Confessions of Cultural Heretics

"When the whole world is running headlong towards the precipice, one who walks in the opposite direction is looked on as being crazy." T.S. Elliot

Archive for the category “Parenting”

Mommy’s Medicine Bag

Being married to a doctor sure does have its perks. If one of the boys spikes a fever of 105, breaks a finger in a door, splits open their eyebrow, or gets swarmed by fire ants (all hypothetical examples of course), free medical advice is always just one call away. But there are times when Daddy’s medicine won’t work, that’s when you need “Mommy’s medicine”.   So without further ado, here’s a list of the things in my medicine bag for treating the common ailments of childhood:

1. chewable papaya enzyme

Think of it as a more appealing alternative to cod liver oil. For stomach upsets of any kind (especially the highly suspicious bed time stomach pain), I give the boys a few papaya to chew on. I have to admit, this was something my parents always kept on hand when we were kids and it tasted so good, we would sometimes sneak pocket fulls of papaya to snack on. Then we would get a stomach ache, then our parents would give us some papaya. 🙂

2. MelaGel

This is a topical salve that contains tea tree oil and has soothing properties for everything from bug bites, sore hangnails, scrapes and scratches. I keep a disk in my purse because I am the mother of sons and we live in the south, so their limbs are always covered with bites and scrapes.

3. Arnica cream-

This ointment is the only homeopathic that REALLY works for our family.( I’m not saying that from lack of trying either.)  It is great for soothing  sore or pulled muscles, promoting bruise healing and I have even found it to be very helpful for easing pregnancy back pain.

4. Pinxav-

My firstborn is a blondie and super fair skinned and we had quite the time of it fighting diaper rashes, especially when he was teething. We tried all the usual ointments, then were introduced to this old fashioned, thick, magical stuff. We were able to find it at our Kroger pharmacy at the time and the original tub we bought over four years ago, we still have and it still is working its wonders on our second born.



A Few Thoughts on Circumcision

So I was asked (and have been asked many times) what my thoughts are concerning circumcision.  For just a little background, during my month on the pediatric service I performed about 50 circumcisions over approximately 24 working days using both of the Mogen clamp and the gomco.

To start, I must say I think it can be very easy to get caught up in the emotions surrounding this topic.  As a father who has two boys, one who is circumcised and who is not, and also as a physician who has performed many circumcisions, I find myself feeling rather neutral on the whole issue. For one, I think the idea that it is a ‘brutal and abusive’ action is a bit overstated. The procedure is actually very quick and clean, with pain medication given to the infant. That doesn’t mean the child doesn’t throw a fit during the procedure, but I have also had many infants act the same way when I was changing their diaper.  Infants are fairly easily consoled and are seem to be able to tolerate a fair amount of pain and discomfort for short periods of time.  I simply state this, not as justification, but as an observation that reflects that this procedure is not nearly as brutal as many try to make it out to be.  So moving beyond the procedure itself,  I think it is important to consider the motivations for circumcision.

Many parents do it simply to ensure that the son “looks like his father” or “looks like his brothers”. These motivations exist, for better or  for worse, and may not be the best intentions. There are other reasons to be circumcised.  Recently the American Academy of Pediatricians issued a policy statement

The policy statement and accompanying technical report from the AAP will be published in the September 2012 issue of Pediatrics (published online Monday, Aug. 27). The documents update the previous policy that the AAP published in 1999 and reaffirmed in 2005.

Since the last policy was published, scientific research shows clearer health benefits to the procedure than had previously been demonstrated. According to a systematic and critical review of the scientific literature, the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime; reduces the risk of cervical cancer in sexual partners, and lowers the risk of urinary tract infections in the first year of life.

The AAP believes the health benefits are great enough that infant male circumcision should be covered by insurance, which would increase access to the procedure for families who choose it.

“Ultimately, this is a decision that parents will have to make,” said Susan Blank, MD, FAAP, chair of the task force that authored the AAP policy statement and technical report. “Parents are entitled to medically accurate and non-biased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical and cultural beliefs.”

