The enormous impact of seemingly trivial decisions 2023

 

Monday will be our 40th wedding anniversary. In honor of that mind blowing number, I am rerunning a post from several years ago. The post not only tells the story of how we met, but shares some of the ingredients keeping the relationship strong and steady.

The enormous impact of seemingly trivial decisions  A few years ago, Sandy and I were taking a hike in the San Bruno mountains. On 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. The offending car itself rolled over several times after hitting the other cars. 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.  I wrote this piece 3 years ago, on August 28th, our 37th wedding anniversary. I found myself pondering 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 likely to ever run into each other. We officially met on an airplane going from Kennedy airport to Israel on September 2nd, 1976. I was seventeen; he was 18. 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 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 menial, and sometimes unpleasant, 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. I don’t imagine that my career path would have led me to doing my ‘nurse Judy blogging’. I look at our kids, who are such a combination of both Sandy and me. I look at my little grandsons who are magical creatures. I bless those forces that got us together . Steven may have disproved the standard biblical God, but for me, I think there were some divine powers at work.

The Pie Theory of life/finding balance

 

The Pie Theory of Life

Here is an update of one of my top ten favorite posts. In honor of all of the parents who have kids heading off to college, I am updating one of my favorite posts. The Pie Theory of life The "pie theory" got its inception many years ago. For a number of years when my kids were much younger, I was the Parent Association president at their elementary school. It took an inordinate amount of my spare time, including meetings several times a week. On many levels it was rewarding being so involved but I assure you, I was delighted to pass the reins when my stint was over. Though I was really genuinely relieved to have my time back, I felt off balance by all the sudden free time in my schedule, and at first I couldn't figure out why I was so unsettled. I finally realized that although the new empty hours were welcome, they had created a bit of a vacuum. I filled it quickly (started taking up karate a few evenings a week), but it was right around that transition period that the "pie theory" helped me make sense of things. Imagine that your identity is a circle (or whole pie). Who you are is divided into many pieces; some pieces are large, some small, some temporary. Some are constants that are with you life long, some are optional, some are good for your soul, while still others are energy sappers that give you little in return. Are you: Daughter? Son? Sibling? Friend? Spouse? Ex spouse? Grandparent? Student? Volunteer? Pet owner? In a job/occupation or seeking one? Doing a hobby that takes time and energy? Member of a book club or any club for that matter? Churchgoer? Exerciser? House cleaner? Carpool driver? Event planner? Adventure seeker? Avid sports fan? and of course last but not least....Parent? The list goes on and on. What activities make up your day, your week, your month, your year? What pieces make up your pie? Take a few moments to figure it out. Get a piece of paper and a working pen (if you can find one) and create your pie. It's interesting to think how you can be identified in different ways by the various pieces of pie. Many folks recognize me as Nurse Judy. More than once I have actually looked at a rash, or given advice from a restaurant table (as my patient husband rolls his eyes.) There was a time years ago when I came to work one day and saw a construction worker on the roof of a neighboring building. He looked awfully familiar and I was struggling to place him; was he a parent from the practice? Someone from school? I could see that he recognized