should know. I have boys. 3 of them.
My oldest was fond of playing in the street. I didn't exactly encourage it, but blink and he was out there. It was the one infraction for which I routinely spanked - accompanied by the admonition, "If a car doesn't hit you, I will. Every time."
To which my son would respond, "That doesn't hurt!"
Kid never knew how close that put him to death. He did survive - his excursions into the street and his mother's wrath.
He's the only one of my kids I never put the "Mother's Curse" on -- you know, "I hope you have a kid just like you!" I was too afraid he'd ask me to babysit.
Want to know what life was like when he was little? I once told a co-worker that nobody who'd read Ransom of Red Chief, by O. Henry, would ever consider kidnapping him.
Part of his problem was that he had a significant speech delay. At age 3.5, I could only understand about half of what he was saying. This was quite frustrating for both of us. Only after his speech improved did I realize that it was actually a mixed blessing.
I also learned of the hazards of teaching small children the correct names for their body parts.
By age 3 3/4, after only a couple of months of speech therapy, he could very clearly (and very loudly) ask, "Mom! Mom, does that man have a penis?"
Loud. Every time he saw a man standing still in a public place.
I knew it was really about the attention, so I'd try to ignore him, because shushing just didn't work. So of course he'd ask again -- louder.
Eventually, I took a chance.
"I don't know, honey, why don't you ask him?"
To my everlasting relief, he did not.
Drinking won't help, of course, but when your kids act like that, the neighbors already believe that you do. I should know. I have boys. 3 of them.
My oldest was fond of playing in the street. I didn't exactly encourage it, but blink and he was out there. It was the one infraction for which I routinely spanked - accompanied by the admonition, "If a car doesn't hit you, I will. Every time."
To which my son would respond, "That doesn't hurt!"
Kid never knew how close that put him to death. He did survive - his excursions into the street and his mother's wrath.
He's the only one of my kids I never put the "Mother's Curse" on -- you know, "I hope you have a kid just like you!" I was too afraid he'd ask me to babysit.
Want to know what life was like when he was little? I once told a co-worker that nobody who'd read Ransom of Red Chief, by O. Henry, would ever consider kidnapping him.
Part of his problem was that he had a significant speech delay. At age 3.5, I could only understand about half of what he was saying. This was quite frustrating for both of us. Only after his speech improved did I realize that it was actually a mixed blessing.
I also learned of the hazards of teaching small children the correct names for their body parts.
By age 3 3/4, after only a couple of months of speech therapy, he could very clearly (and very loudly) ask, "Mom! Mom, does that man have a penis?"
Loud. Every time he saw a man standing still in a public place.
I knew it was really about the attention, so I'd try to ignore him, because shushing just didn't work. So of course he'd ask again -- louder.
Eventually, I took a chance.
"I don't know, honey, why don't you ask him?"
To my everlasting relief, he did not.
Wednesday, August 01, 2007
Tiny Turtle update
Most of tiny turtle's meals consist of Romaine lettuce. He gets a little tomato, little bits of fruit, and as a special treat a tiny cricket to hunt or a bit of shrimp. We're still having a drought here, and worms are mighty hard to come by.
The turtle prefers his lettuce leaves large. He crawls underneath and nibbles from below. We're all entertained by the moving lettuce leaves. With most other foods, he hides until he thinks we're gone before he will come out to eat. With the shrimp, he just doesn't care. He'll eat in front of whoever happens to be around. He looks damp in the picture because I had just misted his terrarium to keep him from having a drought in there too.
He's grown a little. His shell is now 38 mm wide and 41 mm long. He seems to be healthy. He's quite active in the early mornings when there aren't many people around. His skin looks clean and his eyes are shiny. He's quit hissing at us, so I think he's getting used to us. He still likes to hang out in his little pool, but never when I'm looking. I can tell by the little turtle footprints he tracks into the water.
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