Pediatricians are one of the major providers of circumcisions (along certain groups of family physicians and some obstetricians).  This is not about generating more revenue or business, because in most cases I think it would be safe to say that pediatricians would prefer to avoid the trouble of circumcision.  This new statement, in my humble opinion, is a reflection of evidence based medicine.  But note that the AAP still states that the final decision is to be left in the parent’s hands (now if only they would approach vaccines the same way….).

With that said, I think we need to keep a few historical, and biblical, facts in mind. For one, Jesus was circumcised.  In fact, many of us still celebrate the Feast of the Circumcision on the eighth day after Christmas.  Also, circumcision is never condemned in scripture, rather Paul writes “In Christ Jesus neither circumcision availeth any thing, nor uncircumcision: but faith that worketh by charity” (Galatians 5:6) So basically, it doesn’t matter if you are or are not, as long as your faith and salvation are in Christ.

I do not think it is a procedure that should be banned, nor should parents be condemned for having it done. Nor should the uncircumcised (or their parents) be shunned or ostracized either.  This really comes down to parental choice, a choice that should be made with full knowledge of the risk and benefits of the procedure, and a reasonable motivation for having it done.

Let me know if you have more specific questions regarding this topic.

Once again, thank you for your attention!

In Christ,

Dr. Burke

Rug Rats

Kids seem to have a universal set of bad habits. The past few weeks I have battled with our toddler to keep both of his socks on. I am constantly finding random socks strewn about the house. While the chilly floors don’t seem to bother him, I’d rather not have him develop a cold because of his bad habits. So I did what my father did to me and my siblings…I told him about the rug rats.

What are rug rats you ask?

They are small rodents that live under the carpets and nibble toes off of children’s bare feet. Only socks or shoes can protect you from the hungry pests.

So I told Joseph, and I can’t say I was surprised, but it worked. His eyes grew big and he ran to grab his sock and jumped on the couch to escape the invisible rodents while he covered his bare foot.

Then he began to “see” them under the carpet and started shouting at them “rugrats! I have my socks on! Do you want some milk?”

At which, I had to explain their diet consisted of bare toes alone, and that since all of our toes were covered they would be moving on to look at another house for some tasty bare toes.

Funny, Brian and I had just had a conversation this weekend about how every culture seemed to have a monster of sorts that parents would use to scare their children into being good. I have to say I have mixed feelings about this tactic, but I can’t deny its immediate effectiveness. And so the rug rats will live on in the imaginations of my children.


Moving Beyond Fear: Decision Making Regarding Vaccines

Vaccinating children is a hot button issue, to say the least.  When the topic comes up among parents, there is usually some pretty heated remarks, and when you throw a physician into the mix it can get downright dirty.  I have heard a physician say to a parent “I see you wants to keep your child safe” in regards to the decision to vaccinate, which seems to insinuate that a unvaccinated child wants to live recklessly and dangerously.  On the other side of the debate I have heard parents accuse others of pumping their children full of poisons and doing irreparable harm.  The more parents I talk to on both sides of this issue, the more I realize that the decision making about vaccines is not based upon informed consent but on fear.

Fear seems to dominate the issue of vaccines.  On one side it is a fear of contracting a disease that may possibly cause some long lasting side effect or even death.  All of this depends on which disease is being considered.  (For more on this, please refer to Dr. Sears’ The Vaccine Book).  And on the other side of the debate there is a fear of what the ingredients may do to children.  For some that fear may be about autism, or asthma, or other allergies, just to name a few.  There are also concerns about using vaccines developed using tissue from aborted fetuses and the possible negative effects that injected human DNA may have on a child.

On either side, these should be considered legitimate concerns.  Everyday parents must face decisions concerning their child’s safety and well being.  And for the vast majority of these decisions, there are no domineering physicians and parents trying to force the parents hand.  In an era where paternalism is supposedly dead, it continues to rear its ugly head in regards to vaccines.  Time and again, both in my own experience as a parent and in working in health care, I see physicians attempting to force their views upon their patients in regards to vaccines.  In all those cases it was pro-vaccine.  What is a parent to do? Here is an individual who is supposed to know the facts and who is supposed to be caring for their child, who is talking about how the child might die if they do not receive the shots.  And if the parent shows any resistance, then they are practically accused of child abuse!  Please do not think I am exaggerating.   For parents who choose not to vaccinate, this is par for the course.  It is a rare treat to find a physician who is willing to let a parent refuse vaccinations without trying to intimidate them through fear.  With this kind of pressure to vaccinate, plus a parent’s usual trust in their physician, is it any wonder that most parents simply vaccinate their child without a second thought?  Filled with fear of what might happen without vaccines and pressured by the physician they are supposed to trust, it is the easiest road to take.

