Listener Question Marathon part 2 – PediaCast 335
- PediaCast ends the year with a bang with questions from listeners throughout the United States and around the world! Join us for part 2 of our end-of-the-year Listener Question Marathon. Topics include sports turf rubber pellets & cancer, vegan diets, homeschooling, speech problems & bowel issues, egg allergy & vaccines. It’s the final chapter of the BIG show that YOU made… Be sure to tune-in!
- Sports Turf Rubber Pellets & Cancer
- Vegan Diets
- Speech Problems & Bowel Issues
- Egg Allergy & Vaccines
- How Safe is the Artificial Turf Your Child Plays On (discussed article)
- The Dangers of Raw Milk – PediaCast 277
- Vegetarian Diets for Children
- Homeschooling Interview I – PediaCast 008
- Homeschooling Interview II – PediaCast 160
- Constipation – PediaCast 292
- Medication & Pregnancy – Risk/Benefit Analysis – PediaCast 308
- Egg Allergy and MMR vaccine (AAAI)
- Egg Allergy and Flu Vaccine (AAAAI)
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It’s a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children’s Hospital. We’re in Columbus, Ohio.
It is Episode 335 for December 16th, 2015. We’re calling this one, Listener Question Marathon Part 2. So it’s the show that wasn’t really supposed to be, but my first listener question marathon episode was just way too long. At an hour and a half, it’s like movie length. It’s like a feature film. Yeah, way too long for a commute or an exercise or a walk around the block or whatever it is that you do while you’re listening to PediaCast.
So rather than take content out or shorten my answers, because we’re answering 14 of your questions, I decided just to divide the episode into two parts. So this is the second part.
Now, that comes with a little bit of explaining because I had recorded the whole show before. So the segments I left as they were recorded last week. This week, I’m just recording a new intro and a new outro, and with the magic of garage band, we’re going to stitch everything together. It should sound just fine. We’ve stitched together programs in the past and you didn’t even know it.
But anyway, it is a little bit different this week since it’s Part 2 which is something that we’re not used to doing. It’s also our last episode of 2015, before we take a little bit of break over Christmas week and New Year’s week as well. But we’ll be back in early January. And we have 30 — you count it right, you heard right, count them up. You can count them next year. You can keep a tally. We’re going to do 30 PediaCast episodes. That’s our plan.
We’re going do 13 more of our CME episodes which is available for providers over at PediaCastCME.org. They can claim free Category 1 Continuing Medical Education Credit for listening to those programs. All the details are available over at PediaCastCMe.org.
I mentioned it on this program for a couple of reasons. Number one, we have a lot of providers in the audience for this show. Also, even though those are really geared toward physicians and nurse practitioners and nurses, pharmacists, respiratory therapists — anyone really who takes care of kids in a professional way related to healthcare and pediatrics — some of the topics that we plan on covering, especially the general pediatrics ones may appeal to some parents as well, especially if it’s dealing with something that you’re also dealing with at home.
So, just as an example of that, one of the things that we’re going to talk about is appendicitis and the non-operative approach to appendicitis. That’s going to be one of the programs in January with our CME show. Maybe your kid has had appendicitis. Appendicitis is pretty common, so if you ever find yourself in an emergency room, your child has abdominal pain, and a surgeon says, Hey, do you want… and this is sometime in the future, you have a choice, Would you like to have surgery or would you like us to try antibiotics to take care of the appendicitis, since it is an infection in the intestine?
For some kids, they have to have surgery. There’s no question. The appendicitis can become life threatening in fact. But if it’s early appendicitis and you meet certain criteria, then your child could be a candidate to avoid surgery and have the antibiotics instead.
So if you’re interested in that, you want to hear more about it, that’s going to be coming up on one of our CME programs in January. And it’s just information then that you could tuck in the back of your head in case your child has appendicitis in the future which is as common as it is, that could be the case. So just wanted to let you know about those CME programs as well.
Something else I wanted to tell you about, in 2016, I’m planning on tweaking the format of this program, of PediaCast. This is something that I do from time to time. It’s kind of like rearranging the furniture in a room. Maybe this year, we’ll put the couch against this wall. Not because it’s necessarily better, although it might be. There’s a glare on the TV for instance, but sometimes, you just change things up just to change them up.
We’ve been doing the show for… Actually our ten-year anniversary is going to be coming up in July. So PediaCast will be ten years old in July of 2016. So, we’re excited about that, of course. But you can get into a little bit of a rut, so for 2016, I thought we will try a little bit of a new format. It’s not a major change. We’re still mostly weekly programs to the tune of 30 episodes as I had mention.
But what we’re going to try is dividing the episodes into three segments. So rather than one big long show, we’ll do three 15 to 20 minutes segments. We’ll still cover news parents can use and answer listener questions and have interviews with pediatric experts. But rather than having an entire show that’s news and then an entire show that answers to questions or an interview, we’ll divide it up so we could have a component of all three of those in one episode.
Or, we could have a couple of different interviews. Maybe someone live in the studio and then, we’ll do a phone interview and then we could answer some questions. We might even reintroduce the research round-up segment that we haven’t done in a couple of years. We might bring that back.
So it just gives us a little bit more flexibility. We can get more topics in. And the other thing that it does, this new format is it takes into account something that we’ve talked about on this program before. I know we talked about it during a PediaCast CME program in 2015 earlier in the year, but that’s adult learning theory.
Basically, our attention span are about 15 minutes. Twenty minutes is really stretching it, and then you just need to do something different. With the podcast, could be then when you get to the end of the segment, you turn it off and you listen to something else and then you come back to PediaCast and listen to the second segment. Or, if you’re listening to it straight through, at least we’re really changing things up a little bit and presenting different materials.
