Everything Counts

Here's another post for you big kids (I didn't mean big as in BIG, I mean big, like grown up - gosh you're so sensitive) who are trying to lose weight:

You've heard a million times that the key to successful weight loss is including both diet and exercise changes. Sounds simple enough, right? Well the answer actually is pretty simple in an equation that I gave you in my last weight loss post:

Calories eaten - calories burned = weight loss or weight gain

Yeah, okay, I'll admit it, it may be a simple idea, but not simple in practice. When you are bombarded with all this diet information in the media: good carbs/bad carbs, high protein, fat free, etc, etc. I'm here to tell you it is actually pretty simple once you've had a little practice. It involves the scary step of calorie counting, but it gets easy after a while.

How many calories am I eating?
The first step to counting calories is transforming what is on your plate to a number on a piece of paper (or in your iPhone apps). Duh - look at the back of the Doritos bag. Yeah, I know not everything you eat comes out of the Doritos bag. Some of it comes from McDonalds, some from Papa Johns, and some from Taco Bell. Oh wait, those are all the places I eat. Here is a tool that is abosultely necessary to learn calorie counting (it makes it sooooo easy):


I actually have the program on my palm and I'm sure there are iPhone apps as well. In today's world, we eat out so much that its nice to have all those restaurants' calorie information in a easy to find source (it cost like $6 and is at pretty much every bookstore). You could check all the restaurants websites (this does work) but it is a lot of work. Do yourself a favor and buy this book. (Disclaimer: I am not recieving any financial benefit from Calorie King for endorsing this product.) If it doesn't have the exact item you are looking for, you can always find a similar one, it doesn't have to be an exact science.


All calories are created equal!

Despite much of what the media inundates us with, the scientific reasarch does not show any difference between one calorie of chocolate and one calorie of steak and one calorie of papaya. No matter how well written the book is and how smart the author sounds (cue pictorial example):

All calories are created equal! I'm not going to say this is an irrevocable truth of all eternity, we may uncover subtle differences in the years to come, but as far as the equation above goes, it doesn't matter. Just ask this young woman with the obviously great personality:

Let's not get crazy now, if all you eat all day is chocolate, you will be eating VERY little food and not getting many of the wonderful benefits that come with eating other things (vitamins, minerals, fiber, variety). I'm just saying this is part of the good news: you don't have to quit your favorite foods cold turkey (in fact cold turkey is delicious). Turns out the foods that are the most filling for the calorie toll they take are fruits and vegetables, so make friends with them. Also, lean protein tends to keep you satisfied longer, so make friends with those foods, too.

Another calorie inequality rumor that I don't buy in to is that calories are worse after 8PM. Your calorie metabolism is more a refection of how you have been eating over a few days, and late calories do not automatically become fat. I do, however, think that not eating after 8PM is a good idea, because if you are like me that is when you pound the treats. It is an easy way to stop some mindless eating (while you are watching American Idol) and thus the racking up of empty calories.

How many calories should I be shooting for?

This is a little more complicated, but again has some simple mathematical solutions. If you want to lose weight slowly (which is BY FAR the best way to do it, and the best way to ensure lasting weight loss): just take a week or two to calculate how many calories you are currently taking in. Sometimes just keeping track of what you are eating will result in weight loss. Lets face it, some of us are lazy, so eating that extra cookie is so much more work when you have to get up and write it down. After you've figured out what your average is per day, cut it by 25% and see how it goes. If you really eat a lot, it may need further trimming.

Want to lose weight fast? First calculate your basal metabolic rate (BMR), which can be done here . Your BMR is the amount of calories you would burn in a day if you were in a coma. In other words, sleeping all day without any exercise. For quicker weight loss, set your calorie goal at this level, but I wouldn't recommend going more than 200-300 less than your BMR. This calorie total is basically at an unsustainable level, so when you finally get back to a 'regular' diet don't let the numbers bounce up too high or all the pounds will come flying back.

Tip for success:

Give yourself a day off every week (I stole this from Body for Life - italics due to book title, not sarcasm). This will increase your chace of staying on your diet and give you a well deserved break. Don't be stupid about it, though. There is no point in eating 1500 calories a day for 6 days if you eat 10,000 calories on one day. Just relax the the reigns a little bit.

