- Head lice/ Sklice co-pay coupon
- Should you give tylenol before the shots? / vaccine reaction discussion
- Skin fold irritations
- HAND FOOT MOUTH (and butt) VIRUS
- Tips for giving medication
- Strep Throat
- The Poop series: Chapter #1 Baby poop
- Nurse Judy' Blog
- Anaphylaxis/Do you need an epipen?
- Pinworms (ugh)
Friday, August 28, 2020
The enormous impact of seemingly trivial decisions A few years ago, Sandy and I were taking a hike in the San Bruno mountains, in a last minute decision we decided to stop at a nearby Trader Joes on our way home. As we were approaching a large intersection, an out of control car came speeding through, crashing into several vehicles, including the one just in front of us. If we had been seconds ahead, we would have been seriously injured or possibly killed. Seconds. As we sat there stunned, surrounded by sirens and wreckage, I couldn’t help the thoughts swirling through my mind. Had we walked any faster, if I hadn’t stopped to pee, if we zigged when we could have zagged, could we have been in the intersection when the crash happened? Have you ever considered how being in the right place at the right time or a small decision that feels inconsequential at the time, can have an enormous impact on your life's path. Perhaps selecting a certain class in college, where you meet someone who becomes an important friend. That person introduces you to your husband, or helps you get a job...etc. Is it random? Are there some karmic forces at work? I find it fascinating. Today, August 28th is our 37th wedding anniversary. It got me pondering about all the factors that were involved in my meeting Sandy. I grew up in Pittsburgh, He was from New York. I was a year younger. We weren’t simply likely to run into each other. We officially met on an airplane going from Kennedy airport to Israel on September 2nd, 1976. I was seventeen. Sandy likes to tell the story of how he spotted me in line behind him and asked the agent. “ Do you see that little red head a few people back? Can you please put her next to me?" Back in the olden days, there were no computers assigning seats. Instead there was a diagram of the seating chart with little stickers. The agent was happy to help and when I got to the front of the line, he took the sticker next to Sandy’s seat and put it on my boarding pass. The rest is history. So, how is it that we were both on that same flight? On my end, this path started several years earlier with my brilliant friend Steven B. He was my classmate at a private Jewish Day School back in Pittsburgh, PA. I didn’t love the school, but was content enough, coasting along, surrounded by good friends. Steven was much more serious minded. Religion was one of the subjects that was taught. We were in 10th grade when it occurred to Steve that if you believe in God and God gives you commandments, then you are a fool if you don’t follow them all. You can’t pick and choose. Steven began to live his life trying his best to adhere to the letters of the law. His baffled parents probably didn’t know quite what to make of it. The rabbis were thrilled. They considered him a bit of a trophy student. And then one day, Steven came up with some inconsistencies that in his mind, “disproved” the possibility of the existence of God. He sat debating with the rabbis for hours, but they weren’t able to give him the answers he sought. It didn’t seem to occur to any of them that faith isn’t something that anyone can prove or disprove, but that isn’t what this post is about. He was done being in that school and wanted out. Two more years seemed like an eternity. With the same energy that Steve had been putting into following the rules, he now put into relishing his freedom. Indeed, he figured out a system. It turned out that all that was missing to graduate after 3 years was just one English credit. He convinced some of his best friends, myself included, to chip in to hire a teacher for one after-school class and we could all graduate after 11th grade and skip our senior year. I was all for it. My parents were supportive. The school was horrified. This was a private school and losing a dozen kids was not something they were happy about, but there was little that they could do other than change the rules, so that future students couldn’t avail themselves of that option. But, I was out after 3 years of high school. I was accepted and deferred to nursing school at the University of Pittsburgh and decided to spend a gap year doing an organized program called “year course” in Israel. That was what got me to the airport that day. Sandy was there because a dear friend of his convinced him to do the same program. Organized “anything” wasn’t (and still isn't) Sandy’s typical modus operandi. This was a big shift for him. I am somehow convinced that he was there because we were meant to meet. The first week we were all on a kibbutz. We were being assigned to various relatively menial jobs. The question was posed, “Does anyone here know how to drive a tractor?” Really? We were a group of urban kids who had just graduated high school. A tractor? But there was Sandy (who was raised in NYC and had never been on a tractor, thank you very