Review – Baby-Led Weaning (#review, #books, #parenting, #babies, #children, #food)

Baby-Led Weaning: The Essential Guide to Introducing Solid Foods-and Helping Your Baby to Grow Up a Happy and Confident Eater

by Gill Rapley, Tracey Murkett, published 2010

If you pay close attention to certain parenting and child development texts, you are likely to notice one of two paradigms at work– the exogenous development approach and the endogenous development approach. Those are fancy words I just thought up to say something simple, which is that you either believe children can develop pretty well on their own, with parents simply playing a nurturing, supporting role; or else you believe that children are mostly helpless to develop on their own, with parents playing a primary, directorial role.

The idea of “Baby-Led Weaning” (BLW) falls firmly into the endogenous development model, along with other philosophies we fancy such as RIE for parent-infant communication and relationship building, self-esteem centered personal growth philosophy, Montessori for educational and pedagogical practice, and nutrition-based health and well-being (ie, vaccine-skepticism). People who take the BLW approach to transitioning their infant to solids, aka “adult food”, see linear continuity between the infant’s ability to feed themselves at the breast and the later skill of the toddler being capable of feeding themself at the table. The BLW user asks the question, “Why should there need to be a period in the child’s eating skills development where they regress to parental intervention with mush and spoon?”

The actual practice of BLW doesn’t require more than a paragraph to describe. So long as your infant has reached the motor skill maturity to sit up on their own (or you are willing to prop them up on your lap for the duration of their “meal”), you can put a small variety of 2-inch long, stick-shaped food items from the adult meal in front of them and let them choose what and how they’d like to eat. If they want more, you can offer them more as they go. The first few weeks and months of learning to eat actually consists of them “playing” with their food by exploring taste, texture, smell and other properties of the foodstuffs– only later do they discover that the food is nutritious and helps to satiate their hunger. Plan on letting them discover at their own pace, cleaning up the inevitable messes and continuing to provide most of their sustenance by breast or bottle until they’re fully capable of getting the majority of their calories and nutrients from shared family meals, likely past the one year of age mark.

That’s really it. While there are certain foods that are easy to choke on (grapes not cut in half length-wise! hard nuts which are difficult to chew! pieces of fish or animal flesh with sharp bone fragments!) and things children may develop allergies to if exposed too early (honey! dairy! peanut butter?!), like the risk of rolling over and crushing an infant via co-sleeping being almost nil for a family that does not consist of alcoholic cigarette smoking fat asses, BLW is essentially safe and the risk of choking is overblown. It turns out that infants have a gag reflex that begins near the front of their tongue and not the back, and most “choking” actually happens with spoon-fed infants wherein the eating utensil circumvents the natural choke-avoidance mechanism and allows food to get into the back of their throat when they haven’t fully developed the muscle control to swallow.

Like most endogenous approaches, the biggest challenge for parents and other adult-caretakers is having patience to let the infant explore at their leisure and behave as comes naturally without thinking they need to get involved and add something to the mix for any reason other than safety. The temptation to “help” the child learn to eat or to show them a more “efficient” way to get the food into their mouth, for example, must be avoided if the child is to develop the important motor skills of controlling food with their hands, not to mention the need to let the child determine that food is safe and enjoyable to eat. Chewing and sucking endlessly on the same piece of sweet potato stick may not seem like an effective way to eat one’s meal for us, but for the infant it is an essential part of figuring out “What is this?” and “What can I do with it?” Infants are highly empirical and don’t really have an ability to learn by causal explanation and the provision of logical theory. They need to just do stuff on their own.

The book is much longer than a paragraph because it spends a lot of time repeating itself, calming potentially frayed nerves concerning overwrought risks, relating a series of “BLW Stories” of parents who did it with their small kids and had success, and interjecting numerous verbatims from happy practitioners seemingly at random in an attempt to build credibility in the approach. This last bit is likely aimed at female readers– sorry moms, but your cultural appropriation model is highly consensus-based due to evolutionary biology.

A good primer for anyone interested in the approach, though you can skim-read it.

3/5

My Postpartum Experience (#motherhood, #parenting, #postpartum, #fourthtrimester)

As our lion cub is nearing his six month birthday and gaining more independence, I’m finding the time and energy to reflect on my postpartum experience. I want to document this for future reference for myself and for anyone else going thru postpartum.

Immediately after childbirth, I had a pretty good recovery. I gave birth at home, unmedicated, and so I was conscious and clear-headed within seconds of Little Lion’s birth. Getting to be at home with the whole family (my husband, our dog..) and in my bed after that crazy adrenaline surge was amazing. There is no other experience quite like it. I was tired from pushing for four hours, but I wasn’t quite ready to sleep yet (Mistake #1), so we had my in-laws come over and meet their first grandson. They commented at the calmness and peacefulness of our household despite the excitement and activity only hours earlier. Our lion cub slept next to me that night, but I barely slept because I was so excited; ‘There was a baby next to me.. That I had pushed out only hours earlier.. All-natural, at home, unmedicated.. I did it!!’

The months after childbirth are commonly referred to as The Fourth Trimester. It’s the adjust and adapt period: the hormones are regulating, the baby is learning to eat and sleep, and the new parents are rearranging their schedules and barely sleeping. Usually after this period, the new parents will gain some confidence and feel like they finally have a grasp on things (and maybe get some sleep!). 

Postpartum Help 

After the birth, a nurse from my birth center came to check on me and the baby and to teach me when to feed, when to pee (yup, you read that right), and what vitals to monitor. My doula, who was present the whole day, came back within a couple days to “debrief” me 🙂 And my midwife and her assistant both called and were available by phone to answer any questions we had. I really appreciated the open line of communication because I was so glossy-eyed over this baby that I was forgetting what I had learned beforehand! It was great to have people help us process what had happened.

The Lion and I are extremely fortunate in that we have family members close-by who are ready and willing to help us. Grandpa and Grandma Lion live within a quick drive, and Grandma Wolf is retired and can come spend a few weeks with us at a time. Our lion cub arrived right around the holidays, so my sisters in law were around and came to make food, fold laundry, sweep and dust, and keep us company. It was a lot of fun to have everyone over, with Christmas spirit in the air, and the arrival of a new baby 🙂 The next day, Grandma Wolf flew in and stayed for three months. My mom did ALL the laundry and ALL the cooking (except breakfast) and ALL the cleaning. I’m not sure how we would have survived in those first three months without her help! I was definitely ready by the end of my mom’s stay to try it on my own and find our own rhythm, but when we were sleep-deprived and trying to work out the breastfeeding thing, I really appreciated not having to worry about our next meal or having clean underwear (although I did run out once…………………….).

Within the first month or so, I invited some of my closest friends to come visit me, and I took them up on their generous offer to help (#unashamed). I asked them to bring their homemade chocolate chip cookies, I asked them to bring lunch, I asked to borrow their Moby wrap for our Little Lion, I asked them to grab me some olive oil and travel-sized bottles, I asked them to buy a Christmas outfit for the baby, I asked them for Pressed Juicery and acai bowls… These were friends who have either had babies or know what it’s like for new moms. I knew I wasn’t going to get judged for accepting help, I knew I didn’t have to shower or dress up, and I knew that they wouldn’t mind seeing my under eye bags or messy hair or postpartum belly. They were so loving and kind (and still are!), and I think having that support and encouragement (and advice!) really helped me a lot. Moms GET each other.

We are also fortunate in that my husband has the flexibility to change his work schedule and work from home as needed. The Lion worked hard to maintain a sense of normalcy within the first month when I was bedridden for most of the day. He made a big breakfast every day, he took over walking our dog TWICE a day, he ran for groceries after work, AND he got up to change diapers multiple times in the night. And somehow, he did all this while managing to have a good sense of humor and patience for me (and my mom 😉 ).

Recovery 

I did have some incontinence afterwards. My pelvic floor was s o r e and felt non-existent. I also had a tear and required some stitches, so I was pretty sensitive and tender down below. It was difficult to get in and out of bed, and walking short distances took a lot of time and effort. I didn’t immediately go back to practicing kegels because I was afraid of ruining the stitches. I also had hemorrhoids, which made going to the bathroom and even just sitting down a big challenge. I relied on my arms and my core a lot to help me sit up in bed to breastfeed in the middle of the night! My core was okay–I had made sure to keep up my core workouts during pregnancy, and at my six week check up, my midwife pressed around my abdomen and commented that my core was pretty strong, woohoo! (#poledoesabodygood)

One midwife that I had interviewed had told me she usually recommends her clients stay inside for a few weeks: “a week in the bed, a week around the bed, and a week around the house.” I required much more time than that. I had thought that by having a natural, unmedicated birth meant that I would bounce back quickly, but it definitely takes a lot of time and patience to allow your body to heal!

