Rant And Rave – PediaCast 118

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This is a special presentation of PediaCast. You won't find the typical menu of "News Parents Can Use" and "Answers To Listener Questions" today. Instead, the listeners FINALLY get their say with our long-awaited RANT AND RAVE show.

Karen (from PediaScribe) debuts as co-host — turning PediaCast, at least temporarily, into something Karen swore she'd never do: A CoupleCast!

But never fear, PediaCast will return to its regularly-scheduled format next time around. So be sure to stay tuned…



Announcer 1: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every child, for every reason.


Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now direct from Birdhouse Studios here's your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone and welcome to PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike coming to you from Birdhouse Studio and as always like to welcome everyone to the show. It is episode 118 for Monday, March 31st, 2008. This one is Listener Rants and Raves. I warned you this one was coming and I have to give you another warning. This is going to be completely different from our traditional format.


And I want to especially warn any new listeners out there. This may not be the one to start with OK. You might want to back up. Listen to 116, 117 for your very first PediaCast experience because this one is definitely going to be different. Basically I've saved up some listener rants and raves just like it sounds from really the last few months and were going to go to some of those today. And in order to break up the monotony it's not just going to be me. I've invited Karen to join us so she's going to be by in just a couple of minutes.


Who's Karen? Well in addition to being my lovely wife and don't worry just because she's my wife doesn't mean she'll go easy on me. She is also the author of Pedisacribe which is the blogging arm of PediaCast. So those of you who have visited the Pediascribe blog, you know who I'm talking about. And she has a lot of experience with kids so she's definitely an appropriate one to comment on the rants and raves that are coming up. You know she's dealt with kids in the house our own too as when they were infants and toddlers, school age and now my daughter is a teenager.


So we've been through all of the life cycle of a child. She also as a home school teacher and an activity chauffeur and have taken the kids to theatre and youth groups those sorts of things. She's also a pediatric nurse so she has RN and BSN and has had experience in an ICU setting as well as a pediatric office setting. And of course most of all especially as it comes to the rant and rave shows, she's quick to speak her mind. You probably figure that out if you are a Pediascribe blog reader.


And it doesn't matter if her mind disagrees with mine she still going to speak it. So this show is definitely going to be lighter more off the cuff and I think refreshingly different this time around. So again it's going to be a different kind of show, should be interesting. If you disagree and you're finding it boring you know turn on your iPod, find a different show to listen to. Hold out for show 119 ‘cause we'll be back to our regular format next time around.


Alright and speaking next time around, I do want to remind you cause I forgot to do this during our last episode. If you do have an idea for the program, request on a topic just go to Pediacast.org and click on the Contact link and get a hold of me that way or you can also e-mail pediacast@gmail.com or call the voice line at 347-404-KID. Also as I do every episode I have to remind you that the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange a face to face interview and hands on physical examination.


Also your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at Pediacast.org. And with that in mind we'll be back with Karen and your rants and your raves right after this short break.



Dr. Mike Patrick: Alright we are back and before we get to our very first rant or rave. I want to introduce our co-host today, Karen. Hello Karen!
Karen: Hello there!
Dr. Mike Patrick: And welcome to the audio version of your blog. So before we get started those of you who have not heard or have not read Pediascribe the blog why don't you tell everyone a little bit about it Karen.
Karen: Well it's the blog that I took over under protest because the good Dr. Mike was writing it and just didn't have time to keep it up. So he encouraged me to write. And at first I was pretty nervous about the whole thing but as I've developed friends in the blogging community it's been a whole lot of fun to just share with them and go to their blogs and see what's going on in their lives. It's pretty fun!


Dr. Mike Patrick: It's not just a medical blog, right?
Karen: In fact there's a very little medical. It's mostly what's going on in our family and goofy things to kids or Mike have done. I've tried to avoid the goofy things I've done because well it's my blog, my rules and I don't want to look like a fool. So I'll make everyone else in the family look like a fool.
Dr. Mike:& And that makes it fun. I think it's a good compliment for what the program does because you can get written medical advice in lots of different places. So this is a different experience for the PediaCast listeners to you know I don't know. What am I trying to say?


Karen: To find out whom you are as a human, to find out the real you.
Dr. Mike Patrick: No not just me you know our family too and what's going on in our lives. Alright well let's go ahead and get right into this because we have a lots of ground to cover. First off is Heather from Bangkok and Heather had an audio comment in our last show. And this one she had written in several weeks ago and I've been saving it up for the rant and rave show. So let's go ahead and right to it. Heather says, "Hi, Dr. Mike. Excellent podcast as always. I wanted to write in and comment on the e-mail you received about how you have changed. I think it took a lot of guts to share that. I've been a loyal listener since the start. And personally I have not detected any change.


People forget this is a volunteer service and a gift to all of us. You do not have to share your valuable time and wisdom with us, yet each week you do I am very grateful for that. I've learned a great deal from your show and as I am sure many others have. I'm a better more knowledgeable parent because of it. I thank you for sharing with us your time, expertise, and knowledge. Secondly I happened to like the fact you have your opinions as you said it is your podcast and you have the right to share those view points. We do not have to agree but maybe it will give us something to ponder or even learn by listening to the other side or maybe even to validate our own opinions.


But needless to say, it is great that you have your beliefs and share your thoughts on the various topics of discussion. I for one would be worried if you're not passionate about what you do and what you study, that is what drives you and makes you a very good doctor and host. Keep up the good work….
Karen: And husband I must add.
Dr. Mike Patrick: Oh that's very nice. "And keep up the good work, Heather from Bangkok…. So have I changed from the beginning? I have had a couple of e-mail people tell me that I've changed.
Karen: You've always been pretty opinionated and so now in that respect that you have not changed.


Dr. Mike Patrick: Yeah I think maybe I did more toward the beginning do a better job of presenting both sides of an issue a little bit more objectively. I mean that may be the case but I think, I mean I still try to present both sides even if I don't agree with it. And then I'll tell you what I think.
Karen: I need to come clean here. I don't listen to your podcast. I only listen to the very beginning and the very end because I want to see what plug you put in for the blog. But all the rest of the medical stuff I don't listen to.


Dr. Mike Patrick: It's alright folks I actually knew that. Well you just have to take my word for it that maybe I have changed a little but I don't think I've changed in a bad way. Now this next listener though definitely disagrees with that. OK this is Shawna in Virginia and Shawna says, " I have been listening to your podcast since your first appearance on manic mommies. Your show has been wonderful for me and it's giving me the peak into the medical community that I would not normally be privy too. You were originally very good about presenting both sides of controversial issues and in giving your own opinion in a non-offensive and kind manner. Your show was appealing because of the genuine humanized manner and which you presented yourself and your content…. So it was appealing.


"I've noticed the trend that you have become more and more arrogant as your show has increased in popularity. Your references to milk Nazis, I don't remember your exact words, you're barely restrained the rise of comments and the judgments that you passed on mothers from just a few of their sentences has lead me to the point where I cannot tolerate listening to you anymore. I know that I am only one listener but your comment on show 108 was the final straw. "
Karen: I have to wonder if she's still listening or if that was the final straw then she's not even going to know you are responding to her comment.


Dr. Mike Patrick: So we can make fun of her.
Karen: Yeah!
Dr. Mike Patrick: I won't though.& If I was a little more juvenile, I might. I am OK. Shawna goes on to say, "I'm actually also in complete agreement that hospital births are much safer than home births. I do not wish to ridicule you to use your words. But I would like to ask you to not ridicule others by referring to alternative, progressive types as being uneducated and implying that mothers that choose "alternative routes for birth… are lacking "sense and reason…. It's not that you have a lack of experience in conversing with the progressive audience that has worked me into a tease it's that you're now presenting your opinions in an offensive and arrogant manner. In other words you become the sanctimonious pediatrician that progressive types like myself choose to avoid.


Perhaps it's not very contemptuous attitude that makes giving birth at home an attractive alternative to having the deal with over baring and often presumptuous doctors in the hospital setting. At the time when the woman is at the absolute most vulnerable she will ever be in her entire life who would want to have to defend her own decisions against someone that ridicules them.?…
Karen: The thing is at that time in their life the babies are at their most vulnerable they'll ever be.
Dr. Mike Patrick: Right.
Karen: You know there's also a lot that can go wrong so…


Dr. Mike Patrick: So you think that the goal of having a healthy birth outweighs the goal of not being ridiculed?
Karen: Well …
Dr. Mike Patrick: Although they're not really ridiculed.
Karen: Yeah. No one's stand and pointing their finger making fun of them.
Dr. Mike Patrick: Right.