So, hopefully, it will make it a little bit more interesting. Just a different way to do it, not necessarily better. Your feedback though will be greatly appreciated. So if that format, as we get into it, give it a few episodes, give it a chance, see what you think after the New Year. And in fact with our very next PediaCast episode that we release, we’ll be doing that. So, if it’s something that you think is helpful and good and you like it, let me know.
On the other hand, if you’re like, Nah, this is just… We don’t get in to the topics deeps enough in that 15 to 20 minutes, if you’re finding that to be the case, let me know that too. Because nothing’s written in stone. It’s a podcast, folks. We want to be flexible and really, we want it to be most helpful to you in whatever form that can be or however that looks.
Couple other things in 2016 to look forward to, we’re going to take PediaCast on the road. So I’m really excited about this. We’re going to cover two pediatric conferences at the conference. The first will be the Annual Conference of the Pediatric Academic Society, also known as PAS. That is going to be in late April in Baltimore, Maryland. So we’ll be at the conference at the Nationwide Children’s booth podcasting.
Then, we’ll be at the National Conference and Exhibition in San Francisco. It’s the National Conference and Exhibition of the American Academy of Pediatrics. So it’s the big AAP annual conference.
One is more academic and research-focused, the other is more clinical and support-of-pediatricians focused. The first in Baltimore, second in San Francisco. That will be in the Fall, so in October.
Because we’ll be podcasting, and I’ll be at the Nationwide booth quite a bit at that time, so if you are a provider or other pediatric professional and you plan on attending either of those conferences in 2016, I would love to meet you and maybe even have you join me on the podcast. We have a mobile studio we’re going to be bringing with us and we’ll be able to explain to parents and providers who can’t make it to the conference some of the things that are going on — what’s in the news, things they should know about to keep their kids healthy or to remain up to date and caring for kids. So that’s going to be a lot of fun. .
Then, the second big thing we have happening in 2016 is we are going to be moving the studio. So, we’re still at Nationwide Children’s. But right now, we’re tucked into a closet-like space. It actually used to be the copier room. I kid you not. The studio where we are now used to have a big copy machine and all the staff mailboxes. And they were nice. They put the copying machine and the mailboxes out in the hallway. But it is kind of a cramp space, and we have to be careful what times that we record interviews because there’s a conference room on the other side of one wall. There’s a cafeteria on the other side of a second wall.
So it’s a great studio, don’t get me wrong. But in 2016, we’re going to be moving into a dedicated studio space in a brand new building. It’s a brand new building. They’re actually soundproofing the space for me, adding extra electrical. So it’s going to be fantastic, in a brand new building still on the campus of Nationwide Children’s.
Actually, that will be closer a little bit where the action is because the marketing department is in a different building a few blocks from the hospital. So, it is a little harder for the pediatric specialists to get here. They have to drive over and park. It’s not terribly difficult but it’s a bit of an inconvenience. But with the new studio, they’ll be able just to walk from their clinic over to the studio and drop in for an interview.
So that’s another reason I kind of wanted to go with the three segments because I can foresee us doing more quick interviews and maybe even interviews in response to the questions that you have as people can just drop in the studio.
I think lots of good things on the horizon, really excited about 2016, but we still have 2015 to wrap up. As I mentioned, this is part two of our listener question marathon. We covered nine questions last time. This time, we’re going to cover five more. Probably about the same length of time though, because as I looked it, since I had recorded this previously, I had looked and this five actually did take a little bit longer to answer than the previous nine did.
First up will be — and this was one I really had the most enjoyable time researching — and that’s on field turf that has little tiny rubber bits in them, and mom was wondering, could those be associated with cancer. And she had some good reason why she thought that she’d read some news articles and there’s some statistics that were thrown around.
So, we’re going to look into that. So that took a quite a bit of research to look at risks and benefits and what’s out there, what do we know about it, is it safe, what would I do with my kids if they were playing on one of those fields? That sort of thing.
So we’re going to talk about that. Then, we also have some questions on vegan diets, homeschooling, constipation and stuttering — yes, those two were in the same question — and then, egg allergy and vaccines.
Now, let me also say this, if you’re listening to this episode first for some reason, it certainly is a great standalone episode. It certainly doesn’t depend on Part 1, but I just want to draw your attention to the fact that there is a Part 1 here at the end of the year. We covered, in that first one, questions from listeners on pregnancy spacing, infant sleep, tummy time, toddler biting, peanut allergies, toddler’s speech, potty training, toddlers and anesthesia, and also tonsils and snoring.
Between these two episodes, lots of topics coming your way. As I mentioned, I love answering your questions. This are what I would call bread-and-butter pediatric questions because they are just things that come up a lot in the course of practicing in a primary care pediatric office.
So they’re important questions and we’ll have hopefully good well-researched answers for you. It took me quite a while to answer all 14 questions.
Now, if you have a question, answering all of these questions means that I pretty much exhaust our question bank. So we need more, especially if we’re going to go to these three segments per episode and have a lot more questions, opportunity to answer your questions. So please send them my way. There are no silly questions, no stupid questions. If it comes to mind, fire away, ask. Even if you think it’s a silly question, there’s probably lots and lots of other parents out there who have the same question that you have. So please ask away and we’ll get your questions answered.
It’s easy to get in touch with me. Just head over to PediaCast.org and click on the Contact link. You can also call the voice line at 347-404-K-I-D-S, 347-404-KIDS, 5437 if you need the digits, and you can ask your question that way as well.
Also, I want to remind you, the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you do have a concern about your child’s health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.
All right, let’s take a quick break and I will be back with more answers to your questions, right after this.
Dr. Mike Patrick: All right, so here is the question that I found most interesting as I was researching for this listener question marathon episode. It comes from Jessica. She says she’s from OH-IO!! When she’s really excited when she says that because they are all in capitals and there’s an exclamation point or two. About two, there are two exclamation points and a dash between OH and IO. So she’s doing the Buckeye thing. You know, OH and then someone else yells, IO! Which was a little bit more exciting before we lost out on being able to compete for the national championship in college football, but that’s OK. Jessica’s still excited to be from Ohio.