Breastfeeding ( . )( . ) 

I will be writing a separate, more in-depth post about my breastfeeding experience, but the short of it is that we had a tough time with breastfeeding.

My milk came in about four days after giving birth. I did not realize (or remember?) that this would happen, and when I became engorged for the first time, I thought I had mastitis! I was terrified, not to mention I felt like a truck had hit me (and left me with humongous boulder boobs). I felt very sick, and my chest hurt so bad, heavy and stretched out from being so engorged. My mom would run in and out of our bedroom to get more hot towels from the kitchen for me so I could lay them over my chest. I tried pumping it out, but the sensation was so painful I couldn’t keep it up (I also had a regular pump vs a hospital one) and so nothing much came out. It. Was. Stressful. And painful.

The first few times Little Lion latched, it hurt. I kind of expected that, this being my first baby and first time breastfeeding, my nipples were not used to having a baby sucking and pulling on them, etc. But what I didn’t expect was the abrasion on one of my nipples, which caused extreme pain, worse than giving birth. I had to call in two different lactation consultants (IBCLC-certified; why IBCLC over CLC) to find some relief and validation and advice on what to do next. My nipple took almost two weeks to completely heal, longer than anyone expected. Furthermore, Little Lion had a tongue tie, which made his suck ineffective. By the time my nipple healed and we had figured out the tongue tie issue, I was feeling very depressed and discouraged, and our Little Lion was starting to become underweight. We eventually reached a happy medium, where I could provide him with breastmilk through the bottle, and he could nurse at night or before nap time (nursing “recreationally,” as I like to call it), but it took a lot of blood, sweat, and tears to get there.
I am fortunate to not have experienced mastitis, but I did have clogged ducts and the beginnings of an infection… My breast would be hard and tender, I would get a headache, and I’d have the chills. I felt like crap, and that wasn’t even mastitis! It was unpleasant enough the 2-3 times I experienced it that I work hard every day to make sure I empty out my breasts adequately (plus it helps supply stay up).

Weight loss 

During pregnancy, I ate well. I ate a lot of protein (did not really have any food aversion aside from bacon, which was a staple in our household!), a lot of veggies (to keep away the constipation), not much sugar or carb. I referenced the book Primal Moms Look Good Naked a lot. I also continued stretching and physical exercise, walking daily and dancing.

Regaining the pre-baby body (or closer to it) is still a work in progress. Every fiber of my being during the first three months postpartum was consumed with trying to figure out a solution to the breastfeeding, and so even though I received clearance from the midwife at six weeks to resume light exercise, I didn’t do anything. I don’t think I even left the master bedroom for good until at least eight weeks postpartum. I lost weight after childbirth with the fluids and placenta and hormones regulating, but I wasn’t losing much very quickly (naturally, since I wasn’t exercising), and it got kind of depressing.

My mommy friends all told me that breastfeeding helps you to lose weight, but they didn’t mention that breastfeeding also significantly increases your appetite! I was SO hungry, ALL the time. I would need to eat a meal between all the meals, and I was able to eat almost twice as much as I usually do. AND, I would wake up starving in the middle of the night! Even though I was eating all the same healthy foods as I did during pregnancy, I was eating so much of it that it was getting out of hand. My mom and my husband were both concerned because I was always telling them I was hungry… Furthermore, since my mom was doing all the cooking and wasn’t familiar with our usual serving sizes, the proportions were all out of whack (she made two servings into one serving… and I ate it ALL). I also had an unhealthy addiction to granola for about… four months. That’s A LOT of sugar to consume!

Eventually my appetite regulated, and once I taught my mom how to proportion all the food, I started noticing that I felt better and the weight came off easier. When I started walking our dog regularly again, I noticed a big change in my body shape. It took me almost five months, but I finally started going back to my dance classes, and I am doing yoga at home. I don’t do anything too intense because I can tell that I’m still regaining my strength, flexibility, and balance, and I definitely cannot afford to injure myself now. I don’t expect to regain my pre-baby body this year (although it’d be great if I did!) because I am basically starting from scratch–I haven’t done intense physical exercise in over a year! But it definitely feels good to be working towards it.

Anxiety 

A lot of my anxiety stemmed from our breastfeeding issues. It got depressing quick. And I couldn’t dig myself out of it, and I couldn’t bring myself to find help either. It was a roller coaster every day: I would wake up feeling optimistic and great, and then by evening I was a mess and depressed. Not leaving the bedroom probably didn’t help. Once we figured out the weight issue for the baby,  I felt a lot better and more hopeful. Also, healing up enough to get out of the house and get fresh air and see people made my days brighter (the seasons were changing too 🌥). I also started seeing my therapist that I hadn’t seen for a year. It was good to talk to her, but looking back, it almost seemed like I wasn’t ready to accept the help. I was in a brain fog with the sleep deprivation, the breastfeeding anxiety, the physical pain… Once the Little Lion started gaining weight and I felt a little better, I stopped seeing my therapist, thinking that I had nothing left to discuss. But feeling better is not getting better.

Around four and a half months, I felt overwhelmed with all that I had to do at home. Again, I couldn’t seem to get myself together to find help. Again, I was on the roller coaster: happy and productive one day, angry and frustrated and bored the next. I think having this roller coaster of emotions gave me a false sense of security, like maybe things would pass and I would feel better for good soon. It was a denial of sorts, probably because I thought that admitting I couldn’t handle it meant that I was failing at being a mom! On the bad days, all the emotions and anxiety from the first three months regarding breastfeeding resurfaced because I hadn’t dealt with them thoroughly. Compounded with the feelings of being overwhelmed, I couldn’t handle it and lashed out. The Lion reminded me of all the available resources I had: therapy, self-help books, friends, family. I was floored. ‘Of course! Why hadn’t I thought of this before?!’ I immediately reached for Feeling Good and called my therapist for an appointment.

I saw my therapist once a week every week for a month. Now I am going to see her every couple weeks, and I think eventually, once a  month. Talking to my therapist has been unbelievably helpful. I’ve made a lot of changes thanks to these 50 minute sessions​ with her. I look forward to getting to talk things out and have them reflected back to me, and I enjoy having my feelings validated and understood. I’ve learned a lot about self-judgment and acceptance from my therapist. Reading about how to feel good and understanding why and what causes me to feel not-good has been enlightening as well. I catch myself relapsing sometimes, but I try to combat the negativity quickly before it consumes me. Feeling Good taught me some ways to cope with negative thoughts that enter my mind, including changing specific phrasing in our thoughts and speech that we don’t notice is damaging until it’s too late.

I’ve learned to manage expectations, to have acceptance, to not judge myself, and of course, to take care of myself.

Self-Care

The Lion and I realized early on that in order for me to take care of Little Lion and the family, I needed to take care of myself. Whether it’s dinner out with friends, an exercise class, a mani/pedi, or even just some quiet time tending to our garden, I need it to feel refreshed and rejuvenated, I need it to energize me to continue with my job of caring for the family.

I realized that I needed these things. I need the time to put on a little bit of make up (or even to just brush my teeth) or to wear things that I feel comfortable in and feel like I look good in. Now, the clothes don’t need to be fancy because I need to be comfortable and able to lift my arms (aka, pick up the lion cub), and they’ll probably get spit-up on them by the end of the day anyway, but I want to look good as a new mama. None of my pre-pregnancy clothes fit me, and they actually all seemed outdated and dusty from sitting in my closet untouched for 6+ months. And I definitely didn’t want to continue wearing my maternity clothes because now they were too big. So I finally decided, since I wasn’t losing the weight as quickly as I’d liked, I’m going to give my body acceptance, a break, some grace. My body went through A LOT, and I deserved to have a new wardrobe, even if it’s a small one (because my body will change again once I DO lose the weight and/or once I stop breastfeeding). I needed something that I fit in, could nurse (or pump) in, and something that I could feel GOOD about myself in! I’m happy to keep the weight and work it off slowly because I know it’s important for breastfeeding, but that doesn’t mean I can’t feel and look good doing it.

The TL;DR of postpartum recovery is that caring for yourself, mentally and physically, is of utmost importance. Anytime that something doesn’t feel right, whether it’s the breastfeeding or feelings of anxiety, it’s time to find help, to find someone to discuss it with. I hope I remember that for next time because next time, I will have TWO lion cubs to care for!

 

Fear of childbirth, or lack thereof (#unmedicatedbirth, #pregnancy, #motherhood)

This was a draft that I had typed up during pregnancy and apparently never published! 
Recently, a good family friend asked how I was feeling, in terms of emotions. He asked if I felt scared or overwhelmed, maybe because his wife had exhibited those feelings when she was pregnant many years ago. 

