JaneMD passes out from exhaustion

(Passed out from exhaustion - from sodahead.com)

As everyone has noticed, the spacing between my posts have gotten further and further apart. Several things have happened. The biggest issues are probably related to my second job and some recent health set backs. On top of my new 65 hour work week, I have had to schedule surgery, weekly doctor's appointments and have regular physical therapy. Post surgery, I was laid up for some time and my poor children were very concerned about their mommy. Child2 spent the past week following me around and being carried because I was finally mobile again. It has been expensive as well - but I'll be getting able to deduct my health expenses this year since we'll be above the 7.5% threshold. 

To complicate the matter, there was a whole spate of Jewish holidays, so every day that wasn't a Jewish holiday, I was working. If I was working, that meant HubbyJD was working shorter hours to collect Child1 and Child2 from daycare and he had the Jewish holidays off too. I occasionally have downtime at work to write a little, but since blogger is blocked anyway, it doesn't help much. My netbook stopped going online because of a storm frying our modem, so I'm using a different computer. I have a professional publication under my RL name in the works which is cutting into my time too.

While I know everyone has lots of personal stuff going on, internet posting has taken a backburner to everything else. I probably only visited Mr. MoneyM once in the past month and didn't post. I still am keeping my budget update - with a new column dedicated to medical expenses, but I am just to tired to post. Especially when there are so many other people doing it much better than I - if you want science, I love Phil Platt on Slate with his pro-research and pro-science discussion. You already know I like MMM and NoMoreHarvardDebt.

My apologies to everyone who was hoping for an enlightening post, but this doctor is going to go take a nap. After I do all the laundry, take out all the trash, drop off stuff at the thrift store, and go pick up the kiddos from daycare. 

Okay, so no nap.

Jane relies on someone else to discuss chemicals in food

Did you read that buzzfeed article about '8 toxic foods!?' Notice how I didn't link to the article because it

is fear-mongering bull? Scare tactic after scare tactic of horribly researched drivel. (Lieutenant Data totally would have warned you off this course of action, buzzfeed.)

Fortunately, instead of writing and researching a rebuttal, an organic chemist did it for me. Here it is "Eight Toxic Foods: A Little Chemical Education."  This is why people go to college and get science degrees. :) Thank you facebook friends for linking me up with this article. This awesomeness will not be forgotten as it is almost as cool as "Voices for Vaccines."

I haven't had time for many posts with my training for the second job and the fabulous, famous annual June/July resident/physician Shuffle. Rest assured, there will be an update on the biking, the diet, the finances once things get settled down.

Follow-up on Potty Training

I just wanted to share a link to an article written by Steve Hodges, a urologist, discussing some of the topics I touched on in my last blog post. He argues AGAINST pushing your child to potty train early and discusses how pooping really affects your child's ability to successfully potty train. Read it here.

"No Potty MOMMY!"

Daycare asked me about potty-training Child1 who is 2 years old. Another older child is working on potty training and they were planning on introducing the potty to Child1. I gave my indifferent blessing on this and shared some of my reservations. (Beware, I'll be using 'poop' versus stool/bowel movement and so forth)

1) Boys potty train later than girls, statistically. Many boys get potty trained around the age of 3, not so close to the age of 2. I know a 22 month girl who poops on the potty, but I don't think Child1 is all that interested.

2) Firstborns don't have an example to follow. That 22 month old girl I just mentioned has a 4 year old sister who is very proud of her potty skills. Consequently, the 22 month old is super motivated. It took the 4 year-old quite a bit longer though.

3) Parental commitment is lacking. Neither myself or HubbyJD are hardcore 'potty train NOW.' If they do it at daycare, and not at home, then you won't get far.

Daycare understood and hadn't really intended on doing very much. They wanted to let Child1 work on sitting on the potty after meals and seeing if he did poop there, making sure he didn't get afraid of the potty, and learning the idea of wiping and flushing. It will probably be several months until Child1 is actually in a better state of readiness.

Other pieces of advice from JaneMD on this subject. Make sure your child isn't constipated. Miralax is fiber, not a drug, so don't feel like a failure if your child ends up on it. Painful stools tend to make children have stool withholding (trying not to poop) behavior which encourages more painful stools. It becomes very difficult to potty train in those cases.

