The information on this weblog should not be used to diagnose or treat any medical problem. Seek out medical care from a healthcare provider if you are concerned about your health or the health of your child.
This Month
January 2006
Sun Mon Tue Wed Thu Fri Sat
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31
Year Archive
Login
User name:
Password:
Remember me 
View Article  How to Broach the Topic
I've been pondering for quite some time how to broach the topic of circumcision on my weblog. Most of my topics up to now have been subjects that have come up on other forums since this blog's inception, or have been things that are relevent to me and my parenting at the time. This topic is neither. Nor can I come up with some other clever approach to it.

See, I'm a mom of daughters. I never had to argue about circumcision. I did, though... just in case. I couldn't face finding out the gender of my children (specifically the second and third - with the first I would have gone with the flow, and to this day I'm so thankful that she was a girl) without this decision, or rather, NONdecision, being made. It's a nondecision because the default is to leave our child alone, as he was when he entered this world, intact.

My biggest arguement against circumcision, as a nurse, is the pain aspect. Why on earth would a parent choose to subject their child to medically unnecessary surgery and inherent pain? It's a question that baffles my mind, frankly. It's not broken, so don't "fix" it. I also believe that it's not my body, therefore permanent cosmetic alterations are not my choice to make.

Further, I've never seen any good arguements FOR circumcising. All the typical ones I've heard don't hold water with me. Fitting in, and to look like Dad, just don't make any sense, and it is NOT easier to care for the circumcised penis. The pseudo-medical rationale of preventing UTI's, cancer and HIV are all flawed as well.

To "fit in"? My mother had this done to my brother to "fit in", yet she wouldn't buy me Calvin Kleins... which do YOU think was actually relevent to "fitting in"? The pants, or what's IN the pants? For what it's worth, I don't think either of us fit in particularly well - we were both geeks.

To look like Dad? I'd prefer that Dad shave off all his body hair, change his eye colour, hair colour, shape of his nose and whatever else to look like son. Makes sense now, no? I've never heard of penis-comparing-parties within families... and differences are easily explained.

Because it's easier to care for? Wow... where to begin.

How hard is wiping gently? The intact penis takes no more care than (the typical comparison, I guess because of the shape?!?) a finger. Except on the finger you WILL have to do some snipping at some point, so it's actually even LESS work than caring for a finger. You wipe. That's it. The foreskin is there to protect the penis from dirt. Smegma is a good thing. It oozes out to excrete urine and any stool that might, strangely, get under there. However, it won't if not retracted because the unretracted foreskin of an infant is fused to the glans of the penis, specifically to keep stool out. Do not retract, just wipe and go.

Whereas with the circumcised penis, you do have to do wound care for a week or so. Then as the penis tries to heal itself and the foreskin readheres to the head of the penis, you'll have to force retraction and apply vaseline or neosporin to keep it from adhering again at every diaper change. Which sounds easier?

To protect against UTIs? The incidence of any male getting a UTI is less than 1%. Significantly less than for a female. The majority of infants getting UTI's have structural abnormalities as it is, and circumcision will not in any way prevent a UTI when there is kidney reflux. The incidence per the AAP, last I saw, was 0.1-0.2% of circumcised males will get a UTI in their first year, versus 0.7-1.4% of intact males (not very exact, considering the rates of UTI in males are so low). Scary numbers? I think not... but when it's sold as "ten times as likely", then yeah, it sounds scary. Bottom line, your infant is unlikely to get a UTI, and if they DO, you treat the infection, it's not hard. If they have repeated infections, then a VCUG is warranted to rule out structural anomalies.

As a matter of fact, the foreskin plays a role in the immune system of the body. The foreskin serves as a physical barrier to infectious agents, and smegma has antibacterial lysozomes. Drs. Paul Fleiss, MD and Frederick Hodges, D.Phil. stated in their book "What Your Doctor May Not Tell You About Circumcision"
Apart from its lubricating function, smegma has antibacterial effects, most especially during infancy. Antibacterial substances are passed from mother to child during breast-feeding and are secreted in the baby's urine. Breast-fed babies receive substantial amounts of beneficial compounds called oligosaccharides. When ingested, these compounds are secreted in the urine where they prevent certain types of bacteria from adhering to the urinary tract and the inner lining of the foreskin. Animal experiments have found that special cells called plasma cells in the inner fold of the foreskin secrete a compound called immunoglobulin. These secretions protect the penis against harmful bacteria. It is interesting to note that these antibacterial secretions increase in response to bacterial invasion. (http://www.twbookmark.com/books/70/0446678805/chapter_excerpt15690.html)


Penile cancer? HIV? Okay, penile cancer rates are tiny... (American Cancer Society states 1 in 200,000 men will get penile cancer) but yes, it makes sense that if something isn't there, you won't get cancer in it. So you've decreased the existing penile tissue, however the penis still exists, the risk of cancer still exists. Oh, but I could go have a double mastectomy once my kids are done breastfeeding! I won't need those suckers anymore and the incidence of breast cancer are astronomical by comparison! But I won't, of course, it's a fairly absurd notion... so why isn't circumcising an equally absurd idea?