me as well; we kept looking at each other and a moment passed. I could see that he had figured it out first. He gave a big grin and called out "Ahoy there Java's mom!" Of course! I ran into him several times a week with his pack of dogs when I walked my dog Java. Not only did being a dog owner dictate my daily schedule and get me out walking rain or shine, it also included me as a member of a distinct social network in the neighborhood for many years. All the dog owners knew each other by sight and all the dogs by name. Being "Java's mom" was a wonderful piece of my "pie" for 12 years. If you are a pet owner, that piece has a very special place allotted to it.  Your pie is finite. You can only do and be so much, as there are only so many hours in the day. Some folks have too many things competing for time and attention, and figuring out which pieces can be compressed can be quite stressful. Sometimes we make poor choices. For busy working parents this might be a foreign concept, but some folks don't actually have enough pieces to begin to fill the shell. A big empty pie can be just as unsettling as a full one. Have you ever noticed that when you are super busy you can manage to get through an entire to-do list very efficiently? On the other hand, on a quiet day you may have only one or two things on the list but somehow nothing gets done. A healthy pie has plenty of interesting pieces that can grow and shrink according to your needs. The more forgiving and elastic the pieces, the easier time you will have finding a good balance. Your pie will naturally change from year to year, but some changes are enormous. Some people are comfortable having a very crowded pie, while others are quite fine and happy doing nothing at all. Part of this is figuring out what your ideal is, and working towards that. Any large sudden changes to your pie will make you feel unsettled, way less so if you have a glimmer of what is going on; hence this theory. Both of my daughters have taken this to heart. When there is a large shift in your pieces my girls and I refer to this as "pie disequilibrium." Common culprits might include: Event planner: Folks planning a wedding or large event can spend months dealing with all the fun details. When the event is over, that planner piece is gone, your pie has a gap. Caregiver: Folks that spend much of their time and energy tending to someone else’s needs might find themselves suddenly with a large vacuum when that person is gone or no longer needs them. Parent: Huge life changes will create seismic shifts. Nothing will ever match the enormous transitions that take place when you add the parent piece to your pie. My best advice to you as you shuffle all your pie pieces and see how things fit comfortably is to identify pieces that need to be protected so that they don't get too small. As your children grow up it can be a tough adjustment when they are no longer quite as dependent. (don't worry, they still love you.) Luckily this happens in stages. Kindergarten...a full day of school...college. Parents who have the "parent piece" taking up the entire pie may feel a twinge when their kids don't need them in quite the same capacity. You will also find that your role vastly changes when school is in or out of session. DO NOT IGNORE YOUR PARTNER! Protect that piece. Get creative and make sure that you have time for the two of you; have some moments being a couple. DO NOT IGNORE YOUR OWN NEEDS! Being the best parent that you can be includes living by example. Let your kids have parents that are multifaceted and not consumed by any one thing (be that parenting or a job.) Even simple things can impact your pie more than you might expect such as: Sports Fan: If you closely follow a team, you might find some emptiness during the off season. Actor: Before she was a mom, my daughter Lauren had to learn how to deal with the extra time that appears after a show run is over. If you are feeling out of balance take a look and see if you can figure it out. Best of luck finding a balanced, interesting, and fulfilling pie!