much), who had no interest in cleaning up after livestock, or picking olives, raising his hand! He faked it well, thankfully without harming himself or others. He mastered it quickly and absolutely loved getting to know the real ins and outs of the kibbutz. I ended up picking olives. In fact, after realizing that this organized program was not for him, he bowed out and left the program after about a month. We remained together on the kibbutz for several months, before I headed off for other parts of the country; Sandy stayed behind riding his tractor, and became an adopted "member" of the kibbutz. But our connection had been made and was set! Sandy and I spent seven years in a long distance relationship before we ended up getting married. During those years I was back in Pittsburgh. Sandy was at Cornell, then Boston and then NYC. That was before cell phones. I remember waiting for our nightly call at 11:01 pm when the rates would go down. Of course, there were turbulent times peppered throughout. If any couple tells you that things are always easy, then they are either delusional or they are lying. Relationships take work. Sandy and I got through the choppy waters to a place that I wish for all of you. Complete trust, lots of laughing, lots of love, respect and actual deep friendship. We also are comfortable with the fact that we are very different and have many varied interests. If I want to go to a musical, or do a "Sound of Music" tour in Salzburg, Sandy won’t be the person that I bring with me, any more than he would bring me on his mountain climbs. We are okay with that! He remains my perfect travel companion. I can't wait until we can get back to more adventures. So if you are reading this? If I hadn’t met Sandy, I would not have moved to San Francisco. Honestly I may have stayed in Pittsburgh. I would not have answered a little ad in the paper that I happened to randomly see, on a day that I was half heartedly thinking it might be nice to get a job that wasn’t hospital based, thus ending up at Noe Valley Pediatrics. While working at Noe, during the H1N1 crisis 12 years ago, a mom in the practice encouraged me to start blogging in order to give up to date information on the availability of the vaccine; and this blog was born. For all of you who made lifelong friendships when you met each other at my baby boot camp sessions, think of all the little forces at play. I look at our kids, who are such a combination of both Sandy and me, and bless those forces that got us together and helped us navigate the bumps. Steven may have disproved the standard biblical God, but for me, I think there were some divine powers at work.
Posted by Nurse Judy at 9:41 AM
Friday, August 21, 2020
This week's topic Flu vaccine for the 2020/21 season This year the flu season is a bit more complicated because of Covid. Covid has us all (well, most of us….) sitting up and paying attention, but influenza is not something that deserves to be ignored. It is important to keep in mind that influenza is one of the deadliest vaccine-preventable childhood diseases. Each year, influenza kills more children in the United States than meningococcal infection and whooping cough combined. We don’t have a vaccine for covid yet, but we do have one for the flu. Some of the symptoms might be similar, but they are NOT the same illness. https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm Flu vaccines will not prevent COVID-19, but the hope is that they will reduce the burden of flu illnesses, hospitalizations, and deaths on our overstressed health care system. Hospitals have enough to deal with right now. If we can lessen the burden by minimizing the cases of flu, that is worth the effort. Infants can’t get the shot until they are 6 months old. It is recommended that all children over the age of 6 months get the flu protection. If you have a baby at home who is too young to get vaccinated for the flu, please take extra care to make sure that all the household contacts are protected so that you don’t bring the virus home. Children, especially those younger than 5 years, are at higher risk for serious flu-related complications. Folks of any age with chronic health problems like asthma, diabetes and disorders of the brain or nervous system also are at higher risk of serious flu complications. Anyone who is under the age of nine, and is getting the flu vaccine for the very first time, needs to receive two doses of the vaccine in order to be considered fully protected. The first dose “primes” the immune system; the second dose provides immune protection. The two doses need to be separated by at least four weeks. Over the years I have seen patients who have had only their first shot come down with the flu. One dose will not fully protect them. If your child has ever had more than two previous doses of any flu vaccine, they only need one this year. It takes about 2 weeks for the shot to take effect. Children under the age of three get half of the adult dose. Every year the disease trackers do the best they can to predict which strains of the virus will circulate and try to match the flu vaccine to the anticipated strain. Typically the vaccine changes from year to