Thursday, 22 January 2015

Some Important Lessons From Disney - About Measles and Vaccines




This will be quite a quick post as I am short on time and a lot has been written on the subject already (by much better and more important bloggers than me, see below). But it's a news story that has had very little attention in the UK* so I wanted to share it: Over the Holidays there was an Outbreak of Measles at Disneyland in California, the disease is still spreading. To date at least 70 people are known to have caught the disease and that number is growing all the time (It was 57 when I started drafting this post). Understandably this isn't big news over here but it is a story that provides us with a few valuable reminders about why we have vaccination programs:


1- Measles isn't a mild disease.
The most recent stories I've seen about the Disney outbreak say that a quarter of those infected have had to be hospitalised. Mild diseases do not put 1 in 4 people in hospital. However, I don't want to put too much emphasis on that figure as I'm not sure how reliable it is. I could quote all the well established stats about the risks of death, brain damage pneumonia etc. but you can find them in plenty of other places. What I'm going to do instead is give you one of those totally unscientific anecdotes:

I had measles as a small child. It was f***ing hideous.

Thankfully I don't remember it in detail and I came out with no long term harm. But I do recall being in bed, feeling hot, miserable and covered in spots, with my even littler sister ill beside me. My Mum says she had to put sunglasses on me and darken the room as my inflamed eyes couldn't bear any light**. Even if none of the victims of the current outbreak suffer any complications, that's still 70 people going through that misery needlessly, if the reported hospitalisation rate is true then things are much worse.

2- Measles is really really contagious.
Someone incubating Ebola but not yet showing symptoms could spend days at Disneyland and they wouldn't pass it on to anyone. It's a terrifying disease but you can only catch it by direct contact with the body fluids of some already suffering (or dead) from it. Measles, by comparison is a world champion at spreading itself about. You can catch it from someone without ever even meeting them. If someone incubating measles, but showing no symptoms sneezed in a room and then walked out, you could go into that room two hours later and catch the virus from droplets still hanging in the air. So it's hardly surprising that it has been passed on in a theme park crammed full of thousands of kids, many of whom are from the local area which has a high rate of-guess what? Middle class parents who read some stuff on the internet and now won't vaccinate their kids. Looking at it that way, the only surprise is that it didn't happen sooner.

3- This isn't just someone else's problem.
It would be pretty easy to think: "bloody stupid Californian hippies, risking their children by not vaccinating." Then move on, feeling comforted and probably a bit smug that it doesn't effect us, we're smart, we vaccinate our kids, our kids are safe.  Certainly most of those involved in the outbreak were unvaccinated (or hadn't had both doses) and most of them were unvaccinated because of their or their parents choice. Most, but not all. Disney attracts young children and with young children often come even younger siblings. Several of the victims are babies who were simply too young to have been vaccinated yet. There are also a few fully vaccinated people who have just gotten really really unlucky.

The MMR vaccine is very effective, with 2 doses 99% of people will be fully immune. But that does leave that little 1% who for some reason don't produce a good, long term, immune response. If everyone has the jabs that doesn't matter at all, the virus won't be able to spread and will never get anywhere near that 1%. But put 50,000 vaccinated people in an amusement park with one unvaccinated carrier of a disease as contagious as measles and you don't need to be all that great at maths to figure out what might happen.



So yeah it's a long way away and my kids are fully vaccinated, but that doesn't mean I can just ignore it. I feel really sorry for all those suffering the measles right now. Even, perhaps especially, those kids whose parents' grasp of biological reality is so poor that they left their little ones exposed to a potential killer. But I'm also angry that those same parents got to choose what happened to other people's kids, to those babies and that 1%. I'm angry that it could happen here, where my kids are and that somewhere, at some point, there will be another pointless, preventable death.

Ok so that wasn't very short and it got pretty ranty at the end there, as I said, it makes me angry. If you still want to know more about this, here are a few good reads from over the pond:

Tara Haelle in Forbes
Tara Again ('cause she's ace)
Orac at Science blogs
The NY Times Motherlode

12.2.15- Edited to add - I try not to call anti vax parents stupid, I know it's a complex issue and all, but this song did make me laugh:




SBx

*Of course while I was writing this the Guardian beat me to it.