WARNING: USING THIS POST (AND ANY WEIGHT LOSS PROGRAM THAT IS JUST BASED ON DIET) AND NOTHING ELSE WILL RESULT IN FAILURE. Any diet that produces weight loss automatically sends the body into some state of starvation. The body's natural response is to turn down the metabolism. Thus decreasing your 'calories burned'. The ONLY HEALTHY way to increase metabolism is to exercise. Diet after diet with no exercise will just decrease your BMR so low that it is almost impossible to lose weight, and will make you gain weight back faster when you are eating a 'normal diet'.

Hey man, nice shot

This will be my longest post, but it has to be. If I leave something out, I will be asked about it later. Before I get started on my opinions this is the bottom line: The parent is the boss and it is always their call on whether or not to administer vaccines. They (and their children) are the ones who have to live with their decision.

I am absolutely positive that I will offend someone with this post. Great. Sometimes the wicked taketh the truth to be hard. Sorry, I just have to call 'em as I see 'em and this blog is about the truth (or at least how I view the truth - which is obviously the right way). Remember I am trained in the art of pediatric medicine and work for a company where preventative medicine is a keystone, and vaccines are an important part of preventative medicine, so add your grain of salt as needed. And remember we are talking about vaccinations not your mom or your religion, so CALM DOWN.

Let me let you into the mind of a pediatrician and what is going on behind that cheesy grin...

You, the parent, say: "I've been doing some research..." That's all you have to say, your pediatrician knows what's coming next.

What the pediatrician hears: "My pride and/or insecurities and/or belief in misinformation is more important than my child's health." (whether this is fair or not, this is what they are thinking)

Then a discussion on vaccinations ensues. Usually it is either about how you want to avoid autism or how your read a book or website about how an 'alternative' vaccine schedule is more appropriate. Then your pediatrician says: "Well you are the parent, and you need to manage your child's health care according to your own conscience."

What your pediatrician is thinking: "You are an insane parent who has been manipulated or decieved by some outside influence and for some reason this information/influence is much more valuable than years and years and years of vaccine experience and vaccination of billions of children, and arguing with you is worthless since I have a waiting room full of patients and trying to convince you of your insanity would take more than the 15 minutes I have been allotted for you." I'm just being honest. That is really what they are thinking. All of them. Are they right? That is for you to decide.

Why do some parents want to avoid immunizations?

REASON 1: Scared of autism.
One study published about 10 years ago said there was a link between autism and the MMR. Since then study after study has shown this to be untrue. Some even show a protective benefit from autism by those who received vaccines. A HUGE study of the highest clinical power (a double blind placebo controlled trial) in Europe has shown no connection. Now the news has come out that the person who conducted the original study (that showed the connection) falsified information and is under investigation for misconduct (link). With all the evidence we have today, if you are not vaccinating your child for fear of autism you are putting your child at risk because you trust information that has been repeatedly found to be false and is now found to be one man's imagination from the start and no basis in reality.

REASON 2: Peer pressure

Unfortunately this is the most popular excuse these days, although there are few who are willing to admit it. **warning rascist comment follows**: I have never, ever, never had a mother decline vaccination who was not white. I've also never had a father (of any race) decline. These tend also to be part of the middle class. In my own experience, I've noticed as the family gets poorer and richer they are more open to vaccines. I have had a few mothers admit to me they had friends tell them, "I can't believe you are going to vaccinate your kids!" Then they go on to indoctrinate their friend with one of the other reasons listed. Just say no! I mean yes!

REASON 3: An 'alternative' schedule is better.
There are 101 theories on better ways to vaccinate your kids. Most of them are based upon the theory that an infant's immune system isn't ready to develop the maximal response at the age they are given. I may surprise you by my response to this one: this may be true. The one MAJOR problem with this thinking: several of the vaccinations protect infants (less than a year) from death. If you wait to vaccinate, the risk of death or severe illness has greatly declined. You are still preventing your child from an annoying illness, and the long term protection may be better, but I'd rather have slightly weaker protection from death than slightly stronger protection from an annoyance. Who needs vaccine protection more than an infant with an immature immune system? There are still MANY infants dying and getting serious illness each year due to illness that could have been prevented by vaccine (and the numbers are increasing due to decreasing immunization rates).

If you are choosing this reason for avoiding vaccines you are turning your child into one of these:

Calm down, Richard Gere, its a guinea pig, not a gerbal. The physicians/people who put forth these alternative schedules base their ideas on largely untested THEORIES. They all sound pretty good. They need to. They are trying to recruit unsuspecting parents (mothers, really - see above) to try their theories out for them without having to set up an actual study.