I responded that I feel excited! I didn’t feel scared. I have been taking an active part in this pregnancy and childbirth process. I have been preparing to understand what pregnancy is and means, what changes my body and mind are experiencing, the work of my uterus and my placenta, relaxation techniques and comfortable positions during pregnancy and childbirth, and generally, how to adapt and accept all these changes. 

I’ve learned that there’s a difference between pain and suffering. Labor is painful, that is inevitable. But suffering? Suffering is not inevitable, suffering is a mental state. Natural labor has a rhythm, and if I am willing to ride the waves of contractions, labor will be much less suffering (but likely just as painful 😉 

I want and am excited to have an “amazing” experience!

“Decode your body messages, modify your lifestyle, and if you are worried about labor, find out how you can help yourself.” -Kitzinger Complete book of childbirth and pregnancy

Why Do Some Families Lack Clean Water?

There is an ad pre-rolling on Youtube I have seen several times now that features Matt Damon for Stella Artois/Water.org pitching for some supposed concern they have for “solving the world water crisis.” Ignoring the fact that this phraseology makes it sound like a sudden act of nature and not a socio-cultural phenomenon that so many people around the world go without “clean water”, whatever the hell that means, this ad strikes me as utter bullshit worth commenting on for the following reason:

Damon says they SA/Water.org have partnered to bring clean water to “women and their families” in such stricken Third World environments. Why “women and their families”? Why wouldn’t it be “men and their families”? Don’t these women’s families include men? If so, why aren’t the men doing anything to provide the “women and their (the men’s) families” with clean water? Since women are just as capable as men (Feminist Truth), why aren’t women in these countries able to provide clean water on their own?

Why is clean water something that people in certain countries can do themselves, but in other places, we need Matt Damon and a beer company to shill so people will help out?

This is a fraud on a variety of levels, as indicated by the fact that Matt Damon is a part of the production.

Review – The Vaccine Book (#vaccination, #health)

The Vaccine Book: Making the Right Decision for Your Child

by Dr. Robert W. Sears, published 2011

How many people who are “pro-vaccine” have read a book about vaccines?

How many people are aware of the frequency, severity and treatability of diseases which have vaccines available before deciding to take the vaccine? How many people understand the common, rare and potentially severe side effects, the physical components in the vaccines, the method by which the vaccine is manufactured and the availability of competing vaccine brands and production methods?

How many people understand the common vectors of each vaccine treatable disease and thus how to potentially avoid exposure to it entirely?

Who is likely to be better read on the subject of vaccines (even if you argued that they are ultimately misinformed)– your average vaccine taker, or your average vaccine skeptic?

Dr. Bob Sears is “pro-vaccine”– he believes vaccines have done more good than harm in the history of medicine and that they are an important part of individual and public health practices and he believes the standard vaccine schedules for infants and adults should be followed with few exceptions. So why is he having his medical license put under review because he supposedly gave a “non-evidence based” recommendation to a family to not vaccinate their child?

Because it’s hard to imagine a world in which a doctor would come under the scrutiny of authorities for giving a pro-intervention recommendation to a patient that was “non-evidence based”, perhaps we can assume that it is because Dr. Bob has challenged the medical establishment on the most fundamental level possible by writing a book which posits that patients should be informed about their choices and should ultimately provide knowledgeable consent before proceeding with a potentially dangerous treatment regimen such as infant vaccination. Sadly, if you ask most doctors to explain why they want to treat you the way that they do, what you get is not “evidence based” dialog about your choices, but sarcastic reminders about whose medical school plaque is on the wall.

It’s sometimes more like a priesthood than a profession, even though that doesn’t necessarily mean their advice is wrong or should be ignored.

So that is the controversy, but what does Dr. Sears actually say about vaccines?

The first twelve chapters of the book are dedicated to one disease each and its respective vaccine; the remaining chapters explore vaccine research, vaccine safety, vaccine ingredients, vaccine side effects and other topics.

The disease chapters outline the common course of each disease including symptoms, severity and treatment, followed by the common vaccine options available on the market including their preparation method and ingredients and common and rare side effects. There is a “pro” and “con” section exploring reasons to consider administering the vaccine and reasons why people/parents have not wanted to take the vaccine, and then Dr. Sears weighs in with his own take on how important the vaccine is. Each chapter helpfully summarizes the information with simple boxed call outs indicating whether the disease is common, severe and treatable (without a vaccine).

The common/severe/treatable approach is interesting. I found a lot of the diseases covered not-threatening because of the various combinations they “checked” in each category: a disease might be severe and treatable, and not common, or common, but not severe and treatable. The worst combination would be common, severe and untreatable– I don’t remember any disease with that profile. Just the opposite, in fact. According to Dr. Sears, with thanks mostly to widespread vaccination, most of the diseases mentioned are not common (to the point that they’re actually or practically eradicated in the US/West) so there is almost no chance of catching it, vaccinated or not. Several others are typically so minor in their symptoms, especially in infants (versus adults), that they might be mistaken for a common cold if caught. And those that are potentially severe seem to be treatable with antibiotics in most cases, especially if diagnosed early in the course of the illness.

That being said, some of these diseases have the potential to put the victim in the hospital if the disease is not checked early, or it happens to be especially challenging to an individual’s immune system. In such a situation, even with a full recovery and no lasting damage the experience itself is likely to be stressful, costly, traumatic for the child and heartbreaking for the parents to watch– it’s not a joke as far as risks go, and it needs to be considered seriously. And a few of the diseases, if caught and if particularly intense in the course of the disease, do risk permanent neurological or organ damage even if successfully treated. That’s a terrifying possibility!

Reading between the lines a little bit here, Dr. Sears seems pretty clear that whatever risks there are for an unvaccinated child in contracting and fighting any of these diseases, they are even smaller for a child who is breastfed and avoids day care or other germ-ridden public child environments. Assuming this is the course a parent is following with their infant (as we are), it seems a lot more like a judgement call between accepting the risks of rare disease complications the child is likely never to get, or accepting the risks of vaccine side effects (short and long-term) which are inevitable and seemingly random in their frequency and severity. There are several diseases/vaccines mentioned which simply pose no risk whatsoever (chickenpox), or for which the illness can not be contracted by the infant without an infected mother who transmits it during pregnancy or birth, or for which the illness and vaccine do not become relevant until adolescence or adulthood (such as HPV, a sexually-transmitted disease). Taking what’s left, and given our commitment to breastfeeding and homecare/homeschooling, it just doesn’t look like vaccines make a lot of sense for our family.

That was the part of the book I struggled with the most, when Dr. Sears recommended a vaccine not for the infant’s safety, but for public health reasons, such as to maintain low prevalence of a disease across a population, or to protect at-risk family members or caregivers who could catch the disease from the infant and have a more difficult time fighting it (for example, Dr. Sears talks about how a pregnant school teacher could catch a disease from unvaccinated students that could harm her unborn child). This is all good information to have and consider in the event of one of these complicating circumstances actually being relevant to a family’s situation, and certainly the “moral” issues are worth considering and debating, but it seems clear that if the question is simply put as “Does this vaccine represent a worthwhile risk/reward profile to the individual being vaccinated?” the answer we arrived at was often “No.” That’s a very different question from “Is it our job to take health risks with our child to protect other people/children from health risks?”

Interestingly, smallpox has been eradicated but the vaccine is no longer given to preserve herd immunity. Instead it is controlled by the US government as a national defense reserve. In identical situations where a disease, such as polio, has been practically eradicated, Dr. Sears still recommends getting the vaccine for public health reasons, but with smallpox there is no suggestion that the public needs to keep getting vaccinated to be protected from an eradicated illness. Why the different logic?

Another item I made special note of was the relationship between traveling, domestically and internationally, and vaccination of an infant. Dr. Sears is explicit in saying that flying around on airplanes is not an easy way to catch a vaccine-preventable disease, and that there is essentially no risk of this happening for travel within the US, and there is very little chance of this happening for travel outside the US. He does suggest that people who are essentially “living in the bush”, doing missionary work in remote locations or areas where these diseases are endemic in the population, are at special risk for some of these illnesses, but again this doesn’t apply to us because we aren’t going to be traveling to poverty-ridden areas or where access to clean water might be an issue. It was comforting to know that travel as part of our lifestyle doesn’t really need to be changed because of our decision not to follow the recommended infant vaccination schedule.

The other thing I wanted to mention is Dr. Sears’s opinion about the state of vaccine safety research. In short, he says a lot of the studies are wanting. Here are some especially troubling quotes:

Some vaccines aren’t studied alone. Instead, they are given along with several other vaccines, so there is no way to know what their actual side effects may be.

[…]

Most vaccine side effects are monitored for a short time via parent questionnaires.

