Tuesday, April 22, 2008

Mark Winne on US Food Policy

I have been reading through Mark Winne's book, Closing the Food Gap: Resetting the Table in the Land of Plenty. I have learned so much from it so far, and it has already become one of the most influential books regarding community development that I have read. Parke Wilde at US Food Policy recently conducted an interview with Mark. I thought I'd share it here with you too.

Monday, April 21, 2008

Out of the mouths of babes: Getting rid of thrush

Welcome to April's carnival of breastfeeding. This month I am sharing my experience with Thrush. I have always intended to share my story, even before I started blogging. However, I need to point out that the purpose of this post isn't to provide medical advice on how to treat thrush. It is simply my story, and I may have left out some details about thrush that were not relevant to my case, but that may be important to someone else's. Nonetheless, I hope it will provide insight and encouragement to those who read it. So here it is!

Here's my simplistic definition of thrush: it's the white patches in an infant's mouth caused by a yeast infection. However, the infection can also be present on the mother's nipple and the infection can also cause terrible diaper rashes. It is fairly common in infants, and not usually harmful, but it can be hard to get rid of and in some cases it can be quite painful.

The picture above is my daughter with thrush. She was about 10 weeks old. It was taken the weekend before I realized we had it.

All my kids had white tongues. I think for every child, my mother would see that their tongues were white and would mention they might have thrush. Nothing came of it with the first two, but with my third child, I noticed that my nipples would get really hot and itchy. I thought it was the humidity, but then I decided to look at my daughter's mouth. Sure enough, I found some white patches inside her cheeks that couldn't be wiped away. So when I figured it was thrush, I rushed her to the doctor to get rid of that thing! And so my adventure with thrush began...

In our case, it really wasn't that bad. My daughter wasn't having trouble breastfeeding and I wasn't in any pain. But this wasn't an easy time in my life either. My daughter had caught her first cold when she was 3 weeks old. This set off a chain of reactions and needless to say, I was worn out by the little booger :-) Adjusting to a new baby is hard enough as it is, and when a baby that young gets sick, they have a harder time fighting it off. It was really hard to think clearly during that time, especially when you are trying to make the best decision for your baby. So very specific information is important when a parent is stretched so thin.

These were the main questions I had:

  • If it is not that big of a deal, then why is treatment necessary?
  • If it generally goes away on its own, why is treatment necessary?
  • How should I apply the treatment?
  • When should I discontinue the treatment?

The biggest hurdle for me was treating her in the first place. Although I will give my kids medicine, I am not one to habitually medicate my kids. I don't even give them vitamin supplements. So I thought, if it wasn't that big of a deal, then do I need to treat it? To add to my confusion, the MedlinePlus Medical Encyclopedia (run by the National Institutes of Health) stated that treating it is "usually NOT necessary" and that it "generally resolves on its own." (I only include the link to it because it currently says "within two weeks." and I do not recall them specifying a time back then, but I could have been wrong. After all, it was a hard time for me.) Given that I was feeling the itching on my nipples and they started to look dry and cracked, I thought it best to go with the first round of nystatin treatment for my daughter. Gentian Violet is another treatment. It is what was used back when I was a baby, but now Nystatin is usually the default treatment. I really don't know why it has fallen out of style. I went with Nystatin by default because I was too worn out to consider any other alternatives.

It was unclear to me, however, the proper way to apply the medicine. How often should I apply it? I think the bottle said four times a day, but I had read in other places that it should be after every feeding. I take my kids to a family practice. I love having the same doctors as my kids do. They also have a different perspective when it comes to interventions, as they see a wide range of people with a wide range of ailments. So I don't expect them to be experts on thrush, especially when it is a fairly minor condition when compared to other ailments in a lifetime. It just happened that I had to ask the physician assistant I saw that day what I should do to treat my nipples. She looked it up and said that I could apply Monistat. Well, I ended up not using that because there are several different types available, I didn't know which one to get, how to apply it and I really didn't want to call back and ask. The pharmacist said I could apply the Nystatin directly to my nipples. So, after every daytime feeding, I applied Nystatin on myself and squirted the recommended dose inside my baby's cheeks.

