Random Thoughts Today and Tomorrow











{October 30, 2009}   Got H1N1 Vaccines?

I’m not here to discuss whether people should or should not get the H1N1 vaccine. I think there are plenty of good reasons to get it, IE patients with chronic medical problems where getting H1N1 would really knock them out. And there are good reasons not to get it, IE most patients I’ve seen with active H1N1 do just fine.

Either way, my husband and I made a firm decision to get it for our kids and me.  I was really hoping to get it before my ER rotation started. And as both my kids are under 5 and need two shots each, we were really hoping to have them get it before we head to China again for the holidays.  Not that they are at increased risk of getting it in China, it would just be an extreme inconvenience to be sick while traveling.

Once we’ve made our decisions, next came the hard part. Where in the heck can we get the H1N1 vaccine? We kept calling our doctor’s office (Woodland Healthcare), and they always have the same answer “no and don’t know when.”  We called all the pharmacies in the area and got the same response.

Kaiser had both the H1N1 injectable and nasal vaccine for 1-2 weeks prior to anybody else. However, you have to be a Kaiser member. We were willing to pay or even join, but got rejected.  It seems to me this was poor planning to distribute a large amount of vaccines in high demand only to a subset of population and not allow any access to other parts of the population that would really need it.  What can you do, it’s a private organization and it will take care of its own. (I have my own biases against Kaiser as I have in the past applied for medical insurance when I first got pregnant, obviously for the pregnancy. And I was DENIED for having a medical condition such as pregnancy.  My nanny recently broke her collarbone, and while broken collarbone typically don’t need surgeries her Kaiser FP and orthopedic doctor decided she did. One would assume on the basis that her’s might have been more emergent until I heard it was scheduled for a week later.)

Back to the H1N1 vaccine status:

We started following the news and calling county health departments.

Where we live we are close to three counties: Sacramento, Yolo, and Solano.

Sacramento was the first we heard that had the nasal H1N1 vaccine. My daughter qualifies for it but not my son. We decided to wait for the injectables so that they can get it both at the same time and it would be easier to track for us.

Then Yolo County Health Department got their shipment of nasal H1N1 vaccines. My mother-in-law, my husband and I must have called multiple times that day to confirm that I, a medical student, would qualify as a health care worker. I get off work early to drive 50 minutes out of my way to be turned away. They were only giving it to children ages 9 and younger and pregnant women and women with children less than 6 months of age.  I was a little annoyed that they answering service was so unprofessional and uninformed, I wasted my time going up there. However, I was okay with being turned away as long as they were prioritizing. I don’t want bad karma following me just because I took a vaccine that belong to a little kid.

Solano County Health Department gets their shipment of nasal H1N1 vaccines and the day before they start their clinics, they also get their injectables.  The best part about them is that they have an amazing phone line to call for information. Their website was constantly updated. And a very awesome person that worked in the department that deserves so much kudos, took down my husbands and my names and numbers. She called us every time with updates on the vaccine clinics.

Their first clinic they only had nasal H1N1. I decided to go myself to check it out. I got there maybe 5 minutes after they were supposed to start. It was a very cold and windy day. The line was already maybe 100 people long. I’m very happy I didn’t bring my kids that day, if they weren’t sick, they would have been sick afterwards from just the wind. The clinic got started a little bit late, however, they were extremely efficient once they opened their doors. I got my nasal H1N1 vaccine in about 1 hour. Instead of actively screening like Yolo County was. They were passively screening. They had on a form that listed the criteria for getting the vaccine and this time it included health care workers and specifically said emergency personnel. And it asked that people who do not qualify – please do not ask for a vaccine. Otherwise they did not ask anybody or turned anybody away, except for technical details like getting the nasal seasonal less than 4 weeks ago, etc.

The next day, Solano Health Department was hosting another H1N1 vaccine clinic, this time with both nasal and injectable form. We decided to bring the kids this time.  I thought that the line would be perhaps the same, not much worse. I was very wrong. The line outside was very long. My husband went to wait in line while the kids slept in the car and then when they woke up, I took them to a local park. It took maybe 1.5 hours to get to the front of the door. Once inside we got a number, we were 133. They were calling number 85. There were people coughing and sneezing all in the waiting area. So once again we took turns taking the kids outside. This wait wasn’t too bad, maybe 30 minutes.

Our number gets called and we’re thinking, okay very soon now. We go inside and there is yet another line for the injectable vaccines. It is a short line, maybe 20 people, but it was a good 1.5 hour wait.  It was hot and stuffy. There was a mother in front of me with 3 kids. She had an older daughter around 6 or 7, a toddler in her right arm and an infant in a carseat in her left arm. She was amazing.

Total time wait for H1N1 injectables would be 1 month by the phone and then 3.5 hours in line. I kept thinking, these poor infants/toddlers waiting so long just to get poked by a needle and this is a good thing?!

Now then next step is to just hope that when it comes time around for their boosters, there will be enough left.