And yet, is this the best?  Now I am not saying parents should not choose vaccines.  What I do argue for is informed decisions by the parents.  Parents choosing to vaccinate should know what vaccines the child is to receive and when. What the vaccines prevent against, and likewise what the dangers of those diseases are.  And the parents should also be aware of any concerns about safety regarding particular vaccines.  I place the same burden on the parents who refuse to vaccinate.  I would challenge them to tell me what are their sources in regards to the dangers of vaccines? What is it that they are afraid of? Is there evidence for those fears?  What is your current situation and the associate risks with not vaccinating?

Decisions in medicine are supposed to be based upon the available evidence, and the patient is supposed to be given the autonomy to make an informed decision. On both sides of this debate, the parents must move beyond making decisions based solely on fear and begin to make informed decisions for their children.  Neither decision is necessarily wrong, but it must be made consciously and with knowledge.   As parents, we know full well that it is impossible to protect our children from all danger and all risks and daily we must make decisions to limit these dangers as much as is reasonably possible. For those dangers we cannot prevent, we must be willing to shoulder that responsibility if something were to happen, and this holds true for the decision about vaccines.  Rather than living in fear, we must make that informed decision and then face down the possible consequences and make the bold statement that we will not let fear rule our lives.


The Birth of Our Children Part I

This post is the first of two that describes the birth of our two sons.  While both were natural births, our first born was a hospital birth, while our new born was a home birth. We hope that the two experiences will shed some light our approach to childbirth.

All but one of my mother’s eight children were born before their due dates, so when I was pregnant with my first born, I just assumed that I would follow in the same pattern. The closer my due date approached, the more I began to worry about induction and other threats to my dream of having a natural birth with midwives.

On my due date, I went in to the midwives’ office so they could monitor my vitals and the baby’s heartbeat.  Everything checked out fine, and since the contractions I had were few and far between, I went home. That evening I was particularly tired and went to bed early, hoping sleep would come easily. Around 2am I woke to strong contractions. Although they were tolerable, they were too frequent for me to fall back to sleep, so I decided to wake Brian, who had taken to sleeping on the air mattress in the spare room due to my loud snoring which developed in late pregnancy.  Gently, I shook him and told him I needed help timing my contractions. Looking at the time, he said “are you sure?”  It had been such a long wait, I think he found it hard to believe that the baby had finally decided to come.

The contractions were averaging 4-6 minutes apart and were 60-90 seconds in duration. So much for starting short and slow. We called the midwife and she said we could go into the hospital or wait a little while, depending on how I felt. As my mom was going to be coming in for the birth and staying with us to help me with the baby, I suggested that we change the sheets on the air mattress and then see how it went. By the time we were done, the contractions were coming stronger and I decided it was time to head to the hospital. We gathered our bags and I dialed my Mom to let her know it was time and that we’d let her know when we were admitted.

We reached the maternity ward around 3:30 am and I was hooked up to a fetal monitor to record my contractions.  They continued in their duration and space and I was completely effaced and one cm dilated. I informed the nurse that I wanted one of the rooms with the birth tubs, but was told that both of the rooms were occupied and that the maternity floor was quite full due to six inductions that morning. It seemed like poor planning to me, but  we were grateful to get the last room after about an hour of walking the halls and slow dancing. The contractions were long and hard and I became sick, so I had to stay on top of my liquids in order to avoid dehydration and the need for an IV. The hospital staff notified the midwives and Irma came in around 8 am-the start of her shift. She checked me  and I had progressed to 3 cm. She suggested I get in the shower to help me relax. I found the water very soothing and stayed there for an hour, getting through the contractions by vocalizing and stamping my feet and hitting the walls with my hands in rhythm with Brian massaging my back. My back pain was increasing and I had to constantly have heat and pressure on it-keeping Brian busy alternating my hot packs between contractions. I was very tired and became worried I would run out of stamina before the end. Around 10 am she checked me again and I was still at 3cm and the baby was posterior, accounting for my severe back labor and intense, rapid contractions. Greatly discouraged,  I asked Irma about my pain relief options and what I could do to get things moving. Finally, I decided to wait another hour or so and follow the recommendations of position changes to see if things would pick up again before resorting to any interventions. We also took the clock down in the room at Irma’s suggestion so I wouldn’t become focused on the passage of time. Brian coached me actively through every contraction, reminding me to relax and open my hips while joining me in my vocalizing and feet stamping. We hit the shower again and I decided against being checked again-I had found my focus and I didn’t want to lose it. A little before noon,  they checked me and I had progressed to 8 cm! I was relieved, but my contractions were coming on top of each other and the pressure was becoming severe from my unbroken water. They had me turn on my right side to coax the baby out of the posterior position. Irma had warned me it would be very uncomfortable. She was right, but it was also effective. Brian had to leave during this time to get some things from the car,  but Irma stayed with me, massaging my back with oil to help me through transition.