Poop and Solid foods

 

Poop and Solid Foods

Infant poop is a fairly benign substance in the first couple months. Once your baby's food intake moves beyond simply milk, that is about to change. The ‘yuck factor’ when the poop gets on your hands, the walls...etc, moves into a new realm. I remember an email that I got one Sunday morning. The subject line was “undigested carrots, is this normal?” I should have known better than to open it when I was sitting down to eat breakfast. What was I thinking? The answer to the question was yes. It is normal to have little pieces of food show up in the poop, but there needed to be a much stronger warning for the attached photo. I will spare you a more detailed description. As your child's system adapts to digesting substances other than milk, the consistency of the stool will change. When I do my solid foods class, I tell the parents, "You are the Conductor of the Poop Orchestra." This simply means that you are in charge of how much milk, how much solid food, and how much extra fluid goes into your baby.  Your job is to pay attention to the outcome and make adjustments as needed. You don't want watery stools (I am talking about almost clear fluid with flecks) and you certainly don't want formed little pellets. The goal is for the stools to remain soft. At the risk of ruining your appetite or changing your dinner plans, (if I haven’t done so already), think hummus, soft cookie dough, or play-dough. Until your baby starts solids, it is unlikely that they need extra water in their diet (unless you are in a very hot climate). This changes once they start eating food. Now that they are eating, it is time to get in the habit of routinely offering water throughout the day. While it is perfectly fine to put water in a bottle, this is a great time for them to learn how to get some sips out of a cup.  I don’t generally have an exact amount. Even an ounce a couple of times a day is fine. If the urine is light colored and the poops are fine, then you are on the right track. If the stool is getting thicker, the first step is to bump up the amounts of fluid throughout the day beyond what you are already giving. You can offer plain water or very diluted juice. Prune juice is probably the best if they will take it, but otherwise, most any natural juice will do. Coconut water is another good option. The food choices are also important. Most foods are fairly neutral but some will help keep the stools soft. The majority of fruits and veggies fall into this category. Prunes, pears, and peas are some of my favorites. A little molasses can also get things moving. Foods that are higher in fiber are beneficial.  Good sources of fiber are: legumes, such as lentils, black beans, kidney beans, soybeans, and chickpeas fruits, such as berries, apples with the skin on, oranges, cut up grapes and pears vegetables, such as carrots, broccoli, green peas, and collard greens Nuts and seeds, such as chia seeds, almonds, peanuts, and pecans. You can always sprinkle chia or flax into an existing dish to up the fiber. Oatmeal and bran flake cereals are good. Other whole grain products can have some fiber, but you need to read the labels. Marketers have hijacked the term “whole grain” to sell you anything that they sprinkle a little fiber into, while the majority of the food item might still be constipating. Common culprits include whole wheat bread and pasta.  MyPlate.gov is a great resource for meal planning, and AI programs like https://www.parentgpt.io/ are excellent for designing a high-fiber meal plan for a weekly basis. Pay attention and see what is working for your particular child. Some foods tend to make the poops firmer. Most of you have probably heard of the BRAT diet. This is a diet with bland starchy foods such as bananas, rice, or applesauce and toast. This is a standard suggestion for kids and adults if they have diarrhea because these foods tend to be binding. Some of these are also among the first foods that many people offer when their kids are just starting solids, Bananas, rice cereal and applesauce are okay to be on the list for your beginning eater, but if the stool is getting thick, there are better choices for first foods. Beware, I have also found that some organic and/or toddler formulas can be a bit constipating With the addition of new foods, the poops can be quite fascinating.  When I get the frantic “there are little brown worms in my baby's poop” question, the first thing I ask is whether or not they had bananas recently. Dr. Ted gets this question about once a week. It turns out that bananas can cause little brown thread-like substances to be in there; imagine a piece of banana cake.  Different colored foods can give you a rainbow of different poop shades.  My daughter Alana once unbeknownst to me ate a pint of blueberries and had a bright blue load in her diaper that caught me by surprise to say the least. Anything with red color can stain it red. Beets are the obvious culprits, but watermelon can lead to an interesting shade and consistency. Some babies start the solid food journey with pureed food. As soon as they are able, I like to do a combination of feeding styles and introduce some “Baby led weaning”. With this method, babies can simply pick up soft pieces of food and feed themselves. Once they start eating little pieces be prepared to see some of those same pieces pass through without being digested (like the undigested carrots in the gross photo). This is normal. So when do you need to worry if they skip a day of pooping? If they seem happy, I am not terribly concerned, but if they are new to eating solids, I don’t want to let it go too long. Many nurse advise protocols will suggest intervening at 72 hours of no poops. There are some things you can try before 72 hours: Massage their tummy. Go on youtube and search out some Infant Massage techniques. A good belly massage can help stimulate peristalsis (which is the movement within the intestines that moves the poop along.) The tummy may be the most important area, but doing an entire body massage will help them relax.  