[…]

Out of the twenty-three major studies done to date that show no link between vaccines and autism, eighteen have some conflict of interest involving vaccine manufacturers. Similarly, the addition of the hepatitis B vaccine to the infant schedule was driven largely by research done by doctors who worked for the vaccine manufacturers.

[…]

What about the statistical chance that your child might get a severe, life-threatening case of one of these diseases? To my knowledge, that information has never been determined accurately through precise scientific statistical analysis. [… Dr. Sears estimates these risks as follows:] A very rough total of 55,000 cases of severe diseases each year in children. We know that the current US population of kids twelve and under is about 60 million. Dividing 60 million by 55,000 cases means that each child has a 1 in 1090 chance of suffering a severe case of a vaccine-preventable illness over the first twelve years of life. Note that flu and rotavirus are responsible for most of these cases. If one were to run the numbers without those two diseases, the risk of suffering a severe case of one of the uncommon disease is only about 1 in 6000. Most severe pediatric cases occur during the first two years of life. An estimation of severe cases in children two years and younger would be about 34,000 cases divided by 10 million kids, or about 1 in 300.

[…]

What is very clear, however, is that vaccines have triggered autism in a very small number of children. A phrase I recently heard sums it up very well: Vaccines don’t cause autism… except when they do.

[…]

If we were to throw out all research that has some conflict of interest, we would actually be left with very little on either side of the [vaccine-autism] debate […] the right type of research has not been done yet.

In addition, here is what Dr. Sears would consider to be the minimum standard for a valid safety research study, which might be helpful for people trying to evaluate various studies in making up their mind about the risks posed by diseases and their vaccines:

  • Prospective: the study group is selected and then followed in real time. Virtually all current research has been retrospective, looking back into the past at data on groups of children who have since grown up (for which the outcome is already known).
  • Randomized: test subjects are selected at random and placed in either the study or the placebo group in a random manner to avoid bias.
  • Placebo-controlled: a study group exists that is not receiving the treatment in question (in this case, vaccines). This is the primary way to be able to draw conclusions with a high degree of accuracy.
  • Double-blind study: the researchers and the study subjects don’t know who is receiving the test treatment (vaccines). This prevents bias as the researchers observe and collect, and the test subjects report, data.
  • Large-scale research: this is needed for a study to be considered statistically significant and to prove the findings aren’t simply due to chance.

Interestingly, he explains why these studies haven’t been performed to date, and I am not surprised to report it is not an example of “market failure”! The government, as usual, plays a big role here.

A final note: There are several instances where Dr. Sears refers to a disease which has been practically eradicated, but which in recent memory has experienced a sudden outbreak in a localized community before being contained. Aside from a generic geographic description, such as “a neighborhood in Ohio” or something like that, there is no demographic data given about these outbreaks, if it is even collected and publicly known. Wouldn’t it be interesting to know that? If these periodic outbreaks are restricted to specific socio-economic populations, wouldn’t that change the implied incidence of risk for the population as a whole? I’d want to know that information, but the current state of medical research in our country considers this unscientific and irrelevant, so much so that it is politically incorrect to wonder about it. How can facts be offensive? It seems like there is an attempt to control political dialogue here, which I find disturbing.

This book has many virtues but its greatest one is that the information is both comprehensive and well organized, while still remaining succinct. It’s very easy to approach the question of vaccination, its risks and benefits, from a number of angles and find all of them anticipated by this book, and more.

4/5

Notes About The First Ten Days Of Your Life (#infancy, #life)

To my Little Lion,

I wanted to share some observations about the condition of your world at the time of and shortly after your birth, just ten days ago. It may interest you to look back on this some day, and it will be of benefit to me and your mother to remind ourselves of our good fortune, and yours.

You were born during the Winter Solstice last year (it’s New Year’s Day today, so I can already say “last year”, as if you’ve been around so long… we’re already shocked when we realize you have not been around even a month) and what’s more, you were born during a rain storm, the rarest of rare weather conditions where we currently live. Your mother and I are not superstitious people and we don’t believe there is any cosmic agency behind the concurrence of these events, I just find them remarkable because of their natural beauty, much like the nearly perfect weather conditions this morning when I finally took our dog for a walk– cool, breezy, clear, sunny, good visibility all the way off the coast to the island, fresh smelling air after another night’s rainfall.

You were born at home, as planned. The Wolf and I planned for months for that moment, as you were slowly growing inside of her belly, because we thought it gave the most advantages to you and to us. All of our friends who have had children describe the happiest part of the birth of their children as the moment they were released from the hospital and able to come home. We figured, why not just start at home and skip a few steps? We valued the privacy of it, as well. Your mother could labor anywhere she felt comfortable doing so, in an environment she knew well, with only your father and the three birth attendants (the midwife, the midwife-in-training and the doula to comfort your mother) nearby. We looked at your birth as a natural, healthy process and we were concerned that bringing you into the world in a hospital would encourage everyone around you to try to notice what might be wrong with you and your health, rather than what is right. It’s not that we’re anti-hospitals, and we appreciate that we live nearby one in case we needed extra help in bringing you into the world, we just try to live our lives simply and it seemed like we could do without. Your mother took great care to eat well, exercise, think happy thoughts, read a lot about you and how you were growing and how you’d be when you arrived, and so it seemed with such low risks to keep it that way by having you at home.

What did not go as planned was the specific day you decided to arrive! We were expecting you a few weeks from the day you were born. The Wolf and I were methodically going through our preparation checklists each day and week as your expected due date got closer. The day you were born, I was supposed to run to the market and start stocking up on supplies to feed your mother and the birth team. I didn’t get there in time! Your mother started laboring early in the morning and had pushed you out (without any drugs or medical intervention) by the afternoon! We didn’t even get the birth tub here in time for your water birth, she had you right on the bed you sleep in with us at night. The midwife was very kind and let me “catch” you as you came out. It was an exhilarating experience to grab your wet, slippery, bony, hot little body for the first time and lift you up and place you on your mother’s chest. We didn’t know what you’d be — a little boy or a little girl, though your mother says she secretly suspected you were a boy, and every passerby on our daily walks thought for sure you were a boy from the way your mother was carrying you, which is more superstition — but we were excited that you were what you were, if that makes any sense!

The birth team was so great with your mother. The doula arrived first and comforted your mother. Even though you couldn’t LEGALLY be delivered in our own bath tub (well, your bath tub, in your room), which I will tell you more about such silliness when you’re older, your mother labored in there with the doula while we waited for the midwife and her assistant to arrive. Everyone encouraged your mother and gave her the confidence and support she needed to bring you out, even though your father didn’t have any food or drink for anyone!

Your Grandma and Grandpa Lion came over to visit that first night and brought your mother and I some much needed food. They were so excited to see you! Your Grandma Wolf came a few days later, she lives a few thousand miles away and had to quickly change her plane tickets to be able to see you. She’s with us now and will be for the next few weeks. She is a big help for your mother and father, helping with sweeping, cleaning up dishes (your father is rediscovering his penchant for cooking these past few weeks), caring for your dog, doing laundry and even spending time with you which is really her greatest reward. She does all the hard work without complaint, with a smile on her face, getting to spend time with you for even a moment seems to make it all worthwhile to her. Even when you poop and pee on her, the chair, the floor and your dog during your “air time”. (Oh, and your Grandma Wolf is super obsessed with you staying warm, she is always chiding me about it.)

Your Auntie Lionesses came by and pitched in, too. They helped change bed sheets, sweep floors and they gave your mother and father an awesome early Christmas gift– six nights of meals that we packaged and put in the freezer to make more time available for me and your mother to spend with you. You’ve had a few visitors already, mostly your mother’s friends and some of Grandma and Grandpa Lion’s friends. They’ve bought food, gifts and good wishes. We didn’t have a name for you at first. Well, we did, but we hadn’t settled on it. So the first five days of your life created an obsessive mystery for many of the people who care about you. We “revealed” your name on Christmas Day while visiting at Grandma and Grandpa Lion’s house and everyone was overjoyed. Your Grandpa Wolf doesn’t get to meet you, but he gets to enjoy being part of your namesake, which we hope you will be able to appreciate some day.

As I said before, it is hard for your mother and I to believe you’ve only been with us for ten days now. All you know of the world is our bedroom, our living room, our kitchen, the view of the sky on the way to the local bakery and back, the ceiling of your mother’s car, and a few rooms of Grandma and Grandpa Lion’s house. The only people you know about are the few people who have come to see you so far, and most of them looked like funny blurs to you that you couldn’t focus on. You might imagine there are three animals in the whole world, your dog and your grandma and grandpa’s two dogs. We try to keep remembering that everything is new to you right now and everything will be new to you for years to come– you will need patience and your own space to learn and explore the vast diversity of the world and to make sense of it all.