year. This year's vaccine is not the same as last seasons. Some years have better matches than others. This year the flu mist is available and approved for kids over the age of 2. As I do every year, I keep my fingers crossed that this year has the magic combination. This season’s flu vaccines were recently updated to better match viruses expected to be circulating in the United States. The egg-based H1N1 vaccine component was updated from an A/Brisbane/02/2018 (H1N1)pdm09-like virus to an A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus. The cell, or recombinant-based H1N1 vaccine component was updated from an A/Brisbane/02/2018 (H1N1)pdm09-like virus to an A/Hawaii/70/2019 (H1N1)pdm09-like virus. The egg-based H3N2 vaccine component was updated from an A/Kansas/14/2017 (H3N2)-like virus to an A/Hong Kong/2671/2019 (H3N2)-like virus. The cell, or recombinant-based H3N2 vaccine component was updated from an A/Kansas/14/2017 (H3N2)-like virus to an A/Hong Kong/45/2019 (H3N2)-like virus. The B/Victoria lineage vaccine component was updated from a B/Colorado/06/2017 (B/Victoria lineage)-like virus to a B/Washington/02/2019 (B/Victoria lineage)-like virus. The B/Yamagata lineage vaccine component was not updated. (There won’t be a quiz!) Some offices offer the trivalent that is missing protection from that last B strain. In my opinion it makes no sense to not get the Quadrivalent vaccine. Ask for the preservative free vaccine, which should be an option. This is mostly an issue for pregnant women and young children. All flu seasons have their own uniqueness. In my years as a nurse, some were memorably worse than others. There is no knowing how bad this one will be until we are in the midst of it. Since we never really know when the flu season will start with a vengeance, getting your child vaccinated early in the season is your best bet. As soon as a baby turns 6 months old you can get them started with their first dose. Because we don’t have experience with this particular flu vaccine, I can't have a sense of what kinds of side-effects to expect. Major reactions are quite rare, but the mild symptomatic reactions do seem to vary from year to year. Last season it was mostly low grade fevers for a day or two for a small percentage. For most people, including myself, the vaccine was tolerated very well except for a sore arm. Remember that a day or two of aches and a bit of fever is still better than a full-blown case of the flu. If your child has a mild egg sensitivity it is okay to get the standard shot. In my 30 years of giving flu shots, I only had one child have a reaction, and interestingly, it caught us a bit by surprise because no one had ever labeled her as having egg issues. For folks with a known severe egg allergy, be aware that there are now options for a special batch where no eggs are involved in the production. Ask your doctor if that is available for you. It may be that only allergists carry it. In any event it is important to keep a close eye on your child for at least 30 minutes after the shot. If they seem to be having any breathing issues or exceptional fussiness they should get checked out immediately (an emergency room is the best choice.) It is impossible to predict possible delays and shortages with the supply. The safest way to prevent having an issue with a potential shortage is to get the shot on the early side. Assuming that the vaccine is available, I would suggest getting it sometime in the late September/ early October. If your child isn’t feeling well, ideally you should wait until they are better before giving them the shot. When it gets deep into the season, most places will give the shot to mildly sick kids. Ideally you start planning early enough that you have options. When you go for a shot appointment, it is helpful if your child is wearing short sleeves or clothes that will allow them easy access. Perhaps bring an ice pack with you and give yourself a bit more time for some icing in advance. The shot usually doesn’t hurt too much but an ice pack gives some kids a little boost of confidence. You might also order something called a Shot Blocker from Amazon and bring it with you. These little gizmos have helped a few of my ‘shot haters’ have an easier experience. CDC/ Influenza: Vaccine information Statement https://vaccinefinder.org/ NVP patients: This year they are really excited to offer a “drive-through” flu vaccine clinic to maintain social distance. Flu shots will be available in the afternoons, Monday – Friday, starting September 8th by appointment only. Please call the office to schedule flu shots for your family. Parents can get the shots too! Please watch the Noe Valley Pediatrics website for further details. Town and Country patients: According to Dr. Kaplan, they have not set dates for flu shot clinics yet, but they will likely be in mid September. There will be 15 minute slots to allow for social distancing and one family at a time. Dr. Hurd patients: They are supposed to be getting their first shipment the second week of September and plan to have quick nurse/MA appointments available all day on Mondays and Fridays. They will offer shots to parents (and nannies) as well.