Don't forget their little hands! Take your thumb and make firm little circles on their palms. This is a reflexology technique that grandmas have been practicing for generations. Let gravity help them out. Hold them in an upright position and pull their little legs up to a squat position. Nobody poops as easily if they are flat with their legs straight. If your kid is old enough, get them up dancing and moving around.  If they are too young to be really mobile, you can bicycle those legs. Push the thighs all the way up to touch the belly. If you are doing anything that is uncomfortable, trust me, they will let you know. Swirl their little hips around, like a little hula as you move the thighs up and if you do it correctly it will make them fart (very satisfying!) Sometimes a little rectal massage will also help. To do this you can put a dab of Vaseline or some kind of lubricant on a Q-Tip and stick it a tiny bit of the way (just the cotton tip worth) into the butt. When I would take a rectal temp, back when I was working in the pediatric office, more than half of the time the baby would poop right on the thermometer. The Windi is another gentle way to stimulate pooping and help relieve gas at the same time. (There are many brands now that all do the same thing.) A little warm pack on the lower belly can help relax the muscles Epsom salts in the bath can sometimes stimulate poop My chiropractor, Sandra Roddy Adams, tells me that her gentle treatments often get the little ones to to have a bowel movement Dr. Den, my favorite local acupuncturist can do a lot for this (without needles), but if you are not in San Francisco, look about for someone who works with kids. If you little one is over two, consider Magnesium.      If it’s been 72 hours, or when you can’t stand it any longer: There is no intervention needed for infrequent stools as long as you have a happy baby, up to a certain point. It’s almost always a bit of an ordeal to pass a 3-day-old poop, so this is often the time to at least start thinking about options. If it has been many days in between poops and your baby seems quite uncomfortable and none of the actions above have helped (what’s going in the mouth has been optimized for fruit and fiber), my next step is using glycerin. With the glycerin you have 2 options. Glycerin suppositories are little sticks of glycerin (over the counter in most drugstores.) You break off a piece and stick it into the butt (some lube helps it slide right in). This stimulates the babies to poop fairly soon. The other option is a product called Pedialax. These are little bulbs full of liquid glycerin. You pull off the cap and insert the pre-lubricated tip into your baby's butt and squeeze the liquid in. This product works really well. The box says that these are for babies two and over, but I have found them safe and quite effective for younger folks. As soon as they poop you can assess the quality of the bowel movement. If it was soft and mushy, you probably could have let it ride for another day or so, but don’t stress. Occasional use is quite safe. Often just going out and buying either glycerin product will make your kid poop. (I am not kidding!) In any event, it is a useful to have this on hand.  If the stool is hard and firm, then it is good that you helped it pass. If you find that you need to use glycerin more than three times in a row, it is worth checking in with your pediatrician to see if there are any long-term adjustments you need to make. One of the most common interventions is something called Miralax. This is the brand name for polyethylene glycol, a substance that passes through the intestines completely unabsorbed, making it fairly safe to use long-term. It is widely used by gastroenterologists for chronic constipation. If needed for chronic use, Dr. Ted uses 1 teaspoon per year of life on a daily basis (starting at 1 teaspoon per day for infants), and goes up from there as tolerated. What about Probiotics? There is no good data on using probiotics for constipation. In fact, in Dr. Ted’s anecdotal experience, probiotics are more often constipating than they are loosening. ----------------------------------------------- P.S. As a gentle reminder here are the “red flag/when to get checked out” signs for poop: Black /tarry poop (not just “very dark,” it has to be fully black) Copious bright red blood Fully ghost white poop Watery diarrhea associated with a fever and pain. Generally if there is a real issue, your little one will have other symptoms along with the funky poops. Small flecks of blood can happen here and there, especially with large hard poops, so if that happens once in a while, it is just a signal to follow some of the advice in this post to work on getting softer poops. If you’re seeing a lot of it, let your pediatrician know. Constipated kids are really miserable. Please be proactive with diet, fluids and fiber, and try not to let it happen on your watch.