We spend time holding you, but we also give you time on your back — on the bed, on the couch, not yet on the floor but eventually — to look around and move your body on your own. Your movements are jittery and random, but they have great meaning and importance to you. You are working on developing yourself, even when you’re moving around in your sleep, trying to become the person you will be. We don’t ever want to forget that, or try to hurry it, or expect anything of you but that. We resist as much as we can the temptation to “pattern-fit” your behavior right now, especially when people ask silly but well-intentioned questions like “How is he sleeping?”, “How is he eating?” etc. The answer is always, just as you are supposed to, whatever that is each day and night, it’s always changing because you’re always changing, getting a little older and a little bit further along your own plan each moment.

There’s so much more I could say, but this is what I want to focus on for now. Raising you is indeed a challenge, but it’s a challenge we chose and it’s a challenge we love (even aside from all the help we’ve gotten so far). We look forward to each day with you!

Another Story About The ER (#health, #parenting, #infancy, #risks)

The following is an email sent by a friend who reads the blog in response to the recent posts about my visit to the ER. It is about an experience he had with his infant daughter and I got his permission to share it as it is illustrative of many of the principles touched upon in my earlier posts:

When [my baby] was 9 days old she presented with what appeared to be an infection in her right eye (eye lid swelling, puss coming out the side, dark skin around the eye [picture attachment omitted]).

I think we waited overnight (details are a little fuzzy now that it’s been over 2 years) before doing anything because we were hoping it would resolve itself without having to go to a doctor, who might urge us to go to the ER, which we wanted to avoid if at all possible.

The next day it didn’t look better so we took her to the pediatrician, who was particularly concerned and brought another doctor into the room to examine her, we expressed our concern that we really didn’t want to go to the ER if at all possible, both doctors said we should go. They were concerned “because she’s so young” and “because the infection is so close to the brain.”

We got to the ER and it took for fucking ever to even get a room, of course you’re shoved into a massive environment of sick people dying to infect you with god knows what disease they have from living a terrible unhealthy life. It was literally like 6 hours before we finally got a room. At this point it was late at night and I kept thinking, “man, her eye looks better, if it looked like this 6 hours ago I don’t think we would’ve been sent to the ER.”

But the doctors kept saying shit like, “yeah we’ve seen things look better but actually be getting worse.”

The doctors wanted to do a blood test to see what the infection was and start her immediately on IV antibiotics. Additionally, they wanted to do a spinal tap (some advanced way of determining what the infection might be). I wanted to push the IV antibiotics back until we knew what the infection might be (as the results of a blood test might indicate), but they kept pushing and saying, “these things can move fast, we really think you should get IV antibiotics ASAP.”

Eventually we caved and agreed to the IV antibiotics (which was an awful experience in their own right because [my baby] was so small, and her veins were difficult to find, took literally 4 practitioners before they could finally access her vein — [my baby] was screaming like crazy and we were saying, “can’t you find someone else to do it?” And the girl said, “don’t feel bad, she won’t remember it.” Who says that?!) As a side note, god forbid you have to go through something like this, but if you do immediately ask for a practitioner from the neonatal intensive care unit (NICU) to insert any IV into your child, they can find a needle in a haystack.

At this point they were still pushing for a spinal tap and I said, “If the blood results come back negative, is there ANY reason to do a spinal tap?” The doctor said typically no. I said, “Well let’s see what the blood results say then.” The results came back negative, so I said I’m not doing the spinal tap. The doctor kept saying, “well, sometimes things can slip by the blood tests.” But I refused. I left to go home and get changes of clothes for me and [my wife] since we didn’t realize we’d be at the hospital for 2 days, and while I was gone [my wife] said that they sent in some other doctor (female this time) to pull at her emotions to try and get her to agree to a spinal tap, but she refused, we didn’t do it — the infection just looked so much better already (even before the god damned antibiotics).

We stayed with [my baby] in the hospital like 36 hours, during that time we were regaled with fantastical tales of babies contracting Hep B and why we should really give her the Hep B vaccine. I kept asking the doctor to give me a realistic example of how [my baby] would contract Hep B at this age. His examples were literally so absurd they’re not even worth typing them, one involved a syringe with Hep B on it being mistakenly inserted into [my baby] by someone in the hospital, it was so ridiculous I could barely listen to it. We didn’t get her a Hep B vaccine, and still haven’t, and she’s miraculously Hep B free! I also mentioned to the doctor, “even if we agreed that [my baby] should get a Hep B vaccine soon, wouldn’t this be a BAD time to give it to her given that she’s obviously fighting off some infection?” The doctor wasn’t fazed by this logic, they’re total vaccine zealots, they’d vaccinate a cadaver given the opportunity.

In any case, in thinking back on the whole situation and what I would do differently, I think I would just wait an extra few hours before going to see the doctor, and when it looked better pre-IV antibiotics, I would’ve said, “let’s wait another few hours and see how she’s doing.” I just don’t buy their insane logic that something is visibly getting better but somehow actually getting worse. I’m sure there’s some textbook case of this happening to 1 in 1,000,000 babies, but doesn’t seem worth the known risks of IV antibiotics at such a young age.

It’s so sad and frustrating that you can’t simply take a doctor’s advice and trust that he’s already thoroughly immersed himself in the risks and benefits of the trade-offs between treatment / non-treatment. All they know is how to limit their own legal liability.

Hopefully you can avoid such a mess from happening to you!

He adds in an addendum:

Since doctors in large hospitals work in shifts, you naturally see the same doctor for awhile, and then see a new doctor for awhile. When it was time for [my baby] to be released, we were given an older doctor (maybe late 50s, early 60s). Not only was he WAY more respectful than pretty much every previous doctor we had, but he literally said something to the effect of, “if you’d gotten an older doctor, you may never have been admitted to the hospital, probably would’ve suggested you wait and see how the infection progressed.”

It seems that the doctors being minted today are inculcated with one-off horror stories starting on day 1 of their education.

My Trip To South Africa & Dubai (#travel, #SouthAfrica, #Dubai, #safari)

In early November I had the opportunity to travel to South Africa for the first time in my life, which included a visit to a private game reserve, Sabi Sands, in the Kruger National Park region. My prior knowledge of Africa in general and South Africa in particular was derived from things like the autobiography of Roald Dahl, the novel The Power of One, various history lessons about European colonialism and WW2 and assorted contemporary news articles about violence and poverty in post-independence South Africa. Clearly, none of it could really prepare my mind for what South Africa was as I experienced it, and certainly it couldn’t capture the majesty of experiencing exotic wildlife up close (sometimes as close as 6 feet away, protected only by the elevation of an otherwise open vehicle) in its natural habitat, much better than the idea captured by a “living zoo”. As a collection of experiences packed into 11 days of travel, it would be exhausting to fully catalog as a blog post, so I’ll try to stick to some high level perspectives and recollections as far as piecing this entry together goes.

Our trip started in Cape Town, which we transited to through the UK and which involved two day/night cycles which made for truly disorienting jet lag on arrival. Despite being an international airport capable of servicing large, long-distance aircraft like ours, the terminal was “sleepy”, with little people and activity aside from the recent arrivals. Security and customs was a joke– no disembarkation card to fill out, no questions, just a quick stamp in the passport book and then on our way. It suggests South Africa is either quite welcome to having visitors and tourism, or doesn’t take border security seriously. Either way, I appreciated it as a traveler.

The ride from the airport to our destination downtown took us by numerous shantytowns along the roadside. I learned later that these shantytowns are normally populated by recent immigrants from bordering African countries which are even more poor and unstable than South Africa. South African law allows for squatters rights after some short period (may have been 90 days) at which point the shantys can’t be removed. It doesn’t seem like there is a concerted effort to remove them in the meantime as the towns were numerous and expansive. Trash develops along the roadside wherever they spring up but they otherwise appear to be orderly places, with electricity, running water and satellite TV. I don’t know if satellite TV would be the most important use of my funds as an impoverished immigrant and I am always surprised to see how the “destitute” manage to be able to shell out for what appears to me a luxury item. But who am I to judge?

Something that struck me being in and around Cape Town was the number of construction cranes on the skyline! Cape Town by no means has a “scenic” skyline. The architecture is largely dreary and uninspired, it looks like the kind of semi-Soviet concrete structures that populated many Third World countries during itinerant booms in the 1970s and 1980s. But it seems that Cape Town is participating in the same global boom in downtown real estate prices and thus experiencing the regenerative development patterns that can be seen in every other major metro from LA to London to Tokyo. From my hotel balcony near the water front I could see 8 different construction cranes, and I did not have a full 180 degree view looking back toward the city. Surely there were more that escaped my notice.