And you know that the thing is that it would seem to me that if you don't put up or let me finish reading what she had to say. And then I'll make my point. She goes on to say, "I'd like to make a recommendation since you do not converse with the progressive types and you obviously feel such scorn toward people that choose to not blindly do what they're told to do. In other words do everything the doctor tells them they should be doing such as not nursing at night to prevent tooth decay as a recent listeners doctor recommended. Perhaps a little open minded research of your own into the alternative methodology of medicine would give you a better idea of the other side's perspective….


Problem is no research or methodology… "on a psychological level I question if you might be projecting your own lack of knowledge into the community that you distain. Again it is not a difference of opinion or lack of information that I take issue with, it's your delivery. Why would I want to continue to listen to someone that insults portions of his audience in such an underhanded way just because he can? The content on your show can be excess elsewhere. I'll be not as comprehensively come on with other show has such a wealth of information on poop… laugh out loud. I've tried to be as respectful as I can while being blunt and truthful in this e-mail. I am angry as I write this. I do not mean to offend and I sincerely apologize if I have. But I do want to express my own opinion here….


Alright, the thing that started this off is that basically I said that people who choose to have their baby at home are not using sense and reason because it can be so dangerous. Because child birth without medical intervention can be a very dangerous situation and things can happen abruptly and when you don't expect it. And then you're not in the right place to have that happen. So as a physician if I don't put up a big strong firm, this is the wrong thing to do, then it comes across that I'm OK with it.


And that's really not something I'm OK with because if I come across as it's OK and someone does it and then the baby dies or the mom dies, then you're upset at the doctor,& "Well you didn't tell me this could go wrong or I didn't know that could go wrong… -& you know.
Karen: Right. Right.
Dr. Mike Patrick: I think we have a job to let people know when something is very serious.


Karen: Because you've trained in such a setting where you've seen lots of deliveries and things go wrong very quickly.
Dr. Mike Patrick: When you least expect.
Karen: Right. Whereas maybe someone who's given a home birth then has done it four times successfully and they're going for their fifth, they've never seen it. They don't know all the complications and what could go wrong so they think it's just going to go it's just going to smoothly as all the rest ever have and it's just a crap shoot.


Dr. Mike Patrick: Yeah and the other thing I guess from a person who once a midwife or they want the home birth experience because they want to be more in control. I mean, I get where they're coming from because I mean in the way that the medicine has run today it seems like you're a number and you're in and out in the doctor's and then he's going to go someplace else. And it's ‘cause were in personal and maybe they're quicker to do a C-section or quicker to put you on medicine that maybe you didn't need. I mean I get that. I understand that.


Karen: But there's lot of options today to still have a midwife or Duola or whatever you want in a hospital setting. So you have the best of both worlds while you're not in your home, you have the comforts and the people who support you and promote you more natural methods but yet just on the road is an OR suite if something goes horribly wrong.
Dr. Mike Patrick: Does your obstetrician take the time with you to sit down and talk with you or your gynecologist now? I mean she's an OB-GYN. You like her.
Karen: I actually have blogged about how wonderful it is and how I've timed her in the room because it seems like she's in there for 20 or 30 minutes. But in actuality she's in their 5 or 6 that's just because when she's in the room with me I am getting undivided attention. She's making eye contact and all that sort of things.


So I think it's possible in a very short amount of time focus on one patient and not act rushed.
Dr. Mike:& And some doctors spend lots of time with patients.
Karen: Right. Right.
Dr. Mike Patrick: I mean it depends on their schedule, how popular they are, how busy their practice is.


Karen: How sick the patient is? I mean I know in your case if you have a sick patient, the not so sick ones get bumped a bit and from my point of view if my kid is sick, I want the doctor to take a little extra time you know. And so in that respect if I'm the one who gets bumped I can understand that someone else is getting the extra care that they need at that point.
Dr. Mike Patrick: Right. You know this is one of those things too where I still I feel strongly about it. And it is my show and if I feel strongly about it, I want to get that point across I think it's an important point to make. But you make a good point too that there are alternatives. Number one, if you're not happy with the way your obstetrician does things you can look for another obstetrician.


Karen: Which is actually what we did. We had one obstetrician for Katie and me being a young first time mother I thought she was fine. When I got pregnant with Nick, we lived on a different section of town. And the first OB was too far away and so I looked for a different one who was closer and this is the one I still go to and she is wonderful. So not having anything to compare it to I thought the first one was fine. But now that I looked back she was very curt and always seemed rush.
Dr. Mike Patrick: Right.


Well our next one…
Karen: Well actually, on one more point just too bad she's never going to hear your response to this because show 108 was the final straw. She's not listening anymore. So, come back! Hear the answer.
Dr. Mike Patrick: You have to send that telepathically.
Karen: OK.
Dr. Mike Patrick: To get her to come back.


Karen: That's a little too progressive for me but OK let's move on.
Dr. Mike Patrick: Well OK. We have more comments on progressive stuffs so we'll talk about that later. This is from Alicia in Washington DC and Alicia says, "Hi, Dr. Mike. I just listened to Episode 108 where you talked about home births and the flack you're expecting from progressive people about your position. I wanted to let you know that I agree with you whole heartedly. I lived in a very progressive neighborhood and while I don't fully subscribe to philosophies like attachment parenting it's definitely influenced my approach to raising kids. I heard a lot when I was pregnant with my daughter about the medicalization of the birth process.


I think I got a few sideway's glances for never questioning our decision to have our baby in a hospital for exactly the reasons you laid out. You just don't know what's going to happen. And if something did happen, I wanted to be in the best place possible to get the care of my baby and I might need. I think part of what gets to me is that pregnant women who are major players in making these decisions are stressed out – hormonal, emotional and then they're being made to feel guilty about their decisions about whether to give birth, whether and how long they breast feed….
Karen: Well they don't really have a chance, a decision on ‘whether to give birth.'


Dr. Mike Patrick: True.
Karen: ‘Where they give birth'… Yeah.
Dr. Mike Patrick: Right.
Karen: But you said on ‘whether on they give birth' so, they don't really have a choice. Eventually they have to give birth.
Dr. Mike Patrick: Right. Right.


I'm sorry. I read it wrong.
Karen: Yeah I know. I had to call you on it.
Dr. Mike Patrick: OK. Thanks.
Karen: Keeping it real people. We're keeping it real.


Dr. Mike Patrick: That's fine.& Sometimes I listened back to the show and I realized I put the wrong word in and then I cringe and that's when I think I needed to do more post production. "So they're being made to feel guilty about their decision about where to give birth, whether and how long to breastfeed and whether to go back to work by people who have good intentions but who are convinced that their way of doing things is right and people who make different decisions are somehow scarring their children for life. " See so that's the thing. You know I can say,& "Oh don't do it at home, do it in the hospital… and I get slammed for it.


But when they say "No……
Karen: "You should do it at home not in the hospital……
Dr. Mike Patrick: Yeah!
Karen: And who's slamming them? You are.
Dr. Mike Patrick: Alright. Not really. "Not all people who make these kinds of progressive choices are like that but there are enough militant ones that it just adds to uncertainty and guilt that women feel for trying to find the path that works for them and their families.


What I really wanted when I was pregnant but had the hard time finding was unbiased information that wasn't pushing one point of view or another but was just talking about the various options and the pros and cons of each. But acknowledging that the most important thing was what worked for your personality, lifestyle and family. Well that turned into a bit of a rant. I did want to let you know though that I appreciate you're getting out the information even in the face of negative comments….


So, you know it's tough putting together show like this where I mean I do what I feel is right and you get support for it and then you get criticism for it.
Karen: Well one way or another there's going to be a group of people that don't agree with you.
Dr. Mike Patrick: Right. Since this is not a true talk show where people are calling in and can argue with me, it does come across maybe as more of a mantra if you are on the opposing side.
Karen: Well I guess the important thing is they need to know where the fast forward button is on their iPod.


Because if you're saying things that they don't like well then fast forward through it. Take the information that they want to hear and is relevant to them and use it and ignore the rest.
Dr. Mike Patrick: And I've said this before too. If I had to do a podcast that was just dry presenting information without stirring the pot a little bit, I wouldn't be doing this.
Karen: Right.
Dr. Mike Patrick: So the, really they're not going to get a non-opinionated forum. Because otherwise you know I'll just go back to my office and just shut the whole thing down.


Karen: I wonder how many of the people that are giving Alicia advice actually are parents. Because my favor of saying her one of them is that I was a perfect parent until I became one. So you know lot of things that I thought were right and good and the way to raise kids – when I had kids. Those are all blown out of the water you know.
Dr. Mike Patrick: Right.
Karen: So I wonder how many of these people she lives by actually have had any experience doing these things or they're just well meaning individuals too.


