Poison!

I had the interesting experience as a physician and father a few weeks ago of having those two competing interests at odds with each other. It caused me a significant amount of psychiatric grief, something I’m not much prone to.

It begins with me taking a 4 month old child to Maui. I wouldn’t normally chose to travel to such a far destination with my child, for one reason that’s how you get kids sick. My little Ruthie did end up with her first cold a few days after coming back. For another thing: children don’t care about time zones. Their body tells them when they should go to bed and when they should get up, we try to adjust that by “sleep training them” but time zones through things for loop.

So we took Ruth to Hawaii, it’s a 1.5 hour drive to Boise, a 1.5 hour flight to LA, then a 5-5.5 hour flight to Maui. Keep in mind that as recent has a month ago my daughter cried for upwards of 4 hours straight the last time we tried to drive longer then 30 minutes (1.5 hour drive to Hailey and then several hours of crying after trying to put her to bed). It seemed daunting. The start of the trip went off without a hitch.

The thing about Ruth is that she is a social-a-holic. She loves being out and seeing people, even at the expense usually of taking a nap. I’ve joked about it many times before that no one even believes we have a fussy baby. When she’s a church she’s a smiling angel, but the drive home will be continuous tears and then nap refusal and fussy afternoon because of being over tired. So flying on the plane, and transfer, airports was constant social stimulation for her longest stretch ever. We got to Maui 4:30 Maui time which is 8:30 PM here. She is now 2+ hours over her bed time. We loaded in the car over an hour later. We clicked her into the car seat and she cried for 45 minutes straight to the resort.

Now we come to the crux of the conflicting internal emotions. We had a plan in place to give the baby a tiny dose of Benadryl to sleep when we got to the resort the first night and hopefully help her “sleep in” and adjust time zones. The doctor in me has given that advice at times and knew it to be reasonable. The father of a doted upon, precious, darling, 4 month old little girl was crying out “Poison!!!”

Let’s look at this analytically. Benadryl is an allergy medication. It’s an anti-histamine. It’s not a sleeping medication, per se. It helps people sleep because the molecule diphenhydramine blocks histamine receptors and histamine receptors are involved in both allergy but also sleep. By blocking the H1 receptors in the skin and nose it reduces allergy, by blocking it in the brain it makes you tired. It also cross reacts with another category of receptors called the cholinergic receptors and medications that do that often make one drowsy also. It’s pretty safe from a medical perspective at the correct dosing. The side effect is “drowsiness” not “life threatening coma and death in infants”.

I rarely advise it to parents as a physician because over-dosing a child on it can be dangerous and there are deaths linked to doses much higher than appropriate (for example I found an article about a day care provider using 6x the dose I used on my 4 month old on a 3 month old and it dying). I rarely advise it because I can’t be there to assure that the parents understand concentrations and dosing of medications. For me it’s intuitive what 12.5 mg/5ml means and how much 5 ml is. My typical patient doesn’t even know what that sort of formula is or how to use it. I spend a lot of my day during cold and flu season explaining how to dose Tylenol (fortunately most parents UNDER dose that and their kids come to my office with a fever of a 102 on a half dose of anti-fever medication- so maybe it’s unfortunatly).

So again, the MD in me was pretty comfortable with our plan to give our baby one does of Benadryl. The father in me was shouting internally “Kids have died!” Keep in mind that this was only like 2 weeks after I really fell in love with my daughter on the walk from my last blog post. We went ahead with it, giving her a ½ teaspoon, she spit/coughed/gagged most of it out and we put her to bed. She woke up at 4 AM and I couldn’t help but think “maybe we should have given her a little more”….

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Published in: on October 30, 2010 at 2:47 pm  Leave a Comment  

Sustainable Love

This is a two part entry based around this picture.