The next challenge was figuring out when in fact it was totally gone. It only takes a few yeast cells in the right environment for it to grow back to where it was. So, after a few days of it looking like it was gone, I would stop the treatment. Only to have it reappear several days later.

So, given the MedlinePlus information, I decided to see if it would resolve on its own. I did ask the doctor about it. After making sure it would not hinder the baby's feeding (and it wouldn't because neither one of us were in pain), he allowed me to give it a try.

And, of course, it didn't go away on its own.

So I tried Nystatin again. By this time, my daughter, although maybe just 3-4 months old, was well familiar with the routine and would do all she could to keep from getting that dropper in her mouth. She would even try to spit (razzing style) to keep me from giving her the medicine. So I dreaded giving it to her.

Then finally things changed. After I was almost done with the second round, I decided to call the counseling mother who had helped me with some breastfeeding problems that came about because of my daughter's cold. I wish I had called her first and I have no idea why I took so long to call her. I think we were 6 weeks into this before I did. Not only did she give me the most practical directions, she helped me think through the other treatment options, and asked the lactation consultants in her network about the "resolving on its own" statement (which, by the way, they said that in their experience it is quite unlikely, especially in the warm southern climates).

So this is how I finally got the thrush out of the mouth of my babe:

  • After every daytime feeding, I drew the recommended Nystatin dose in the dropper, then put a small amount from it in a spoon.
  • Then, I put some on my finger and apply it directly inside her cheek, making sure I applied it in ever nook and cranny. Sometimes I used Qtips, but it was easier with my finger.
  • I would also apply some on my nipples. I'd also apply some just before I went to bed.
  • [update] Another important thing is to sanitize clothes (especially bra and nursing pads - don't use disposeable pads), toys and other things that go into the baby's mouth.

After the symptoms disappeared, I kept applying it, although I can't remember how long that was. You can always ask your health care provider about that. When all was said and done, my daughter was 5 months old.

So, in all, what could probably have been resolved in 2-3 weeks lasted about 3 months. What a difference it would have made if I had just picked up the phone and called lactation support. If you live in the US and you don't know of any lactation groups around, call the La Leche League's 24-hour Hotline at 1-877-4-LA LECHE. I cannot overstate how much easier it is when you have someone to help you through any lactation challenge you may have.

I also have read claims that unrefined coconut oil has antifungal properties, but the nystatin was cheaper (even after 3 rounds) and more accepted. I already had some refined coconut oil in my pantry for cooking purposes, so at one point I used the oil on myself, as I felt it provided an additional protective barrier, and the nystatin is somewhat sticky.

Among websites, KellyMom and the La Leche League's website were very helpful. For additional experiences with breastfeeding challenges, check these posts from other carnival participants (updated throughout the day):

Jen at Mama's Magic
Half Pint Pixie
Stephanie at Speech Act
Barbara at Mom on the Go
Sinead at Breastfeeding Mums
Tanya at Motherwear Breastfeeding Blog
Donna at Blessed Nest Perch
Lauren at Hobo Mama
Angela at Breastfeeding 1 2 3

Wednesday, April 16, 2008

A need for dialogue...

"Lord, I have a heavy burden of all I've seen and know
It's more than I can handle
But your word is burning like a fire shut up in my bones
and I can’t let it go" (When the Saints, by Sara Groves)

Have you ever read or heard something that causes such a reaction within you that you have to fight to think about other things? That's how I feel today.

As I read Bryan's comment about obesity in low income neighborhoods on the What to Eat blog, it stirred me up again and I just can't let it go.

I am all for personal responsibility. That is really where it ends. It doesn't matter if you give the person all the food they need to eat well, they still need to be the ones to eat it. But I feel that sometimes people oversimplify it because they are basing their opinions on false assumptions. People, including myself, draw their opinions from their personal experiences. Everyone has a story to tell. Our experiences are important, it is a part of real life. Yet, I have not been at a grocery store in the poorest parts of the city. So I can't make the assumption that they have a decent produce section in their store. Actually, I can't even make the assumption that there is even a decent grocery store to begin with. Most people wouldn't even want to drive through certain parts of the city, so how can I tell someone who lives there that if they want to lose weight on a limited income, they should go for walks?