She says, Hi, Dr. Mike. I’m a long, long time listener, back from the BirdHouse Studio days. For those who have no idea what Jessica is talking about, PediaCast started in 2006. And from 2006 to 2008, so those first two years, the show was recorded in BirdHouse Studio, which was located in the basement of my home in London, Ohio. The sound quality wasn’t so great in those days but I’m glad you brought it up, Jessica, because as I mentioned in the intro to the show today, we’re going to be moving to a brand new studio in the spring — still on the campus of Nationwide Children’s Hospital but moving to a newly constructed studio space.
And I’m thinking, really, and it just occurred to me as I’m doing the show and talking about it — yes, I’ll credit Jessica for moving my thinking in this direction — but I think a brand new studio deserves a new name which could really be an old name that has meaning. So maybe, just maybe, Birdhouse Studio on the campus of Nationwide Children’s Hospital will live to see another day. It certainly would fit with animal friends culture theme here at the hospital.
So, I have all sorts of ideas floating around in my head now. Thanks, Jessica.
All right, she goes on to say, I always enjoy your commentary and recommend your show often to friends. I appreciate your no-nonsense approach and your use of facts to tell the story. No drama, no agenda, thank you for that.
She then provides a link to a story from NBC News entitled How Safe Is The Artificial Turf Your Child Plays On? I’ll include the link in the Show Notes Episode 334 over at PediaCast.org. I know there’s going to be a ton of links on that particular page as we’re covering these stories that you guys are sending me.
Jessica says, The article got me thinking and since I’m not a scientist or a doctor, I thought maybe you could provide some thoughts on this. Is there danger to inhaling and eating these rubber pebbles. Are the bad things in the tires really bioavailable and absorbed into the body? Or are they just passed on through like many substances that we eat and drink? One comment says, “After the vulcanization process, the ingredients are inert. Is that supposed to mean safe? I can’t wait to hear your thoughts on this. I’ll be tuning in. — Jessica
Well, thanks for bringing the story to our attention, Jessica. So you all know the sports turf that the article and Jessica have in mind, right? With those little tiny rubbery pebbles, they help your shoes grip and cushion falls. The gist of the article is this, a soccer coach goes to a hospital to visit a young goalie who is getting chemotherapy for recently diagnosed non-Hodgkin’s lymphoma. The nurse makes a comment to the effect of, You’re the fourth goal keeper I’ve hooked up this week. The soccer player, the one with cancer thinks about this and says, You know, I wonder if it’s from all those rubber particles that get everywhere on my clothes, in my hair, between my cleats.
So the soccer does some research and finds 38 soccer players across the country, 12 of them from her home state who have been diagnosed with cancer of one sort or another, and 34 out of the 38 were goalies. And since goalies are the ones who come into contact with the rubber particles the most as they dive to deflect balls, there may be something to this after all.
The rubber particles, some of it’s new rubber. Others, old processed tires contain all sorts of chemicals so could those be causing cancer? And the answer is we don’t know, it has not been adequately studied. The article goes on to say that we don’t know the toxic effect of ingesting the rubber particles. Although to be fair, it’s not like soccer players are grabbing handfuls of the stuff and eating it. I supposed if they did this, it might be a problem.
But the rubber isn’t made for eating right, and most kids including goal keepers aren’t ingesting significant quantities. I mean, maybe some getting in their mouth here and there. Most are probably spit out, a few might be swallowed but is it enough to be a problem?
It’s a good question. Old tires may contain lead or mercury, but as Jessica asks are these toxins bioavailable? Or do they stay locked up in the rubber and pass through the GI tract in the form and condition in which they entered? It’s a good question. Unfortunately, we just don’t have good answers at this point. Maybe it’s a problem for goalies and maybe it’s not.
So next, we got to think about the rubber touching skin or getting into scrapes. That’s a pretty small blip on my risk meter. But again, no studies to say for sure.
What about the smell? Are there toxic chemicals in rubber smell? Well, here’s where things get interesting. The smell comes from hydrocarbons, which are used as solvents in many industries, including the rubber industry. We do know a little bit about this because of occupational exposure and yes, there are some risks. But we can also measure the amount of hydrocarbons that are waiting up from the field and the amount of exposure based on studies that had been done is unlikely to be enough to cause concern.
So what’s the bottom line here? Well, there probably are some risks. The question is how big are the risks and are they worth the benefits? So let’s take a little bit of a closer look at both of these things and just see where we end up.
So, what are the risks? Well, there’s the chemical risk which is still a mystery. We can look at the data, 24 soccer goalies with cancer across America, but is that really significant? How many soccer goalies are there across America playing on field turf? Thousands, tens of thousands, maybe a 100,000. I don’t know for sure, but it has to be a pretty high number. How many soccer goal keepers are in your neck of the woods? In mine, there’s like soccer fields all over the place. Many of them with the field turf that we’re talking about. So it’s pretty high number of soccer goal keepers out there.
How many soccer goal keepers have cancer who play on those types of fields versus how many soccer goal keepers are there who have cancer who play on real grass? I don’t know, these are all questions that have to be answered before we get too excited about 34 goalies, right?
What about the nurse who saw four goalies for chemotherapy in one week. Well, I assume the four goalies live in the same community, so what other exposures do they share? It’s only anecdotal and it may or it may not mean anything. So the toxic risk is really sort of still a black box at this point. And it’s one that we probably ought to be opening and examining. That’s my opinion, anyway.
There are other risks. The thought is rubber pellets improve grip and cushion falls. But do they really? There actually been studies that show more injuries on these fields compared to real grass especially knee and ankle injuries.