Try to use the child's natural physiology. The best time to go potty is after eating a meal because the gastrocolic reflex is working then. Gastrocolic reflex is why you feel the urge to go to the bathroom during your meal or right after. 

Don't spend a ton of money on the 'magical singing self flushing potty.' You didn't train on an electronic potty. The more the potty seems like a toy; the more it will be treated that way. Books, however, are perfectly welcome as a method of relaxing. It works on adults, too.

Say it with me, 'potty training is WAY more important to the parent than the child.' Your child, while not enjoying being wet and poopy, is only motivated to change because YOU care. Your child doesn't know any different so why would he/she spend energy on it? If you want an amusing potty training story about motivations, read Parenteconomics. The dad tries numerous ways to motivate his kids to potty train - and most of them backfire - until he outsources the problem to daycare by his third child. I personally have trouble keeping Child1 on the toilet to relax long enough to poop because Child2 is wandering the house while I supervise potty time.

So keep your cool and remember that almost every healthy child will be potty trained before 4 years old and it is not a reflection of you if your kiddo takes his/her time. When your child is doing an exclusive interview twenty years from now for inventing warp drive, she/he will not be recounting triumph over adversity because you didn't buy the most expensive potty. He/she will be recounting your attitude if you become a toilet-training tyrant.

 

(P.S. Alot of naked toddlers come up when you use goodsearch to look for 'potty.' Don't let it be your kid!)

New job, new bike

So two little kids, a full time job, some medical issues, and a NEW JOB have led to a delay in updates. For the five people actively checking in, thanks!

Okay, where we last left off, Jane had some horrible trip on Airtran during Passover and will never be traveling like that again. I applied for a second job and got it, which has required more training and additional hours. I am still going to be working full-time at my current job, but once or twice a month I'll be working in a pediatric urgent care. HubbyJD supported my additional employment (he, jokingly, claims he made me get a second job because I wasn't working hard enough). A good part about this job is that I can bike to it since its about 1 mile from my apartment. A bad part is that I'll be doing it on weekends around midnight.

With this in mind, I started actually biking on our fold-up Schwinn and bought a Nashbar Kid Karriage, which was on sale with fresh shipping for under $100 with tax. I have now biked two four mile round trips to the gym, once alone and once with the kids. My legs are killing me, but I'm sure this will get better with time. I may eventually invest in an actual bicycle with gears since HubbyJD thinks we can all go biking together now .

What has our budget been doing? Subtracting medical expenses and getting hit TWICE by uninsured drivers (we had to pay the deductible), we are around $5,500 a month. There was a tax error on my part as well that resulted in us owing money. When I filled out my initial W-4 form in 2011, I worked half a year as a low paid resident, half as an attending, and HubbyJD only worked 5 months of the year. For 2012 we both worked the full year and, despite having an additional child, made too much money to get the student loan interest deduction or the loss on our rental house. Add in that I had not updated my W-4, my failure to take out enough money resulted in owing. (Fortunately, my bi-monthly housekeeper is a CPA student, filed our taxes for free, and is helping fix the W-4 issue, especially since we know have to project the income from my new job.)

On the plus side, our lease ended and we bought our car at the end. We anticipate selling one or two of our cars and buying older four-door stick shift models. We FINALLY completed the refinance of our out-of-state rental which resulted in a slightly decreased monthly payment - $60 so at least that frees up $250 in the budget. Let's see if my potentially new biking habit can shrink our gas budget some too. My bike investment so far was $35 for 2 children's helmets and $100 for the trailer - minus $75 in giftcards = $60, which we now are referring to as my mothers day present.

Stop the AntiVaccination Billboards!

I have to say, since I read Slate, I am loving the science guy Phil Platt, so far. He pointed this out today on Slate. He said it much better than I am going to today. The crux of the issue is that the vaccine-hating "National Vaccination (mis)Information Center" is putting up these horrible antivaccine billboards. They show a cute baby and say "Vaccinations? Know the risks and failures."

It makes me want to hurl, literally and figuratively. Want to watch an infant die of pertussis? Mumps outbreak in New York brought on by an unvaccinated kid from Britain? Hib deaths in Minnesota in 2008? I was counting the seconds until Child 1 and Child 2 were vaccinated.

