the worst part.

I got my flu shot on Friday.  The worst part?  My office nurse made me weigh and take my blood pressure before she would give me the vaccination.  Talk about ouch!

“Should I get my flu shot?” is one of the most frequently encountered questions I answer between the months of October and February.  My answer; almost always a resounding “yes.”  Why?  Not only because the flu is terrible to have, it kills people.  And I’m not talking about the “my husband has the flu and now he acts like he’s dying but I might kill him instead” kills people.  Like it really kills people.  While the current reporting systems don’t allow us to know exactly how many people die from the flu in the US annually it is likely to be somewhere around 20,000 people including about 150 children.  The young, the old, the pregnant and the immunocompromised are the most at risk.

So why would anyone question getting their flu vaccine?  Oh, let me count the ways.

Many of my patients think the influenza vaccine can give them the flu.  Wrong.  It does create an immune reaction and you develop antibodies in about 2 weeks that should be protective against the flu.  Most patients receive either the trivalent (traditional) or quadrivalent flu vaccine. Trivalent vaccines protect against an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. The quadrivalent vaccine (what my nurse was giving me in the above photo) has protection against an additional B virus.  These are inactivated or recombinant immunizations which means, in short, they won’t give you the flu.  And remember, it takes 2 weeks to be immune, so if you get the flu 2 days after you get your shot don’t blame the vaccine.  Blame the person who exposed you to the flu virus before you were protected.

Some patients just don’t think they need the vaccine.  Maybe they have never had the flu.  Well, trust me that it only takes one week of feeling incredibly ill with the flu to convince most people they never want to skip out on vaccination again.  I also tell my patients that even worse than getting the flu is giving it to someone else.  If you have a child, a pregnant woman or a person over the age of 65 you care about then the influenza vaccine is for you.  If you have friends or a family member who has cancer, asthma, diabetes or another immune disease then the flu vaccine is for you.  Giving the flu to someone who is at high risk of hospitalization or death is not nice.  Pregnant?  Pregnant women who get the flu are more likely to have severe illness, be hospitalized or die from the flu.  Scary much?  Trust me, I repeat that line on a weekly basis.  Plus, the infants of pregnant women who are vaccinated for influenza in pregnancy have protection that can last up to 6 months.

So what do I say when asked by someone if they should get the flu shot?

Yes.  You’re pregnant and I don’t want to risk seeing you in the ICU with the flu.  Plus your baby can’t receive a flu vaccine until 6 months of age and you want to protect your infant until they can protect themselves.  You can be vaccinated in any trimester so trust me when I say if you don’t do it today I will ask you again at your next visit.

Yes.  Immunizations carry much less risk than the diseases they protect you from.  Does the flu vaccine guarantee that you will not get the flu?  No.  But it does significantly reduce your risk.  You still need to wash your hands, avoid sick people, cover your mouth when you cough and all those good things your grandma has been telling you since you were small.

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Yes.  Getting a flu vaccine is more than just about protecting you.  It’s about avoiding the flu so you don’t spread a virus to someone who can’t get vaccinated.  Or spreading the illness to someone who could get very sick and hasn’t had time for their vaccine to be fully protected.  Or your wife.  Husbands, get your flu shot.  If you give the flu to your wife no one will be happy.  The Pastor had the flu last year and I literally locked him in one room of the house until he was no longer contagious.

Yes.  Because you care about your kids and your family.  My kids will be disappointed to learn the nasal spray isn’t recommended this year.  The needle stick will be the worst part for them.  But the good news is this…first, they get excited when they get on the scale at Dr. Melissa’s office (unlike me!) Second, they think doctors and nurses are awesome and trust that they will be protected.  Finally, there are stickers…and probably treats on the way home.

So go get vaccinated.  There are about 150 million doses available so I’m sure you can find one.  Some more news for those of you still skeptical.  Now you can be vaccinated if you are allergic to eggs.  There is even an intradermal version: which means the needle is about 90% smaller for those adults in the group who are afraid of sharp things seen above.   No matter if the weight or the blood pressure measurement or the waiting in line to get it done or the actual needle stick is the worst part.  This gynecologist and pastor’s wife thinks it will be worth it.

(photo credit my arm, Heather’s hands and Erika for being the photog.)

 

an ounce of prevention.