Dr. Mike Patrick: Right. Right.
Karen: I think she needs to know.
Dr. Mike Patrick: Alright Kimm from Florida, this is another good one. Kimm says, "Hi, Dr. Mike. My name is Kimm and we're from the Florida Panhandle. I have a cute story for you and a not so cute story for you. This morning while we were eating breakfast, my three year old son was talking non-stop….
Karen: That's typical.


Dr. Mike Patrick: "When I stopped to listen I overheard him quoting almost word for word the PediaCast intro. He even quoted your typical first line ‘Hello everyone and welcome to PediaCast.'
Karen: OK you need to get this kid to call the Skype line and say that. It would be so stinking cute.
Dr. Mike Patrick: OK Kimm.
Karen: Kimm with 2 M's from the Florida Panhandle.


Dr. Mike Patrick: Please have your three year old call the Skype line and do it for me. ‘Cause we'll put it on the show. That would be great.
Karen: Yes! Absolutely. I mean our kids they do bits for the show but they're getting a little old. They don't sound as convincingly cute anymore.
Dr. Mike Patrick: Yeah! Yeah! That'll be great. Kimm goes on to say, "After laughing hard we loaded up the car and I turned on an episode of PediaCast. He was thrilled to do the intro with the podcast. He was very cute and shows what I listened to most in his presence.


In one of the episodes I listened to today, I'm really far behind, you talked about home births and mentioned the dangerous involved. I experienced a near death birth with my first son. I had an abruption when I was 33 weeks pregnant. Our doctors saved our lives. I was told that I had lost at least 1,000 CCs of blood. That didn't include what was lost in my clothes, the hospital parking lot, our car, and the bathroom. I'm a former gymnast and I still coach. I am and always have been a very healthy person and have great eating habits.


I carried none of the signs for having an abruption. I'm so glad that I had a good doctor and nurses in the hospital. Should anyone slam you for standing up and speaking against home births, feel free to share my story. Thanks for all you do, Kimm…. So I mean so that's make it worth it.
Karen: Right, you just never know that things can turn south so quickly.
Dr. Mike Patrick: Right. And with that kind of knowledge knowing that that kind of thing can go wrong and knowing that you are making the decision that puts your baby in danger and your own life in danger.


You know for me to say that woman who make the decision to have a baby at home are being – I don't want to stay stupid – but I mean really you bluntly say what that is, I mean it is what it is. And to me it's not very smart.
Karen: Yeah now as people will argue well she was only 33 weeks pregnant. She wasn't attempting a home birth. It doesn't really matter because if she was 40 weeks pregnant, she could have an abruption then at home trying to deliver at home. I mean an abruption for people who don't know is when basically the placenta completely separates from the wall of the uterus and you know that's what keeps the baby alive so there's no nothing there to nourish or breathe for the baby.


Dr. Mike Patrick: Right.
Karen: And that could happen at 33 weeks, it could happen during a home birth…
Dr. Mike Patrick: Yeah, even if it happens in the hospital it's a dangerous thing.
Karen: Absolutely. And people who read the blog know that I've been watching a lot of the Discovery Channel birth shows lately and you know most of the time things work out fine. But I guess I'm not a big gambling person or I'm going to take those odds and say it's…


Dr. Mike Patrick: Especially when you're talking about your life and your baby's life.
Karen: Your baby's life – like what is more important, your baby's health or not having an episiotomy? What's more important, your baby's health, your health or sitting in a tub of water when you deliver? I mean you know break it down.
Dr. Mike Patrick: Right. I'm with you.


OK Cathy in Austin Texas says, "Dr. Mike I had a comment about Episode 107…. – Oh by the way we'll have all the shows that people are commenting about. If you go to the show notes we have links to those episodes. "I had a comment about Episode 107 in difficult infants. And all I can say is where were you were eight and half years ago?…
Karen: I still had him locked in the basement. I just want him out like two years ago.


Dr. Mike Patrick: It was no podcast eight and half years ago.
Karen: Right that's true!
Dr. Mike Patrick: "Kidding aside my now eight and a half year old daughter was born furious and then screamed non-stop for 12 solid months….
Karen: That doesn't sound like anyone I know – Katie.


Dr. Mike Patrick: Our daughter was just like that. "Moving on to the toddlerhood she had severe separation anxiety and heaven forbid if there was a substitute teacher, should make herself throw up or would scream for hours until I would return to pick her up. She did everything hard. She slept hard, screamed hard, ate hard, absolutely no middle ground. First we thought it was a joke. Surely the hospital swap babies. Surely the Mongol hoard would show up to claim her as the reincarnated Genghis Khan.


It strained my marriage to a literal breaking point and worn me down utterly. I can only joke now because time has softened the bleakness of those days. Now in 3rd grade, she's in the most amiable child. Everyone remarks on her graciousness and natural charisma. She excels academically and in sports and relations challenges. She has an advanced self awareness where she knows that if she's around a bunch of friends for an extended period like a sleep over, she has to have a lone time to recharge.


When she needs me she can articulate what she needs like a snuggle, help going to sleep because she knows I will take her seriously. I do not fear for her future nor do I worry about peer pressure. Maybe I fear for future boyfriend since they will not know what hit them and I feel so completely blessed to have her in my life. But when you're holding the screaming baby and you've been doing it for six hours you can't imagine that it gets better. But it does get better and seemingly overnight.


I didn't have support services to get us through but relied upon some awesome books about parenting high spirited children that may be one of the actual titles while some of the books have some zany ideas that became obvious that if you're going to successfully parent a high spirited child, you'd better be creative and always consistent. Consistent routines are a big thing. You also need a good outlet for the parent like a weekly night out. I love the show and I'm glad you are able to give it all the time you do.


I always walk away from listening to you feeling more informed and better equipped as a parent. I enjoyed being able to share this with others too so thank you, Kathy….& Boy, that does sound like Katie.
Karen: Wow! They're like separated at birth.
Dr. Mike Patrick: Yeah!
Karen: That was Katie did.
Dr. Mike Patrick: Yeah I mean really. And I know it's tough. I always kind of joke that God has given us two kids that have gone through, not everything thankfully because there's some terrible things kids can go through. But it does seem like so many times in the office I can say, "Oh yeah well when we had that problem at home. This is what we did……


Well I'm really talking more as a friend and a parent than as a pediatrician.
Karen: Right. Right. I will say too it does get better. I mean like it did with Kathy. Katie – amazingly she's 13 so obviously I didn't kill her on process. But she was seems too easier to get along with now than when she was an infant or a toddler.
Dr. Mike Patrick: Right.
Karen: At least now you can relate to her and you know talk things out where as gosh for the first I don't know seems like forever. She just did nothing but scream.


Dr. Mike Patrick: You know that book sounds familiar.
Karen: Is it Raising a High Spirited Child or?
Dr. Mike Patrick: Yeah Raising a Spirited Child maybe. We should look that up before for the show.


Karen: Is it the Dobson one? James Dobson? A Strong Willed Child? Raising a Strong Willed Child maybe
Dr. Mike Patrick: Yeah maybe that was the one. We had a book about high spirited kids.
Karen: Yeah but who had time to read?
Dr. Mike Patrick: No kidding. I can't tell you anything that was in it.


Karen: If only there was a podcast that get those into.
Dr. Mike Patrick: Hey I know one you could try.
Karen: Oh yeah OK. I don't listen to that one. We are already covered that.
Dr. Mike Patrick: That's right yeah like you would. Well if it weren't mine you would right?
Karen: We'll see because I have the added benefit if I can just look at you and say what this is? Or what do I do about this?


Dr. Mike Patrick: Right. And then I can go Google it.
Karen: And get the answer or you can just tell me, "Oh it's nothing….
Dr. Mike Patrick: Yeah.
Karen: You're not dying.
Dr. Mike Patrick: Yeah that's more often it.
Karen: It's pretty much what it is.


Dr. Mike Patrick: OK let's move on, Sarah from Tasmania.
Karen: Cool!
Dr. Mike Patrick: Yeah! She says, "I just wanted to say thank you for your recent podcast on autism number 107. I am not a parent but I work with children, I baby sit and have friends with children and I'm also autistic with Asperger's. I found your presentation on the vaccine study more balanced than most I've heard…. – That balanced.
Karen: Oh?
Dr. Mike Patrick: She found it balanced
Karen: Fair and balanced.


Dr. Mike Patrick: "This issue is what I think don't will go away until we do find the causes of autism spectrum disorders because people need answers. My own opinion has always come down to the little evidence that while there may be some isolated cases of autism triggered by an adverse reaction to a vaccine and already susceptible children compared to the enormous evidence of death and disability that can occur in many children if we don't vaccinate for the major childhood diseases. Vaccination comes out on top.