If the theorist is wrong, and their schedule increases infant death, they say, "Oh well, dang, I guess my theory was wrong." I'd imagine the mother of the child who died as a result of this schedule might be a little more disappointed. I'm not judging. I enrolled my son in a pharmaceutical study when he was less than 6 months old. Made some good money when we really needed it. But you are volunteering your guinea pig for free.

Another alternative is the 'spread the wealth' theory of only doing one or two vaccines at a time. This is another one that has no basis in scientific realilty. In my own personal opinion, I find this schedule as tantamount to child abuse. Instead of getting all the shots over in a span of about 60 seconds, a parents decides to spread the pain out over many months, mutiplying the number of traumatic days by up to 3-4 times for absolutely no medical benefit. You are a meanie and maybe a commie.

REASON 4: Various conspiracy theories, including pharmaceutical companies benefitting from this schedule

Dr Gregory House said it best when he was talking to a parent with the same concern. He basically said you can choose which company you want to support: the pharmaceutical company or the 'teeny tiny coffin' company.

Conspiracy theories are always a little off, and if you believe in one, you probably are a little off, too. Sorry to offend you, but if you do believe in the conspiracy, this post isn't going to change your mind anyway (because I'm obviously a part of it).

Take home messages: Is the current vaccine schedule perfect? Not likely.
Does someone have an alternative schedule that will work better? Maybe.
Did you pick the right person's thoery that will revolutionize vaccines? Not likely.

As for me and my house, we will participate in the most tried and true schedule available that protects babies when they really need it (when they are babies) - the one currently recommended by the American Academy of Pediatrics and the Centers for Disease Control. It will likely be changed many times over the years. This is good and healthy sign that we are striving for the best schedule availabe. I would be worried if it wasn't true.

Addendum: Are vaccines completely safe?
No. Usually just pain at the site of injection and fussiness and occasional fever are the only bad effects. Rarely there have been reports of seizure afterwards. Whether it is connected with fever (and thus the very benign febrile seizures of childhood) or purely from the vaccine, that remains to be seen. If you have had a child who had a seizure after a vaccine, it can be scary. The truth of the matter is, however, that seizures are typically benign despite how scary they look and are not life threatening. You still made the right decision, because you may have saved your childs life by protecting them through vaccination, even though they had a seizure.

More severe reactions? Vaccines have been blamed for all kinds of illnesses all the way to sudden unexplained death. Anyone with kids will tell you, they get shots every few months for the first couple of years. If something serious happens, there's always a recent round of shots that can be conveniently blamed for it. Did the vaccine cause it? Probably not. In the unfortunate event that a child suffers a severe illness, every parent asks the question "Why?" repeatedly. Sometimes its nice to have something to blame it on. Unfortunatley vaccines frequently take the scapegoat role.

It's a proven fact

I guess its a good of time as any to post on my feelings on science in general. A friend of mine had a girlfriend in high school that used to drive me nuts. Whenever we had a disagreement, she would say, "Well its a proven fact!" and that would be the end of the conversation. I don't even remember what we were talking about, but that statement bothered me more than the argument itself.

Living in the scientific age, it is tempting to think we 'know' many things that we do not. True scientists have a hard time giving something the label of 'fact'. There are many strong ideas that have been tested and retested and still get the title 'theory' rather than 'law.'

This can be a challenge as a doctor, as many people want to come to the doctor and be told exactly what they have and exactly what to do to make it better. This is especially difficult when dealing with pediatrics as far less scientific studies are done on children compared with adults. I have a feeling 50 years from now we will look as silly as Theodoric of York looks to us today. I know this is a Saturday Night Live sketch, but its actually pretty historically accurate:







If you don't want to watch it, here's the best line:
"Why just 50 years ago we would have thought your daughter's illness was brought on by demonic possession or witchcraft. But nowadays we know that Isabelle is suffering from an imbalance of bodily humors perhaps caused by a toad or small dwarf living in her stomach."

The biggest problem I see is that there is so much research being done, that isn't properly interpreted. Especially if the media catches wind of something, a circus ensues. The basic problem is best shown in this cartoon:



The most common misinterpretation I see is when a study finds a correlation, and it is interpreted as a cause. Using that reasoning, I can prove tomatoes cause cancer. A study could easily show that 98% of those that developed cancer had eaten tomotoes in the last month. In this case the correlating elements have absolutely nothing to do with one another. This may sound like a ridiculous argument, but I've heard it many times (except substitute vaccinations and autism for tomatoes and cancer).