An interesting thing happened to me a few months ago on a Sunday morning.  I was doing my after church thing…which means my children run around the sanctuary like banshees and pastor Jason is talking to a hundred or so folks and no one can decide what to do for lunch.  It’s a routine of madness.  In the midst of all of that I was approached by a family in our church.  These are people I adore.  They are faithful, they are helpful, they are fun.  Their oldest has started that tortuous time we call middle school.  As a side note there are literally 10 million things I would do over again before middle school.  Like medical school, the last 4 weeks of pregnancy in the Oklahoma heat, 24 weeks of Gyn Oncology service as a resident….middle school seems like the worst thing….but back to the story.

This lovely family had visited their local pediatrician for a routine well child check.  Their pediatrician had appropriately recommend the meningococcal vaccine and the Tdap vaccine (which they happily accepted) and then something strange happened….their pediatrician then asked them to “consider the HPV vaccine…to ask their friends, to read about it, to think and let the doc know what they wanted to do.”  So they came to me to find out “why wouldn’t our doctor want our daughter to have this vaccine?  Is there something wrong with it?  What should we do?”  At this point I am making that face when you are horrified by something…the one with your eyes wide and your mouth open.  And of course I said yes..yes..yes…please go back and get the HPV vaccine series for your child!

If you didn’t know, Human Papillomavirus (HPV) is responsible for about 17,000 cancers a year in women and about 9,000 cancer per year in men.  About half of men and women in the US will be infected with HPV at some point in their life…around 79 million Americans.  Most of those infections occur between ages 19-24 and most of those young men and women will clear the infection on their own without a problem.  So, you might ask, why do we vaccinate against HPV?  Well, we know that almost 13,000 women in the US will be diagnosed with cervical cancer, and 99% or more of cervical cancer is caused by one of the high risk strains of HPV.  4,000 of those women will die of their disease.  Additionally, more than 200 million health care dollars will be spent in 1 year in the US to treat other HPV related diseases such as genital warts.  When you take into account all the screening for HPV related cancer and treatment of pre-cancerous HPV diseases the cost adds up to about 8 billion dollars.  That’s billion, with a B.  Imagine what our health care system could do with those dollars if we would significantly decrease or eliminate the burden of HPV disease through vaccination.

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The vaccine works.  Multiple studies have shown it to be extremely effective.  We’re talking 99% effective against the pre-cancerous changes that I see and treat on a weekly basis to try and prevent my patients from getting cervical cancer.  Right now about 39% of US adolescents are being vaccinated.  The goal is for 80% of those eligible to receive the full vaccine series.  In short, we are doing a terrible job folks.  In contrast, our friends in Australia have a vaccination rate around 75%.  They have virtually eliminated genital warts in those women under the age of 21 and soon will see a dramatic reduction in cervical cancer.

So why wouldn’t all our girls and boys age 11-12 receive the 3 dose HPV vaccine series?  Well,  first of all, our health care providers aren’t recommending the vaccine.  My friends from church have great trust in their pediatrician and have faithfully received all the vaccinations recommended to them.  But the HPV vaccine was not.  If we as health care providers would recommend HPV vaccination along with other routine immunizations for 11 and 12 year olds we could exceed the 80% immunization goal.  What are the barriers to provider recommendation?  Well, there could be several.

Our culture has made the HPV vaccination into a moral argument.  Parents believe that their child is more likely to become sexually active if vaccinated.  This has been proved incorrect in the medical literature over and over and over again.  Kids are no more likely to become sexually active after HPV immunization than they are to go seeking out someone to snuggle up with who has meningitis after being immunized against it at the same age.  We assume that people infected with HPV and those who have HPV related diseases must have done something wrong, behaved inappropriately, had “loose morals” or some other kind of disgusting label such as that.  The reality is that this disease can affect anyone.  Show me someone whose life turned out exactly as they had planned and whose children turned out exactly as they had planned and maybe you have an argument against vaccination…maybe.  But really for all of us, we don’t know what life will bring.  We can’t predict much of what will happen to us or those around us.  As I like to tell the medical students…no one leaves on a plane for  Africa to do some good missionary work with the intention of finding someone with yellow fever and being infected…but we still get immunized before the trip without question.  Immunization against HPV is just the same.