Posted by Nurse Judy at 9:05 AM
Friday, August 14, 2020
Ergonomic tips I have a wonky shoulder. The issue most likely stemmed from a combination of doing something dumb a few months ago and age (sigh). With all of the quarantine stuff going on, I ignored it as long as I could, but finally ended up at the orthopedist (shout out to the amazing Dr. James Chen). Thanks to a cortisone shot (that I was a little nervous about, but it barely hurt) I am now getting some of my movement back. I am also starting physical therapy. One of the things the PT was reviewing with me was my body mechanics when I am in front of the computer. I am tasked with having Sandy take a candid photo of me when I am working so that they can take a look at my habits and see if I am aggravating things with the way I am sitting. He hasn’t done it yet, but I know that I won’t need a photo to point out that I am probably not following the rules. With more and more families working from home and many kids doing school through 'distance learning' we all need to be paying attention to our body mechanics. Extensive time in front of the screen can lead to back, shoulder, and neck strain. When looking at the screen, your eye line should be level with the address bar on your web browser. It may be easier to get a proper position if you can use an external monitor or laptop stand to prop up your screen. Have your kids sit in front of their device and see if their head is straight or if they need to tilt up or down. Elbows should naturally fall flush with your table/desk height. An external keyboard and mouse as part of your work station will promote better wrist alignment. Trust me, if you can avoid carpal tunnel stress, it is worth the effort! Kids are not spared from getting wrist issues from over use. Make sure the chair you are using gives adequate support. If you don’t have a supportive office chair, putting a firm cushion or folded towel under your tush will raise your hips and increase the curve of your spine, This should make sitting more comfortable. Your feet should not be dangling! I have been guilty about this. Place your feet on a few books or boxes under your desk, so that your thighs are nearly parallel to the floor and your hips are slightly higher than your knees (the squatty potty is probably a little too high for an adult, but might be just the thing for your child). If you are on the couch, hunching over your laptop, I am betting that you are NOT in a good position. My son-in-law says that getting a standing desk was an absolute game changer for him. They are available from Costco and are fairly affordable. One brilliant reader shared the suggestion that you could use an ironing board and adjust it accordingly! Here is a CDC checklist for making sure your workstation is optimal For those of you on the phone for much of the day, use a phone headset if you have one. Constant cradling the phone between your neck and shoulder can cause trouble. Think of the 20/20 rule. For every 20 minutes spent looking at a computer screen, you should spend at least 20 seconds looking at something else 20 feet away. This gives your eye muscles a break and helps reduce eye strain. Even better, get up and move. My fit-bit gives me a reminder to move and then a little buzz if I get 250 steps every hour. I have been on zoom meetings a lot lately. For at least a few minutes every hour, I turn off my video and get up and stretch when I get that nudge from my device. Set up some type of incentive or alarm to remind you to move. It is amazing how effective that can be. Even more importantly, get outside! My awesome colleagues have identified some meetings that don’t really require us to be in front of the computer at all. We go outside and connect via phone while we walk. Be creative. Kids need recess too! Beyond the simple body mechanics, make your work station an easy place to concentrate. Having a television on in the background is not ideal. Be mindful of glare. Glasses that can protect folks from blue light have become popular. I reached out to my favorite optometrist Dr. Vincent Penza to see if they were a worthy investment. He forwarded me this article. My takeaway was that blue lights from screens are not actually dangerous. While some people feel like the glasses make their eyes feel less tired, the science behind that is lacking.There is certainly no harm in wearing them. The blue light experienced from the outdoor sunlight greatly exceeds what any device gives off. Please don't minimize the importance of wearing sunglasses when you or your kids are outside! Blue light does impact melatonin which is connected to your sleep rhythm. This is why most experts strongly recommend avoiding screen time for the period of time before you go to bed. If you are wearing headphones, make sure the volume is not set too loud. Here is one of my blog posts that tells you have loud things are and when it becomes hazardous.
