How important are well-child visits for babies?

[Joanne]

Omg, I'm in love with your brain. I consider this post a monument to critical thinking. THANK YOU. This is exactly the kind of balanced approach I tried to take with ds, and it still wasn't easy to decide.

 

But you just demonstrated how complex the issues are that surround vaxxing our dc. I'll say it again: thank you. Brilliant post.

 

She's a brilliant lady. I know for a fact they considered this with prayer and copious amounts of time. :001_smile:

[Joanne]

Anyone trying to convince you there is no risk to vaccinating and anyone trying to convince you there is no risk to not vaccinating should not be taken seriously.

 

Exactly what I was trying to say, only I did it less eloquently. LOL.

[Alice]

I never said I don't do well check-ups (we're at the doctor's every three months), but I was adding a caveat that just because you go for well check ups, does not mean you should blindly follow what the doctor says. Yes, we had an awful experience with a well know highly thought of ped, who nearly killed our child. Perhaps my experience colored my choice of words; I apologize. Our Endo is one of the best in the country; I don't believe he intent was to be offensive. However, I can't tell you how many times I've received advice from our ped that contradicts what our endo has advised. I think I'll listen to the specialist.

 

I do feel the OP's issue is in having a doctor who will listen, and work with her. No matter the specialty, I think this is in short supply.

 

I appreciate your apology. What bothered me was that your Endocrinologist's statement was inaccurate (and offensive). Pediatricians, family practice docs and internists all have the same amount of education. It's 4 yrs of med school and three years of residency. If you specialize it's an additional three years of fellowship in that particular sub-specialty only. Other specialties have longer residencies (from 4 for OB-Gyn to 7 for general surgery). The longer residencies tend to be in specialties where there is a high amount of specific skill training (surgery, procedures).

 

The pay structure is not necessarily tied to the amount of education. It has a lot to do with the fact that insurance companies pay for things we do rather than when we think. I can make a lot more on a simple procedure that takes 10 minutes like a "foreign body removal from foot" (splinter) than on a kid with chronic headaches that I meet with for 40 minutes and spend a lot of time thinking about the diagnosis. How much I'm paid really has nothing to do with the level of education. And my decision to go into pediatrics really had nothing to do with either the length of residency or the amount of the salary. It was because I loved it. That's the case for most of the pediatricians I know.

 

I would certainly listen to your endocrinologist for endocrine issues. And I'm quite sorry you had a bad experience with a pediatrician. Absolutely there are bad docs in every specialty. But for your endocrinologist to "often laugh at how little pediatricians know" is ludicrous and offensive, intentional or not.

 

 

Haven't finished reading all the replies yet - I just wanted to say thank you to Alice, this post was incredibly helpful. :)

 

Good! I'm glad it was helpful, it makes me feel better about highjacking your thread over my own personal issues. ;)

[6packofun]

I agree. I found out that I needed an update on my MMR vaccine while in the hospital after giving birth to my first child, even though I'd been fully vaccinated as a child. Should I feel guilty for all the possible deaf babies I may have left in my wake during those years? Whose fault was that? Should I have somehow KNOWN that maybe I was a carrier for a disease which I was vaccinated against and *trusted* to be effective?

 

Baloney. I, as a parent, am tired of being spoon-fed selective information about vaccines and other medical issues. It seems like many of the pediatricians are passing on their spoon-fed educations to US. I see on so many health websites the line that "we know vaccines are safe because they're tested for many years..." and on and on. Uh, need I say Gardasil?? Or how about the reason that there are millions of dollars given to families through the Vaccine Injury Compensation Fund? Ugh, don't get me started. LOL It's so much about the money and towing the line. Hmph.

 

And I say all of this as someone who is trying to get my kids *caught up* on vaccinations! LOL

[elizabeth]

All of our children have had all their vaccinations, and I do think people should vaccinate, but you make it sound as if there is no risk. Have you read the papers (about each vaccine) that you sign?