The other thing I noticed about Cape Town is that it is geographically scenic. Framed by Table Mountain in the background, Cape Town appears to offer many retreats and activities for the active bodied resident. And standing on Table Mountain you can see all that you might like to see– Cape Point and the southernmost part of Africa, the Stellenbosch wine region and dramatic, glassy ocean blue views. With international shipping routes converging at the cape, the horizon is peppered with interesting longhulled ships here and there. There are opportunities for ocean sports, hiking, climbing, air sports, “extreme sports” and more.

We took a tour of the wine country, Stellenbosch, and I found it both scenic and idyllic. And the wine was fantastic. I chatted with a friend before my trip who is a wine snob, who insisted “South Africa doesn’t have any good wine.” I just don’t know what to say to that kind of ignorance, it is demeaning to the country to even treat the objection seriously.

When I visit some place new I always try to ask myself, “Could I imagine living here?” My biggest stumbling block is usually thinking about what value-added service I could provide to have a comfortable income in this new place. Nothing stuck out to me in terms of economic opportunities during my short visit in Cape Town. And while I don’t think I’d rush to find some place to live there, I could see myself enjoying my lifestyle there.

After a few days of acclimating in Cape Town, we were off to the bush for the safari. We took a small aircraft (jet) from Cape Town to a municipal airport in the northeast of the country, and from there boarded an even smaller aircraft (twin propeller) where luggage weight was a concern and flew directly to the game reserve’s air strip about 15 minutes away. Here we were picked up by our guides and trackers in their Land Rover trucks and proceeded directly into the reserve. Not knowing what to expect, I was quite shocked when a few minutes later we spotted a herd of elephants in the brush, thinking that we needed to drive to some “attraction” area to do some animal spotting. This would be a theme throughout the visit, the unexpected nature of animal sightings which occurred nearly everywhere.

Before going further, I want to talk about health risks in the bush. November in South Africa is the beginning of the summer rainy season, and the rains activate insects which have lain dormant through the dry winter period. The health recommendation for the trip was to take vaccines for Typhoid, Hep A and Malaria (and/or anti-malarial pills). According to the CDC, the country is a known risk factor for the first two and the particular area we were going to for the safari, near Kruger, is a known malarial zone.

Prior to the trip, I agonized about whether or not to take steps to protect myself. As a general rule, I am a vaccination skeptic. I also was trying to think about the risk of getting ill and/or bringing something home with a pregnant wife near term. After doing a lot of research and thinking about it, I decided not to take any vaccinations nor to take the anti-malarial pill regimen. My reasons were many. First, I found out that typhoid and hep A are extremely uncomfortable symptomatically, but they are not considered lethal nor do they cause lasting tissue damage, and a normal person can fight the disease and heal on their own if they contract the disease. I also studied the transmission mechanism for these diseases, which is contact with bodily fluids (specifically blood or feces) from an infected person. I was never going to be anywhere on the trip where I expected to be exposed to that kind of hygiene problem, and I didn’t see why I was at more risk of this transmission mechanism at home versus in South Africa. Googling and reading stories on TripAdvisor confirmed these suspicions– people with more competent doctors were laughed at for considering these precautions on anything but remote mission work, and even then.

As for malaria, I did a lot of research and realized that we were unlikely to encounter a lot of mosquitos at this point in the season. In addition, most people reported success in warding off bites (which are the only vector for the disease) with simple bug spray repellant. Finally, while malaria can be lethal, if it is contracted it is pretty obvious and can be treated with anti-viral medications at that time with a high rate of success. The side effects of anti-mallarial medications are well known and include horrible nightmares, vomiting, diarrea and other miserable flu like symptoms, which seem to occur with some frequency.

I decided to take my chances and I am really glad I did. I experienced my time in Cape Town as quite “civilized”, at no point did I feel there should be a reason for there to be a heightened risk of transmission of typhoid/hep A via food contamination, the most likely vector given that I don’t do intravenous drugs or hang out with prostitutes. In fact, many parts of Cape Town came across as very “hip”. I think hygiene is something they understand in this part of the world and the economy, which is so dependent on tourism, would really suffer if they were poisoning all their visitors with careless, avoidable disease transmission.

As for malaria, I didn’t see one mosquito the entire safari, nor receive one bite of any insect or spider (I saw many insects and spiders). The day we arrived was the first day of rain after the dry season, and we were leaving four days later, which happens to be the normal gestation period for the larvae once they receive water. So we lucked out in that sense. However, I spoke to the guides about this and they kind of laughed at the idea of taking anti-malarials. None of them took any and none even wore bug spray. They felt it was an extremely small risk and treatable if it occurred. These are trained ecological scientists (more on that soon) and wilderness survival professionals, not snooty dorks from the city that read anti-vax hoaxes on the internet. They just found operationally it wasn’t a risk in their area.

Meanwhile, many of the other people on the safari who had taken the meds had horrible side effects to the point that they were crippled with symptoms for several precious days. When the rumor got around that they might be experiencing side effects, they one by one stopped taking their meds and recovered instantaneously, enjoying the remainder of their trip in perfect health. Aside from spraying myself with a citronella bug spray before going out more out of habits back home than anything else, I did nothing to preserve my health on the trip besides eating well as I always do, getting sleep and being aware of my surroundings. This seemed to work just fine.

The safari experience is hard to describe to a person who hasn’t enjoyed it. It is not simply like being inside a zoo exhibit, because at a zoo animals behave differently than they do in an expansive habitat. They live on a kind of rhythm created by their feeding schedules and the coming and going of people as the park opens and closes. They lose their instincts, they stop mating, they no longer hunt to survive, they no longer have to avoid predators. Often times they become depressed or deranged. So going on a safari is not a “super zoo”, but a qualitatively different experience entirely. You now are watching animals do what they always do as if no one is watching and nothing disruptive has happened in their life. You are watching them be truly natural. Modern humans struggle to understand this, but what is natural is often fundamentally different from what is man-made.

On our safari we road around the massive acreage of this game reserve in a Land Rover, with our guide driving and our tracker sitting on a chair hanging off the hood of the vehicle. It is quite noisy and obvious moving along the trails (and quite ferocious in terms of mastering the terrain, able to climb and remain balanced in steep slopes, operate in deep water, crash through small trees and other brush as necessary) but it doesn’t seem to disrupt the animals. They perceive it as a large but unthreatening animal moving through their environment, as long as the humans all remain inside.

We’d start with a 430AM wakeup, gather for a quick snack and coffee and depart by 5 or 530AM. The sun rises around 330/4AM, so by this time it has been up for awhile but it is not yet warm. We would drive and see what we could see for a couple hours, stop on the trail and make a snack and second coffee on the hood, clean up and continue driving for another hour and a half, ending around 830AM. The rest of the day was to be spent at leisure at the lodge, until afternoon tea again around 4PM, followed by the afternoon drive at 430/5PM. A similar pattern ensued, with a break for a snack and the last half of the drive occurring after sunset at which point the Land Rover headlights come on and the tracker sweeps the horizon with a floodlight rhythmically, looking for the glint of reflection coming from a hidden animals eyes.

The “Big 5” on the safari that everyone hopes to see are the leopard, the lion, the rhino, the elephant and the buffalo. We managed to see all of these, and more. We were truly spoiled as we often saw some of them more than once, or doing unusual things (mating, recovering after a kill, with newborns, etc.) We were often so close that, while I never feared for my life because we were with professionals who understood the risks, my own instinct was to tighten up and remain still not wanting to make any sudden movement unintentionally. It felt like that sudden move could invite a beast to come lunging into my lap in one snap motion!

Things that can’t be communicated in photos, and only poorly in videos, are the sounds of the safari. Warning cries. Combat sounds. Horseplay noises. Mammals, birds, insects. And of course the smells! At this time in the season, the bush and the grass are well eaten away and some of the animals are on the verge of starvation. An entire season’s worth of shit of every conceivable species is littered over nearly every square foot of ground and while it doesn’t smell bad (even when it’s fresh, most of it is essentially grass and leaf material, it is the meat-eater feces which smell putrid) it adds something to the environment. So does the occasional rotting carcass, which can literally be smelled from a mile away and which is totally revolting at proximity when driving by.

And then there are just general landscape items that are hard to capture because they become almost monotonously mesmerizing as they are passed by repeatedly. Hundred year old termite mounds that look like small hills dotting the landscape every fifty or sixty yards. Trees being slowly consumed by strangling vines. The nearly endless variety of grasses, bushes, trees and other plants, some of which have still not been cataloged and fully speciated.

All of this stuff we were whizzing past for hours every day for four days, all of it so different and unusual and unassimilable in my normal experience parameters that I was amazed at how quickly I became inured to it as a stress-induced response to being incapable of taking it all in in such a short period of time. Something funny that happened again and again was the way I’d get a photo of an animal, and then we’d come across another specimen of the same one I had photographed earlier, and I decided to set my camera aside and just watch because “I’d already seen this”, and the animal would proceed to exhibit some unusual or unexpected behavior and I’d be cursing myself for setting the camera aside! But simultaneously, I was fighting that urge to just be present and let my memories develop organically rather than trying to catalog everything at risk of missing out on actually perceiving it live and honestly.