When he returned, Brian called my mom to update her on my progress while she drove to Toledo. While they were talking, my water broke and I told him to get off! I was very close and having trouble staying on top of the thunderous contractions as they racked my body. Brian had to remind me to keep my moans low and controlled so as to avoid hyperventilation. He encouraged me and cheered me on, helping me to stay focused on this awesome task. Suddenly, I knew I needed to push, and the nurses encouraged me to start giving little pushes. Irma came back in the room and suddenly, they were positioning me to bear down and bring this baby into the world! It was all happening so fast and the power that came forth from my body along with the contractions was unbelievable. I heaved with all my might and was so focused that I had to be reminded to look in the mirror as the baby’s head crowned.  The midwife had me blow off some contractions as my pushes were so powerful and she didn’t want me to tear. Weeks before , I had been reading a book of birth stories and the women talked about the guttural sounds which they were shocked to hear come from them as it came to the pushing stage. I too had this experience, amazed by how barbaric I sounded, but too involved in the process to care.  I felt the intense burning ,or the “ring of fire” as they described it in birth class, as the head crowned and was delivered. One final push brought forth the shoulders and then the rest of the baby slipped into the hands of the midwife as if coated with Vaseline.

Someone exclaimed “the baby’s out” to my disbelief, and I watched as they sucked the fluid from the baby’s mouth with a bulb syringe.  “The baby’s not crying” I worried, but Irma assured me it was fine and then I heard the most beautiful noise I’ve ever heard-the first crackled cry of my new baby. The baby was placed on my chest within seconds and our eyes met-oh how bewildered those eyes looked! All I could say was “hi baby, I’m your Mom” over and over. Brian leaned over us and said “it’s a boy, hi Joseph”. Up to this point I hadn’t even thought to look or ask what gender the baby was. We had a boy! We were finally meeting the little one we had talked to for the past 9 months face to face! Oh, what joy and amazement, looking down at our son. My love for my husband intensified in that shared experience, to a level I had never imagined as we gazed with pride and admiration on Joseph, the manifestation of our love, now made visible to the world.


A Few More Thoughts on Fatherhood

During my first year of medical school I was prompted to write a short post about attachment parenting.  It has now been nearly three years since that post was written, and now my son is no longer the quiet little infant, but a wonderfully energetic toddler ever exploring the world.  As I re-read the first post, I had flashes of wonderful memories, and then began to contemplate how my son has grown since then.

I think the most amazing part is the close relationship he and I have.  Despite the fact that I did not feed him with the bottle, or that he preferred to find comfort at his mother for the first two years, he and I have a spectacularly close relationship.  As he continued to grow and began crawling and then walking, eating solids and the like, I began to take as much of an active role as I could.  This was not always easy, being in the midst of medical school.  As he completed the first year of life, I was still in the classroom, and then as he worked his way through the second year of his life, I found myself working very long hours in the hospitals and clinics around Toledo and beyond.  However, I never let this become an excuse for me to not be a father to my son.  In fact, I worked extra hard to either finish my work quickly and efficiently (and competently!) in order that I could have time to spend with my wife and son.  As my son grew older I was able to do more and more with him and began to teach him what I know.  Throughout all of this, both my wife and I made sure to be present for my son and to address his needs as they arose.  Those same aspects of attachment parent I wrote about before, continue to be present in different ways.  As he became more aware of the world and its dangers, he knew that we would be their for him ready to help and to keep him safe.  And as time has gone on, my relationship with him has only grown deeper and stronger.