 

absolutely. My child has anaphylactic allergies to eggs and nuts. MMR is created if you will in egg medium so we Vax'd over several hours for her safety and in an allergists office within a hospital. :lol: I daresay I am sort of in the business of reading carefully and making sure my clients do before any one of them signs papers. You know little stuff like living wills, wills, conservatorships, divorce papers. So yes I read before I sign and make certain that clients have papers read to them as many of them are elderly, mentally and or physically differently abled and some just sad. These are not easy matters to face.

[scrappyhappymama]

I certainly appreciate a staggered vaccine schedule. That way it is easy to determine which vaccine might have caused undue swelling, or perhaps an allergy to one of the components. But to simply choose not to vaccinate without a scientific reason for doing so violates the very essence of the social contract . In fact , if I were a member of this group I would say it was downright un-Christian. While a child might come through measles, mumps, rotavirus , chicken pox, etc these diseases can be carried before symptoms are apparent and they can kill without mercy those who are immune-suppressed, especially those who are undergoing cancer treatment. It is selfishness and willful blindness to suggest that your choice not to vaccinate at all does not affect other people. It does. The whole theory behind vaccination of heard immunity depends on the social contract. How would you feel knowing that your measles-laden child caused another child to be born deaf? It happens . Measles used to be one of the main causes of women bearing hearing-disabled children . As I said, I get doing a very careful, slow, methodical vax schedule. But to pretend that it is simply a matter of private choice is a moral illusion . Those choices do affect other people and you need to account to other people because they can be affected seriously by your choices.

 

I think you make valid points. However, the implication that choosing to vaccinate has no potential negative consequences, either to the child being vaccinated or to the people they come in contact with, is missing the other side of the story.

 

Herd immunity existed before vaccines did. For example:

 

The chickenpox vaccine, IMO, is one of the worst excuses ever for Big Pharma to make money. My son's generation will now enter adulthood, not with naturally, active acquired immunity (the best kind), but with a waning active artificially acquired immunity, right when the disease poses the worst risk if infection sets in. If I had a dd, I'd be especially concerned, because even if she's had the chickenpox, if she is around hordes of other young adults all getting sick with the disease, and she's pregnant and her own immunity is compromised, guess what? That's a BAD SCENARIO.

 

Anyway, point being that I think there are "good vaccines," there are "less helpful" vaccines, and then there are what I call "corporate scams contributing to a national health crisis."

 

Parents have to be willing to research and be discerning, because the risk is never a sum-zero game (i.e., all risk assumed by one party, no risk for another) you know?

 

I agree completely with everything you said here. The chicken pox vaccine is one that could easily be argued in reverse as far as the impact of vaccinating on the rest of the population. The widespread use of the chickenpox vaccine is causing a dramatic increase in shingles, because people are no longer getting the natural "booster" effect of being exposed to active chickenpox by their children, grandchildren, neighbor kids, etc. Of course, now there is the shingles vaccine to address that issue, allowing the pharmaceutical companies to make even more off the problem they've created.

 

 

In the past, children with chicken pox exposed adults to the virus over and over, topping up their immunity to the virus and preventing most cases of shingles. *Natural* herd immunity to shingles! Now however, public health officials have deemed it wise to prevent chicken pox in young children (and saving all those sick days from school and work!), a disease that is relatively mild for most children. In exchange, we get young adults with immunity wearing off and who are much less likely to go for their boosters, and therefore likely to contract chicken pox anyway, but at an age where it is more painful and dangerous. And adults are succumbing to Shingles at increasing rates, which is also much more painful and debilitating than childhood chicken pox.

 

I am merely pointing out it is not a morally neutral choice in that it does have effects on the health of unknown persons. I guess that implying selfishness as not a desirable virtue is another taboo. Absent an allergy there is no scientifically verified risk. However, that is not the issue. The study about an alleged tie to MMR vax and autism was totally false and its author said so. To suggest that your choices are not morally neutral is not insulting in the least and I cannot see how it would be insulting. The fact that it feels like hypocrisy to claim to believe X and live or conduct oneself in accord with something in opposition to X at tthe same time, might give one pause . Maybe there is merit to my proposal that there are moral choices being made and there are consequences.