Discussing opinions is good, but it's not enough. I for one am yearning for some more dialogue. I am new around here, so I don't know how this is being addressed in my city. I also know that when I feel very strongly about something, I feel the urge to speak (or write in this case). But I am painfully aware that I don't see the big picture and that I too am missing something.

I really need a way to work all these thoughts out because it is getting in the way of me taking care of my home and family.

I included the opening lyrics from Sara Grove's song, "When the Saints" because it really reflects how I feel right now. Sara Groves has spoken out about social justice over the past couple of years, and her latest albums is a reflection of the things she is learning along the way. This song is very encouraging to me, because it seems like we can do so little, but God hasn't called us to coward down. As she states on her website: "I can't just fight when I think I can win."

So what is coming next? I don't know. But I don't want to just think about it any longer. At least not by myself.

Sunday, April 13, 2008

This week in review...

This is a quick one as there haven't been as much buzzing around in the nutrition world. I think there may have been some noteworthy posts, but they can wait until next week. Some that come to mind I really want to comment on them and that takes more time.

By the way, don't forget to vote on my poll. Thanks.

Anyway, here are some things that have been going around here:

I painted a wall border in the boys room. I wanted to take winnie the pooh out and give them something they could claim as theirs. It took 6 months to remove the older border and paint it, but now it's done! I would have put up other borders but I couldn't find any that were thick enough, cheap enough, or that coordinated with the existing colors. I found some peel and stick sports stickers on clearance at Target and used that instead. Painting can be a pretty good workout. the rolling can work your upper body, the squatting works the thighs, and then if you run up and down the steps to turn circuits on and off so you can paint around the outlets you can get some cardio workout in too (can you tell how sedentary I am?). Oh, and the reason why I even mentioned this is because my 5 year old was so excited about it, he wanted to sit in the room and watch the paint dry. I chuckled and explained to him that people say that when they are bored, but he said, "but I'm not bored". He really wanted to see the paint dry. I didn't let him because I know that would mean he would be touching it every minute to test if it had dried.

For the most part, the kids have been really good, but I am noticing some new trends that I need to figure out how to best deal with them. The boys are getting competitive about everything. I know that's normal, but it would be nice if the three year old didn't scream bloody murder every time we get back from an outing, just because he wants to get to the back door first.
And this morning they ganged up on their little sister and started chanting "stupid N" because apparently she wasn't playing with the blocks and trains their way. Granted, she's not even 2, so she doesn't realize what they are saying, but they need to understand why this is wrong. Where do people get the idea that children are so innocent???

That's all I can think of for now. I really need to get some sleep. I've had a rough 2 nights and I need to keep getting up before the kids. It has made such a difference to my day. Oh yeah, I said I'd write a separate post about that, didn't I. Maybe next week :-)

Thursday, April 10, 2008

Guess what???

Thanks to Hanna at This Garden is Illegal, the plants I originally had thought were strawberries are actually:


I felt so stupid when I looked at it last week and saw it in other parts of my yard, that I thought for sure I had been mistaken. I should have looked up pictures of strawberry leaves on the internet instead of poison ivy and such.

Hanna has written about strawberries on her blog.

Thanks again Hanna!

How often do you weigh yourself?

Please take some time and answer my poll.

[update] The results are in:

What is this?

Being an absolute novice (aka dummy) in gardening, can someone please tell me what this is and if this is going to harm me if I tear it out of my garden bed?
Thanks in advance :-)

Saturday, April 5, 2008

This week in review

I am starting a weekly post where I'll share interesting blog posts, news stories, and whatever else is going on in my life.

Blog posts and news of note:

Around here:

I've been reading Closing the Food Gap: Resetting the table in the land of plenty by Mark Winne. It has been a very captivating read so far, although I had to slow down this week. I am currently on the chapter where he addresses social policy and personal responsibility. It is has given me a lot more to think about regarding social policy and it is done in a way that doesn't pitch it against personal responsibility.