What can you do? Contact Clear Channel. Here is what I wrote - on the fly.

I am highly concerned about your decision to allow extremely flawed and dangerous billboard warning people off vaccines to be set up in your facilities. Are you aware we are having a huge pertussis outbreak? We haven't had an outbreak like this since before 1970. Infants, like the one in the picture on the billboard, are at huge risk of DEATH from pertussis since it stops their breathing. I doubt you would allow billboard that encouraged people to drink and drive even if its someone's 'opinion and money' that it is okay. Please take down this horrible dangerous billboards.

I also joined the 'Voices for Vaccines' facebook group. And I totally, shamelessly stole the billboard from the Slate page linking to 'Every Child by Two.' I did not place a link to the evil billboards so no one mistakes what I'm about.

Every Child By Two

 

Really, someday soon I will be posting more financial stuff. Really. Occasionally I just am really hit by something I read online, but that is what blogs are for.

Jane, antibiotics, and CRE

While I often alternate between finance and medical posts, based on some recent news, I went for a medical post.

Perhaps you have been reading the scary articles about CRE (carbapenem-resistant Enterobacteriaceae)? If you haven't, just search 'CRE superbug' and hear the doom and gloom for yourself. Basically, these awful suckers are found in hospital. They have been stealing resistence coding genes from other bacteria previously treated with antibiotics and are now resistant to our last line of defense antibiotics - carbapenems. The antibiotics also kill off the non-resistent competing bacteria giving these bad guys free reign in a patient. Half of the patients who get the infections will die because no antibiotics can treat them.  The bacteria are currently found exclusively in healthcare facilities . . . for now. . .

Freaked out? Wondering what you can do to protect yourself?

• Wash your hands constantly while visiting a hospital. Touch something, cough on something, get coughed on - wash your hands. Try to keep from bringing as few germs as possible home from the hospital. Make sure everyone, including your doctor, nurse, tech, and housekeeping staff do the same.

• Minimize your use of antibiotics. You probably don't have CRE, but the more 'normal' bacteria you keep around, the less resistant bacteria you are carrying. Many illnesses are actually viral and antibiotics will do nothing except kill of the innocent bystander bacteria.

• Avoid visiting immunocompromised/elderly people while you are sick. They are the most vulnerable and constantly exposed to more antibiotics and germs. If a patient on chemotherapy gets a cold and fever, they may get treated with antibiotics. Even if it's probably just a virus, they can't take the chance it could be bacterial. An untreated bacterial infection in a patient with no white blood cells to fight it is almost always fatal.

There are plenty of times you will need antibiotics, but give all things time to show virus versus bacterial. Colds actually last 2 weeks, not 1 like people think they will. Antibiotics don't benefit people who have the flu virus. (Techinically, the flu virus softens people up for secondary bacterial pneumonia which is typically treated with antibiotics - in the ICU, on a ventilator, not the majority of flu cases)

Don't worry, in the future, I'll be writing a post on how I cope as a doctor knowing about all the killer germs out there. Hint - my kids eat dirt at non-hospital places.

A little discussion of the flu vaccine

Congrats all, this year's flu season is almost over. I hope you got your flu shot. I did, the kids did, and HubbyJD tried to get his several times. He missed flu shot at the office day and the Rite Aide, Walgreens, and Hospital Pharmacy were out each time we visited.

I was going to give a few words about common misconceptions or you can read the CDC website here.

1) The flu isn't serious. 
The flu is very serious. Averaged over 30 years, 30,000 people die in the US per year from the flu and 200,000 people get hospitalized. A good half of the 150 kids who die of it yearly are under 5 and don't have any other medical problems. Mathematically, that would be a worse than 1/10 chance of dying if you get hospitalized from the flu.

2) The flu vaccine gave you the flu.
No, it didn't. If you got an injection, the flu virus is DEAD. A known side effect of the flu vaccine is cough, mild chills, and low fever. The live virus - nasal version - is could theoretically (and has never been demonstrated to do so) give you the flu. Just in case, certain populations like cancer patients and the immunocompromised are never given the nasal flu vaccine. If you aren't passed out on your couch for days having people feed you soup, you didn't get the flu.