Additionally, our culture loves to believe what we read on the internet (ironically what you are doing right now).  Despite this vaccine being shown by research in the US and multiple studies in Europe to be safe and demonstrate no pattern of serious neurologic or other injury, many in the US are still afraid that HPV immunization will make your child sick or is some kind of conspiracy theory.  Does the vaccine hurt?…yes.  Are adolescents, especially girls, more likely to pass out with this immunization?…sure.  Do all immunization involve a very small likelihood of serious risk?…yes.  But that’s about it.  And those risks are much smaller than the risk you or your child has of being affected by HPV related disease.  Our role as health care providers is to educate and advocate.  If you ask any of my medical students they will tell you how they endured the “all things HPV” lecture during their time on OBGYN.  My hope is that there will be more voices who advocate for HPV immunization and than any loud voice that might tell them otherwise.

Screen Shot 2016-05-30 at 1.19.37 AMSo, health care providers….RECOMMEND the HPV vaccine.  Telling a women she has cervical cancer, treating recurrent genital warts, seeing complication of pregnancies caused by the treatment of HPV related diseases is heart-breaking work.  Trust that your patients will listen to you.  Present them with the truth and advocate for their future health and the health of the people they love.

Parents, pre-adolescents, teens, and those who know or love a parent, pre-adolescent or teen: don’t assume it can’t happen to you.  As Ben Franklin said “an ounce of prevention is worth a pound of cure.”  I hope I have to find something to do with those 20 hours a month I spend screening and treating HPV related disease.  I hope that someday we will speak of cervical cancer and other HPV related diseases like we do of polio.  Ask questions, get vaccinated, tell others.  If you have questions, ask a trusted health care provider.  If they can’t answer them, find another health care provider who can.  You never know who the 4000 lives are that would be saved.

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listen…to…your mother.

Listen…to…your mother.   It’s a phrase I utter about seven thousand times on a Sunday morning.  When I can’t seem to get the girls to find their shoes, brush their teeth, get in the car and a multitude of other things on the way to church I emphatically state “listen…to..your mother.”  They think it’s hilarious to repeat the phrase over and over to each other and giggle about how crazy I sound.

A dear friend said to me this morning: “Mother’s Day..sometimes it just seems like too much.”  And I get that.  Mothers feeling overwhelmed at a day to celebrate them, yet unable to escape the responsibilities of the daily routine.  Women who wish they were mothers but are unable.  Women who mourn the loss of their child or their own mother.  Families who need reconciliation on these celebratory days.

So what to write about on this “too much” day.  After much thought (kidding…I was napping this afternoon), I thought I would make a list of what your mother would want you to know if she was an OBGYN married to a Pastor.

  1. Educate your kids about their bodies: My kids remind each other to “wash around your vagina” in the tub.  When BK was born, Mc said breastfeeding was “weird.”  To which I replied, “yes dear, it’s only the beginning of weird stuff your body does.”  Kids who know how their bodies function can express when they are injured, uncomfortable or, God forbid, touched inappropriately.
  2. Vaccinate your kids against HPV: People, it’s not a conspiracy theory.  It’s a vaccine that has the potential to eliminate or nearly eliminate cervical cancer and significantly reduce HPV related diseases.  Trust me.  I deal with this, literally, every day.  Does every vaccine have a small risk of complications?  Yes, but significantly less likely than me seeing your kid later in life for an abnormal Pap test or some other problem.  Plus, there’s more formaldehyde in pears and bacon than in vaccines. (mic drop).
  3. Make sure your kid has a trusted adult they can talk to that’s NOT YOU.  As parents we think we want or need to know everything that is happening in our kids lives.  The reality is that we can’t do much about it.  I can tell you everything your kid says to me in the office but then she wouldn’t trust me and she already doesn’t listen to you.  What I can do is encourage them to be safe, be healthy, see the consequences of their actions before they happen and be honest with you.  So make sure they have a pastor, a doctor, a coach or a mentor you trust.
  4. Let your kid be honest with you.  When they do something dumb and are brave enough to tell you about it be sure to remind them how glad you are they were honest with you amidst the lecture about how disappointed you are.
  5. And finally, be easy on yourself.  I am reminded weekly by Pastor Jon and Pastor Jason that God has already made His mind up about you and the news is good.  It’s okay to be stressed, sad or overwhelmed on Mother’s day.  Or any day.  Forgive others, forgive yourself.  Love people more than they deserve and let yourself be loved more than you deserve.  And don’t forget to see your Gynecologist and go to Church.

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