**It's not entirely clear why I wasn't vaccinated, this was before the MMR was introduced but there was a single jab available (I'm not that old!). My parents are lovely and not anti vax conspiracists, so my best guess is that it got missed in the confusion and worry caused by a big scare over the whooping cough (pertussis) vaccine that was going on at the time.

NB: Disney seem to be responding very responsibly to the outbreak. Several staff were among those infected and they are now taking steps to ensure all staff are vaccinated and immune. They are also telling unvaccinated kids to stay away.


Saturday, 17 January 2015

Caesareans, Sex Lives and the Good Old Daily Mail.


I was wondering what to write next on this blog, I had a couple of posts in mind before Christmas that I never got time to write, but they are hardly topical now. However, thanks to the NCT twitter feed I have something new to be cross about:



It's a startling figure, I knew the C section rate in the country was high but 52% of women choosing major surgery just because of worries about their sex life? That's pretty incredible, so I did a bit of digging and it turns out there were some recent news articles I missed about this. The main one (and do sit down for a minute as this may come as a shock) is from that great defender of truth, reason and equality - The Daily Fail Mail.

I'm just going to call this as I see it right here; the Daily Mail piece is inaccurate, misleading, sensationalist, racist and deeply misogynistic.

First let's deal with the facts, or rather the torturing of them. The 52% figure is the overall C section rate in Brazil. Unless every single Caesarean performed there is due to fears about future sex lives then then the Daily Mail headline is clearly utter nonsense:

More than half of pregnant Brazilian women choose Caesareans over natural birth 'to protect their sex lives'

(Also, on a slightly pedantic note, 52% of births isn't the same as 52% of women, but anyway)

Even with this explained though, the 52%  figure is still quite misleading as it hides a huge disparity in the mode of birth between those using the state system and the millions of women in Brazil who have private health care. In state funded hospitals about a decade ago the caesarean rate was comparable to the current UK rate of about 24%. But since then it his climbed and some figures put it as high as 40%. But even this seems low when compared to the staggering 84%* of births that happen by C section in private hospitals. 

This disparity between public and private is important as it hints at another reason for the extreme number of surgical births in the country: Hospitals can make more money out of C sections. They require more people, more equipment and longer stays than a straight forward vaginal birth. They can also be scheduled to occur during office hours and the hands on bit for the doctors is usually pretty quick. No doubt this isn't the only reason behind the high levels of c sections but it makes rather more sense than most Brazilian women caring more about their sex lives than their babies birth! 
*****Edited to add: for more on this see the comment below by Eloisa, who had first hand experience of this in Argentina which has a very similar health system*****

So where did that claim come from anyway? Was there a big national study of women's attitudes to birth which turned up the huge numbers basing major decisions on concerns about getting a bit, *ahem*, stretchy? Nope, as far as I can tell the whole thing comes from a comment made to a newspaper by one individual, Vera Fonesca, Director of the Brazilian Federation of Gynecological Associations who said that: 'The Brazilian woman is concerned with her sexuality and fears that giving birth will alter the perineum, which is a myth.' 

Oh and since we are on the subject of myths, contrary to what the Mail article says: - 

THERE IS NO WORLD HEALTH ORGANISATION RECOMMENDED CAESAREAN RATE! 

There used to be one, until they admitted that some bloke just made it up and there was absolutely no evidence for it! - They dropped this rate in 2009! For how many more years am I going to have to say this?

and breath....

Actually, no, lets not calm down, lets get onto the racism and sexism that weaves it's way all over this story. 

First off, the Mail must have been so very pleased that this is happening in Brazil! Try to think of a stereotypical image of a Brazilian woman- most likely she is gorgeous. Tanned, toned, with enviable breasts covered in the tiniest of beach bikinis or sparkling samba costumes. She oozes sex appeal, she's a feisty, passionate lover. So of course all Brazilian women are like this, and it's not surprising that for more than half of them, the biggest concern of impending motherhood is getting back to all that wonderful sex, right? I wonder if the Mail would be so interested in the C section rate in Belgium?