3) The flu vaccine paralyzes people.
People fear getting Guillian-Barre Syndrome from the flu vaccine. The rate of GBS in the normal population is 1 in 100,000. The rate of GBS in the flu vaccinated population is 1 in 100,000. Before molecular chemistry, PCR, and multiple other medical techniques were in use, the 1976 Swine Flu vaccine increased the rate of GBS to 2 in 100,000. I think they were still using vinyl records back then too, so I don't find that comparable to my current MP3 player.

4) I don't have to get it every year.
The flu virus is constantly mutation/experiencing 'genetic drift' so the vaccine is updated every year. They make their best guess when they manufacture the vaccine and protection is typically in the 60-80% range, sometimes as high as 90%. Occasionally a strain will show up late and they have to scramble to make a new vaccine, like the Swine flu of 2009-2010.

5) My doctor will be able to give me some meds if I get it.
Not really. The flu is a virus. Our virus fighting abilities are AWFUL. Tamiflu and Relenza are most effective if used for flu prevention or possibly intervening in the first two days of the flu. We use these medications more often if you have additional medical conditions in the hope they will keep you from getting hospitalized. We treat people in the hospital with them, but really, it comes down to supportive care (oxygen, fluids, managing blood pressure, etc), treating secondary infections (pneumonia on top of the flu), and hoping your body will fight it off. We had 20 cystic fibrosis patients on oxygen trapped in the hospital for a month during the swine flu and a full ICU . . .

6) The flu vaccine causes autism.
The research falsified by Timothy Wakefield was only about the MMR vaccine - which didn't cause autism either. Mercury also doesn't cause autism, and some flu vaccines contain a tiny amount. The original mercury argument was that the cumulative exposure of mercury across all vaccines in the first 6 months caused autism was disproved, but to keep people from refusing vaccines, almost all vaccines are mercury-free. (Besides, if mercury caused autism and we took the mercury out of vaccines - why are autism rates going up? Was the mercury actually protecting kids from autism?)

I could write a long time about vaccine misconceptions, and I will eventually in greater detail discuss autism on this blog, but that topic deserves a MUCH longer series of posts. Keep safe and if you didn't get vaccinated this year, make sure you get vaccinated early next year - HubbyJD will be!

Jane is NOT above recycled presents

My presents did NOT look like this!

Happy Holidays to all. We just celebrated Chanukah over here and once again used a low low bar for purchasing presents. As the Mommy, I, Jane, was responsible for purchasing all of the gifts for our family except myself. I financed some of our purchases with freebie gift cards, outlet shopping, and online deals. As the Daddy, HubbyJD was given a list of books that I wanted, a loaded gift card, and specific instructions on when and where to purchase my presents from that list.

Ideally at our house, we give one present each night, hopefully under $10 for 7 of the 8 days. On the 8th night we typically give each a $20-30 gift. We have yet to engage in the contest for the lowest priced gift, though that day may be coming. This year I made some one-time more expensive purchases for HubbyJD's office - professionally framing his some of his certificates. Other presents were $3 picture frames with our pictures in them and sweatpants. I got, as expected, books and my requested DVD of Firefly the Series.

Child1 and Child2 got a different tack. One of my friends wanted to get rid of some of her barely used toys and gave me three times the number of toys I could possibly use. Some of the items I donated onto my synagogue's playroom, but other ones I sorted, cleaned up, and gave the boys. Eventually I did buy a few specific trifles. In all I don't think I spent more than $40 on all of their presents. We lit our candles, ate a doughnut, and opened presents. They eventually played with their presents - blocks by far are the most popular thus far - but the sheer novelty of ripping off the paper was more exciting.

Maybe one day my children will go to a huge birthday party and realize some of the other kids get big new expensive toys. However, at this point, they don't care - and even if they did - in 10 minutes a new toy becomes a used toy. A set of blocks is a set of blocks as far I'm concerned.

(If you were wondering how I wrapped blocks without a box, I can fill you in. When we moved, I bought curtains that came in zippered clear vinyl bags. Those saved bags made great containers to stack the blocks inside and then wrap. The blocks got moved to a big plastic container and the zippered bags now store other toys.)