Regarding your reviewer there's nothing wrong with being opinionated if A – You say that you're stating your own opinion and B – You give evidence for them. Of course it's quite likely that a lot of alternative therapies have some value and need to be studied further to prove or disprove them. But proponents need to remember to first do no harm. They need to prove safety and then efficacy. And if they want to be taken seriously they got to do those things if they want to be taken seriously by the scientific community.


Anyway all these rambling and I just wanted to say you're doing a good job and keep it up….
Karen: Sarah makes a very good point. She is not a parent. So I happened to have look for the rants and raves for the show. And there's a couple of people who mention I passed on your podcast to all the parents that I know. Well this right here just proves don't save it for the parents.


Send the information to everyone you know. Because someone like Sarah could find something interesting or…
Dr. Mike Patrick: Yeah! Yes.
Karen: Or someone down the line or they know people who are parents and they can pass it on.
Dr. Mike Patrick: Right!


Karen: Don't keep it to yourself.
Dr. Mike Patrick: Right.
Karen: Spread the word.
Dr. Mike Patrick: That's right. Well it does seem like, "Well this is something I'll tell my parent friends… but although I have a lot of teachers, medical students, nursing students you know who listen. So yes help spread the word folks. We'll always appreciate that.


I do want to make the point here and that we'll talk about this more when we get to the whole progressive series of e-mails. But I'm not against progressive and alternative stuff and like Sarah says here, it really comes down to backing up what you believe with scientific studies. And I mean if we live in a world governed by scientific laws and I guess I'm sort of a grumpy scientist when it comes down to it. I think that if we're going to have an opinion on something we should have evidence that it works.


Karen: Right. Right.
Dr. Mike Patrick: OK. Not everyone agrees with that. OK now speaking of that, speaking of evidence in science and me being a grumpy scientist this next one is really embarrassing. This comes from Molly in Madison Wisconsin. She's a graduate student in zoology. She says, "Dear, Dr. Mike. OK you said it twice now so I have to call you on it. In recent episode you discussed a couple of gene therapy approaches and both times you referred to the components of DNA, which is adenosine, cytosine, thiamine, and guanine… yeah.


You referred to those components of DNA as amino acids. But in fact…
Karen: No you didn't.
Dr. Mike Patrick: No, I did.
Karen: No, they're nucleic acids.
Dr. Mike Patrick: If you listened to the podcast you could've warned the first time that happened.


Karen: Do you want me to listen to the podcast or do your laundry? Your choice.
Dr. Mike Patrick: OK
Karen: Back to Molly.
Dr. Mike Patrick: I'll shut up.
Karen: Really?


Dr. Mike Patrick: So just…
Karen: Promise?
Dr. Mike Patrick: No, it's not going to happen. "So just to clarify each gene has a particular sequence of nucleotides which code for a chain of amino acids or a polypeptide. These polypeptides are then assembled into proteins. No worries though we still enjoy your podcast. In fact my husband and I might be some of your oldest listeners. We found your show the day after you posted your first episode. Our daughter was a newborn then and we were nervous new parents.


The education you've given us through PediaCast has been most helpful. Thanks. Keep up the great work, Molly…. Oh that is so embarrassing.
Karen: Oh well you know.
Dr. Mike Patrick: You know what though, the further you get out from basic science classes I remember once a doctor told me that when I was, I think it was like my family doctor or someone I think when I was in college.


He said in order to be a doctor the amount of organic chemistry that you really need to know you could fit into a thimble. And it's really a lot of it, a lot of the basic science stuff.
Karen: Right.
Dr. Mike Patrick: It's learning it to have his background. But you certainly don't use it everyday.
Karen: Right.


Dr. Mike Patrick: But she's right. They're nucleotides and not amino acids.
Karen: I mean I would like to know how Molly found the podcast one day after her baby was born. I have to wonder if she did a Google search that contains the words baby poop something because that's how a lot of people find the podcast and the blog. They search for baby poop.
Dr. Mike Patrick: Actually they found the show the day after I posted my first episode. Not the day after they have their baby.


Karen: Oh, OK sorry. Yeah but the baby was new.
Dr. Mike Patrick: See I called you on that one.
Karen: Let's edit that. Please. Please. Edit.
Dr. Mike Patrick: I don't think so.
Karen: OK.


Dr. Mike Patrick: Alright Colet in Alaska says, "This is not hate mail…. It's going to be bad when it start out with that you know.
Karen: "I don't mean to offend you but……
Dr. Mike Patrick: "This is not hate mail but I would love to add something to the e-mail you received about the eight-month old who won't play on his own. One thing you didn't mention for the baby that just can't be consoled is baby wearing. Some babies just need to be held all the time and the options are endless. There are all sorts to pick from that are comfortable for the parent and child.


My daughter is 10 months old and while she's pretty good about playing by herself, she has her moments and they're usually when I need to get something done around the house. I even use a cozy carrier while I'm volunteering at my older daughter's pre-school class. But having a baby close to you and up at a level where they can see what's going on can help boost their sense of security. I can get household chores done, move around and a little one is pretty content if not passed out.


There are so many benefits to baby wearing that I think it could be an excellent topic for future podcast. Also another quick tip for trying to get a shower, if a bouncy seat next to the shower and clear view of you doesn't work; I've taken my little one in the shower with me. She loves it, so did my first….
Karen: Just be careful they're slippery when they're wet.


Dr. Mike Patrick: They are slippery when wet like bridges. OK. "And I either put her in a tub seat at the back of the tub so I can get cleaned up or back in the bouncy seat with a towel on it. Being a working mom I tried to spend as much time with my little ones….
Karen: Hey wait, every mom is a working mom.
Dr. Mike Patrick: That's a good point.
Karen: OK
Dr. Mike Patrick: Alright.


"Being a working mom, I tried to spend as much time with my little ones as I can. It can be stressful so I strive for quality time where everyone is happy. And I've included some helpful websites…. – And we've included them in the show notes. So Colet, your links are there for everyone to see. And one of them is Great Things About Baby Wearing. It's just sort of an introduction to the topic and then there's a discussion from Dr. Seers, so they're about baby wearing and then a Cozy Carrier Country and a link about sling rings. So, those are all in the show notes and so thanks to Colet for sharing those.


Karen: I think that this is really what Katie needed as a baby. I mean she demanded constant attention if you sat her down, she'd cry. If you try to put her to bed, she'd cry whatever. So I think that sort would really help. I remember getting a sling as a shower gift but I had absolutely no idea how to use it. We'd put Katie in it and basically the chop would fold over and she perfectly suffocate in there.
Dr. Mike Patrick: They don't come in directions.
Karen: Well it's it but they were so weird. I mean this is before the internet and blogs and you know support like that was big. So I didn't know who to ask, no one that I knew slinging their babies.


I mean I've see babies as tiny as Katie and they looked fine in the slings. But Katie – I just couldn't get her in there comfortably but if I knew now or knew then what I know now.
Dr. Mike Patrick: Did you get a sort of a back?
Karen: I don't know.
Karen: She's five pounds.


Dr. Mike Patrick: Well I know but when do you stop doing that?
Karen: I don't know I've seen in the internet people with toddlers have slings. You know they sling them over their hip and stuff.
Dr. Mike Patrick: But the toddlers who are in slings are properly in slings because they still demand to be in the slings and then who's running the house? I mean when does the child have to struggle in to suit themselves? I don't know.


Karen: But if we could have done without all the crying you know? Part of it is mother sanity you know how close to the edge was I?
Dr. Mike Patrick: No right. Well yeah now I do understand that.
Karen: We could have got her to stop crying so much.
Dr. Mike Patrick: Right. I don't know. No I think it's a good idea in general.


Karen: At least for the shot. It can't hurt.
Dr. Mike Patrick: Yeah. Yeah. You may be putting off the inevitable because then when you get to the point that you're not going to put them in the sling anymore, then they start crying cause they want the sling.
Karen: Or are you just giving them the safety and security that they need as young infants. So they feel better being separated from you as an older toddler.


Dr. Mike Patrick: Yeah or it may make the separation more difficult because there's so used to being right next to you all the time. I don't know. I think it's so individual, like is there some kids that could do the sling and then one day say, "You know what, I don't want to do this anymore…. Or gradually get away from it and it'd be fine. And then there are others that are going to cry when you'rea part no matter what.
Karen: Right. Right.
Dr. Mike Patrick: Alright. Oh I should mention also too that Colet also said, "Once again I love the show and the rants…. – So she likes the rants.