Probiotics 2023

 

Probiotics

I have been wanting to tackle the probiotics conversation for years because I get a lot of questions from parents that go like this: “My baby is fussy and has weird loose poops, should I give them probiotics?”  “My toddler is constipated, will probiotics help?” “Should probiotics be part of my child’s general health maintenance? The list goes on and on. I love collaborating with Dr. Ted so I asked him to help me out. Usually, we pick a topic and look at the current data. We go down lots of rabbit holes. I pepper in some of the more anecdotal experiences (put breastmilk on everything) and then voila, I have a post. Finding straightforward and simple answers should be easy right? Alas that wasn’t quite the case with this subject. We ended up working on this topic for months. The one thing that stood out from our digging is that the importance of gut health is becoming more and more documented. As an increasing amount of research is being done in this area, probiotics are often billed as the future of gut medicine. A panacea for all your poop woes. Unfortunately, research on how to modulate gut health is lagging. While we know more now than we used to, there is still so much emerging knowledge. So Dr. Ted and I did a deep dive into the available information and came up with the glaring conclusion: “...we still don’t know sh*t” That said, we’ll try to get you answers some of the more common questions. What is the microbiome? A wide array of bacteria and other organisms live in and on the human body. We know that these microbes do things, such as break down the food we eat, and release chemicals that have impacts on our health. There is a complex dynamic between hundreds if not thousands of strains of bacteria, viruses, and fungi that live in our microbiome, and they live in symbiosis with each other. There are times where the good bacteria keep bad bacteria at bay, and there are times where the bad bacteria become dominant and harm the good bacteria. I am always a fan of finding ‘balance.’ Never is this more important than in our guts. High-level patterns we know for sure: The difference between probiotics and prebiotics. There are two common ways that humans can choose to support the microbiome directly - probiotics and prebiotics. The World Health Organization defines probiotics as “live microorganisms, which when administered in adequate amounts confer a health benefit on the host.” Prebiotics can simply be thought of as the food/fuel for organisms in the microbiome to confer a health benefit. The most commonly used prebiotic example is fiber, which is passed through the intestines undigested to feed healthy bacteria. Even though it sounds like prebiotics should “come before” your probiotics, the timing doesn’t matter, and you don’t always need to take both. Our gut always has some natural probiotic strains that will benefit from prebiotics, and supplemental probiotics can thrive without specific prebiotics.   Variety is important. Time and time again, when we look at samples of human microbiomes, having diversity is correlated with better health. To that end, natural sources (see ‘fermented foods,’ below) and supplements with a lot of variety will both be more physiologic than supplements with a single strain. The microbiome can be disrupted by outside forces. The following factors have been associated with microbiome changes: Illnesses, like viral or bacterial infections Antibiotic use; repeated use correlates with longer changes What you eat, overly-restricted diets, additives, and high-salt lead to disrupted biomes. Probiotics are an ‘umbrella’ term. If you were asked “are animals good?” you might want some more specificity to the question. Which animals? Tigers or puppies? Good in what way? Probiotics can be thought of similarly. There are hundreds of different strains of probiotics, and very few of those strains are thoroughly understood. Certain health conditions will respond better to specific strains. Fermented foods have some of the best natural probiotics. Most people think about “probiotics” as something you buy in the form of a supplement. Those can be pricey. In fact, the best sources of probiotics are the natural ones from fermented foods  Kefir Greek yogurt Kimchi Miso paste Kombucha (for kids over 4) Pickles  Sauerkraut  Tempeh buttermilk Many things on this list can be pretty salty, so read labels and make adjustments when possible. Maybe try making your own pickles! Some common questions In looking at how far-reaching the data around the gut microbiome is, we found ourselves reading studies from all over the spectrum of human health. These are some of the most common questions people ask us. What do strain amounts mean? Probiotics are measured in colony-forming units (CFU) The CFU shows how many viable bacteria there are in each dose. We are usually talking about millions or billions!  