OK, so what are the benefits? Well, conservation. We’re doing something with old tires. Of course, that means nothing if we’re harming our kids in the process, but we just don’t know that at this point. They don’t need water. They don’t need fertilizer or weed killer which represent toxic exposure on natural turf, right? Can, if fertilizer or weed killer is being used.
Here’s the biggest benefit though. It’s where your child’s sport team plays. Your kids are outside. They’re being physically active. They’re with other kids. Huge benefit and field turf is where it’s happening. That’s huge.
So what’s the bottom line? Well, for me and my family, I consider risk and benefits. Your analysis of this may be different. That’s fine. The process is what’s important here.
I would prefer natural turf. Especially if it’s natural turf where you’re not using a lot of insecticides and fertilizers and such. It’s really true natural organic turf, That would be preferable. As we look at those injuries, statistics and the possibility of there being some toxic effect. So that would be my number one preference.
But if that’s not an option, if the only field available is one of these rubber pellet field turf and that’s it — that’s where the soccer team is playing and my kids want to play soccer — then I think the benefits outweigh the risk compared with not participating at all. That’s my opinion, based on what we know now. But I do think it would be prudent to investigate any potential toxic effects. We certainly owe that to our kids.
The city and school and amateur and professional sports officials, when you’re looking at turf options, look beyond the sales pitch. Is dirt and grass really such a bad thing?
That’s my take, Jessica. And, as always, thanks for pointing us toward the story. Thanks for your question. And in response to your OH-IO! I will say Go Bucks in the Fiesta Ball on New Year’s Day versus Notre Dame. Hopefully, that game will go a little better than our one against Michigan State did a few weeks ago.
That was a fun one to look into. It’s interesting question. I think those where we still just don’t know the answer yet. This is where the hypothesis phase of medical research comes into play. Someone ought to be looking into this — is field turf with the rubber pellets, is it safe? It probably is, but there are enough questions that maybe we should be looking into it a little bit closer.
Next up, we have Stephanie in Indianapolis, Indiana Hello, Dr. Mike. My in-laws had been talking to us about implementing a vegan diet for our family. We are just starting to learn about the health and environmental benefits of a plant-based diet. But, I’m finding it difficult to understand how dairy should or should not fit into our plan. Most pediatricians really push milk and dairy for young children as a crucial part of their diet due to the calcium and protein.
But according to much of what we’re learning, dairy is really not appropriate for humans to eat and drink. What are your thoughts on a vegan diet for children and dairy specifically? Thank you.
Well, thanks for the question Stephanie. First, I would encourage an examination of who you are learning from and what you are learning. Is it evidence-based? If so, what are the qualifications of those doing the research? Who is funding the studies? Are there conflicts of interests? Are the studies published in peer-review journals and are the results statistically significant?
Pediatricians push cow’s milk because for most children, and there are exceptions, but for most children, it is an excellent source of essential nutrients, including calcium, vitamin D, fats and proteins, all important building blocks for growth and development including brain development. These statements are based on evidence.
What about hormones and antibiotics? Well, hormones are destroyed in the acidic environment of the human stomach. There’s no evidence that they post a risk. And this fact is the reason that insulin and growth hormones which are hormones are given as shots. They don’t make it past the stomach.
Antibiotics in cow’s milk, that can be a problem in terms of developing bacterial resistance. But the FDA has really cracked down on this practice, and most cow’s milk does not contain antibiotics.
And you can always buy from a reputable organic dairy, although you do want to make sure the milk is pasteurized, so don’t go too organic. Raw milk, not good idea. We talked about that back in Episode 277, the whys and what fors. I’ll put a link to it in the Show Notes for this episode if in case you’re interested.
So on the whole, when I consider the evidence, the benefits of pasteurized milk far far outweigh any risks. And I think that is a clear and convincing analysis, which is why pediatricians push it. It’s not a conspiracy, we’re not in cahoots with the Dairy Council. We’re looking at the evidence, simple as that.
Now, with regard to a vegan diet. It’s not optimal. Humans are omnivores. We need plants and animals, the same as all other omnivores that are out there. Now, can you make a vegan diet work? Well, you can. But you have to be intentional about it. You have to make sure your kids are getting all the nutrients from somewhere. You also have to follow their growth and development closely to make sure that they are getting those nutrients.
The American Academy of Pediatrics has an excellent article over at HealthyChildren.org called Vegetarian Diets For Children, and it doesn’t include information about vegan diets. That would be a good read.
Also, be sure to talk to your child’s primary care provider if you go with that plan. They may have some tips. They’ll need to know that your child does have a vegan diet, so they can follow your child’s nutritional status closely, as they do with all kids.
But let’s face it. Many of our omnivore choices aren’t the best, so that’s why we follow the growth and talk about nutrition with all kids. We’re not just going to take those with vegan diets and say, OK, we need to only counsel you. Everybody needs to be counseled on good diets because of the some of the choices that we make. And part of that, it’s not just as our fault as the choice maker. It’s also the fault of the people who provide us with the choices. It seems like there is an increasingly difficult time finding nutritious food that’s not pack full of fat and calories.
But you do want to be transparent about this with your physician. I think that’s really my bottom line here. So that your doctor or your nurse practitioner, whatever provider you have knows what’s going on and can follow growth and development along.
Here’s my biggest piece of advice. Find a dietitian and together come up with a plan. If you need help finding one, ask your doctor. He or she should be able to point you in the right direction. So vegan diet can work with some effort. But again, humans are omnivores. The best fuel for our bodies is a combination of plant and animal material. That’s a fact, regardless of which ways some folks may want to spin it.
Again, if you’re looking to do a vegan diet, and the two people that you want in on the loop here is your pediatrician. And I think a dietitian. I think that’s a great idea to have a dietitian involved with the planning out menus and figuring out what the best choices are going to be.
Thanks again for your question, Stephanie. Really do appreciate you writing in.