Karen: I don't think that was really too awful. She said this is not hate mail. I was expecting like, no it's fine. You're fine Colet.
Dr. Mike Patrick: Alright next up is Ann in Maryland. Ann screams. She's like your dad.
Karen: No, her spelling is so much better.
Dr. Mike Patrick: Oh true. True. Karen's dad writes all his e-mail in all capital letters. It's like the Number Lock or not the Number Lock, the Caps Lock is on.
Karen: And nothing is spelled correctly and their sentence fragment is all over.


Dr. Mike Patrick: So Ann has better grammar and her spelling is spot-on but her letters are all capitals. OK so Ann says, "Hello, Dr. Mike. I love PediaCast and I have been recommending it to all my friends with kids….& Don't forget, recommend it to your friends without kids too. "I download your episodes to my IPod and listen at work. I've never been a fan of letting my babies cry it out. But you have addressed it on several occasions and it does seem to make sense. We have been living with my in-laws for the last year and my son has been in our room at night since birth….


Karen: OK living with my in-laws thing – it'll not going to happen.
Dr. Mike Patrick: And your son's been in the room since birth.
Karen: Yeah. Nick never slept a night in our room.
Dr. Mike Patrick: But sometimes people's situation you can't avoid.


Karen: Right you can't avoid it.
Dr. Mike Patrick: "He is still nursing and wakes up several times at night and requires me to nurse him before falling back to sleep. I know, I know not a good habit for several reasons…. Although, you didn't mention how old your baby is. But I don't think there's anything wrong if they wake up in the middle of the night and need to eat and then you nurse him and they go back to sleep. You know if it's a half an hour ordeal and everyone's back to sleep. I mean some babies don't need a night time.


Karen: And part of the bad habit may have been created because she is living with in -laws. And she probably is less likely to just let the baby cry it out.
Dr. Mike Patrick: Right.
Karen: I mean probably as soon as the baby cries, she jumps because he just doesn't want to disturb anyone else.
Dr. Mike Patrick: Well she does say several times at night. So, and that's not ideal.
Karen: But again she doesn't say how old the baby is. She's been living with her in-laws for a year and the son has been in her room at night since birth. Is he close to a year old? Did they move in close to when he was born or is he just born few months ago?

Dr. Mike Patrick: ‘Cause nursing him several times at night if he's a two month old that's fine.
Karen: Yeah.
Dr. Mike Patrick: But, if he's a one year old or even if a 15-month old then yeah some of those kids don't need to eat once in the middle of the night. There are those kids who do like Katie was. OK. "We are moving in to our new house and I would really like to get away from this bad habit and have a more structured bedtime unless interruption at night. He will have his own room and I would like to stop nursing soon.


My concern is that I saw an episode of Dr. Phil,… – OK there's my concern too.
Karen: There's your problem.
Dr. Mike Patrick: "My concern is that I saw an episode of Dr. Phil with Dr. Seers who does not recommend letting them cry. He says it can deprive the brain of oxygen as well as cause security issues…. Did Dr. Seers really say that crying cause can deprive the brain of oxygen?


Karen: I don't watch Dr. Phil, so I don't know.
Dr. Mike Patrick: I have a hard time believing he said that.
Karen: Yeah.  
Dr. Mike Patrick: Maybe he did but…
Karen: I don't know where he's getting his medical knowledge from then because that doesn't make any sense.
Dr. Mike Patrick: It doesn't make any sense.
Karen: Cause when they cry they breathe much deeper. They pull in more oxygen.


Dr. Mike Patrick: Right. OK. "I'm also worried about too much change with moving to a new home and moving him into his own room at the same time. I'd like to know your opinion about this theory. I realized you're already probably overwhelmed with questions but I respect your opinion not just because you are a pediatrician, but also because you back your medical knowledge with common sense approach which is refreshing. Thanks…. See I don't get this. OK so Dr. Seers I do I know that he does not subscribe to the letting your babycry it out thing.


Karen: Right. He's the Baby-Wearing guy that was mentioned earlier, right? Right?
Dr. Mike Patrick: Right. See? So, I think that Dr. Seers just doesn't like to hear babies cry.
Karen: Yeah.


Dr. Mike Patrick: And you know the other thing too is there is a large body of… I shouldn't say research. There's the idea out there that especially younger babies when they cry, they are crying because they are upset. Like we attach emotion to a baby's crying.
Karen: Right.
Dr. Mike Patrick: But the baby may not be emotional. It's just maybe that the part of their brain that makes you cry is firing.
Karen: Right.


Dr. Mike Patrick: It doesn't mean they're sad. It doesn't always mean they're angry. Sometimes they just cry.
Karen: Right. Sometimes I just cry. I'm just kidding.
Dr. Mike Patrick: OK but not since the Zoloft.
Karen: Yeah! Woo! Not since cowboy.
Dr. Mike Patrick: Oh we're going to get in trouble for being insensitive to people with depression and anxiety.


Although we're among them.
Karen: Yeah that's right.
Dr. Mike Patrick: You're among friends here. Yeah I don't understand this. I think that Dr. Seers must be saying, "I don't like to hear babies cry…. Does letting your baby cry cause security issues? I mean are you more insecure as a child, I mean no one's done that study.


Karen: I would think that letting a baby cry and never checking on them and being a detached parent in general even when the baby is up and awake, that might cause some security issues. But I don't think that letting them cry here and there to get them to go back to sleep is going to be huge in their lives. Again I don't have any medical research to back that up but…
Dr. Mike Patrick: But we do talk about spoiling children and the baby equivalent of spoiling is to never want them to cry because…
Karen: You give in to their every want or every want, not even need.
Dr. Mike Patrick: Right. But if you've given to their every want and then the next thing that happens is they're toddlers and you're giving in to their every want and then their children giving in… I agree you know a two month old baby. I'm not saying like you're a two month old cry. I'm not saying that.


Karen: Right. Right.
Dr. Mike Patrick: But you're 15 month old.
Karen: Right. We had to do the cry it out method for Katie because she never slept and if she never slept neither did I. Now that time I was working and it would've made me, well no – it did't make me an awful parent there for a bit because I was so sleep deprived I couldn't deal with her when she was awake. So it was either let her cry it out a bit and teach herself to go to sleep or I was going to be pretty ugly.


Dr. Mike Patrick: Yeah. Well you know too the notion that if a baby is really upset and you're letting them cry it out, most of these babies it goes away after like three or four nights.
Karen: Right. Oh yeah.
Dr. Mike Patrick: I mean it's all it takes.
Karen: Yeah it took about three or four nights for Kate and then it was perfect.
Dr. Mike Patrick: So and then she was sick and then you start over again.


Karen: We all have an exception.
Dr. Mike Patrick: Right. But for Dr. Seers to say that crying causes the brain to be deprived of oxygen? I mean that's just a silly.
Karen: It is.
Dr. Mike Patrick: OK
Karen: Now it sounds like there's a lot of a change in these babies' lives coming up. And again we don't know how old this child really is and I know Dr. Mike would say, " It's alright just put him in his own room and let him cry it out and stop nursing all at once…. But as a mom I would have to say just make the changes. You know get him to the new house. Put him in his own room. Then in a couple of weeks look at stopping the nursing and then you know and then work on crying it out. I don't know just something about making all those changes all at once in a little guy's life – seems a bit mean.


Dr. Mike Patrick: I'm with you. I think that's good. Couple of weeks is good. OK we're going to go the Skype line now and listen to Shawna from Georgia. So hold on here.
Shawna: Hi Dr. Mike it's Shawna from Georgia. I was listening to your latest episode where you were talking about your listener feedbacks show is coming up and you were mentioning those controversies that she's tackled the last few weeks. And the one regarding pediatric ophthalmologist versus optometrist really hit home. Just like before I drop my son off in school, he was talking about how he would like to have his lazy eye repaired because the children at school are making fun of his eyes saying his eyes was crooked.


Just to give you a brief history, he's worn glasses since he was four then he was seeing an optometrist from the time he was four, he has now almost 14. And no one mentioned to me the fact that he has a lazy eye or Amblyopia. And because of our health insurance changing he had to change doctor and got with a really good doctor.& As soon as he walked on the door he said, "What are you doing for his lazy eye?… And I said what are you talking about? Until he told me you know basically that he was of the age where a patching probably would not work. It should have been done much earlier; he was eight at that time. So he's been seeing by an optometrist for a total of about four years at that time.


And he said, "We'll try patching but I think it's going to be too late…. So we sought a second opinion and started seeing a pediatric ophthalmologist, I'm sorry, and she tried the patching as well and it was too late. And so now he is 14 and he is almost blind in that eye. And there's nothing that can be done about it. So you know when people write in and call in and talk about your rants, please don't take that personally because you know if hits home to you and you see that there's a second side, you need to investigate that.