Here's another question - Why is it inherently wrong for a mother to be concerned about her own sex life anyway?

Certainly if the sole reason for a huge number of c sections is false fears about  future sexual enjoyment then that is a problem. But in that case caesareans aren't the cause of that problem, they are the symptom. The problem certainly won't be fixed by demonising those who choose surgery. Those fears aren't entirely false anyway. Vaginal birth usually causes no major, lasting, harm to the mother. But there may be reasons for some women worrying about how a vaginal birth might effect their future sex life. Many women suffer a torn perineum during birth and that could cause difficulties in the short term (although bravo if you feel like having sex at any point in that "short term" anyway). In rarer cases vaginal birth can lead to longer term harm and/or issues with incontinence, which could impact on a mothers sex life. These things are rare but they exist and it's perfectly reasonable to consider them. 

Sometimes the damage isn't physical. Some woman experience considerable psychological trauma during birth and go on to develop PTSD. Where the traumatic birth involved a lot of internal examinations and interventions, especially if the woman feels she was forced into these and didn't truely give her consent, then future intimacy can become a huge trigger, sending the woman straight back to the stress and terror of the birth and leading her to avoid sex altogether. 

On a related note, women who experienced sexual abuse earlier in their life may well want to avoid a vaginal birth and all that can go with that so as not to dredge up old traumas, something which could also effect their future sex life too.

All of those are reasonable excuses, but why do we even need excuses?

Let's think about a completely different decision, one that involves only men's bodies for a change. If a man is found to have early signs of prostate cancer he can have surgery or other treatment to reduce the risk of that cancer progressing. But the cancer may never progress anyway and the treatment can damage a mans sex life. So some men decide to avoid the surgery and accept the increased risk of cancer rather than the risk of those side effects. I'm yet to see a headline declaring that "Men Risk Cancer To Protect Their Sex Lives". Why should there be? It's a perfectly reasonable decision. Prostate cancer mostly occurs in older men, most of them will have children already but that doesn't mean they don't still want to have a sex life - so why doesn't the same apply to women? Our society has mostly moved on from the idea that young men should "spread their wild oats", while women save themselves for their wedding night, but mothers as sexual beings still doesn't seem to be something we are entirely comfy with. Mothers are supposed to exist in a constant state of grateful self sacrifice for their offspring. Still wanting to be able to have a decent shag with the kids Dad doesn't really fit in with that.

So does the Mail think that 52% of Brazilian women are so dim witted and sex obsessed, that they would still choose needless major surgery, even if they had accurate information about how unlikely it is that a vaginal birth would harm their sex life? Or are they just plain horrified at the thought of a woman, a mother, making that a consideration at all?



None of this means that I think a c section rate of 84% or even 52% or 40% is fine. Speaking as someone who has had two C section and a very long labour I know from bitter experience that the surgery is not an easy option! I really don't believe that huge numbers of Brazilian women would choose a C section without a good reason, if they were actually given decent information and not put under pressure by hospitals. 

But (like the WHO) I don't think there should be any ideal caesarean rate. Contrary to what some of the news stories are saying, modern caesareans are very safe for both mother and baby. Especially when they aren't done in a rushed emergency. So if a woman looks at all the evidence and decides she wants one, even if her reasons seem frivolous to some people, you know what? Her body, her choice.

Mostly I'm annoyed with the Daily Wail, but the paper seems to actively troll it readers, so they are probably pleased about that. But what about the NCT tweet that got me into this rant in the first place? I really want to give them the benefit of the doubt, best case scenario it was a poor choice made by an individual manning the twitter account and in need of something topical. But the NCT has often been criticised (and not just by me) for being anti caesarean and propagating unevidenced nature-knows-best type beliefs. They always counter that they support all parents' choices and give only evidence based advise but if that is the case why promote a "news" story that is so very lacking in evidence and which is sexist, anti choice and sensationalist too? As I say I'm inclined to go with the best case scenario that it was just a silly mistake, but at worst it suggests that some of those old judgmental attitudes and beliefs still linger in the organisation. Come on NCT, you can do better than that.