All right, we have Arielle in Phoenix Arizona. She says, Hello, Dr. Mike. My daughter is about to start school and my wife and I are leaning toward homeschooling. Our current thought is to homeschool our children until high school at which point, we would send them to public high school. As I believe this is also what you did, I would love to hear your thoughts on the subject in terms of socialization and independence of homeschooled children. I think it would also be great if your children commented on their experience.
As always, thank you for what you do. We find your insights a tremendous help.
Well, thanks for writing in, Arielle. So, my daughter Katie went to public school in kindergarten and we began homeschooling with the first grade and continued that all the way through high school. My son Nick, homeschooled the entire way, kindergarten through Grade 12.
Now, why did we do it? Well, we’re not anti-establishment. We subscribe to the Christian faith but this wasn’t a religious issue for us, as it is for some. It doesn’t bother me that my kids learn about evolution or global warming or sex education. Because even if I don’t agree a 100% with everything that’s out there, if there’s a particular thing I don’t agree with, I still think it’s good for kids to be exposed to a little bit of everything, to learn to think for themselves, rather than someone else’s opinion, even if it’s my own. Look at the evidence and make up your mind. I think that’s important.
So , when we were looking for a curriculum, we went with the pretty classic education using former Secretary of Education Bill Bennett’s K12 curriculum the very first year it was available. We, and by we, I mean mostly my wife, guided them all the way through elementary and then through middle school. And then, for high school, my daughter Katie attended the George Washington University Online High School. So technically, we weren’t homeschooling. I mean, really it was a private online high school. But it’s really still homeschooling.
Nick graduated this past year from the K12 International Academy. All around good experiences and I don’t think either of them would have wanted it any other way.
So why did we do it? I didn’t answer that question. Honestly, this is a little embarrassing but it’s the truth. I want to be transparent. My wife and I went on a ski trip when Katie was in the kindergarten. And, sitting in the hot tub, I kid you not, we were like, You know if we homeschooled, we could take the kids on vacation whenever we wanted, for as long as we wanted. And that was the spark. And boy, did we end up taking advantage of that with a couple two-week vacations a couple of times a year.
We were and still are a family that does a lot of things together. We don’t have a ton of equity in the bank to show for it, but boy do we have relationship. When we should have been saving for college by someone’s standard, we were hanging out at Disney World in the beach and around a cruise ship and really going on vacations and doing stuff together a lot.
We aren’t doing those things now because Katie is a senior at a private liberal arts university, and you can guess where my pay checks are going now. Still not the bank, but we’re a close family. My kids genuinely love one another, and I think homeschooling and being together so much and going on vacations and doing stuff together as a family I think really formed relationships that are deep and meaningful.
While Katie is at college, she and Nick hook up Wii U and play Splatoon and Mario Kart along with her college friends. He brings her DS home and they play Fantasy Life. There are still times that they sit on a pile of Legos and build stuff together. I know they don’t want me saying that, but it’s fun. It’s doing something. I go in and play with the Legos with them too. So, you know, they have a great time as a family together.
OK, so what about socialization then? What about relationships outside of the family? My daughter’s away at college. She has roommates. She has a very nice boyfriend, lots of friends. Socialization was never an issue.
My son is not living in our basement. We do let him sleep in his bedroom, but he’s taking some time off between high school and his next thing, whatever that will be. He’s gainfully employed. He’s working fulltime, literally doing the job of his childhood dreams which involves making pizza at a local family-owned and oriented company that will soon be expanding to Nashville.
That’s where we are and that’s where we’ve been. Now, in terms of my kids’ perspective on all of this, on the podcast, Nick, he’s not the interviewing type. It took a half day to get him to say This is PediaCast, that you hear at the beginning of every episode, which he recorded a decade ago. He’s just not the interviewing type. Interviews turn in to jokes and a big giggle fest. He’s more stand-up comedian material than serious podcast material, and if you know him, you’re shaking your head in agreement right now. You know exactly what I’m talking about. Funny, yes, impeccable comedic timing. Serious interview, not so much.
But he’s also one of the most selfless and caring people that I know. He gave his sister over $500 which he had saved from his minimum wage job, so that she could go serve the native population of Montana for a summer. That’s Nick.
Katie has been on the show a couple of times to talk about homeschooling back when she was in the midst of it. And Nick does a brief appearance as well, which adds to the character of that show. So you listen to it, you know exactly what I’m talking about. I’ll put links to those episodes in the Show Notes for this episode, 334, so you can find them if you’re interested.
Katy has always been the more serious of the two, so she was an easy and she’ll naturally talk your ear off. That also makes interviewing easy. But she’s a good listener too which will come in handy as she pursues graduate school and a PhD in clinical psychology.
So that’s our homeschooling story. Looking back, I think it was a good choice. Certainly not for everyone, but homeschooling served us well. The kids had friends and activities. They took music lessons. They completed science experiments. It all worked out and each is doing exactly what they want to be doing in the current season of their lives.
So, I hope that helps, Arielle. Be sure to check out those past episode where I talked with mostly Katie on the show about homeschooling. That would be PediaCast Episode 8. Boy, that’s an old one from 2006. So she was quite young then. And then, number 160, a little more recent from 2011.
Of course, Arielle, thanks for writing in. It’s always appreciated.
Dr. Mike Patrick: All right, we’re going to go international with our next question. This one comes from Stacey in Yavne’el, Israel.
It’s a long one and we’re running short on time, so I’m going to answer this one as we go. Stacey says, Dear Dr. Mike, I would like to take this opportunity to thank you for such a wonderful podcast. Yours was one of the first podcast I begin listening to around two years ago. Suddenly, I feel like an educated adult again. Plus, it wasn’t just academic. You were teaching me immediately practical information. Of course, this meant that I binge listen to all the back episodes.