Should pregnant people automatically take probiotics? There’s evidence that some bacteria travels up the birthing canal to seed the future microbiome. To this end, some birthing parents have started to use “prenatal probiotics.” In a small number of studies, the use of some strains, including Lactobacillus and Bifidobacterium species, have indeed been shown to decrease inflammation in mom. This can decrease the risk of preeclampsia and other disorders like gestational hypertension.  The data isn’t conclusive enough to support that this is something that everybody has to do. In other words, don’t let this cause stress if you opt out. It’s entirely possible that these studies were confounded by other variables. For example, parents that take prenatal probiotics might be more likely to engage in gut-healthy behaviors. Anecdotally, Dr. Ted has noticed that babies born to mothers who took prenatal probiotics appear to have lower rates of colic and diaper rash, which may indicate a healthy microbiome. Bottom line. This appears to be a safe intervention, benign and maybe useful. If you didn’t do this and your child has these problems, let me stop you before you start feeling guilt (baseline reaction for many parents). You can’t manage the past. Know that there are likely millions of children with perfect guts that still have these problems, and there are options for infants. Tell me about the probiotics marketed towards infants It is possible that babies are missing some important strains of good bacteria. Think about this gut imbalance almost like a vitamin D deficiency. If a breastfeeding mom is low (and this is more common than you might think) her breast milk won’t have adequate amounts of this essential vitamin. If this is the case, the breastfed babies will benefit from a Vitamin D supplement. Even though many moms have reasonable vitamin D levels, the AAP suggests that all breastfed babies get vitamin D drops just in case. To follow up with this analogy, a birth mother might be lacking in certain strains of bacteria that can be useful for babies. This could be due to generations of antibiotic use and/or dietary changes. Other interventions, such as C-sections, may further interfere with the normal transmission of flora during vaginal birth.  To fill in this deficit, researchers have created a probiotic for just this strain. The primary one that has been studied is Bifidobacterium Infantis (B.Infantis). Some of these probiotics, such as Evivo (a brand of B. infantis) are expensive although you don’t need to take them long term. Unlike vitamin D, there is not a universal recommendation quite yet. Anecdotally, we have noticed that many babies taking B. infantis poop less, get less diaper rash, and gain weight well. Taking it is quite safe, and in babies with diaper rash, excessive poops (>10 per day), or colic it may be beneficial. Most infants take it easily but there are some babies who don’t seem to like it. One quirk about Bifidobacterium infantis: it’s been shown to specifically break down and metabolize human milk oligosaccharides (HMOs). The studies that have shown that it decreases stool output, diaper rash and colic were done on parents that were exclusively or mostly breastfed. There are some formulas that market themselves as having HMOs, but rigorous studies on if Bifidobacterium infantis makes use of those HMOs are lacking. Can probiotics help with their colic/rash/fussiness/loose, frequent poop/constipation issues? There are ongoing studies about this. Some strains with ample data are Lactobacillus reuteri and Lactobacillus rhamnosus, both of which are marketed to infants 0-12 months of age (and older). These strains have been studied more extensively than B. Infantis, and the American Academy of Pediatrics even recommends a short trial of Lactobacillus reuteri in babies with colic, although in formal trials, only 30% of babies have been shown to benefit from this. Common brands that are popular for colic include culterelle, Gerber Soothe and Biogaia. Culterelle is covered by some insurance plans if your doc writes a prescription. Again, it’s worth remembering that the data here are extremely new, and every baby reacts differently to probiotics. Baby probiotics aren’t a classic medicine where we can predict the impact. If you’re that parent with an endlessly crying baby, probiotics are certainly another tool to try.  