 

Yes, maybe there is merit. But I submit that perhaps the moral choices do not always fall on the side of vaccinating in the interest of public health!

 

Absent an allergy there is no scientifically verified risk. However, that is not the issue. The study about an alleged tie to MMR vax and autism was totally false and its author said so.

 

The fact that several studies, focusing on specific elements of particular vaccines, have not demonstrated a verifiable relationship between MMR and autism, does not preclude the real possibility that the causal relationship has just not been discovered yet. Several media outlets reporting these studies and the debunking of one led with headlines of "Autism is PROVEN NOT to be caused by vaccines." The logical fallacies there are egregious! Lack of evidence, particularly when the study is narrowly focused, does not PROVE anything, other than that the particular hypothesis was not supported by the study. Lack of evidence could be due to an alternative causal relationship, a poorly designed study, or a true lack of causal relationship. In fact, since there is plenty of anecdotal evidence of at least a correlation, this issue merits further study, NOT relegation to the realm of "PROVEN WRONG! Nothing to see here people. Move along." That's just insulting to the many many parents who have watched their children regress, for whatever reason, after a series of vaccinations.

 

A correlation and an unknown cause are reason enough for some parents to be hesitant to vaccinate.

:iagree: And this is a morally valid option!

 

I am not vehemently pro or anti-vaccine. Nonetheless, I do think that the "risk", if such a risk even exists, of your child getting ill from a vaccine is far less that the risk an immunosuppressed child faces if he or she contracts pertussis or any other contagious illness. So yes, I think Elizabeth is probably correct in saying your position is somewhat self-centered.

 

The fact that it feels like hypocrisy to claim to believe X and live or conduct oneself in accord with something in opposition to X at the same time, might give one pause . Maybe there is merit to my proposal that there are moral choices being made and there are consequences.

 

Is it safe then to presume that all the "non-self-centered" parents on this board have been recently immunized against pertussis? As is recommended, to protect the children who are too young to be immunized themselves? And all adults here have had their MMR booster recently as well, correct?

 

Overall, and this is the post I forgot to quote, but as Joann and others said, it is a bit silly to believe that vaccination decisions are made in a moral vacuum. I truly believe that many parents on both side of the issue are doing what they feel is, in the big picture, the right thing for their own children and society. Perhaps, for civility's sake, we can debate these issues, and maybe even become more informed ourselves, without casting morality stones?

[Pepper Potts]

 

I think it depends a lot on whether you are a grounded, common sense person who has a basic idea of what something going wrong might look like. There are signs and symptoms for everything. Many people are so idealistic about vaccines and child rearing ideas, that they are not really grounded in common sense at the same time (and the same could be said of many of those who have stong views either way). Trust your mother instinct, read a lot about baby milestones and growth patterns- educate yourself well- then work with a doctor as needed. Use them- don't give your power up to them. They are useful, but as servants, not masters. They take their own power way too seriously and that is too disempowering for mothers, I feel. Empower yourself, then find what you need.

 

:iagree: Very wise words. :001_smile:

[kht2006]

I've had whooping cough twice, and it's one of the diseases I'm more concerned about.

 

If you are breastfeeding, then your accquired immunity should provide some protection for your child.

 

I am so thankful to have a dr. office that will support me and my family. Even though I don't call on them often, I really do that I want to have that support. We don't discuss my stand on vaccines often, although we did at first. When I made DD's well visit appointment for the summer, the receptionist asked 'do we need any vaccines for this visit?' It sounds like she asks everyone that. (She may think I go to the health department for vaccines).

 

Last winter DD broke her leg. My pedi was able to call in xrays which allowed us to avoid the ER and see the orthopedic surgeon in his office that same day. If we had gone through the ER we would have gotten the resident on call instead of the 'Mayo Clinic Pediatric Rotation' Orthopedic Surgeon.