 

And how ironic is this. My son also needed two shots of the seasonal flu vaccine, being this is the first time he is getting it. I had originally decided to wait to try to get them at the same time – nobody wants to go to the doctors multiple times just for shots.  Of course, now, we cannot find seasonal flu shots anywhere. My doctors is out of them, tells us to call local pharmacies. We called every singly pharmacy in the area and many don’t have them, if they do, they do not do pediatric seasonal flu shots.

My husband and I had another heart to heart talk at this point and decided the seasonal flu shot – not as important this year.

Good luck to all those this season dealing with H1N1 madness!



{April 2, 2009}   Fever and Vomiting solved

She broke out in a rash. Whew. Thank goodness. 

What disease could it be when it’s high fever for a couple of days. Fever leaves and rash comes? 

Roseola infantum! 

I’ve never been so happy to see a rash. If she hadn’t had two episodes of fever before this, I wouldn’t have been so frantic up to this point.



Absolutely nothing!

So I went to my 38th week prenatal check-up today. It’s very strange because I just changed hospitals to be closer to my in-laws and this new place doesn’t do routine urine dipsticks. I’m so used to being bladder ready and peeing into the cup as soon as I arrive. Oh wells.

Anyways, the doctor checks me and says I’m dilated two centimeters. That’s a big change from not being dilated last week. But what does it really mean? Nothing. Doesn’t mean I’m going to pop right away. Preggos can walk around being dilated 2 for weeks. So I didn’t want to really tell my in-laws, might get them too excited and worried. However, being the big-mouth that I am, I still tell them and of course they think I’m going to pop this weekend. Still, it is my 2nd baby and multips most definitely can go at anytime.

Another way to see if I’m favorable to go into labor is the Bishop’s Score. It’s looks at several categories and gives a score, highest is 13. The score means two things. The lower the score, the less likely labor will start without induction. However, below 5, induction will probably fail anyway. The higher the score, the more likely spontaneous labor will start. And above 9, induction is likely to be successful.

Bishop score
Parameter\Score 0 1 2 3
Position Posterior Intermediate Anterior -
Consistency Firm Intermediate Soft -
Effacement 0-30% 40-50% 60-70% 80%
Dilation <1 cm 1-2 cm 2-3 cm >3 cm
Fetal station -3 -2 -1, 0 +1, +2

 

I love wikipedia, btw, and this chart is from there.

So I’m basically only a score of 1, because I’ve only got the dilation thing going for me. Which, I should emphasize again! – is very common for preggos to be walking around 2 cm dilated during their last two weeks.



I previously mentioned that my daughter was sick right before our planned trip to China. Our flight was on a Thursday. On the Saturday before, she started to act a bit sick. She woke up from an afternoon nap and had a minor fever or 100.4. However, every temperature from then on was normal. She had this harsh sounding cough and quite a bit of snot that was making it hard for her to sleep. Otherwise she was acting pretty normal during the day. She played and watched TV. She was a bit sweaty, but otherwise just fine.

I explained all this to the family practice doctor that we took her to see on Monday. If we weren’t traveling, I wouldn’t even have brought her to a doctor. My mother-in-law was the one that brought it up and I agreed to help alleviate her fears. She was watching my daughter on Saturday when my daughter hit her head and she’s been worried about that ever since. Nothing I say has been able to truly convince her that a bump on the head does not lead to a upper respiratory infection.

The cough, by the way, I believe is due to post nasal drip, because she definitely had snot. And she only coughed whenever she woke up. So she wakes up from her afternoon nap and is coughing and my mother-in-law calls me saying she wants to take my baby to urgent care. We get there, and urgent care doesn’t open until 5pm. The only appointment we can get is with a family practice doctor.

So I explain everything to the FP, saying that I just want clearance for travel and to assure my mother-in-law that it wasn’t her fault. She does all that. Does the typical lungs, heart, ears exam and states my baby has acute otitis media. It comes as a kind of a sup rise, since my baby has not had a fever and has not been pulling on her ears. Plus she’s never had AOM. I’m sure it helps that I’m an osteopath and I work on her head whenever she’s sick.

Either way, I’ve learned a while ago that it’s sometimes easier to just go with the doctor instead of trying to be the family doctor. But as I’m leaving the clinic, I’m thinking about it and I really think the doctor pulled a fast one on me. I also know from rotations experience that FP’s tend to over diagnose AOM. It’s like they have to slap some diagnosis, it might as well be AOM.

What can I do anyways? My daughter was diagnosed and even if I don’t agree with it, it would still be wiser to just give her the amoxicillin (a  pretty benign antibiotic). We give her the first dose right before she goes to sleep and once she’s asleep I decide to take a look in her ears. Her ears were so full of wax, I have no idea how the FP could have diagnosed AOM. So I try to remove a bit of the wax to get a better look and now I am really convinced that she doesn’t have AOM. I’m getting really frustrated with this doctor. I know sometimes doctors think that the patient expects an antibiotic, but I had clearly explained to her that I just wanted medical clearance for my daughter to travel.

So in the end we gave the antibiotic to my baby anyway. Until up to the flight and then we stopped. It gave her not too bad diarrhea. Otherwise she’s been pretty much “recovered” even before we left anyway. And now my mother-in-law is trying to get her to drink yogurt as much as possible.

I am never going back to that FP.



et cetera
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