SBx

*I've actually seen a variety of figures for both public and private in various newspapers but I'm going with the most commonly used, which is also the highest as I haven't been able to find a good original source - if anyone has one, please let me know!

Thursday, 8 January 2015

Postpartum Hypothyroidism, Pregnancy and Being a Bit of a Divvy

This will make it two personal(ish) and non ranty blogposts in a row!

I made a classic error over the Christmas holidays and ran out of my thyroid medication. Given that it was my own fault for being a divvy and not checking sooner I didn't feel I could justify a GP appointment to get more the same day. So I ordered a repeat online, and assumed I'd be ok to go without for a few days. From this I learned two things:

1- Always check you have enough meds for the holidays and order repeats in plenty of time.

2- I'd forgotten how miserable having untreated hypothyroidism actually is.

I did write about my thyroid condition way back in 2010 but I've learned some new stuff since then, especially through having another pregnancy. So now I have my pills and I'm out of the "thyroid fog" I thought it was time for another blog post on the subject.

***NOTE: I'm going to refer to postpartum thyroditis in this post, but technically that's not what I have, I'll explain that a bit more as we go along!***

Part One: The Basics 
or: Stuff your GP will probably know

What Is Postpartum Thyroiditis?

The thyroid is a little organ in your neck responsible for a variety of hormones which need to be produced in the correct amounts. But sometimes it goes wrong and starts producing too much (hyperthyroidism) or too little (hypothyroidism) of these hormones. This can happen because of all sorts of things but postpartum thyroiditis happens after pregnancy and can involve either hyperthyroidism, hypothyroidism or, often, both, one after the other. Fortunately in the majority of cases it sorts itself out and may never need any treatment.

What Causes it?

During pregnancy, the immune system gets turned down a bit, to prevent it from attacking the baby. Once the baby is out the immune system is allowed to bounce back again but sometimes it gets a bit carried away and starts attacking the mother's own thyroid. There then ensues a bit of a hormonal slanging match as the hormones produced by the thyroid and those that control it all scream at each other about what they think the thyroid should be doing. Ok clearly that isn't an entirely accurate, technical description, but the upshot is the poor thyroid ends up getting it's hormone making all wrong. In the case of postpartum thyroiditis this usually means it starts off making too much and ends up making too little.

What Are The Symptoms?

This is one of the really tricky things about this condition. The major symptoms are tiredness, aching, depression, mental slowness and weight gain (there are quite a few others too, see here for more info).

Basically it makes you feel like cr*p. Ordinarily you would probably notice that, but what if you've just had a baby? Aren't you supposed to feel like cr*p anyway?

*****
When I was pregnant for the first time there seemed to be no end of people who gleefully told me I would never have a good nights sleep again, my body would be ruined, my social life destroyed etc. etc. Throw in the epic labour and the c section (which I'd been taught should be avoided at all costs because of the hideous recovery) and it simply didn't occur to me that there was anything wrong with me. I felt utterly awful, but perhaps this was just what it was like to be a Mum? I'd surely be laughed out of the room if I went to the GP and complained that ever since I had a baby I felt tired and fat? I looked on in wonder as other mums lost the baby weight, got out and about and actually did stuff. It didn't look that hard for them so why was it for me? Were they all just putting on a show like I was, pretending they were coping or were they genuinely better at it all and I was I just being a bit pathetic. I failed to do the birth thing properly after all, perhaps I was just wasn't very good at being a Mum? 
*****

How Is It Diagnosed?

Thankfully this bit is more straightforward. Usually postpartum thyroiditis gets better on it's own and the mother may never realise she had it. But if it goes on and she actually plucks up the nerve to speak to a doctor then there is a simple blood test which can figure out what's going on. It looks at the levels of the hormones produced by the thyroid and at something called TSH (Thyroid Stimulating Hormone).  When the thyroid isn't producing enough hormones it's TSH's job to tell it to work harder so a high level of TSH in the blood test means the thyroid is under active (hypothyroid).