Moreover, I love that you do not talk down to us from on high but rather you speak to us both as an experienced parent and physician. It truly makes all the difference because your background enables you to give us the benefit of the higher medical education and on-the-job experience but filter through the knowledge of what it’s like to be a parent in the nitty-gritty here and now.
Well, that’s nice. And thanks for the vote of confidence Stacey. That really does mean a lot to me.
She goes on to say, I’ve lived in Israel for more than 15 years but the relationship here between doctor and patient in my personal experience has not mirrored the cozy one you often reference, i.e. ask your doctor who knows and cares about you. Even though I speak Hebrew, the language barrier just does not allow for the kind of relationship you speak of. Plus, when it comes to medical issues, I don’t want to mess around and risk a misunderstanding. So, I am very grateful to have you as a trusted resource.
There are a few questions I’ve had for some time now, but with my five kids under the age of 12, it’s been a challenge to curve out the time to sit down and compose my thoughts. We’re here now though, so here goes. And yes, I know you don’t practice medicine over at the radio.
All right, so here comes her first question, This problem is cleared up, but for about two years, my now five-year-old boy was having trouble making number two in his underpants. At first, I thought it was just because I toilet trained him before he was ready. But over time, I came to see these accidents were just that, accidents. Incidentally, your podcast on constipation was immensely helpful and informative at that time.
She’s speaking of PediaCast 292. That’s our show on constipation, and I’ll put a link to that in the Show Notes at PediaCast.org for this episode, 334.
Concurrently, my son was having problems stuttering. Both of these issues cleared up at the same time, seemingly of their own accord. My question is, is there any evidence in the medical research of co-morbidity of speech problems and bowel issues?
I don’t think so, Stacey. I have not heard of a connection there. But you know, constipation and encopresis which is the medical term for having accidents involving stool… Oftentimes it is caused from holding your stool like we talked about in an earlier question, you hold your stool too much it starts to build up in there. It’s in there, it’s got to come out. It’s got nowhere to go if you’re holding it.
And once you get to the point where your large intestine is just full of poop, then as new stuff from the small intestine comes in, in liquid form, it kind of passes around that bulk that’s stuck in there and leaks out. Or the new stuff comes in and pushes a little bit of everything through, kind of like play dough in a tube. It comes out whether the kid wants it to or not. So a lot of times, encopresis does stem from kids holding it and not going.
There’s other cause of constipation, too. But it’s common is my point. Speech issues, including stuttering also extremely common in kids. So it makes sense that the two would occur at the same time in the same child without the presence of an underlying cause-effect relationship. But there can be an association because they’re both common things in young kids.
So likely to be a simple coincidence and it doesn’t really have a causal relationship. But they may be associated at the same time since they are so common.
Another question, My last two pregnancies ended in C-sections due to unstable lie. Do we know what causes unstable lie?
Well, unstable lie just means your baby is moving around in the womb prior to the onset of labor and not necessarily oriented in the head-first position when compared to the position of the birth canal. So you want the baby head first when labor starts because if the bottom or an arm or a leg go through first, it’s going to present a problem.
She says, Both times, the doctor manually flipped my baby externally, only to have the baby flip right back afterwards. So the OB-Gyn can push on the abdomen in an attempt to orient the baby head first. Sometimes that works. Sometimes the baby still just move around because they want to move around. Your baby knew which way he wanted to face and the doctor wasn’t going to stop him. Sounds like a stubborn child to me.
Why are doctors more eager to perform a C-section before the onset of labor? What are the technical difficulties involved had they waited until the onset of labor? I was always curious thinking that perhaps the baby might have positioned itself correctly by then.
Well, once labor begins, if the head isn’t first, it’s more likely that you’re going to run into a problem. It’s a lot harder to pull a baby out through the abdomen if leg is tucked in the birth canal, right? Better to open and close in a calm, controlled manner than dealing with a stuck baby with mommy’s belly cut open. Hope that makes sense.
I understand what you’re saying, Stacey. Why not give natural labor a chance before you go with the C-section. But again, we’re talking about risks and benefits here and there’s less risk of performing a C-section in a controlled way prior to labor rather than waiting for labor and risking a stuck baby, which really can be a problem and can potentially be life threatening for both mommy and baby.
Also, is there anything in literature that gives suggestions to prevent unstable lie? So, I’m not an OB-Gyn, but I don’t think there’s any good way to prevent it. Either your baby is going to stay still with their head down or they’re going to move around and do a not-so-good position. It just is what it is.
She goes on to say, Moreover, my first three labors were regular and I was able to hold my baby right away. With the C-sections however, the nurse merely brought the baby’s face to mine and whisked it away. It was hours before I was allowed to hold my baby. I presumed this is because they think that having just gone through major surgery, they suspect I would drop the baby, but I know my body and I can tell you that I felt more than strong enough to hold my baby. In your experience, did they ever allow an immediately post-partum C-section mom to hold their baby?
Absolutely, they do. Here in the United States anyway, as long as it’s safe for both mom and the baby, which is the case with an uncomplicated delivery. In those cases, we certainly want to encourage mom and baby bonding. If there’s a safety issue such as a sick baby or a mom with significant complications, then outcomes trump bonding.
But I sure would think they would offer you an explanation on why that happened.
So if they whisk your baby away, and the baby was gone for awhile, I would want to know why. Maybe your baby was sick and needed some oxygen, or maybe needed some fluids and had a fever. There’s all sorts of reasons — had a little blood sugar. But you think they would talk to you about that.
Of course, if you were having complications, then it makes sense that they would keep you separated for a little while until you were stabilized. But if mom and baby are both fine, then there’s no reason not to let that bonding occur. That’s our thought here in the United States anyway.
She goes on to say, Also, a C-section is major abdominal surgery. Of course, during the procedure, I was sufficiently anesthetized and felt nothing. But afterward, the only pain medication they allowed me was a souped up version of Tylenol called optalgin. It was barely effective. Why?