 

My pediatrician helped me decide to see a pediatric specialist for the leg. (The casting techs at the local clinic were not skilled at casting anyone under 10). My local pedi was able to call in a pain prescription refill on the weekend. We could have gotten by with Motrin, but I was so glad to have it just in case for the long road trip to the specialist.

 

I hope you find a doctor who will let you explore the vaccine issue. I am thankful we live in a country where parental rights to make medical decisions for their children are still in place.

[Jan in SC]

I think well baby visits are very important.

 

When researching medical information, it is important to use a reputable source. Please don't use "popular science" paraphrasing or simply listen to stories of friends. Access medical journals and find the posted research. Determine who funded the research and then make your decisions. If you choose to selectively vaccinate, not vaccinate, or to vaccinate on schedule, at least know why so you can have a discussion with your physician.

[ktgrok]

Are you serious??? There are a multitude of developmental milestones that need to be watched for and physical changes as well. If you want a doctor to permit you to be under a physicians care not a pseudophysician then you might as well stop looking. I do understand staggering the vax schedule or having them administered with a crash cart nearby due to allergy to components or growing medium(eggs) but expecting an MD to rubberstamp your particular mode of thinking is going to be interesting. Neglect is neglect no matter what the intentions. You need to find an MD who is willing to discuss the realistic risks with certain vaccines and have a discussion along with the well baby check up. They check for vision, hearing etc I cannot imagine pretending to live in a third world country medically in order to accomodate my irrational fears.

 

What????? Please. Despite your beliefs, there are 3 pediatricians I can think of in a 5 mile radius of me that are fine with delayed, selective, or non vaccination. I go to one :)

 

And honestly, he is the least alternative medicine of the 3. But is is VERY much a believer that the parent makes the decisions. And he does discuss which ones he feels are more important in our area, at what times of year.

 

The original poster was asking a very logical question. Your response was absurd.

[ktgrok]

I'd make sure my baby was seen by a doctor somehow. There are developmental issues they look for that you won't notice. That's why they measure the head and weight and all that so frequently. A doctor can't "FORCE" you to give your kid a vaccine, can't you just go in and say you don't want vaccines but want the baby looked over? There are so many things that "if they are caught early" can be treated, and things that people who aren't doctors just don't know about. And I'd want a relationship with a doctor, even if we didn't agree on things, for the time when I did immediately need one--like when your kid wakes up with a high fever & screaming or something. :grouphug:

 

There are some pediatricians that will refuse to see/treat children that are not vaccinated on a particular schedule. it sounds like the OP was dealing with one of those.

[....]

Just so you know (although maybe someone else mentioned it- I did not read the whole thread)- here in Australia we don't go to paediatricians unless referred for specific issues from our MD.

A nurse does Well Baby visits. They weigh, check for various things.

 

 

That makes so much more sense than what we do.

[ktgrok]

I have to respond to the accusations that there are no risks to vaccines other than allergic reactions, and that people that choose to not vaccinate, or selectively vaccinate are doing so based on anecdotal information.

 

I selectively vaccinate, based on the risks of the disease versus the risks of the vaccine. And I'm not basing my knowledge on internet chat groups or horror stories of a friend of a friend. I read the freaking insert. I read the CDC information. I'm pretty sure the CDC is a reliable source. I used their numbers, as well as other government sites to crunch some numbers. And for most vaccines the chance of my child having a serious complicaton from the vaccine was higher than the chance of having a serious complication from the disease. That is math, not paranoia.

 

Then I took those FACTS and talked to my doctor about what diseases were specifically an issue in my area. My biggest concern was pertussis because my oldest attended school at the time and could be a carrier for it. (EVEN fully vaccinated you can be a carrier for pertussis - the vaccine does NOT prevent infection, it prevents serious illness from the infection). So we did that one, on a delayed schedule. My ped was also concerned about the number of HIB cases, so we did that one, particularly because it had the least chance of serious side effects. And that is it. My son also had a very selective schedule as his father has a very serious immune mediated disease and we are trying to prevent the same in my son.

