Friday, December 06, 2013

Immunizations, Benjamin at 18 months, Miriam at 4 years

With the recent measles outbreak in Southern Alberta, as well as many reports of whooping cough outbreaks the past few years, vaccination has been a hot topic. Hotter than usual, at least.

We're pretty keen on immunizations at our house, having dragged our family around the world. For one thing, polio, a disease of the past in many places of the world, is still alive and well in others (which means, essentially, that it could potentially make its way back to places it has been eradicated from). Egypt—a place we called home for two years and where our second child was born—hasn't exactly eradicated polio yet. For another thing, we weren't nearly comfortable enough with the medical system to trust they'd be able to treat any horrible disease we could've contracted. I'm not sure I'm that confident in the medical system here to think doctors/technology can just "cure" us of these terrible diseases scientists have painstakingly created immunizations against in order to protect us from ever contracting the disease.

We plan on returning to lesser developed countries in the future so we need to keep our immunizations current. You probably want to keep your immunizations current as well because you never know what germs are stowing away in that airline passenger's cough. I'm just saying...

Anyway, having moved several times in the past eight years has meant relocating our medical records time and time again. This is kind of a hassle.

Different places have different immunization schedules and before a couple of days ago I didn't know there was a reason for this. But, honestly, that's because they are "different countries with different populations." The doctors within those countries do their best to create a schedule to ensure the best possibility for herd immunity and so forth.

I did question this once when we lived in Egypt. We were there on a student visa and were never granted permission to work so we were living off the savings that we'd managed to scrape up while Andrew finished his undergraduate degree. Having a baby there was relatively inexpensive—our insurance covered everything but our $50 deductible (yes, you read that right). However, they wouldn't cover "routine care" which meant well-baby visits would be entirely out-of-pocket (who dreamed up this insurance plan?). The vaccination schedule our doctor put us on was a little more rigorous than the one we'd seen in the States. Our doctor wanted us to come in every single month. Every. Single. Month.

The cost wasn't astronomical, but it would've ended up being about $100 per month just to see the doctor, not including the shots, since we weren't able/about to go to the "local" clinic and had to use a private doctor.


After reviewing our finances, we made a rather desperate plea to our doctor to "tweak" Miriam's immunization schedule. At this point Rachel was four months late for her two-year set of immunizations.

I looked at when shots were due in the States and compared them to when shots were due in Egypt and described my own little immunization plan to our doctor and asked if we could come in every other month in order to lower the overall cost (since we simply don't go to the doctor every month in the States (at least not for well-baby visits).

He shot down the idea entirely and instead sent this reply:

"[I have] always felt indebted to [the LDS Neonatal Resuscitation Program, etc. etc. etc.] and [have been] disappointed not to have the chance to pay back for at least a small part of what they did for my country and our babies. Now, would you be kind enough to give me the chance to show how grateful I am? [It would be an] honor and pleasure to receive you and all your children for routine and non routine check ups including all vaccines that can not be postponed for no charge at all. In fact I will be really sad if you don't come on first working day next saturday morning. I will be waiting for you."

I literally cried because our finances were literally tied up between vaccinating our children and flying home after graduation. I mean, we could've paid for vaccines and then left the children behind or something like that but I'm not sure that would've worked out too well. We came back to the States with literally nothing. Andrew went to BYU the same day we flew in to beg for a job (actually, to interview for a job that he'd been parlaying about from Egypt before we left—which he got, by the way, so blessings all around, but still...). We were broke.

And we still are, but that's beside the point.

The point was that our wonderful Egyptian doctor wouldn't even hear of delaying our children's vaccinations and would rather vaccinate them himself than risk them contracting polio or measles or hepatitis or anything like such as. Because those diseases are a) uncomfortable and b) can come with life-altering or life-threatening or life-taking complications. They aren't exactly something to mess around with. Lesson learned.

That doctor is an angel in our books. He's simply fantastic.