I don’t know. Maybe they didn’t give you enough of it. Maybe the dose wasn’t right. Or maybe you needed something more. I really don’t know. But in that case, so if a mom post-partum is having significant pain and what they give you is not helping, you definitely want to let your doctor know because pain control is important. Probably something else they could have given you or make sure that it was the right dose.
It’s not going to get rid of pain a 100% but we definitely want you to be comfortable and it’s OK to speak up if you’re not comfortable.
All right, next stop she says, Can’t they allow something substantive for pain relief. I hear that post appendectomy patients get better pain relief. Yes, nursing will transfer it, nursing, in other words, breastfeeding, will transfer it to the baby but come on, it’s not a chronic condition. It’s only a matter of days and I would need something more than Tylenol. Believe me, I’ll switch to the minor medications as soon as possible but give a girl a break. What are your thoughts?
I’m with you Stacey. Again, pain control is always a good thing and it sure does sound to me like you needed a break.
Also, what are the considerations between staples and stitches? Are there any? Staples are quicker and easier but they may also scar a bit more. In the end, either one is effective. It really boils down to the skill, comfort level and typical practice of the person closing your wound.
And then she says, OK, so now, I’m expecting. They’re going to tell me I have gestational diabetes, but my blood sugar numbers are consistently around 105 and 110. I just heard on the Preggy Pals podcast that doctors used to classify a women with gestational diabetes if her number was 130 higher. But it since lowered the official numbers to be safe rather than sorry.
In the past, altering my diet did nothing to lower my numbers. If my number is borderline how great are the risks to my baby? Considerations a physician makes when deciding whether or not to give insulin?
Boy, you really are out my league now Stacey. I can tell you this, if your blood sugar is high, your baby’s blood sugar will be high as well, which leads to your baby making more insulin, which access the growth hormones. So you get bigger babies who have difficulty traversing the birth canal. And when they are born, they’re still making all that insulin but they’re not hooked up to your blood sugar anymore. So they go low and they can become hypoglycemic because they are overproducing insulin temporarily. And that can be life-threatening if it’s not managed appropriately.
There are plenty of other risks too. In terms of numbers and insulin and such for the mother, I’d listen to your doctor. I suspect they are up to date on the latest guidelines. That’s not something that I would question. Guidelines for the management of gestational diabetes do change from time to time based on current evidence and your OB would know a lot more of that than I do.
Finally, she says, Could you talk about taking Ritalin during pregnancy. Also, what about anti-depressants risk/benefit analysis discussion? Is it riskier to take these medications during pregnancy? Or rather is it safer for the baby if these medications are taken after the birth but while nursing?
This is a great question, Stacey. I’m going to refer you to a PediaCast episode 308, 308, for this one. We talked about deciding whether you should or shouldn’t take certain medications while breastfeeding. Rather than saying yes to this or no to those, we walked through the exercise of a risk-benefit analysis. Actually, looking up the drug info as we go, surveying the risks, thinking about the benefits, how to arm yourself with knowledge and discuss it with your doctor coming from a place of knowledge.
While you’re asking about medications, I understand this question in particular is asking about medications that you take during pregnancy rather than breastfeeding, the process is the same. So walk through that process in episode 308 and I’ll put a link to it in the Show Notes for this one, 334.
Again, I’ll know, we’re filing up the link so there’s going to be a lot of them, but look for Episode 308 on those links and walk through that process and then do that same exercise looking up Ritalin. I give you some idea where you can look this stuff up. Also, look up whatever antidepressant you’d like to look up. I’ll give you again resources in that show to look up the drugs and begin thinking through the process on your own.
I’ll hold your hand in Episode 308, but really you can do it, Stacey. It’s the same process.
She goes on to say, Thank you so much for your time and consideration and thanks again for all your hard work in making this podcast this fantastic. Sincerely, Stacey in Israel.
Well, thanks for taking the time to write in, Stacey. I really do appreciate you listening, sharing the show and participating by writing in questions.
All right, it is hard to believe but we have made it to Question Number 14. So we are nearing the end of our listener question marathon. This one comes from Agnes in France, so another international question, Hi, Mike. Thanks for the friendly and informative show. My kids are six and eight and have had blood test for allergies. Both are allergic to egg yolk, not severe but moderately. For this reason, we were advised by our previous doctor not to vaccinate them when they were younger.
We have since moved and our new doctor highly suggests that we vaccinate them with a mandatory variety here in France. We, of course, want to do what is best and safe for our kids and would like your opinion on the safety of giving them vaccines that contain egg protein. Trying to weigh the risk versus benefit and your input would be much appreciated. Thanks.
Well, excellent questions, Agnes. Thank you so much for sharing. There are really two issues here. The first, are your children really allergic to eggs? Or, is the only problem a number on a piece of paper? The reason I say this is that blood allergy tests are notorious for not correlating with clinical findings. In other words, the number is high but you eat the food and you don’t have a problem at all.
So an allergy is defined by a reaction, not a number. Now, there was a time when kids with bad eczema or recurrent wheezing would have a big blood panel done, a bunch of allergies were identified by high numbers and you were told to avoid those foods. But now we know those numbers really aren’t helpful. They don’t always correlate with an actual reaction. In fact, they frequently don’t.
Now, on the other hand, anaphylaxis, which is a life-threatening allergic reaction to egg protein, that is possible with the high number. These reactions are also very reversible when quickly acted upon in a controlled setting.
So, if you really want to know if your child has an egg allergy and the only thing you had to go on is a number on a piece of paper — in other words, they’ve never had an actual reaction — you could go to your doctors and ask them to do a food challenge, or ask to be referred to a pediatric allergist and ask them to do the food challenge. Don’t do it yourself at home. You don’t do the egg thing at home. This should be at your doctor’s office, or at a pediatric allergy office, just in case.