 

I'm sorry if it seems selfish to you that I don't vaccinate my kids to keep your healthy. But I would never forgive myself if my kid had a serious reaction to a vaccine that I didn't really feel he needed anyway, but I was getting to protect society at large. My duty is to my child first, society second. Besides, the disease most thrown around with that accusation is pertussis, which is silly because even fully vaccinated people can still be carriers. The companies that market the vaccine forget to tell you that part in their heart wrenching commercials. UGH.

[ktgrok]

I will say that I DO like having regular well baby visits, even when we don't get a vaccine. My ped knows my kids well. When my daughter broke her arm he was able to help us navigate the red tape of the hospital and personally called an orthopedist to meet us there, that he knew. It would have taken much longer otherwise. And after having my son's broken finger misdiagnosed in an ER I just don't trust ER doctors very much. They are too busy, and not familiar enough with kid issues.

[A.Balaban]

Sometimes I feel the same way.

 

But, then I read the story about baby Scarlett (brandi and chris . blogspot . com) who had a genetic brain tumor discovered at 2 months old. She is now nearly 8 months old, and has had two 12 hr+ surgeries to remove the tumor, a serious infection, and is now undergoing intensive chemotherapy.

 

You can't trust doctor's to catch the developmental milestones. Its our job as parents to be on top of that stuff, as well. My pediatrician completely missed my son's 18 month milestones, and I didn't realize it until a friend asked me about it a couple months later. (I was eight months preggo at the time, so I was a bit distracted) So, yeah.

 

Doctors are good and not good. I just roll with them and then go on with my life. :)

[MelanieM]

I have to respond to the accusations that there are no risks to vaccines other than allergic reactions, and that people that choose to not vaccinate, or selectively vaccinate are doing so based on anecdotal information.

 

I selectively vaccinate, based on the risks of the disease versus the risks of the vaccine. And I'm not basing my knowledge on internet chat groups or horror stories of a friend of a friend. I read the freaking insert. I read the CDC information. I'm pretty sure the CDC is a reliable source. I used their numbers, as well as other government sites to crunch some numbers. And for most vaccines the chance of my child having a serious complicaton from the vaccine was higher than the chance of having a serious complication from the disease. That is math, not paranoia.

I agree. When I did all my vaccine research several years ago, my primary source was package inserts and governing bodies that are recommending the vaccine. I looked at the risk profile and did the math.

 

We do not do well baby check-ups. After early experiences with my first I decided there was very little value for our family, and that was that. I do have various people that I go to if I have questions or want to check on something, but that doesn't include a pediatrician at this time.

[beaners]

This is just for the OP, not a response to any of the other posts.

 

If you didn't talk to the pediatrician, but instead to someone else in the office, the pediatrician himself or herself may have been alright with a slightly altered schedule. I have had more grief from assistants and receptionists than I have ever had with a doctor. That said, there are some doctors who truly don't think it's safe to not vaccinate, and refuse to accept non-vaccing patients.

 

Our pediatrician is alright with our homemade delayed and selective schedule. However, I was given information that he was okay with non-vaccing, and that is not the case at all. He tolerates a parent's right to make decisions, but he really thinks vaccines are in a child's best interest. So if you use a place like the mothering boards or a local email group, keep in mind that their recommendations aren't always accurate. (Great, more difficulty, right?)

 

Your baby is still pretty little. There are quite a few vaccines to consider at this age, but there are a few (chicken pox, mmr) that you don't need to worry about yet. My own family skips the HepB and rotavirus for little babies. We do Hib, pnuemococcal, and DTaP. (Or is it TDaP? One is for older people and one is for younger children. I always confuse the two.) We do polio a little later because we aren't likely to be exposed to it.