The other thing that can be tested for when a thyroid problem is suspected is antibodies against the thyroid. Again, this is a simple blood test but if the antibodies are present then it is a good indication that there is a problem even if the other tests are a bit borderline. Unfortunately testing positive for the antibodies also means the condition is more likely to stick around permanently.

How Is It Treated?

If the thyroid is over active (hyperthyroidism) then it will probably resolve itself quite quickly and won't need treatment. So from here on in I'm going to concentrate on hypothyroidism (but if the hyper version lingers I believe a short course of beta blockers should sort it out). Hypothyroidism (under active thyroid) is also quite easy to treat with Thyroxine pills. These basically replace the missing hormones and hopefully, once you find the right dose (which may require more blood tests) should alleviate the symptoms and side effects are very unlikely.  Most cases of this will sort themselves out in about a year but in some cases (like mine unfortunately) this doesn't happen and those little white pills become life long companions at which point it isn't technically a postpartum problem anymore!

Me, pre diagnosis. Looking back on this the eyes are more honest that the smile and the baby weight was clearly going nowhere.



Part Two: Hypothyroidism In Pregnancy
Or: Important stuff your GP might not know


*****
My thyroid condition was managed entirely by my GP for a couple of years. But when we came to thinking about baby number two I happened to listen to a podcast which mentioned the problems hypothyroidism can cause in pregnancy my GP didn't seem to know much about that so I asked to be refered to a specialist. Perhaps other GPs are more knowledgeable about this but none of the ones at my surgery seemed to be.
*****

The Risks

Untreated hypothyroidism can be a big problem in pregnancy, it seems to increase the risk of all sorts of bad stuff including miscarriages, low birth weight, premature birth and pre-eclampsia. In some cases it may also impair the baby's intellectual ability. Clearly avoiding all these things is pretty important.


 - MASSIVE CAVEAT ALERT - 
I'm not a medical doctor and the treatment advice I was given will not be appropriate for everyone. If you have or think you have hypothyroidism and are planning a pregnancy don't just follow what I say here, go see your GP,  if they are as hopeless as mine, go see a specialist!! 
(here endeth the caveat).



Treating Hypothyroidism in Pregnancy

Normally hypothyroidism is monitored with occasional blood tests to check those TSH levels. So long as they stay below about 5 (there are units, but this is complicated enough already) then the patient is probably on an ok dose of thyroxine. In pregnancy this isn't good enough (something my GPs had no idea about until I told them).

In pregnancy, especially in the first trimester, the TSH level needs to be lower, I was told by the specialist that mine needed to be below 2.5. There is obviously a problem if GPs aren't aware of this as it is quite normal in the UK not to see any other medical professionals during the first trimester if all is going well. Yet this is the most critical window.

Luckily for me the specialist had told me what to do in advance, he had made a small increase to my thyroxine dose and as soon as I got a positive pregnancy test I increased it again then checked the new dose with a blood test a week later.

Monitoring

With the right dose of thyroxine on board, hypothyroidism shouldn't cause any problems for the rest of the pregnancy but I was monitored very closely anyway. I had blood tests every 4 weeks to check my TSH levels were staying low and I also had ultrasound scans every 4 weeks to check the baby's size - although given that my first was a hefty 9lb 10oz (4.4kg) I wasn't too worried about this one being smaller! I was initially also having separate appointments with both the Obstetricians and midwives every 4 weeks but thankfully the docs decided that was a bit OTT and scaled back their appointments!