My son would have better vision today, had I been listening to a podcast such as yours when he was younger and had known what to look for and what to ask. So keep up the good work and don't take the criticisms about that personally and don't change what you're doing because it could be helping someone. And if you have a child that has a lazy eye please get a second opinion or any other medical condition for that matter. Give a second opinion it's your child's health especially when it's something that's permanent. I'm sorry maybe I got on too much for a rant there myself. But anyway keep up the good work. I love your show. Bye-bye.


Dr. Mike Patrick: I've always said that when I give advice as a doctor, the advice I give is what I do for my own kids. And so opinion is going to play a part of that. But when I say, "I would see a pediatric ophthalmologist and not an optometrist…& it's not to be offensive to the optometrist out there. It is what would I do for my own kids? That's what I would recommend you should do. And I'm not here for the optometrist. I'm not here for any other professional organization. I'm here to help parents.


Karen: And it's not like you're getting a kick back from the ophthalmologist.
Dr. Mike Patrick: Yeah right. Right. Right. You know I understand that there are optometrist who would know when to refer.
Karen: Right.
Dr. Mike Patrick: But there are lots that don't.
Karen: Right. That's really kind of sad.


Dr. Mike Patrick: In general, pediatric ophthalmologist though, they're not going to ignore that because it's not something you ignore. OK well it is sad.
Julie in Switzerland says, "I'm writing in response to a few comments that you've made over the past couple of weeks most specifically in Episodes 107 and 108. Those were a couple controversial episodes.
Karen: I don't know, I didn't listen.
Dr. Mike Patrick: Yeah I know you didn't. "But first let me tell you a bit about myself. I'm a 34 year old first time mom to a 12-month old boy. I'm also an RN BSN and have master Public Health.


I've been listening to your show since I discovered at last spring. I consider myself a ‘progressive' and I'm very pro breast feeding at the same time I believe in the importance of scientific evidence when it comes to making medical decisions. In my personal life I use a combination of alternative and modern, western medicine. I avoid antibiotics and other medications if at all possible…. I think all the good doctors do that too.
Karen: Right. Right.
Dr. Mike Patrick: You know we do avoid medicine if at all possible. Most of us do but I do believe in vaccinations, although I have some issues with systematic hepatitis B vaccination for infants.


"I truly enjoy your show and listened every episode as a health care……
Karen: But the question is, does she read every blog post? She listens to every episode of yours but does she read the blog?
Dr. Mike Patrick: I don't know.
Karen: Good. If she's not reading it, she should.
Dr. Mike Patrick: Yup! Please. Please Julie. OK.


Karen: Read the blog.
Dr. Mike Patrick: "I truly enjoy your show and listen every episode….
Karen: We've been through that.
Dr. Mike Patrick: Yeah you're right. "As a health care professional I have learned a lot. And as a mother you have addressed many of my concerns. I appreciate you taking the time to explain scientific studies and concepts to people.


And even if I don't always agree with every single thing you say, I recommend your show to all of my friends and family members with children. And yes I did write a favorable iTunes review last fall. So I guess my issue is that I don't really understand the recent increase of rants against progressives. I've always ignored the breast feeding Nazi comments because I do understand that some people out there take things to the extreme and it's both annoying and tiring to constantly fend them off.


Extremism in any form as quite unattractive. Still, I feel you do your listeners a disservice every time you labelled those who appreciate the value of alternative medicine as progressives. Your use of the word is clearly negative. I feel there's a huge disconnect in the US health care system with all of the new knowledge and technology. Treatment has become increasingly complicated and difficult for the average person to understand.


As health care providers we are overwhelmed by the sheer volume of work and there are moments when it is all we can do to stay afloat. Communication and health education often fall to the bottom of the priority list for lack of time. The patient is easily lost in all of these and sometimes walks away not really understanding their diagnosis or treatment. Don't get me wrong, I also believe the average patient needs to take more responsibility for his or her own health.


I mean we all know by now that we need to stop smoking, eat less and exercise more. And it's exhausting taking care of 400 pound patients who want to keep eating their Big Macs while expecting you to fix them. There are moments when I wonder if some patients are just hopeless. When I was pregnant my OB rushed me in and out and didn't really seem to care about the fact that this was my first child and all that it represented to me.


On the other hand, my midwife took the time to offer me a cup of tea asked both my husband and me about our feelings toward the pregnancy and help us to develop a delivery plan outlining how we would ideally like things to go. Of course my water broke at 32 weeks and I ended up having a horrible experience in the hospital so much for best laid plans. I don't advocate home births but man hospital births are not the ideal either. When I work the med surge units in the hospital I had patients that would ring the call bell every four and a half minutes and ask for a couple of ice or for another pillow or whatever and sometimes I think it was just because they were scared and nervous and didn't know what was going on.


I guess what I'm trying to say is that it's no mystery to me that many people are turning away from Western medicine and towards more alternative practices. Part of it also points to the overall breakdown of the social fabric of our society. People are lonely and isolated and in general our health care system only reinforces this. You feel sad, depressed, ill, whatever and you get eight minutes with your doctor or nurse who may or may not remember your name and you walk away with a prescription and you don't feel any better at all.


Western medicine has an important role but I think that it has many flaws. Alternative medicine is not the answer to every problem either but I think it can compliment Western medicine. If you have a cold or a skin rash I don't see anything wrong with starting with herbal teas, using essential oils or seeing a traditional Chinese,…… What is TCM?
Karen: Eternal Classic movies.
Dr. Mike Patrick: No. No.
Karen: Oh no, no, traditional Chinese medicine. We had to Google it.
Dr. Mike Patrick: Yeah!


And then she says the honey worked right? "Heck if it works then maybe you and I would get more lunch breaks if it doesn't then make an appointment with your MD. I think that is our job as health care workers to be open to the possibility that other treatments do exist and can work. We need to be a bridge between the two communities and make sure that people make safe and educated choices about their health like knowing the difference between which rashes might improve with an oatmeal bath then which ones require immediate medical attention.


Alternative medicine is not going to go away not while Western medicine is unable to fulfil all of the needs of patients. We need more MD's who are willing to listen to patients who asks questions about alternatives and to not make them feel stupid for wanting to try them. Geez, who is ranting now? Dr. Mike, I guess I'm asking you just takes it easy on some of us progressives. We just want to make the best decisions for ourselves and our families.


Yes there are some who go too far and need to not shout so loudly. But you find these people everywhere spouting extremism on every possible subject. You have a unique opportunity to reach a broad cross section of people. It would sure be great if you could be one of those bridges at least where science permits it. And if not perhaps you can lighten up on the sarcasm…. I don't think it's going to happen.
Karen: Yeah. It's not going to happen.
Dr. Mike Patrick: I know it…


Karen: I taught him everything he knows about sarcasm.
Dr. Mike Patrick: I know and it's true folks. "I know a negative review hurts but your good reviews far outweigh the bad ones. You provide so much information to parents and it would be a shame if listeners tuned out because they felt you didn't respect some of their choices. Sorry I know this is long so thanks for reading. Keep up the good work. Take care, Julie currently living in Switzerland but moving back home to Seattle soon….


OK , you know what I want to say here is I think the only people who would tune out because of something I've said have only listened to one show. Because if you take the bulk of the shows and you look at it in its context, then you understand that I'm a little sarcastic. I mean you don't take it quite as seriously. And I have never said not to try herbal tea and honey first. I mean, I don't look at this as Western medicine versus alternative medicine. It's common sense.


Karen: Right. Right.
Dr. Mike Patrick: Sure, take some honey for cough before you call the doctor. I don't have a problem with that. But when you try something that delaying real treatment can be harmful or you do something like have a birth at home when you can have an abruption and then bleed to death in your living room because someone didn't sit down and have tea with you…
Karen: Right.


Dr. Mike Patrick: Then I mean at some point you have to say what the common sense approach is? And that's the one I tried to take.
Karen: I'm just going to quote her. She said, "With all of the new knowledge and technology, treatment has become increasingly complicated and difficult for the average person to understand…. That is so true. But back when treatments were not complicated and they were easy for people to understand, they died.


I mean when you have much more complicated treatments and people are living longer and back 100 years ago it was, "We're going to put these leeches on your body…. I mean those pretty easy to understand, but did it work?
Dr. Mike Patrick: Right.
Karen: You know. So things have gotten complicated and understanding it has gotten complicated.
Dr. Mike Patrick: Right.