Today, when my son scrapes his knee or bumps his head, he comes running to daddy so that I can make it better.  Usually it is a simple touch or kiss and he is back to his usually happy self.  Or when he is not feeling well at night, he calls out for me to make him feel better.  Again, a soothing word, a loving touch, and he settles right down.  This does not mean his mother cannot or does not sooth him, but as he grows into his role as a young boy, he turns to his father more and more for instruction and guidance.  Having created a bond early on, I now hope to only deepen that relationship by continuing to be present for him, to answer his questions about the world and to care for him when he stumbles in his journey.

I very much believe that it is because we have continued to reinforce to my son that we will be there for him, that he has become the little adventurer that he is.  He always wants to be outside exploring and playing and he loves people.  When he meets people that we introduce him to, it only takes a few moments that he is climbing in their laps or sharing his toys with them.  And he absolutely adores children.  By immediately attending to his needs as a young child and beyond and being constantly present for him, he has learned to trust us.  Through this secure relationship, he now has the freedom to explore the world and meet new people, knowing that we will be their to help him if stumbles or get scared.

The time since my first post has only reinforced the blessing that attachment parenting is.  The science is there, the anecdotal experience is there, and it just seems to make sense.  Only time will continue to tell if this really works, but as I write this post (wearing my second son in his sling), I know that I will continue to practice attachment parenting and I encourage all of you to consider doing the same.

A Few thoughts on Fatherhood

This was originally written during the first year of medical school when my first born was about 3 months old.  

I thought that I would give just a few thoughts about family life…

Time is inconsistent. When I am studying my psychology lecture it moves slower than molasses in the winter, yet this first year of medical school has passed in the blink of an eye. The same goes for my son. The past three months have gone by so quickly, yet it seems as though he has always been a part of this family. What a joyous three months! Despite the challenges and changes that come with a child, I wouldn’t change a thing.

One of the benefits, or perhaps curses, of being a medical student and a father is the opportunity to compare what I am learning in the classroom to what I see in real life. One of the courses that I am taking this year focuses on the behavioral sciences, which is essentially our first introduction to psychology. We have covered topics from child development to personality disorders. From my perspective, there seems to be a consistent message which focuses on the importance of the parent-child relationship, especially during the first years of life. The beginning of all this is in the attachment between the child and the parents. This attachment begins even before birth, when the child begins to hear his parents’ voices, and continues to develop in the moments after birth when he is placed in the arms of his mother and takes his first feed at her breast. The focal length (the length the child can see) is about 9 inches, the distance between the breast and a mother’s eyes when she looks down at her child, allowing that bond to continue to develop. The mother is intrinsically reciprocal to the child in so many ways. This was the way that we were designed by our Creator, to fit snugly into our mother’s arms, for love! It is vitally important for that attachment to develop between the child and his parents, for that sense of trust and knowledge of love to be established. When this breaks down, the child does not learn what it means to be loved or how to trust, which in turns does not allow the child to learn how to interact with those people around him. Subsequently, the child can have language and learning disabilities, behavioral issues, and poor brain development and physical growth. It all can be affected by that attachment between the child and his parents!