Should probiotics be a daily supplement for my young child? After infancy, the microbiome is a little more fixed. Just like with iron or other vitamins, a healthy lifestyle and a little attention to the right foods can be sufficient, but if we find evidence of a deficiency we would supplement (think kids with anemia or rickets from low vitamin d). Probiotics may fall into this category.  Probiotic supplements are likely not necessary for everyone, but if someone is experiencing any signs of gut imbalance, such as bloating, pain, or diarrhea that can’t be explained by the doctor or things such as food intolerance, it is safe and probably worthwhile to do a trial of probiotics.  What about after my kid is sick? Will probiotics help to reset the gut flora? Anecdotally, probiotics along with a bland starchy diet are our first line of treatment for kids with a tummy bug. Finding a brand with multiple strains may be the best way to help get the gut back in balance. A couple of good multi-strain probiotic choices that I have had success with for my little patients are Jarro-dophilus and/or Florajen for kids. Will probiotics help with eczema and asthma? We were tempted to not even include this question, because the answer is so muddled. It is early in the understanding of the research. There seem to be a number of correlations between poor gut health and asthma/eczema. That said, the research doesn’t give us an answer yet about which probiotic strains you can take to decrease the odds of having asthma or eczema, so even talking about this connection doesn’t feel responsible.  Then what do you do if you have a child with bad eczema? Moisturize, Moisturize, Moisturize, but as far as diet goes, we would recommend a balanced diet with a predominance of natural prebiotics: fruits, vegetables, and safe fermented foods like kefir, apple cider vinegar, and sauerkraut. Pay attention to any foods that seem like they are triggers that are making the eczema worse. Should I take probiotics with antibiotics? As of this writing, the answer is all over the place. There have been a number of studies that suggest a small benefit to taking probiotics with antibiotics, whereby the number of days with diarrhea might be shorter. But wait, along came a well-publicized study done recently that suggested that people who took probiotic supplements while taking antibiotics actually had a gut that was disrupted for longer than that of people who didn’t (but this study only analyzed poop content, it didn’t ask participants how they felt.) For a moment I shifted my advice on this front, but I am back to adding the probiotics to the mix. That is just a ‘gut check’, pardon the pun. In any event, We both absolutely recommend finding natural sources (Greek yogurt, kombucha, etc) as soon as the patient is interested in taking them. More questions without good answers. How do I choose the best probiotic?  There are a lot of ways that probiotics will market themselves. Strain number, size, etc. can all make for strong claims on boxes. Be a careful label reader. Make sure that everything in the probiotic is safe and there is nothing you are allergic or sensitive to, like soy or dairy. Can too much be no good? This depends on the specific strain, and the size of the person who is taking the probiotic. Typically taking a larger amount might cause some temporary bloating but is not dangerous. Anyone who is immune compromised should check with their doctor. How much does refrigeration matter? This also depends on the product. Most medicine, probiotic or not, will stay more potent in the refrigerator. But not all strains require refrigeration to stay effective. In any case it is very important to pay attention to the expiration date. Probiotics are likely not as potent as they age. Is it better to use a brand with many strains than one strain? In general, this seems to be true, but it’s difficult to come up with specific guiding principles. Some strains, like Bifidobacterium infantis, can have a big impact without variety, but in general, variety seems to be more physiologic. Can you use 2 products at the same time? Yes, you can, but the impact and symptoms from doing that are less understood. It’s safe, but there could be unintended side effects like bloating. In conclusion... Gut health is worth your attention. Adding fiber and fermented food to the diet is beneficial. Probiotics when taken as directed may have some good health benefits and are generally considered safe. So there you have it. Lots of food for thought but much less clear direction than I was hoping to offer. Enormous thanks to Dr Ted for writing and working on this post with me. Shout out to Brittany Williams for her input as well!