Sometimes I've wondered if we were right to accept such charity since there are millions of children in the Middle East going unvaccinated. But, it was such an obvious answer to prayer—and one that we hadn't even dreamed of—that we couldn't say no.

Fast-forward to today (or yesterday, rather, since that's when I took Miriam and Benjamin in for their 4 year and 18 month appointments, respectively).

Benjamin had his appointment first since the nurse had taken Miriam off to have a vision and hearing test just before the doctor came in. I'm happy to announce that he's a full twenty pounds (21 lbs. 0.3 oz)! Wahoo! And not only that but he had a bit of a growth spurt and he's now 29.92 inches (76 cm)!

That's still off the charts low. But! But when you adjust the charts for prematurity he snuggles right in between the 10th and 15th percentiles. For height. He's on the chart (the adjusted chart) for height, guys! This is big news! It's huge! And so is his head, which is steadily in the 50th percentile and still knocks him off balance (I asked him what was on his shirt the other day and he bent over to check and fell right over into a somersault—and it was hilarious). He is 76 cm tall. His head is 47.5 cm around. Just looking at those numbers makes me giggle. His head is huge! It's like an orange on a toothpick! It's virtually a planetoid!

Benjamin's doing just great in all regards and seems to be caught up with his non-premature peers in every regard except speech. He's a little delayed there but earns some leeway because he came two months early. The doctor said that as long as his language is progressing (not plateauing or regressing) that we can hold off on consulting a specialist. She said she'll be expecting big things when she sees him again in six months (but that if I feel nervous about his language development at any time before then to make an appointment and she'll refer us to a specialist for an evaluation). His receptive language is good and since he's using words as well as signs she feels that he might just need these last few months to get caught up with where he should be. Most preemies are all caught up by the time they're two.

He only got a flu shot because our appointment was a few weeks early for his second Hep A since we'd done his 1 year check up with Rachel's 6 year check up.

Scheduling appointments for three kids is a bit of a beast. Our office likes to double up on appointments. I'm sure it saves them time (I know it saves me time) but it does mess a bit with immunization schedules. He'll just get his second Hep A shot at his two year check up. As it was we were about a month late for Miriam's four year check up.

She is also doing just fine.

Miriam was 100 cm on the dot (3 feet, 3.37 inches). And—this is huge—she's 30 pounds! 30 lbs. 6.4 oz., to be precise, and in the eleventh percentile for weight (37th for height).

She was due for her "four year set" of immunizations but they had a bit of a hang up in the office because they couldn't find her immunization record...anywhere. I would have brought it with me if I had known, but I had brought in the last time we were there for well-kid visits (end of June) and they said they'd entered it into the system. I told them so. The nurse went off to hunt around some more.

After some excellent sleuthing (and about an hour of waiting while trying to entertain two kiddos in a room filled with stuff that no one is supposed to touch) the nurse came back in triumphant.

"Here!" she exclaimed. "I found them! They were filed with Rachel's paperwork! (And whoever entered them put all the vaccinations into Rachel's account so I'm going to have to sort that out as well.)"

I still have to bring in the records again because in some of the photocopies some pertinent information (such as patient's name or the exact kind of vaccine used) was cut off but we got it mostly sorted out and Miriam ended up getting her immunizations, which she wasn't exactly pleased about. Frankly, though, making Miriam do something she doesn't want to do is a cakewalk compared to making Rachel do something she doesn't want to do (though she was almost excited that she would be getting four shots (because she's four, after all)).

"Can you climb up on this table for me?" the nurse asked. "Just lie down right here."

"No," Miriam pouted. "I don't want shots!"

"It's time for shots, Miriam," I prodded. "It's much better in the long run, I promise. Hop up on the table. Come on, now."

"Okay," she sniffed.

And then, just like that, she climbed up onto the table and prepared for her shots. We talked about coping mechanisms while the nurse was on a paperwork hunting safari but the nurse shared a new one with us. She said she'd count to three and then Miriam should blow like she was blowing out a birthday candle.