Karen: But people are also living longer.
Dr. Mike Patrick: And you know huge proponents of or I guess the people who are going away from the Western medicine just because of what it is or less time and all that. They are also making a generalization that all doctors just want to rush you through.
Karen: True.
Dr. Mike Patrick: That's not a good generalization.
Karen: It's not true.
Dr. Mike Patrick: I mean what is this? This is podcast takes me hours each week to put together and I do it because I care about patients and I'm an MD. I'm of the Western medicine background and yet I'm here talking to all of you because I care about kids.


Karen: But then how come when I show you something like where my arm hurts and I tell you I think its bone cancer and you say, "It's nothing you probably pulled something…. I mean you're not giving me the time that I need.
Dr. Mike Patrick: But you have bone cancer every week.
Karen: No sometimes I have aortic aneurism. And sometimes I have, I don't know pick a really scary disease I probably thought I have them all.
Dr. Mike Patrick: And we have raccoons in the attic.
Karen: Yes. Yes we do.


Dr. Mike Patrick: OK I think you might want to check out the blog.
Karen: I'll just up my Zoloft. Moving on.
Dr. Mike Patrick: It's like the plumber who doesn't fix his leaks at home. Because when he's home he just wants to relax.
Karen: OK but if I die of bone cancer, who's going to do your laundry?


Dr. Mike Patrick: If you have bone cancer, it's going to hurt more than one day in the same place.
Karen: "How long has it been hurting?… Six minutes.
Dr. Mike Patrick: Get back to me when it's hurt for a week.
Karen: OK. Just see this is what I have to put up with.
Dr. Mike Patrick: Oh yeah!


Emmanuel, I love that name.
Karen: It means God with us.
Dr. Mike Patrick: Emmanuel in Paris, France says, "Hi, Dr. Mike. Whilst I think your vague comments about progressive are unnecessary. You keep it real and I like that. I don't think you're being insensitive, rude or arrogant; it's refreshing to hear a straight opinion from an American because your fellow citizens tend to be so politically correct and refuse to address important issues just because they might make someone uncomfortable….


Amen. "Did you see this article of the New York Times about people refusing to be weighed at the doctors? I was absolutely shocked. I love what comment 10 had for reply. ‘Perhaps the stupidest thing I've ever heard. This is somehow more embarrassing than putting your legs in a set of stirrups having a finger inserted in your anus, having your testicles held while you cough, your breast mashed between a pair of plates. Hard to comprehend that someone would possibly compromise their health because of what some stranger might think of their weight.'


"I think this obsession with political correctness has a great deal to do with your country's obesity problem. Cheers, Emmanuel…. I put a link to what she's, she's talking about an article that was at the New York Times and I have a link to it in the show notes. But yeah I mean apparently people now are upset that they have to get weighed at the doctor's office because they don't want the doctor to know their weight.
Karen: Crazy.
Dr. Mike Patrick: It is crazy. Alright Melissa in Yakama Washington says, "Dr. Mike I just wanted to comment on Episode 97 with the breast feeding. I don't agree with your answer however this is not why I am commenting. I wanted to say the term you used jokingly, nursing Nazi is highly offensive.


I know this was meant as a joke and to let listeners know you would not have the same answers and other person but Nazi is a highly offensive comparison. The Nazis were responsible for deaths of over 100,000 people. As a German descendant it is now becoming easier for people to see not all Germans are Nazis. But terms like this keep that stereotype alive just my thoughts….
Karen: OK I don't think you were saying Nazi in reference to the German people in the holocaust. I think that your point was that the Nazis – the German Nazis expect you know way back when. Where a group that felt that their way and only their way was the way it had to be done.


And I think that you just use that term to talk about the militant breast feeding people who think that their way and only their way is the best way to feed the baby. And they were sometimes refuse to accept any other way and they'll guilt people into thinking that they're doing a huge disservice to their child for stopping breast feeding or not starting in the first place. So I think it's just the concept of I'm right and you're wrong.
Dr. Mike Patrick: That's bad, regardless.
Karen: Right.


Dr. Mike Patrick: You know we need to have a discussion and give your opinion, that's fine.
Karen: But you're not equating nursing Nazis to people who killed 100,000 people.
Dr. Mike Patrick: I don't think that there are nursing Nazis out there who want to round up all the formula feeding moms and put them in a gas chamber. I don't think that.
Karen: Yeah probably not.


Dr. Mike Patrick: No. I don't mean that they're Nazis in that sense. Right it's that they are these militant people who think breast feeding is the only way to go.
Karen: And having been on the receiving end of some words and glares from a breast feeding consultant after Nick was born, I know what it's like to have the guilt instilled and I fully intended to nurse Nick. I mean I have had started nursing him in the hospital. The kid had to eat every 45 minutes and in order for me to be a better parent I needed to sleep more than six minutes at a time.


So I ended up you know it's a choice to give him a bottle formula or do I shake him so I went with the formula and shortly after he fell asleep ‘cause he was finally happy. The breast feeding consultant came in and gave me the whole speech about nipple confusion and how I shouldn't do that and it's bad and all that which the kid ended up nursing for like nine months solid. You know so I don't think I confused in that much.


Dr. Mike Patrick: Maybe her baby wasn't smart enough to be able to tell the difference between a rubber nipple and a breast. OK but our baby was smart enough to tell the difference.
Karen: You just offended stupid babies so that's just wrong.
Dr. Mike Patrick: And you know I wasn't talking about the German Nazis anyway. I was comparing him to the Soup Nazi in Seinfeld.
Karen: Oh, yeah the Seinfeld Soup Nazi. I wonder if all the soup chef people, you know soup makers were offended by…
Dr. Mike Patrick: Yeah you look folks you got to lighten up here a little bit.
Karen: That's right.
Dr. Mike Patrick: Yeah OK.


Karen: OK.
Dr. Mike Patrick: Politically correctness.
Karen: Thanks for your thoughts, Melissa.
Dr. Mike Patrick: Adina in Boston says, "Hi, Dr. Mike. Well sorry I had to get back to you about your comments about nurse practitioner just what you didn't want. Clearly nurse practitioners or physician assistants don't have the same training as MD's. But in many parts of the country and even in some medical practices there aren't enough MD's to go around. So NP's or PA's which are physician assistants have to take up the slack and I don't think this is a bad thing.


In my experience the nurse practitioner at my husband's medical provider was the one who diagnose the life threatening bowel obstruction. If he hadn't seen her he might not be here…. So you think the doctor in that office would miss the bowel obstruction?
Karen: Yeah that's I was thinking too.
Dr. Mike Patrick: That's I don't think you the doctor would have missed that.
Karen: Yeah.


Dr. Mike Patrick: "At My son's pediatrician's office we often get an appointment with nurse practitioner because the doctor is busy. I'm happy to have him seen by the NP who is great and I'm sure if there's something she's not comfortable with she would consult with one of the docs…. As long as she recognized that she needed to consult.
Karen: That she was uncomfortable.
Dr. Mike Patrick: Right. "Same at my own doctor's office I understand that medicine is an art, not a science and that you really need experience and a feeling for what you are seeing in order to practice well. I think the NP's and PA's do get this training especially for what they are supposed to be doing.


For example in women's health clinic there's often an NP or PA and then it's just fine for most women's health issues. So I hope you don't get a lot of negative comments but I think you will…. And then Melissa in Portland says, "I recently found your podcast series and was interested to hear your opinion of pediatric nurse practitioners. I feel that many of points were valid however I feel that your knowledge of the educational background on PNP's is inaccurate.


They do study chemistry, micro biology, physics etcetera. Bachelor and Master Degree programs each emphasize research both critically evaluating, writing and conducting it when generally spends at least four quarters with a specific class in research in addition to utilizing evidence based medicine including critically evaluating research ourselves in other courses. Secondly although you eluded to the fact that there are good PNP's as well as vending machine PNP's.


You didn't really put as much stress on the fact that they are good pediatricians and sub part-pediatricians. Perhaps the focus on choosing a provider for your child should be on the individual's ability and not gross generalizations. I've met many of pediatricians that I wouldn't recommend sending even a well child too. And PNP's working in acute care that I wouldn't trust with my child's life. Finally if PNP's we're not allowed to open independent practices, many rural areas would not have pediatric health care services….


Karen: She doesn't make a good point there.
Dr. Mike Patrick: Yes. She does. "In Portland there's a nationally recognized clinic founded and run by PNP's that provides care to children with no insurance or State Medicaid. Good PNP's……& So how do they make a living?
Karen: Don't know about that. I think they get paid in chickens or goats. OK I don't know.
Dr. Mike Patrick: I mean you got to pay your electric bill.
Karen: Right.