 

My pediatrician is alright with us skipping a few of the check-ups because we live a ways away from his office. I usually have a few questions for each visit, and it is reassuring to have someone tell me something is normal. I think the visits are worth it for my reassurance that everything is fine.

[Susan in TX]

 

Anyway, my actual question is - how important are well child visits when one isn't giving vaccinations? .

 

I was told by my first pediatrician, back in 1989, that if I wasn't going to vaccinate, then there was no reason to do well child visits.

 

Susan in TX

[jenangelcat]

We don't vax or do well baby visits. There's nothing done at one that I can't do at home myself.

 

In all the places I've lived there have been waiting lists for doctors several years long. So if well visits were important to me I'd have to go sit at the ER for hours every time to get them done by the on call physician.

[Lady Dove]

My children have had the same pediatrician since my son was 3 yrs old. She came to see my daughters when they were both born. I feel I have an awesome relationship with her, and will be sad when my children outgrow her. It CAN be hard to find a good doctor that you can afford (or accepts your insurance) and trust, especially on the vaccination issue. I prefer vaccinations, and since we have been seeing her my children are up to date. It is very important for babies to see a doctor aside from being vaccinated. There are various developmental milestones that babies should reach that sometimes only a qualified physician can look for. If babies don't reach these milestones, doctors can start finding causes and solutions. It's never too late, and don't beat yourself up. It can be overwhelming. Why not call your local hospital, your insurance provider, or even recruit local friends and family to help? I found their doctor through my hospital. Ask neighbors what doctor they use for their children...call around. I'm sure you will find what u r looking for. :grouphug:

[Susan in TX]

I also - from the bottom of my heart - ask you to please vaccinate for pertusis as soon as you can. There are flare ups all over, some are adults who weren't vaxed giving it to their own children... tragic. We recently had large group of kids in the school system where we live out for it - there were no percentages given, but it was reported that many were not vaccinated. Thankfully - no one died from it.

 

Many of the current serious cases of Pertussis are from VACCINATED parents or other adults giving it to infants who are too young for the vaccine to be given, or to be effective. http://www.cdc.gov/features/pertussis/

 

The immunity from the vaccine is not 100% effective and wears off over time. The best protection from the disease is, of course, natural immunity from having aquired the disease...but that has obvious risks.

 

Susan in TX

[Susan in TX]

I certainly appreciate a staggered vaccine schedule. That way it is easy to determine which vaccine might have caused undue swelling, or perhaps an allergy to one of the components. But to simply choose not to vaccinate without a scientific reason for doing so violates the very essence of the social contract . In fact , if I were a member of this group I would say it was downright un-Christian. While a child might come through measles, mumps, rotavirus , chicken pox, etc these diseases can be carried before symptoms are apparent and they can kill without mercy those who are immune-suppressed, especially those who are undergoing cancer treatment. It is selfishness and willful blindness to suggest that your choice not to vaccinate at all does not affect other people. It does. The whole theory behind vaccination of heard immunity depends on the social contract. How would you feel knowing that your measles-laden child caused another child to be born deaf? It happens . Measles used to be one of the main causes of women bearing hearing-disabled children . As I said, I get doing a very careful, slow, methodical vax schedule. But to pretend that it is simply a matter of private choice is a moral illusion . Those choices do affect other people and you need to account to other people because they can be affected seriously by your choices.

 

And what about the children who die or are permanently damaged from the vaccines? It does happen. http://www.cdc.gov/vaccines/vac-gen/side-effects.htm Are they to just be sacrificed for the greater good?

 

Susan in TX

[mommaduck]

I was told by my first pediatrician, back in 1989, that if I wasn't going to vaccinate, then there was no reason to do well child visits.

 

Susan in TX

 

And I've been told by a couple of family doctors, when talking about scheduling check ups/physicals, to just bring them in when they're sick or if I suspect something and need them to look further.

[elizabeth]

In response to this query:

Is it safe then to presume that all the "non-self-centered" parents on this board have been recently immunized against pertussis? As is recommended, to protect the children who are too young to be immunized themselves? And all adults here have had their MMR booster recently as well, correct?