I leaned over Miriam's torso to restrain/comfort her and held out my finger for her to blow on, putting it down each time as if she'd really blown it out. It wasn't too bad at all.

Both the kids got a book and a bookmark (Miriam said she wanted to wrap her book up and give it to Rachel for Christmas (so that's what we did—after reading it, of course)) but didn't really stop their complaining until I handed them each a pack of fruit snacks on the way out the door. After all, they'd just been poked with needles and it was 4:45 (their appointment had been scheduled for 2:15)! We had been at the doctor's office the entire afternoon!

The nurse raved about how well Miriam did on her hearing and vision tests. She said that most kids don't really understand the instructions but Miriam picked up on them right away and did everything perfectly. I asked Miriam to tell me about the tests and this is what she said:

"So, the hearing test was... Okay... You know, like... Okay... Say you're driving in the car to a long-away place like...Florida...or Utah...and you're on the highway. You have to be on the highway because you're watching a movie and you can't watch a movie until you're on the highway, right? That's a trip rule. But Mom and Dad don't want to listen to the movie so they give you those things that you put on your head and right over your ears."

She mimes putting headphones on.

"What are those called?" she asked.

"Headphones," I told her.

"Right!" she said. "Headphones! So I put on some headphones and then they just made beeping sounds and I had to raise my hand when I heard the beeps. It was easy."

"And how did the vision test work?" I asked.

"It was just shapes," she explained. "They just had a poster with shapes on it and the nurse pointed to the shape and said, 'What is that?' and then I told her and then she said, 'Very good.'"

"What kind of shapes did they have?" I asked.

"Oh, circles, squares, triangles and a thing what I don't know what to call it so I just called it house, but once I said, 'Uh...a square with a triangle on top?' and the nurse still just said, 'Yes. Very good.'"

I thought she might be talking about a pentagon but Andrew informs me that it really is a house shape (or an upward arrow...or a square with a triangle on top). He accompanied Rachel when she did her vision test so he'd know.

And if you're wondering what we did while waiting in the doctor's office forever we:
  • played I Spy
  • played Peek-a-Boo
  • played Ride A Little Pony
  • played This is the Way the Baby Rides
  • read every book in our diaper bag (six of them, some of them more than once)
  • read the two new books the doctor left for us
  • read every sign and poster in the room
  • found a flashlight in the diaper bag and let the kids take turn being "doctor" and shining the light in each other's ears and mouth and nose
  • played Pat-a-Cake
  • played Peas Porridge Hot
  • played every other hand clapping nursery rhyme I could think of
  • nursed Benjamin (twice)
  • talked about coping mechanisms
  • texted Daddy
  • drew on the magnadoodles
  • stopped Benjamin from fiddling with things
  • identified pictures on the doctor's computer screen saver
We were just about going stir-crazy by the time they released us. I didn't even stop to make follow up appointments (first because Miriam doesn't need one for an entire year, Benjamin doesn't need one for another six months and, second, because my kids wanted their promised fruit snacks now and I didn't feel like I could keep the treat from them much long since it was dinnertime and we'd spent the entire afternoon sitting in the same room (the clinic has a no-food policy)). 

So that's my long story about immunizations and my children's well-child visits. If you made it to the end, here's a high five for you: high five!

3 comments:

  1. I made it to the end. I was curious how you entertained your children that long so I'm glad you included the list. :) Sorry it took so long and also that they put Miriam's information in Rachel's file!

    That really is sweet about the Egyptian doctor offering vaccines for free.

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  2. That is a really interesting story about the Egyptian doctor. The UAE's immunization schedule is a little different, too. Sterling got a bcg shot at 10 days because tuberculosis is still a thing here.

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  3. One of the weird things about BCG shots is that it can actually cause false negatives on a TB test. I remember when I was in college some guys we knew were freaking out because their foreign roommate had a reaction to his TB test, now I know there is a good chance he had just had an immunization when he was a child.

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