Some people hold their beliefs about certain things (vaccinations, global warming, bigfoot, etc) as dear to them as their religious beliefs, which can be dangerous. It can be devastating when something you hold as 'fact' gets proven wrong by the next study. We just need to do the best with the information we have, and roll with the punches when we get more.

Yes, this post is a preface to a post on vaccinations.... get ready...

I will try to fix you

Annoying complaint #2: Doctor, you have to help me. My son got a runny nose and cough three days ago, and he STILL HAS IT! What do I do?!?!? Please FIX HIM.

What the doctor hears: "I'm not leaving here until I have a prescription for antibiotics in my hot little hand." I have to admit, this type of response on the doctors part is annoying, too. Almost as annoying as the complainer. Education is much better than a reluctant antibiotic prescription.



News Flash: There is still no cure for the common cold. And no, antibiotics still don't work.

What can I give my child to make them better? Sorry. Turns out, lots of fluid and lots of rest work the best. I know THAT'S SOOOO BORING. Most studies of cold formulations show that these medications do absolutely nothing for children under the age of 6. Most studies also show they do nothing for children over 6, either, even 35 year old children. I know there is a place for sudafed in adult care, and I personally am a HUGE fan of Nyquil when I am sick. But most groups who have a statement on is (American Academy of Pediatrics, American College of Chest Physicians) say you should avoid cold medications in children under 6 (ACCP goes as far as to set the age at 14). I know what you are thinking.. these medications work great for me, why not my kids? The answer: Kids are different. Imagine that.

Okay, there's more to do than just fluids and rest, but those are the only 'cure' we have. Here's some other things that can help:



Mom: A ton of good old fashioned TLC helps anyone feel a little better when they are sick. I try to convince my wife this is what I need when I am sick, but she says she will never be my mom. Apparently, I already have on of those.

Saline water: Nose drops for the babies. Full-fledged lavages for older kids. It's uncomforable, but it works like a charm. Even better than sudafed. Your at home recipe for a nice salt water lavage: 1 tsp of salt and 1 tsp baking soda to 2 cups water. Some recommend pickling/canning salt over table salt and distilled water to tap, but if you aren't going to do it because you don't have those things, just do it with table salt and tap water. They sell bottles to (gently) shoot the stuff up your nose at the store, or you can just use a bulb syringe.

Cool mist: Cool mist humidifier in the room tends to improve symptoms and help with more restful sleep.

Honey: Yes, honey.

No, not THAT honey, this honey:

There's actually good evidence to show that honey helps coughs much more than cough syrup (which should be no surprise, since cough syrup does nothing). There are some good studies to back it up, also. 1/2 tsp for age 2-6yo, 1 tsp 6-11yo, 2 tsp 12yo and over. DO NOT give this to babies Unless the baby is a terrorist and/or poses immediate danger to the safety of all Americans (in other words: unless you want to kill them).

Cough drops: My favorite when I am sick. Only for older than 4 years due to choking danger.

Medicines: Yes, there are some medicines I recommend to my patients. Of course you can use tylenol/motrin for fevers. Also I'm a big fan of using Benadryl/diphenhydramine at night before bed, and maybe again in the day if your child is still taking naps. Remember, I said rest was very important to recovery, and while benadryl may produce very marginal results with the symptoms, they have the perfect side effect for this situation: sleepiness. I am pretty free with it (but do not endorse benadryl use to put annoying kids to sleep).

What should I expect?

Cold and the flu can last a long time. Usually the first few days are the worst and include runny nose, cough, sore throat, and fever. After that, its totally unpredictable. The fever typically subsides, but the runny nose and cough can go on for weeks! I am personally sporting a mild cough that's been with me for 4 weeks.

What about this green snot?

No it, in and of itself, does not mean there is an infection present. It is the natural course of a viral illness to produce thicker/darker mucous as the body fights the illness. Many times is it a sign that you are almost over your illness. But if the dark thick stuff persists for a long time or is accompanied with a new fever (remember your original one went away), I would see a doc to evaluate for infection. Actually, I think any new fever after the initial one has been gone for 2 or more days should probably be evaluated as it could signify an early pneumonia/sinusitis/ear infection.