So there we go! There are a few potential problems for mums that I heard a lot about while I was pregnant, post natal depression and incontinence being the main ones. But I had no idea about postpartum thyroiditis until a medical student friend spotted a very slight lump in my neck (another symptom) and suggested I see my GP (see not all doctors are bad and said med student is now training as a GP herself). I also have friends who've developed other immune system related problems after having a baby yet there seems to be little awareness of these conditions and I wonder how many other mums are just putting up with them, not realising treatment is available? No one wants to turn pregnancy and motherhood into an endless warning list of what can go wrong, except perhaps the "you'll never sleep again parade". But I'd like to see a little more awareness of these things even if just among GPs, midwives and health visitors. I pretty much pay no attention to my condition now, but my little visit back to the cold, tired fog I was in for the first months of MissEs life was a reminder of just how much those little white pills improved my life - and in future I'll try not to run out of them!

SB




Sunday, 4 January 2015

2014 In Pictures


I've deliberately been writing less about my kids on this blog this year, focusing on the health stories and bad science that far fewer "mummy bloggers" write about. I guess I'm finding a niche as all those how to be a blogger posts tell you to.  But I've really enjoyed putting together a few memories in past years and I often return to those posts again and again. I take so many photos, it's easy with a camera phone to snap away all the time but I rarely get the chance to actually comeback to those images and remember all the great times we have in between all the ordinary business of work, school, and general life. So here are a few, though by no means all, the best bits of 2014.


January 
A trip to see the butterflies at RHS Wisley




February
At half term we visited Greenwich. While other parts of London were packed with tourists, it was strangely quiet, if very cold, and MissM, on the brink of walking, explored the famous painted hall.




March
A few little firsts: My first attempt the at the dreaded World Book Day costume came out pretty well, MissE got her first proper bike and Me and F had out first night away since MissM was born as we celebrated our wedding anniversary at a little boutique hotel in Margate. (Where I learnt that, even without kids to wake you up you still can't get a good nights sleep if you are not used to drinking any more and have a Bellini, half a bottle of wine and an espresso Martini with dinner! fool)



April
We headed off to Coombe Mill farm in Cornwall for another wonderful week, I think this was our fourth year and it gets better every time. MissE was rather taken by the train driver, and MissM got thoroughly wet and sandy on a nearby beach.





May
In May the dreaded Chicken Pox struck us, which meant that poor MissM was stuck at home with Daddy while me and MissE headed off for some Mummy-Daughter time under canvas at the lovely Feast In The Woods Festival







June
On a glorious June day we celebrated the wedding of one of the girls (many) Aunties. Which gave me the perfect excuse to dress them up in matching frocks!





July
The Summer really kicked off in July when we headed out on the recently invented ancient Nunhead festival of Beating The Bounds.


The end of MissE's first year of school meant her first ever sports day




And once the holidays were underway we got a chance for a day out with just the two of us being totally touristy





Next we headed off to Spain for a small amount of walking, a fair bit of splashing and a heck of a lot of eating!






August
In August we were back in our trusty tent again, this time at the Just So Festival (I can only imagine how cold mermaid lady must have been!)





And it was MissE's birthday which meant magic tricks and of course the obligatory Frozen costume




September
In September we celebrated my parent's Ruby wedding anniversary at center parcs and of course it was back to school for year 1






October
October half term couldn't come soon enough and we headed to Devon to hit the beach (well wrapped up!)



With Grandparents on tap to babysit F and I even got chance for a long walk on Dartmoor. We could barely see, but it was worth it to remember how much we enjoyed walking together before we were doing it pushing a buggy and stopping to say hello to every individual ant!





November
Astonishingly MissM is now 2! Time is just flying but I love this age, even if she has mastered the terrible twos tantrums already!





December
Both girls had a really wonderful Christmas this year. We started to get into the spirit by visiting Father Christmas at the museum of London





We also had a trip to the museum of London docklands, where MissM had a go at being a builder




As the big day drew nearer we kept tabs on father Christmas with the NORAD Santa tracker




And of course there was plenty of cooking and eating!





So that's that for 2014. Thanks to everyone who has continued to read my blog this year and to all the new people who have found me one way or another! Thanks also for all the comments, shares and retweets for what I write, it's always much appreciated. I hope you all have some good memories of 2014 too and even more to come in 2015!



Happy New Year from the SouthwarkBelle family!