Posted by Nurse Judy at 8:39 AM
Friday, August 7, 2020
This week's topic Personal Musings: Happy Birthday Lauren I was going to write about the fact that August is national vaccine awareness month. Immunization rates are lower than they should be, mostly due to the quarantine. Other things such as the importance of ergonomics now that we are slouching over our computers so much were on the list of possible topics to tackle, but I just wasn’t getting motivated. I considered skipping a week altogether, but writing the weekly posts has been one of the ways I have been keeping some normal routines intact during the quarantine. So please indulge me as I do another post that is mostly personal musing. Both of my kids have summer birthdays. That means I got to waddle around with an enormously pregnant belly in August for my first daughter and July for my second. This gave me an enduring love of San Francisco weather and the delicious fog. I couldn’t have stood the heat and humidity of the east coast. Last month I wrote about my July baby Alana when she turned 30. I had no qualms about her reaction to getting showered with some birthday love and attention. This week it is my daughter Lauren’s birthday. 33! Even though she is my actress who is quite comfortable on stage, she otherwise does not seek to be the center of attention. Lauren would tend to ignore her birthday if given the choice. Between her amazing husband Adam and the rest of the family, we won’t allow that to happen. Before Lauren was born, there was no crossword puzzle with answers confirming the baby’s gender and name But…. Right before I gave birth, my mother in law and I were having tea at the Japanese tea garden in Golden Gate Park and the fortune in my cookie was “ a short stranger will soon enter your life!” I am in complete awe of this oldest daughter of mine. She is an adventure seeker. This is the daughter who successfully guided her dad and she to the summit of Mount Kilimanjaro and then to Everest Base Camp a couple of years later. They both would have liked to try to go higher, but fortunately they were wise enough not to cross me! Before their first climb someone asked about their training. Sandy talked about how he was in the gym daily and hiking our local mountains while wearing increasingly heavy packs. Lauren, who was living in NY at the time, paused and responded that she was too busy to do any hiking but she was practicing learning how to pee standing up. Aside from the mountains, she has been skydiving twice (that I know of...), is certified to scuba dive and has flown a plane. She loves to travel and actually spent weeks traveling solo through Europe. She does try to protect me, so there may be things here that I simply was never told about! She is hands down the funniest person I know. She is a remarkable mimic. She had her Lowell high school teachers voices and mannerisms down pat, and would imitate them so perfectly that when I would go to the open houses and meet the teachers in person, I could barely keep a straight face. She can make a stand-up routine out of little every day events that will have everyone in the room hanging onto her every word and howling with laughter. Her brain has little savant traits that even she agrees are off the charts. She can unscramble the jumble in the paper instantly, no pen needed. There is a game called Set, that is based on pattern recognition. I haven’t met a person who can match her. She has been beating me at scrabble for years, and I am pretty good! She has always been musical. She was singing all of the Disney and Rodgers and Hammerstein show tunes with perfect pitch at an age where most kids are simply learning to talk. My favorite thing is still to listen to her sing and/or play piano. She and I play piano duets, as I used to do with my mom. Most of the time we sound pretty good, but full disclosure, there are plenty of times when one person is ready to turn the page and the other person is still playing because somehow they ended up a few measures behind. She and her dad play guitar together. She is one of the lucky people who has discovered the career path that they are meant to be on. She changes lives of children as well as adults by exposing the neuro-diverse to the joys and benefits of theater. Families leave her students' performances in awe, and frequently in tears, of what their children have accomplished. She is a teacher of drama and improv, and has been sought out by world renown theater companies to help them reach this population with their work. In 2019, she was the first ever recipient of the San Francisco Arts Learning Achievement Award, presented to her by Mayor Breed. I am constantly learning from her. All you parents out there. Savor every single stage, but it is okay when they grow up and turn into amazing people who make the world a better place. Happy birthday Yaya!
Posted by Nurse Judy at 9:31 AM