Sunday, February 08, 2009

sleep eludes

Baby Julius now has our collective cold...he can barely breathe what with all the snot. Thank God he is 24 pounds and allowed to take Advil cold and Tylenol Cold. (You know, the stuff they said didn't work? hahahahahahhaha, maybe they should speak to the entire pediatric ENT team at Sick Kids, all of whom heartily endorse it.)

Seriously, I love how the keep banning drugs off the market these days with little or no evidence of harm. It's like the new favourite thing to do is ban everything. In reality, they should just make sure it works for certain things and stick to them and study the drug properly if they have no studies.

Like pediatric decongestant? It works just fine, thanks. There are no studies on it in children. Only adults. But the FDA and Health Canada decided to go thermonuclear and BAN it. Funny thing is, that it likely does work well in children. They just haven't studied it yet. The companies are going to study it now because they are getting a lot of pissed of parents and a lot of high level guys like the ones at Sick Kids who are angry that children are being put in danger of chronic ear infections, ear drum damage, ear tube insertion surgery and possible deafness as a result of dipshit bureaucrats trying to cover their ass.

Oh and did I mention the monetary incentives? You see the ENTs at Sick Kids are paid flat rate salaries they negotiate and they only see the most serious cases, and are incredibly busy, so they don't want to see any unnecessary surgeries. They have enough to do. But the ear tube surgeries are still done regularly for any child who has had more than three ear infections. By local ENT surgeons. Who get paid per procedure, and depend on them to cover the bills. (ENTs also got screwed when it was discovered that tonsillectomies are rarely medically necessary. Business dropped and so did office profits.)

You see, about 7-8 years ago, a Cochrane study came out about the effectiveness of ear tubes for children with chronic ear infections. It turns out that ear tubes do absolutely no good at all for any normal children. They are effective for children with cranio-facial deformities, (like Downs, or flat heads from lying on their backs) but pretty much no other children. In the case of normal children with constant ear infections, they should get the pneumovax vaccine, and stay on children's decongestant to dry up the fluid in their ears. They should also be fed sitting bolt upright at all times, and never ever go to bed with a bottle of anything, water, milk, or juice. Breastfeeding is different because you can't culture germs in it and it can't come out of a breast unless the baby is actively sucking and swallowing, so therefore it can't pool in the ear tube and drum and brew up an infection.

The Ontario Ministry of Health could do something about this, and stop paying for a multitude of medically unnecessary procedures, (arthroscopic knee surgery, ear tubes, frozen shoulder rotations, preventative appendectomies, cystoscopies with irrigation, etc, etc...) and someday pay for medically necessary ones, like IVF with SET and PGD or miscarriage treatment, or helmets for plagiocephaly.

Health Canada could operate on the basis of medical evidence for drug safety and say---do things to prevent the death of babies and improve maternal infant fetal health.

But if that were to happen, all hell would break loose, the universe would end, and sunshine and rainbows would come bursting out of my ass.

You know, because it would mean the Doctors actually give a flying fuck about saving lives instead of cold hard cash.


  1. We are just getting over a nasty flu at our house too. We both were completely knocked on our asses and I fully endorse the advil and benalyn. What with the fever and chills, hacking and sneezing, those drugs do provide relief. While I dont support overly drugging kids with over the counter meds, they certainly have an important role in managing colds and flus in babies and kids. Hoping you and yours get well soon.

  2. What gets me is that I think the problem in the states was parents combining medicine (e.g., not realizing "cold" medicine often includes aspirin) or giving the wrong dose. Well here's a news flash people: READ THE FUCKING BOTTLES! Our ped pretty much told us if it works, keep using it. If it doesn't (cough syrup = cough drop for the amount of relief we get), don't. So we do.

    I hadn't heard that about tubes. I had chronic ear infections as a child, and only when Bella had back to back bilateral ones this winter did I hear of the "three and we tube you" rule. Seemed a bit drastic to me, but then none of my great stash of shit was drying out her ears, either. I suspected some ENT faulty plumbing, but I imagine here an ENT would also steer me towards tubes. Meh.