But at the doctor’s office, while being watched by the medical staff, they’ll have your child eat some egg and see what happens. If there’s a severe reaction, they can give epinephrine and antihistamine, possibly steroids and then you know. But it’s also very possible that they aren’t really allergic if all you’re going on is a number on a piece of paper. You’ll sure save yourself a whole lot of trouble down the road by knowing if they really are allergic to eggs or not.
Again, I don’t know what your situation is, Agnes. Maybe you’ve already done this. Maybe your child did eat egg and had an immediate reaction, plus you got the high number. That’s a different situation.
So the second issue here is the vaccines. Let’s say for argument’s sake that your child is allergic to egg protein. They’ve had a documented reaction. They really are allergic. Here in the United States, routine immunizations with egg protein include the MMR vaccine and the annual flu shot, the flu injection. There are others with egg protein such as the yellow fever vaccine but these are for travelers or the military, not routine well child immunization.
So considering the routine vaccinations, it’s really the MMR (measles-mumps-rubella) and the annual flu shot, the injection form that we’re talking about.
Now, according to the American Academy of Allergy, Asthma and Immunology, they state that history of egg allergy is not a reason to skip these routine injections including those with the history of anaphylactic or severe allergic reactions.
Now, the American Academy of Pediatrics agrees with this in regard to the MMR vaccine. They are a little more wishy-washy on the annual flu vaccine. They don’t disagree but they don’t come right out and say it’s OK. They say, ask your doctor. But the allergists, they give the green light on the annual flu shot for egg allergic individuals. However, and this is important, those with egg allergies should get their vaccines at the doctor’s office and they should be watched for a little while after the shot.
If there’s a history of anaphylaxis, it’s probably best to get your shot at the allergist office, so that they’ll really know what to do. They’ll really be going to be in tune to this. They can watch. They can intervene with epinephrine and antihistamines if the situation calls for it.
Based on lots of studies, the situation probably won’t call for that. But there’s always that possibility, like the boy scout say, it best to be prepared. In other words, don’t get these injections if you have a history of egg allergy especially if it’s an anaphylactic reaction. Don’t get these injections at like a local pharmacy or a little clinic kind of place or school, if you’re school is offering flu shots. Go to a doctor’s office so they can decide and give and watch and act if needed.
If you have a history of severe reaction, getting those shots in an allergist office would probably be the safest way to go. So someone who’s really in tune with this can be the one to again watch and act if needed.
I’ll put links to all of these recommendations from the American Academy of Allergy, Asthma and Immunology in the Show Notes for this episode, 334, again over at PediaCast.org.
Thanks for asking the question, Agnes and for listening and telling your friends and family and your doctor and friends about PediaCast. Your doctor will like me, I think, since I agree with his recommendation on completing those vaccines but again, with the caveat of getting the vaccine done at the doctor’s office not in like a grocery store clinic kind of place.
Dr. Mike Patrick: All right, we are back with just enough time to say goodbye and to thank each and every one of you for taking time out of your day to make PediaCast a part of it. Actually, I want to thank you for taking time out of your year to make PediaCast a part of that.
We had a banner year in 2015 with the most listeners, most downloads that we’ve ever had. So I’m really excited about that. The audience is growing. The word’s getting out and that’s a great thing because we want to really stamp out misinformation wherever we can and provide great evidence-based up-to-date quality information as you think about the healthier kid.
So thanks for that, and 2016 is I think is going to be great with our new format that I had told you about previously. Lots of shows scheduled. We’re going to be taking PediaCast on the road. We’re moving to a new studio, so lots of great things on the horizon. I really have you, the PediaCast audience to thank for that. So I really do appreciate your support of this program.
I want to say happy holidays. Whatever it is that you’re celebrating here at the end of the year, enjoy your families and just have a great time with your kids. If you exchange presents, get down on the floor and play with them. I have as much fun playing with my kids’ stuff as I do my own. That’s probably true for you, too.
So just have a great holiday and we’ll see you back again early in January.
That is all the time we have. PediaCast is a production of Nationwide Children’s Hospital.
Don’t forget, you can find PediaCast in all sorts of places. We’re in iTunes in the Kids and Family Section of their podcast directory; also on most podcast apps for iOS and Android. If you can’t find us in your favorite podcast app, let me know, and I’ll do my best to get the show added to their line-up.
We’re also on iHeart Radio, where we not only have this program, but also PediaBytes, B-Y-T-E-S. Those are shorter clips from the show that can be weave them together with other content providers to make your own custom talk radio station.
We also have a voice line if you’d rather phone in your question or comment. That number is 347-404-KIDS, 347-404-K-I-D-S.
We’re also on social media including Facebook, Twitter, Google+ and Pinterest with lots of great content you can share with your own online audience.
And, of course, we always appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids or those who take care of children, including your child care provider. In fact, next time you’re in for a sick office visit or a well-check up, a sports physical, a medicine re-check, whatever the occasion, let them know you found an evidence-based pediatric podcast for moms and dads. We’ve been around for nearly a decade, so tons past content and all of it deep enough to be helpful, but in language parents can still understand.
And, while you have your providers’ ear, please tell them we have a podcast for them as well, PediaCast CME. It’s similar to this program. We do turn up the science a couple notches and provide free Category 1 Continuing Medical Education Credit for listening. Shows and details are available at PediaCastCME.org.
We also have posters if you like to share the show the old fashion way and those are available under the resources tab at PediaCast.org.
Thanks again for stopping by, and until next time — which will be next year but that’s really not too long — this is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.
Announcer 2: This program is a production of Nationwide Children’s. Thanks for listening. We’ll see you next time on PediaCast.f Nationwide Children’s. Thanks for listening. We’ll see you next time on PediaCast..