As for HIV, the studies conducted in Africa are not generalizable to our population, and from what I can see are inherently flawed. To say that circumcision protects agains HIV is misleading and irresponsible. What protects against HIV is safe sex and universal precautions when dealing with body fluid.

Okay, deep breath... and now with my soapbox firmly stuck to my feet, I'll wrap up.

Should I have had a son there is no way I would have inflicted the pain of medically unnecessary, permanent cosmetic surgery on him. It's his body, it's his choice.
View Article  Pain Reliever versus Fever Reducer
There is good reason to avoid treating every little fever. A fever does a job for the body. It is part of the immune response, creating an unfavourable environment for germs. Germs like 98.6, fevers up to about 101 in infants, arguably 102, shouldn't be treated with antipyretics such as Tylenol (acetaminophen) or Motrin (ibuprofen) in the absence of suspected pain.

Such medications can actually harm the liver with chronic use, Tylenol specifically (and Motrin isn't recommended for infants less than four months of age). So using them judiciously is a good idea.

That said, I DO treat when I suspect pain in my child. There is no reason to leave a child, especially an infant who cannot communicate well, in pain. I've seen research to indicate that pain can even prolong an illness (although at my fingertips I do not have the references to back that assertion up... maybe I'll post a follow up when I have to time to do the literature search).

Finally, on rare occasion I have used Tylenol and Motrin synchronously, and that was when a fever reached dangerous levels, and wouldn't respond well to only one medication. Such was the case when my first daughter had a febrile seizure. Her temperature rapidly reached 105.7 and was difficult to break. We treated her for a couple of days with both medications to try and keep her under 103.

Final note, in a newborn, seek care if a fever exceeds 101 rectally. Some bloodwork to rule out serious infection may be warranted.
View Article  Baby Talk
I don't mean the "goo-goo-ba-ba" kind of baby talk. I don't mean toddler-speak, either. I mean the preverbal communication that mom's get to know of their babies from birth. The slight variations in pitch in their cries that differentiate "I'm hungry" from "I'm tired", the posturing that means "I'm pooping now", and some even more subtle methods of communicating.

The above listed examples I consider sort of a "micro-speak" - it conveys a message about what's going on right now, something mom and dad need to do something about in the present. Then there's a "macro-speak", that communication which is a little more broad, not as urgent. In my experiences now with Chloe, the macro-speak is what tells me when she's sick, or getting sick.

When she had strep throat (following in the footsteps of the rest of the family) the only symptoms she outwardly exhibited was that she was waking at night suddenly. She didn't have a fever, she wasn't fussy, nothing. Yesterday I knew something was up as she refused to use the potty, preferring to pee in her diaper the minute I put it back on her, and refusing to nurse in the morning - then snacking all afternoon. This followed one episode of projectile vomiting first thing in the morning, so we could have attributed it to an upset stomach, but I knew that was not it. Sure enough, I'm awake now at 2:15 AM, (after being awake - right after I fell asleep - at 10 PM for half an hour, and 11:30 PM for over an hour) with a girl who's nose is totally occluded, doing the old saline and suction routine. In retrospect, she was probably even coming down with it the day before THAT even, as she took 3 naps, about 2 hours in length each. Then yesterday she only took short sporadic naps, only one 30 minute nap total in the afternoon. All behaviours very much unlike her.

The communication is there - too bad the language isn't one you can learn in a classroom!
View Article  Another Year Wiser?
Goodness I can only hope. I'm officially in my MID-thirties now, 34... somehow I held onto 33 as "early" 30's. Semantics? You betcha. Does it really matter? Not at all. So why do I care?

Reality is, the number doesn't bother me at all. "Aging" doesn't bother me one bit. I can have wrinkles, and grey hair and all that stuff, and it would be fine. So what's bothering me?

Well, I guess it's that I'm one baby step closer to the end, and I don't want it to be over. It's been one helluva ride so far and I'm not ready for it to be one third done, or more.

Here's to hoping that when the time comes, part of the process, part of the wisdom, is that you're at peace with it being the end. Until then, I'm banking on having so many more years that I'm gonna be stinkin' brilliant at the end... Too bad I won't be around to use said brilliance. (Where's a smiley when you need it?!?)
View Article  Fitting in Exercise
We do what we can, right? Life's busy, but it's a priority for me, so I make the time. Lately it's been after the girls go to bed a lot. However, the last week I'm finding myself working out in spurts throughout the day - 30 minutes on the trainer here, 40 minutes there, lifting weights later... all within one day.

Okay, so I'm not always at my freshest, and my hair gets washed every other day whether it needs it or not (HA!), but I'm figuring that maybe, just maybe, this is really good for maintaining my metabolism?!? Or whatever I need to tell myself to keep doing it, I guess.