The highest praise I can give the safari experience is that it is one I will be eager to share with my children at some point in the future. They can certainly live without it, anyone can. But it is a trip worth taking if you want to take a trip. It is just so different in terms of the sights, sounds, smells and sense you get in “being there” that it has no comparison to any other travel I’ve done up to this point in my life (and I think it’s taken the crown for most “exotic” from my trip to Japan in 2001, an experience that has not been surmounted despite a recent return trip to Asia that touched many other countries).

On our way home, we decided to stop over in Dubai for a day and see the sights. I will keep this brief. I was not impressed with Dubai. In fact, I was a bit offended with how impressed I was supposed to be. To me it was a depressing place– a false city of gilded monuments to a capability that doesn’t belong to the people who live there, constructed with resources that other people discovered and learned how to produce. It is the most sickening welfare society I have yet come across and I couldn’t get over how phony it was, with it’s attitude of “we’ve brought the best the world has to offer to one place, our city!” trying to paper over the fact that there’s nothing remarkable or noteworthy originating there.

I was really happy we only decided to spend a day there!

My Recent Trip To The ER

Three days ago I critically reflected on the idea of preventative medicine in a post where I talked about a troublesome health condition that I had developed and my experience of having it examined at a local doctor’s office. Today, I went to the ER for that same condition.

What happened?

Between Tuesday, when I first noticed discomfort in my leg, and Wednesday, when I decided to go get a doctor’s opinion before spending some family time out of town, the swelling and redness increased, but I did not develop any other symptoms. On Thursday, the swelling and redness had encircled my entire lower leg, down to my ankle (but strangely not affecting my foot) and up to my knee joint, but not beyond. On Friday, no one who had a look (and there were many prying family eyes beside mine) could tell a difference between Friday’s swelling and Thursday’s– it didn’t seem better, but it also wasn’t clear it was worse. On Saturday morning (today) we packed up and made for home, and the swelling seemed unchanged.

Some family members tried to look up bug bite sites to help guess at what caused my reaction. Others just expressed shock and concern that I wasn’t doing something, anything, to address the obvious symptoms. Suggestions were made that I visit the ER in town at our vacation spot, or at least do it when I got back.

Here is how I was thinking about this decision: the fact that the swelling wasn’t getting obviously worse seemed like a good sign, the way the body fights its fight against invaders and injuries is going on below the surface, and without some kind of evidence (increased pain, swelling, etc.) that it is slowly losing the fight, I assume it is winning it. The discoloration was more extreme and enveloping, but no increase in pain with it seemed less than frightening. I did not develop any other symptoms which suggested a spread of the condition to other vital organs– no dizziness, nausea, vomiting, confusion, etc. And as ever, I am an otherwise healthy individual who rarely experiences illnesses and generally makes speedy, fully recoveries on my own. I felt like I had a lot on my side in terms of weighing the wait.

When we got to town, I had lunch with a friend from high school who was in the area visiting relatives. His father is a doctor, and he mentioned my leg to him, to which his response was the predictable “He should get it checked out.” His dad is a good doctor and a thoughtful person in general, so I asked if he’d take a look at it to see if it was at all obvious from a visual inspection what was going on. He agreed and was surprised that I did not have tenderness or problems moving my toes up toward my shins, indicators for possible blood clot. Still, my leg looked “nasty” in his very medical opinion and he suggested I go to the ER and have them take a look. It could be a blood clot or cellulitis, an under the skin infection, both of which generally require medical intervention to treat.

The blood clot thing did concern me. I was exhibiting some of the symptoms (swelling, redness, soreness) but not all of them, and based upon my diet and exercise I assumed it’d have to be freak luck or a weird immunological response (say, to a bite?) to develop a blood clot in my leg. It seemed a really low probability, but the way to diagnose it is an ultrasound, which I’d rather not do if I don’t have to, but I don’t see as a health disaster for me for attempting.

A trip to the ER brings with it some risks– contracting an infection you didn’t come in with, incompetence in conducting routine medical exam techniques (blood draw, IV), “intervention spiral” where the medical professionals push you to treatments for diseases you don’t even have that just make your health worse, false positives. So I don’t want to go to the ER if I can avoid it. And I still think I could’ve avoided it. Aside from the swelling and redness, nothing else about my condition seemed to be getting worse and I wasn’t exhibiting any other symptoms, it seemed like it was worth taking a punt.

I decided to go to the ER based on the following:

  • second opinion of a non-specialist MD was that my reaction/condition was not “normal” and may be symptomatic of conditions that are potentially tissue-damaging or fatal
  • family was getting worried and doesn’t have the same mental and emotional framework for thinking about this as I do, so they’re going to increasingly see my approach as needlessly risky and stubbornly defiant over what could admittedly be a long self-recovery period
  • so far, no one including myself is able to diagnose what’s likely going on with any certainty
  • because I believe I am an otherwise healthy individual with a strong immune system, I think the specific risks of being exposed to an ER are pretty low for me, so I am willing to trade the potential cost of exposure to risks for gaining more certainty about my condition; my suspicion is that my condition is nothing to be worried about, but I am not prepared to take a gamble on it as we near the delivery date for our first child (best part about this, my wife was pretty skeptical and kept sending sarcastic texts to me as I explained what was going on along the lines of “What did you expect at an ER?”)

Getting admitted was even easier than going to the GP’s office on Wednesday! I filled out a half sheet of paper with my name, birth date, phone number and reason for coming to the ER. It was raining today and there were all of 2 people in the waiting room when I arrived, I got pre-screened in about 3 minutes and then walked to my private room in another 2 minutes and was seen by a nurse attendant in another couple of minutes. The doctor came in and talked to me while a scribe annotated the conversation about 5 minutes later. In total, I was at the ER from about 3pm to 6:30pm.

Before I go further, I want to make something clear: I don’t see myself as anti-Western medicine or anti-medicine in a general sense, and my observations are not supposed to be read as some unbridled skepticism or lowbrow guffawing at the “scam” of the system. I felt I was treated with concern and respect by everyone who I interacted with at the ER, and whoever is the equivalent of the General Manager of that operation is doing a great job because it runs smoothly and its clear customer service is something they’re trying to deliver. This ER is in the hospital I was born in, and which we may have to turn to in the event of a complication with our home birth plans in the coming weeks. I don’t think it’s necessary or reasonable to try to scandalize the people or the process. I simply want to illustrate my thinking about the interventionist mindset and how I experienced it at the ER.

And I knew exactly what kind of a jungle I was walking into. I made the decision when I went to the ER to also go along with (but question first) any routine intervention they’d attempt to administer unless I could get them to talk themselves out of it, or I seriously feared it posed an undue risk to my health. I’ll provide more explanation about this in a bit, but for example, they put me on an antibiotic IV– that wipes out my carefully cultivated gut bacteria and potentially exposes me to direct bacterial infection through intravenous contact, but I believe my full immunity and health profile make it statistically unlikely I will be unduly harmed by this specific intervention.

With that out of the way, I will say this: life is an uncertain enterprise.

Perfect knowledge and omniscience is not something any individual can obtain, nor need they try. We are always grasping at a little bit more illumination in our lives, more clarity when there was less focus, more understanding when before there was ignorance, and this goes for the practice of medicine as well. The contributions to the improvement of human life on this planet by innovations in medicine and physics over the last 200 years are truly astounding, so astounding that some people have concluded that we know most of what we can know about these subjects or that, at least, we need not question their conclusions. I just don’t share this conviction. I look at all actions in life as being about tradeoffs, and I see these tradeoffs being motivated by perception of uncertainty and a desire to gain more certainty. So I look at medicine as offering many answers, but not everything, and certainly not any answers that shouldn’t be questioned. Everything should be questioned, if you’ve stopped asking questions you’ve probably started to experience the knowledge dishonestly.

I went to the ER to try to relieve some uncertainty.

The nurse informed me that they planned to run a blood panel on me, which meant they needed to draw some blood. The reason for the blood panel was to see if there was any distress markers in my blood, particularly an indication of acute infection. The two theories that the doctor who saw me had were that I either had a blood clot, or an infection. Because they were going to put an IV into me to draw the blood, they decided they’d just hit me with an antibiotic drip right away as well. This was puzzling to me, because they planned to do this before confirming the results of the blood panel. The response I got from the doctor was (summarized) as follows:

MD: It’s better to be safe than sorry, don’t you think?
ME: Let’s say I have an infection, what are the chances my body could fight this on its own?
MD: (pauses for a few seconds) …mmm, 50/50. But if your wrong, and your body loses, you could lose your leg. I don’t want to scare you, but I’ve seen these things go fast, like if that’s what it is, you could be fine and then an hour later you’ve lost and it’s too late.
ME: I generally try to avoid antibiotics.
MD: Me too! I never give my kids antibiotics. Like, I won’t give them antibiotics unless they’re dying. Trust me, I wouldn’t suggest this unless I thought it was absolutely necessary, okay?