A sleep update... Unfortunately my youngest still wakes up at least twice at night, but it appears that if I get up earlier, I'm not as tired. I have finally started carrying my cell phone in my PJs so that I can stay track of time and use that as an alarm (instead of my kids). So far I have been less tired and have gotten a lot more accomplished. But there is still a lot to sabotage my plan (subject for another post), but this time I'm not giving up.

Oh, and my three year old has been diaper-free for a week. Even at bedtime! I thought it would never happen. So for you moms out there who think their kids will never go to the bathroom on their own, they will.

It is finally looking like spring here. For starters, we have been to the playground 3 days this week. I came across this post about how you survive Cleveland winters if you get through February. I did and even though we had a blizzard in March it was much more enjoyable because it wasn't as windy and it was not as cold. Oh, and I'm the only blogger who loves the early daylight savings time. I probably wouldn't like it if I had to be somewhere in the morning, but the brighter evenings do so much for me.

I have to figure out to what extent I'm going to garden. Although I have tried growing stuff on the porch to my former apartment, this is my first try at a real garden. I took another close look at my garden bed and what I hoped was strawberry vines may actually be something else :-(
I'm really hoping it's not poison ivy or its cousins.

Tuesday, April 1, 2008

Truly misleading (and sometimes comical) claims about food

In honor of April Fools Day, I'd like to write about how manufacturers like to tout the so-called nutrition advantages in certain products. Manufacturers aren't lying, they are just trying to make their product more appealing. After all, they want you to buy it, so they try to persuade you that you are getting something good. I admit that some people will use it to justify their decisions, even though they know better. On the other hand, these statements often mislead and cause confusion.

So let's get started with the comical:

Gone are the days when health claims were used to get kids to eat their veggies and when eating was for the pleasure of eating. Take this example of pork skins being sold at the North Carolina State Fair:

Now, I'm not faulting these guys for selling pork skins, but no one I know ever ate it because they thought it would be good for them.

And then there's the vitamin and mineral enriched soft drinks. I really appreciate the industry's ulterior motive of restoring America's health by adding some vitamins and calcium to the very drinks that often displace these nutrients from our diets.

Then, there's Snicker's Charged, a Snickers "energy" bar, loaded with caffeine, B vitamins (known to help in energy metabolism) and taurine (an unproven energy stimulant). It's a nice change from drinking Red Bull and the like, if you're dependent on that stuff. I didn't think much of it until I was in the line at the grocery store one morning when the person behind me grabbed one of these bars and started eating it. She then tells her adult daughter that it has vitamins in it, as if she was seeking validation. Does she really need validation? I wonder if she would have picked up a regular Snickers if the Charged wasn't there. Who knows? Maybe she was just surprised.

Now to the confusing stuff:

Ocean Spray CranGrape Juice Drinks. This one (and most likely the other varieties) goes to my hall of shame. Recently, an email list colleague (and a very wise and experienced food allegry & intolerance dietitian) shared how she mistakenly picked up a bottle of the thing instead of 100% juice when she was in a hurry. Later on, she not only saw that she got fruit drink with 15% juice, she noticed the label also claimed the product had no artificial flavorings or preservatives.
A closer look at the ingredients shows that it contains Red 40 and Blue 1 (colors). The manufacturer was telling the truth, the drink does not have any artificial flavorings or preservatives, but they won't tell you it contains artificial colors. After all, that's what ingredient lists are for, so the consumer can see for themselves what is (or isn't) in a product. So, by all means overstate how great your product is, but keep the rest to the fine print. And why did they add the color? To make a lower quality product look more like the better quality one.

And the last on my list today (my kids are getting hungry) is the whole grains claim. Ever since the Dietary Guidelines for Americans recommended that half of our grain consumption should come from whole grain, the industry has eagerly complied by adding all sorts of whole grain versions to their foods. It's a reincarnation of the "wheat bread vs 100% whole wheat bread" claim, where they add a little bit of whole grain and now can say that it is a "sensible" choice. This also goes to the hall of shame, but there are so many products out there that I can't even name them all.

Check out some other examples in my misleading claims category. Feel free to add your own.