  3. I disagree on where Cochrane stands on the ear tubes, though what I went and found quickly is quite new (Oct. 2008), so clearly not the one you are referring to. Still, online, here:

    Summary --
    "Grommets (ventilation tubes) for recurrent acute otitis media in children

    Acute otitis media is a common disease of childhood, involving inflammation of the space behind the eardrum (the middle ear cleft). Episodes typically involve a fever and a build up of pus that stretches the eardrum causing severe pain. The drum may then rupture, relieving the pain, and a discharge of pus enters the ear canal. A small proportion of children suffer with recurrent acute otitis media, which is defined as either three or more acute infections of the middle ear cleft in a six-month period, or at least four episodes in a year.

    One of the strategies used to treat this condition is the insertion of a miniature plastic ventilation tube (or grommet) into the eardrum, which prevents the painful accumulation of pus in the middle ear. This review aims to assess the evidence for the effectiveness of this treatment in reducing recurrent acute otitis media.

    We searched for scientific studies which compared treating children with recurrent acute otitis media with either grommets or a non-surgical treatment such as antibiotics (or no treatment). In these studies, children with ventilation tubes in place were considered to have suffered an episode of acute otitis media if they had a discharge of pus from the ear.

    Five suitable studies were found. The studies were assessed for scientific quality, and two were found to be suitable for further analysis. The combined results from these two studies suggested that more children treated with ventilation tubes are rendered symptom free in the six months following surgery compared to those who received other treatments or no treatment. One of the 2 included studies involving 95 children showed that ventilation tubes reduce the number of episodes of acute otitis media in the first six months after surgery, by an average of 1.5 episodes per child.

    When considering the size of this effect, it is important to bear in mind that the studies were not perfect in their design and execution. To be confident in these findings further high-quality research is required. "

  4. Yes, Alex, wrong study, and in fact, wrong point completely, hon, sorry! (Can't see your blog ID, I assume you are one of my female blog buddies, apologies for calling you hon, if you are a guy!)

    Yes, for a short period of time, ear tubes might work to prevent infection---until they fall out and either have to be redone, at great expense. (an average time of one year later, usually redone twice)

    But the question is, why on earth would anyone put a kid through general aneasthesia multiple times, just because they don't feel like preventing or treating ear infections?

    Either non-surgical strategy works perfectly.

    What you need to do is find out how many fewer children were left hearing impaired, if any as a result of tubes? In other words was there any long term negative effect from not having the surgery. Any positive effect? etc...

    Have to run and make breakfast, but from the one I have read, no difference. And if something has no benefits and lots of risk...not worth my tax dollars or my kids life.

    (I'd email this reply, but for some reason can't find your email on your ID, sorry!)

    And Tash, yes, the tylenol OD was an issue, but they banned it even for advil cold, which sucks...and why I sus[ect it's more than just the OD issue.

  5. Damned the internet. Patients shouldn't stick their noses in medical literature, only makes them ask annoying questions. ;-)

  6. Hi again, Aurelia,

    Fair enough, and yes, I am a "hon." Not a blogger though you can email me at alexicographer at gmail if you want. I went back and found the review you mention (or maybe a more recent version as the one I found was 2005), and you're right, no effect on hearing loss.

    And just for the record though I got a little over-excited (trigger-happy?) in my original comment (a) I (also) agree completely about your point that many of the decisions made in medicine and medical policy that get made aren't evidence-based and (b) more to the point, I am sorry to hear that Julius isn't well, poor guy (and poor mom, too!). I hope he'll recover quickly.

  7. You poor thing! I wonder how we're going to handle those congested colds when these babies come along. That stuff wasn't banned when my 8 year old was small and it always worked. She never had an ear infection until she was 18 months because we followed the guidelines you discussed and we were able to keep her congestion away when she was sick. I hope someone wises up and lets us have access again to them.

  8. Better late than never, but I have to say you are (usually) right about things-- but as to ear tubes, way off base, at least for some of us. My daughter had chronic ear infections, and was breast fed, and given decongestants, and given ever increasing strength of antibiotics-- which damaged her teeth, and the inability to get rid of the infected pus in her ears damaged her hearing. Yes the tubes fell out eventually, no I did not get them redone-- by that time, her little body had grown enough to not get the infections so often. The tubes were a life saver for her language development and keeping her out of the ER ever other week from spiking temperatures that no combination of OTC meds could control.

    I am all for letting nature take its course, and the new trend is to not treat most ear infections except with decongestants anyway. But when you baby is spiking 105 fevers in the space of an hour after a week on antibiotics, something more has to be done. The studies show that for children in similar situations the benefits outweigh the risks, even when factoring in two surgeries.