PARENT GPT

 

Parent GPT

Parenthood is a roller coaster. The joys of watching your kids grow, laughing at the silly stuff, and snuggles are the highs, but real life usually tosses in some lows. Some of those steep descents can be really rough.  Almost all parents have times when they worry about something or have questions about how to make life easier. For the last several years I have been the advice nurse at a startup called Oath Care. We understand the mental load that parents carry on a daily basis. We recognize that this constant responsibility can be exhausting and overwhelming. That's why this company is so determined to build the modern support system parents need. In just the last few months, there’s been so many updates in the world of artificial intelligence. This has opened up a new world of possibilities on how we can continue to better support parents - whether that’s using AI to write bedtime stories or summarizing mass amounts of research in seconds. We are beyond excited to share our latest feature with you, specifically designed to help make parent’s lives easier. Meet ParentGPT ParentGPT is a generative AI chatbot designed to provide you with instant & comprehensive answers to most parenting questions. You can find ParentGPT as a new feature within the Oath Care app today to help reduce the mental load throughout your parenting journey. As an advice nurse I know all about finding rabbit holes on the internet. By the time they get to me, parents are often in a full panic about something they read. Spoiler alert: No your toddler won’t get a brain injury from falling as they learn to walk No your infant won’t get botulism from accidentally eating a Honey Nut Cheerio No they won’t have developmental issues if they skip crawling and go right to walking. The internet can be a minefield. It can also be a gold mine. Artificial intelligence adds a new layer to that statement. It can make the gold shinier and the landmines feel more hazardous. Those of you who are looking things up in the yellow pages while listening to music on an 8 track (most of you probably don’t even know what I am referring to) will try to resist this new technology, but this is going to be the new normal for the next generation. We may as well embrace the benefits, while being sensitive to the fact that sifting through information might be even more complex.  But here’s the thing. No information on the internet or artificial intelligence is going to take the place of community or some hand holding when you are concerned about something. I think we have found the sweet spot! What makes ParentGPT special Curated Prompt Library: Our team has curated a comprehensive prompt library tailored to the stage of parenthood you're in. From creative bedtime stories to weekly meal and activity planning, ParentGPT offers a wealth of AI-powered suggestions that adapt to your specific needs. We continuously update the prompt library based on feedback and popular prompts created by parents like you. Comprehensive AI-Powered Answers: With ParentGPT, you can ask custom questions and receive detailed answers in seconds. You even have the ability to provide specific details such as your child's age, location, or background, allowing ParentGPT to tailor its responses to your unique circumstances. Expert and Community Support: We understand that some questions require the insights of medical experts or the real-life experiences of fellow parents. That's why ParentGPT seamlessly integrates with our community & can connect you with medical experts and a supportive network of parents if you’d like a second opinion or simply hear from other parents. If you like the ‘Nurse Judy Approach’, this is where you can find me. Just like the Oath Care communities now, ParentGPT is designed to provide friendly, non-judgmental and supportive answers, even on topics that can be controversial. To start using ParentGPT and benefit from its AI-powered assistance, download or update your Oath Care app to the latest version and discover instant answers to every question at your fingertips. As this is new technology and you are among the first to have access to this new feature, we appreciate any feedback you have by emailing us support@oathcare.com. We hope this new feature helps make your parenting journey a bit easier. As we all learn to navigate this emerging technology here are some extra pieces of advice. Keep in mind there is a big difference between hard scientific data and advice. There is rarely a one size fits all answer to most questions. I am a big advocate of gathering all the advice that is offered, sifting through and finding what resonates.  The Parent GPT might indeed be a wonderful source of pearls. I especially like the idea of meal planning…bring it on! But when you see ANY information on the internet, trust your gut. Consider it akin to asking a second opinion. If something doesn’t make sense, keep asking. We have tried hard to make sure that all of our information is accurate. But just as with an old fashioned google search, if your quest is accurate information, the International Federation of Library Associations and Institutions (IFLA) has a handy 8-step process which is quick, easy to understand and available to help distinguish fake from real news and facts from BS. 1. Consider the source – is it usually reliable and have you ever heard of them before? Uncle Arnold’s neighbor might not actually have his facts right, 2. Read Beyond – read the whole story, not just the headline 3. Check the author – are they a real person? 4. Look for supporting sources – misinformation is less likely to have multiple verifying sources 5. Check the date – maybe it wasn’t fake news when it was posted but is it now? We live in an ever changing world. 6. Is it a joke? – Some articles are meant to be funny and take on a life of their own. I have seen articles in the Onion that got me going before I realized they were parodies. 7. Check your own biases. There can be valid, multiple points of view  8. Ask the Experts –find some good fact-checking websites that you like. There are lots of good ones out there Check out the ParentGPT and I hope to see you in the Oath community!!