Dr. Mike Patrick: "Good PNP's they provide the limits and have a network of other providers, Md's, other nurse practitioners, health providers etcetera to consult when necessary. I personally have worked in acute care for over 10 years. Know the signs, symptoms, diagnostics, management long term follow-up needs of Kawasaki, Steven Johnson, OTC deficiency….& Over the counter deficiency?
Karen: Yeah I Googled what OTC deficiency was and it was some extremely rare thing one in like a 100,000 births. Some amino acid thing.


Dr. Mike Patrick: It gets picked up on newborn screen.
Karen: She makes it sound like oh she can pick this up and you know manage this which a bit I'm guessing just based on odds she probably never actually seen it.
Dr. Mike Patrick: Maybe in training.
Karen: Maybe.
Dr. Mike Patrick: Yeah. That's something that usually would show up on a newborn screen.


Karen: But I don't know that you would know the symptoms diagnostics and management of it off the top of your head. It would mean that's something you would probably would have to look up.


Dr. Mike Patrick: But probably the kid would show up with failure to thrive and you'd end up checking lactic acid, pneumonia, and urine amino acids and serum amino acids and organic acids in the urine well OK.
"I applaud you for taking on this role as it generally draws a heated response from someone… the old catch 22. I would ask you to consider broadening your collegial relationships with PNP's and consider looking at PNP's as adding to the compliment of options in today's health care market.


PNP's and MD's working together form a very synergistic relationship. You neglected to mention any of the skills that PNP gained through their education and experience that MD's do not. We have a wealth of skills most doctors don't have….
Karen: Like what? She failed to mention.
Dr. Mike Patrick: Even one.
Karen: Even one.
Dr. Mike Patrick: OK.


"So get to know a PNP. Thank you…. You know I've said this before. There's a role for pediatric nurse practitioners. But I don't think it is a role as playing the doctor in an office practice
Karen: Right.
Dr. Mike Patrick: I look at this way. It's our fault as doctors that this sort of thing even comes to be. Because is there a secondary pathway to becoming a lawyer? I mean basically pediatric nurse practitioners are nurse practitioners in general not just in pediatrics. They are practicing medicine.


Karen: Right.
Dr. Mike Patrick: So can I practice law without being a lawyer? I mean the only way I can practice law is to go to law school. Now I can become a legal assistant, I can become a court reporter but the legal profession, would they allow there to be to another way to get entrance to the bar and practice law?
Karen: No.
Dr. Mike Patrick: No. But see us as doctors have allowed this to happen. I think you know what if you are a young woman or young man and you want to practice medicine, go to medical school.


Karen: Go into medical school. At Ohio State they are really good.
Dr. Mike Patrick: But you know what I'm saying, I don't understand how there's this alternative pathway to practicing medicine.
Karen: Right and if you're learning basically just as much or as Melissa alluded to even more because you have more skills than doctors have, I mean why do that? Why not just go?


Dr. Mike Patrick: Why go to medical school? Might as well just become become a nurse practitioner. It'd be much easier.
Karen: It's a lot cheaper too probably.
Dr. Mike Patrick: Yeah.
Karen: OK.


Dr. Mike Patrick: But they do have to have supervision don't they? I think in Ohio I'm sure they do.
Karen: Yeah probably depends in the State.
Dr. Mike Patrick: These one's that are practicing by themselves in a clinic, who's supervising them?
Karen: I don't know. I know if it was my kid, I would take him to an MD.


Dr. Mike Patrick: I'm going to come across as the arrogant doctor who doesn't think anyone can do as good of a job as I do. I know that's why it comes across.
Karen: Right.
Dr. Mike Patrick: But my point is the chemistry that she took. OK she did all these things, why didn't she go to medical school?
Karen: I don't know. I took chemistry and all the physics and that sort of stuff in college too but that doesn't make me nearly as smart as I would be if I have gone to med school.


Dr. Mike Patrick: If you want to be a dentist, you go to dental school.
Karen: Right.
Dr. Mike Patrick: If you want to be a lawyer you go to law school. If you want to be a doctor you go to medical school.
Karen: Right.
Dr. Mike Patrick: OK. Well someone agrees with me. Dr. Smith in Virginia says, "Dr. Mike I'm a pediatrician and an avid PediaCast listener. And after hearing the recent episode about nurse practitioners I finally had to write you.


Please do not apologize about your view points about nurse practitioners, family practice residents, and optometrist. You are only saying out loud what many in the medical field feel. Many outside of medicine do not understand the differences and the different medical areas and easily take offense. Those of us who are physicians understand that nurse practitioners are very important to physicians and help many people with many common conditions but they are not doctors….


You are right! "Pediatrics is often repetitive but those years of studying organic chemistry, biology, anatomy, pathophysiology, physics and all the other classes for which I have missed several nights of sleep are important for when that rare illness comes along. That is the time when that MD comes in handy when you have to use those critical thinking skills you learned in medical school and have to put it altogether….
I agree. I agree. That's basically what I'm saying.


Karen: He could be you. Is that Dr. Smith? Did you write that yourself?
Dr. Mike Patrick: No, I didn't write that.
Karen: I mean ‘cause Dr. Smith – that's not very creative.
Dr. Mike Patrick: I'm from Ohio.
Karen: Yeah but you could've made up that you're from Virginia so it didn't look like you.


Dr. Mike Patrick: No I didn't. No that was real e-mail. It was a real e-mail I swear.
Karen: OK, who's to know? Thank you Dr. Smith wherever you are.
Dr. Mike Patrick: You know there are nurse practitioners that do an awesome job at what they do.
Karen: Right.


Dr. Mike:& If you're a nurse practitioner in the newborn nursery, you have a limited scope. You're still not practicing medicine. You have the supervising neonatologist who is watching over. If you're a nurse anesthetist, you have the anaesthesiologist – you are basically helping them out. OK I don't get it.

Karen: You know what you need is a PNP who attends at home births. You would like that. A nurse practitioner doing home births who doesn't vaccinate. How about that? Wrap that all into one.
Dr. Mike Patrick: There you go. OK.


Do we have anything?& You know we're at an hour and 20 minutes?
Karen: Oh my, that's because you're so chatty.
Dr. Mike Patrick: I mean we had lot to cover.
Karen: Yeah.
Dr. Mike Patrick: Like I said the show is not like any other that we've done before.


Karen: So I want to hear your feedback, should he keep me around or should he fire me?
Dr. Mike Patrick: Make you stay with the blog.
Karen: Yeah.
Dr. Mike Patrick: No, I think this was fun so I think we'll collect more comments and then do another one of these down the road.
Karen: OK sounds good.


Dr. Mike Patrick: OK.
Karen: And while you're waiting for another one and check out the blog. Got a contest going on right now for a Skeeta bag?
Dr. Mike Patrick: Yeah I've been mentioning that.
Karen: Yeah I know. I listen to the beginnings and the ends.


Dr. Mike Patrick: So you know about that part.
Karen: Yeah.
Dr. Mike Patrick: Alright. Let's take a break and we'll be back.& Thanks again, by the way.
Karen: Oh yeah you're welcome. I have to go do more of your laundry.
Dr. Mike Patrick: OK.
Karen: OK.
Dr. Mike Patrick: Alright we'll be back. You know what; there a show was back when I first started this where I folded laundry. Do you remember that?


Karen: And then I had to Skype call you.
Dr. Mike Patrick: That's right.
Karen: And thank you for folding laundry or something.
Dr. Mike Patrick: And then you thank Manic Mommies.  
Karen: I yeah I did do that
Dr. Mike Patrick: Because they guilted me into folding laundry.
Karen: Yeah.
Dr. Mike Patrick: Alright we'll be back right after this.



Dr. Mike Patrick: As always thanks go out to Nationwide Children's Hospital for providing the bandwidth for the show today. Also Vlad at Vladstudio.com he is the provider for the art work that you find on the website and in the feed. And of course thanks go out to Karen for joining us for this episode and most of all thanks to you for joining in and listening, for participating with the program, and helping to spread the word.


If you've not checked out the blog, Pediascribe, and Karen has peeked to your interest, please do take a minute to check it out. You can find it at Pediascribe.org or check out the link at our site at Pediacast.org. Don't forget iTunes reviews are helpful. We also have a Poster Page where you can download PDF files and print them out, hang them up on bulletin boards, that sort of thing.


Stay tuned Episode 119 we will return to News Parents Can Use and answers to your questions. And before I get in and dated with e-mails asking Karen to return because I know that's going to happen. I will invite her back. We'll have her back. We'll do another one of this.
Karen: And maybe next time I'll I get paid.
Dr. Mike Patrick: Yeah don't hold your breath. I'm still waiting to get paid. Alright and until next time this is Dr. Mike and Karen saying, "Stay safe, stay healthy and stay involved with your kids…. So long everybody.


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