Part 1 Sustainable Exercise

I have been reading a book called Blue Zones by Dan Buettner about the places in the world with the longest life spans and the factors that lead to the “hot spots” of centenarians. I haven’t finished the book yet, but the thing that the book has really impressed upon me is the importance of what I’m calling “sustainable exercise”. The two places I’ve read about in Blue Zones the people are forced by lifestyle, geography, work, etc to exercise at a moderate level….indefinitely. This is very different then how I have lived most of my life. There was a time when I lived on Capital Hill that I walked a lot and the period during medical school that I commuted by bicycle. That has not been the norm and most of my exercise in my life has really been “training” for races. I’ve been in very good shape at different times, late high school I was in excellent shape. About 2-3 years ago I was in excellent shape, racing bicycles and/or running races. The bicycle racing was not sustainable for me however- see my other post about that.

I’ve been running semi-regularly over the summer and was getting back up to 5 or so miles with my weight having come down some and my fitness returning. The problem being that I would feel sore during the early part of the week, tired from work during the later part of the week and got to the point where I only ended up running on the weekend. Three days of weekend warrior running was not a sustainable program. So as I’ve been reading this book I came up with this idea of trying to just make moderate sustainable exercise a regular part of the daily activity. For me this probably isn’t going to be running. Biking maybe. Swimming (if that was available to me) would probably work, but there is no pool during the winter available in Jerome for lap swimming. Driving to Twin for exercise during the winter doesn’t seem to fit the idea of “sustainable” to me. So Dorothy and I started walking in the mornings before work. It’s about 1.5 miles round trip on the gravel road which we did every day this week so far- it takes about 30 minutes for us. The picture above was taken on Tuesday. It’s nice and cool in the mornings, we enjoy each other’s company, the sun rise and the exercise. It has been great for all of us (see part 2 below). This “sustainable” exercise will be supplemented on the weekend by much longer walks, running and eventually hiking and backpacking again. I’ll very likely get a mountain bike which I think will be sustainable exercise. I’m not sure how well this will work come winter as the temperatures get very low, but we’ll see, layers may just make this sustainable despite very cold temperatures. Maybe they make baby balaclavas?

Part 2 Scales in the Favor of Love

The picture also marks a turning point in my feelings about and my relationship with my daughter. We (Dorothy and I) have had a rough transition to parenthood. Few have seen our difficult times because Ruth seems to be pretty well behaved in public, but as recently as 13 days ago she cried for 3 straight hours while we tried to get her to bed. I have loved my daughter because she’s my daughter but honestly the joy I got out of having a child was far exceeded by the pain, inconvenience, crying, etc. The scales were tipped until Tuesday this week to “I kinda wish I hadn’t had a child” or maybe “there’s no freaking way I’m doing this again”.

Then something changes Tuesday morning. We had such an amazing walk that I had Dorothy take a picture of us on my camera phone (the one above). She was so cute, talking through 3/4 of the walk, which is mostly “ahhhhhgrahhhhhahhhhgrahhh”. The talking was punctuated by her looking up at me and smiling and then going back to looking to the side (much as she looks in the picture) and talking. For the last 1/4 she cuddled up to my chest and fell asleep. On Tuesday I could not stop thinking about her at work. I kept looking at that picture and showing to everyone. I was counting down the minutes until I could get home and see her. I worked late and got home just about as Dorothy got her to sleep and for the first time in Ruth’s life I was disappointed she was asleep.

Why the sudden turn around? Part of it is that our daughter has now been napping for about 12 days. The difference in a child from three 5 minute naps in a day to two-three hour long naps during the day, is pretty remarkable. She has been less fussy, more fun, more interactive and easier to get to bed at night. All things that have improved the mental health of our household. The difference started when Dorothy stopped drinking coffee two weeks ago today. Over-night change.

Before when people asked “How’s little Ruthie?” or “do you love being a daddy?, I’d respond one of two ways 1) those that I thought could take it I told them the truth “being a father kind of blows” or 2) those that I didn’t think could take the truth I told them “she’s really growing” which is a true statement but not quite the whole truth.

Now I can really say “I love my little girl”. A deeper love then the “I’ve decided to love and support my child (see my feelings about love in my previous blog post “You Complete Me”) that I had before. This is a “I adore my baby” kind of love. Several sagely fathers a little further down the road had told me “Just survive the first four months and it gets better”. Her 4 month birthday is tomorrow….I guess I’ll know what my advice to fathers will be.

Published in: on October 1, 2010 at 12:26 am  Comments (2)