Of course, if I don’t have an infection, but a blood clot, then what good were the antibiotics? And if I have neither, what good are the antibiotics?

The nurse also informed me I’d get an ultrasound of my leg done to check for the possibility of blood clots. The doctor and the nurse worked together with a doppler to check my pulse in my legs and feet, which they were able to confirm, but their concerns about the heat emanating from my swollen leg led them to the “safe vs. sorry” compromise of ordering another test.

As the nurse walked me through the test regime I was about to run, I asked, “Any idea what this will cost me?” Of course he didn’t know, and up to this point, no one bothered checking with me about the cost of services. It ended up being $250 for the co-pay and I don’t know yet what it was for the tests. I also don’t know if the IV antibiotics costs more than an oral treatment. I asked the nurse about this and he went into a rationalization about not taking chances, etc.

The nurse was very good at drawing my blood. The injection was almost undetectable. The ultrasound technician was also efficient. We talked about her automobile purchase history and she had me all checked out in about 15 minutes. An orderly wheeled me around from room to room in my gurney bed, which enhanced my feeling that something was really wrong with me and at any moment I could crater. I noticed passing through the hall that the other patients at the ER were all males, either very elderly males probably near the end of the road who had had a fall, or gotten sick, or very young males who had just made a very poor judgment call and were now paying the price.

I couldn’t help but thinking, “What is wrong with this picture?” as my seemingly-healthy, 30-year-old trim frame was being shuttled from room to room. Two ideas came to mind: either nothing was wrong with me, and that’s why I shouldn’t be in the ER with these people, or something was REALLY wrong with me, and that is why I was suddenly in the ER with these people.

I waited another 45 minutes by myself on my bed gurney before learning of the test results. A financial admin came in and out to run my insurance and have me initial some boilerplate. I started initialing without reading it and got halfway down the list and saw something saying I agreed to have my medical history inserted in a state database. “Do I need to do this?” “No. I know, next thing you know you’re going to be getting called by a telemarketer…” (not really what I was worried about on that one). So I didn’t initial it, went back over the ones I did, finished the others and wondered what law or series of events had conspired to have a financial admin highlight for initialing the sharing of private medical data in a public database without comment or concern?

Ultrasound: no blood clot found.
Blood panel: no acute infection indicated, blood work looked very good including liver and kidney function (I made sure to ask my nurse for a copy of my blood panel so I could interpret it more fully later, since a blood panel costs $$$ and I planned to do one eventually anyway, this helped me recoup some of the cost on this unnecessary intervention visit)

So, what was wrong with me? The doctor admitted she really didn’t know. Her suspicion was that I was bit by something and it either had some bacteria on its fangs, or it triggered a strange reaction. She told me she wanted me on an antibiotic regimen “just to be sure”, and to come back immediately if my leg felt tingly or numb. She said I could take some Benadryl to try to treat the inflammation as well.

I asked the nurse to help me interpret my blood panel. How did it look? “It looks great, really good panel, no indication of acute infection…” “So then why am I being administered an oral regimen of antibiotics if there is no infection indicated?” “Well, the body is funny, it COULD be infected and it just hasn’t shown yet in the panel, but anyway, we’ve seen a lot of crazy stuff, better safe than sorry right? I mean it can’t do any harm to get the antibiotics, it can only make it better.”

He grabbed my checkout paperwork and had me look over it and sign. The paperwork says that I acknowledge the diagnosis and the treatment being recommended. The nurse says, “We don’t know what you have, but we’re calling it ‘cellulitis’.”

I gained some additional certainty that I don’t have a life-threatening blood clot and that I am not at risk, as of this very moment, of losing my leg to a bad infection as one doesn’t seem to exist. My experience led me to conclude that allergy and immunology medicine are perhaps younger, frontier sciences within the practice of medicine with higher levels of uncertainty than the practice itself. Everyone’s still uncertain about what actually happened to my leg!

Why I Try To Avoid Visits To The Doctor’s Office (#health, #medicine, #choice, #selfesteem)

I don’t go to the doctor much. I think that’s a good thing, but people who believe “an ounce of prevention beats a pound of cure” might be horrified to know that I don’t even do my so-called oil changes and other regularly scheduled maintenances with regards to my body– false positives, risk of complications from the cure that are worse than the disease, etc.

Generally, if I’m not in pain, I’m not going to see a doctor. And even sometimes when I am, I think, “This too shall pass” and carry on. I pay attention to my body, I’ve gotten pretty good at knowing when I’m in trouble versus experiencing discomfort that will resolve itself over time. I have a pretty high pain threshold I think, I won’t even mention I have a headache until I’m somewhere around a migraine for someone else.

And I do believe in prevention! That’s why I eat a nutrient rich diet, exercise (weight lifting) weekly and walk my dog daily. That’s why I work hard to keep a reasonable bed time and get as much sleep as I can. That’s why I try to think happy thoughts and help others do the same. And that’s why I listen to my body and take it easy when it tells me “No!”, rather than flailing myself before the altar of No Pain, No Gain and reveling in masochistic torture.

So I do my darnedest to avoid visiting a doctor. That’s why I’m bummed I decided to go in today, and that’s why I think this decision was yet again illustrative of my principles!

You see, where I live, medicine is practiced a bit oddly– legal liability dictates that the doctor does anything he can to avoid taking responsibility for your treatments and it’s consequences, as they don’t want to be sued for malpractice. But their medical school instruction plus their ever closer relationship with the State leads them to an aggravated mindset anytime you insist on thinking for yourself and following your own judgment. Think about that, they don’t want you to make your own choice, but they don’t want to be responsible for the choice you make.

I had some kind of strange reaction to an insect bite on the back of my calf last night. I don’t know how it happened or what bit me, I’ve never seen anything like this on my leg, nor felt this kind of pain, which is severe but within my tolerance levels. Normally, I’d just keep walking around and unless it seemed to worsen or I showed other symptoms, I’d just let time work it’s magic on healing it. Painful, yes, but nothing my body can’t handle.

Unfortunately, my plan was to travel out of town for the holiday this week to spend time with family. If my condition worsened, I might end up in an ER in a strange place. I don’t want to end up in an ER, and certainly not in a strange place. As a result, I decided to visit the GP at the last minute to see if they thought it looked dangerous. If it was going to kill me or save my tissue, I’d want to intervene, but anything short of that I’d just make do.

I should’ve just kept on going and took my chances.

The doctor squeezed me in, which I’m very grateful for. But because I hadn’t seen them in over ten years, they subjected me to a battery of questions about my health, my family’s health, and so on. I spent 20 minutes talking about everything but my bite and about one minute actually discussing the course of action about the bite.

I got lectured about the need to do regular check ups. I got lectured about treatments available for some historical conditions, as if I was unaware, hadn’t tried them and was suffering needlessly (because the assumption is I don’t take care of my health). I witnessed the doctor exhibit some unhealthy conditions of her own and then was told not to worry, wasn’t contagious, etc.

The worst mistake I made was mentioning that my wife is pregnant and nearing her due date.

“When did you last get your tetanus shot?”

This is a terrifying question. Something innocuous like this, ostensibly asked our of concern for my health and the health of my family, could lead to a spiral where either the baby snatchers come for my kid, or I submit to vaccinations and other invasive treatments I don’t have any interest in.

She continued, “I don’t mean to alarm you, but EIGHT babies in the whole state died last year because of whooping cough connected to tetanus, likely contracted from a parent or relative who didn’t get their shots. I wouldn’t want you to be one of them!”

When she said 8 in the whole state, I wanted to laugh. Are you kidding? I probably have more risk driving my baby around in its car seat (don’t worry, she lectured me about that, too). And its probably not PC to say, but I doubt those babies had my socioeconomic background (ie, I’m wealthier and I don’t have relatives traveling back and forth to third world countries or other impoverished areas). It’s simply not reasonable to be worried about this risk, measured against the potential complications.

“It’s really quick and out nurse is great with shots, can I go ahead and get that taken care of for you?”

No, thanks, I’m traveling and don’t want to deal with it right now.

“Okay no problem, I’ll put a note in your file that you’re going to come back in two weeks and take care of it. Due to state mandate, they won’t let you go near your baby if you don’t have an up to date tetanus shot.”

I sure hope I don’t get that call.