So that is what I have learned, but what have I experienced? The answer: Love and Joy! My wife and I decided from the beginning that we would attempt Attachment Parenting (Dr. Sears). This means that we have exclusively breastfed Joseph on demand. When he is hungry, he eats. Pretty straight forward. Why breastfeed, you might ask? From my training both as a medical student and a NFP instructor, I have learned that breastmilk is the absolute best type of food you can give to a child. According to the studies, Joseph’s nervous system is developing at a faster and more efficient rate than a formula fed child, and he is getting every nutrient that his body could possibly need, in just the right quantities. This is something that formula has never been able to do. Moreover, breastfeeding is wonderful for my wife’s health. By breastfeeding, she is helping to reduce her risk of breast and other cancers and the hormones released during breastfeeding help to reduce her stress levels. This makes my life a little bit easier too! The best part about breastfeeding is the bond that is established between Joseph and Johanna. The physical closeness, the physiology, the spiritual giving of herself, all of these help to create that attachment between Joseph and Johanna that will help Joseph be a well-developed individual. All of this is supported by scientific studies! That was just one aspect of attachment parenting, exclusive breastfeeding on demand. What more? Co-sleeping. This is where my attachment comes into play. From the moment he was born, he has spent each night in our arms. This means that the last thing that he sees before falling asleep is one of us, and we are the first thing he sees when waking up. It is such a joy to hear him peacefully falling asleep, cooing and nestling into the crook of an arm, and perhaps a greater joy to see his bright smile as he awakens to see us watching him. I have few greater pleasures than holding him tight against me as he drifts off to sleep. Co-sleeping also means that we do not ignore his cries of distress either during the day when he is napping (sometimes with us, sometimes on his own) or at night. Rather, we quickly attend to his needs, whether it be an empty stomach or a full diaper. Over a short period of time, Joseph has come to learn that his needs will be met very quickly, and so rarely does he get so fussy, that he is inconsolable. Most of the time, simply picking him up quiets him down. All of this is helping to establish for him a sense of trust and security, which is a vital step in a child’s development from a psychological perspective. In co-sleeping and attending Joseph’s needs I have a great opportunity to develop my relationship and attachment with him, but I think the best time I have to do that is when I get to carry him in his sling. Whenever we go out together (as a family) I have taken on the role of being the baby-carrier. We use a sling, which allows Joseph to cuddle right up to my chest, where he feels me and I feel him. Whether at the store, at a friend’s house, or during Mass, I have Joseph right near my heart, literally. I can look down and see his great blue eyes staring right back at me. Nothing is more precious than the smiles he will give during those times. Yet, it doesn’t stop just with the smiles and looks, but he knows that he is safe when he is against me, so no matter where we are, or who we meet, he always has a smile on his face, because he knows that he is with his mother and father.

As time goes on, I expect that Joseph will continue to grow in his outgoing personality and become a well balanced child, who knows that his parents will always be there for him and who count his needs important enough to sacrifice their own comforts and wants for what is best for him. As a medical student I have come to realize that attachment parenting is the best way to facilitate the raising of a well adjusted child. In every way, this form of parenting promotes what the ‘experts’ say is best for a child. Moreover, this method works with our natural parenting instincts, rather than against what we feel is best for a child. From my experience so far, I can only say that this feels as natural as anything could, and I am ever grateful to God that my experience is reinforced by my medical school education.

Toddlers and TV

We rarely let Joseph watch TV or videos. The one exception however, is when I cut his nails. I have found this to be a wonderful way to keep him distracted while I clip as fast as I can. He is just getting to the age where he actually pays attention to what is going on, and isn’t too pleased when I turn it off. The last two weeks have been especially rainy and have really tested my resolve to avoid using the TV as a babysitter.

Last night, we were chatting with some friends and some of the events of my childhood came up and as we laughed over them, I realized something. Out of all the memories I cherish in regards to my upbringing, not one is connected to the movies or shows I watched. All of them have some tie to a loved one or beloved pet or place. As a stay at home mom, it is easy to forget amidst all the busyness of running a household, the reason why I  stay at home is for those unforgettable moments with my son, not so I can be productive and check everything off my list.

I have come to see the balance that can be achieved. Instead of sitting him down in front of the TV so I can get some things done, I am trying to involve him in the things that MUST be attended to. His sense of wonder is refreshing and offers me such perspective on the beauty of housework. He now will rush to the washer when it rings so he can help load the laundry into the dryer. One by one, he reaches in and pulls out each article of clothing so I can put it into the dryer. After the last item is out, he sticks his little blond head into the machine for a final check then squeals and claps for himself for a job well done. Although this whole process takes much longer, he is learning the goodness of work and I am learning the joy in the little things.

Besides helping with the laundry, he now sweeps, vaccuums and washes floors with me. The other day, he even put his leftover banana bread in some tupperware! I must admit, there are times my little tag along does try my patience as his helpfulness can be counterproductive. That is when I must remember how fortunate I am to be with him everyday and that he WANTS to be with me! My chance to influence him is here and now. I pray I don’t waste a moment….


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