Yes to both. Sadly I am immuno compromised due to steroid use for Rheumatoid Arthritis and have to watch carefully for exposure to disease as I can pick up all sorts of infections many that could put me in the hospital. My husband has completed radiation therapy for vestibular schwanoma recently and has had recurrent bouts with shingles from childhood chickenpox and survived rheumatic fever as a child . This also means we have to be very careful about exposure to illness. My point (for the third time) is that you are not making a morally neutral choice, you are clearly making deliberate choices that could bring great harm to others . I care not a whit what your justifications are nor am I judging you . I am however annoyed with the inability of so many posters to OWN their choices and attempt to justify them as something other than that. I live in the world of science many here do not have that as their ultimate reality and thus we can just continue taking past one another for no purpose as our paradigms are clearly in fundamental conflict.

[mommaduck]

Wow, I just realised that this thread turned from the question of well baby visits to an attack on the OP for her, I'm presuming educated, choice to delay or refuse vaccinations.

 

Nice...:(

[MelanieM]

Yes to both. Sadly I am immuno compromised due to steroid use for Rheumatoid Arthritis and have to watch carefully for exposure to disease as I can pick up all sorts of infections many that could put me in the hospital. My husband has completed radiation therapy for vestibular schwanoma recently and has had recurrent bouts with shingles from childhood chickenpox and survived rheumatic fever as a child . This also means we have to be very careful about exposure to illness. My point (for the third time) is that you are not making a morally neutral choice, you are clearly making deliberate choices that could bring great harm to others . I care not a whit what your justifications are nor am I judging you . I am however annoyed with the inability of so many posters to OWN their choices and attempt to justify them as something other than that. I live in the world of science many here do not have that as their ultimate reality and thus we can just continue taking past one another for no purpose as our paradigms are clearly in fundamental conflict.

 

Elizabeth, I'm sorry you and your husband are dealing with health issues. However, your assertion that those who disagree with your opinions on this matter are not living in the world of science are condescending and untrue. There are many people who have looked at the same scientific information you say you live by and come up with very different conclusions. I am one of those people. I made my decision not to vaccinate after careful research and risk analysis. Also, even if I believed vaccination was always in the best interest of society as a whole (I don't), I still wouldn't think it a morally inferior choice to not want to risk the health and wellbeing of my own children for the good of the many. My responsibility is first and foremost to the children placed into my care.

[melmichigan]

I think it would still be important for your child to have well baby visits. There are pediatricians who will listen and discuss risk/benefit with you as well as alternative schedules, and even no schedules. My oldest two are on the spectrum, we have a wonderful pediatrician and we do adapted schedules with my DC. Yes, I do believe in vaccinations, although all may not be necessary for certain populations, and yes my DH and I are up to date on our dTap vaccines :), but I do feel you should have a pediatrician that is open to discussing things with you that you can have confidence in. I would continue to look around until you find that.

[Serenade]

 

Pediatricians can be amazing, awesome support for parents and there is something so reassuring about having someone you can call when your child is really, really sick on Saturday night- and they know you and they know your child... even if it is a large practice- at least there is the familiarlity with their standards, etc. and they can tell you which E.R. to go to and call ahead to help you before you get there.

 

It is worth it and important. It does not mean you have to do every vaccination that they suggest when they suggest it. They should be willing to work with you.

 

I hope this makes sense,

Rebecca

 

I agree with this. I love my pediatrician -- because he is willing to discuss things with me and not mandate. I've even chosen a course that was contrary to his advice, but he was willing to accept it, and we usually talk about progress on the issue at our yearly well-child visits. Because he was willing to listen to my point of view, I am very open to things that he suggests.

 

I would look around and try to find a doctor who will work with you -- not one that demands that you do X & Y. Discussion is so much more productive.

[YLVD]

Admittedly, I have not read through the whole thread. I will say that I can understand issues with vaccination. My DD is vacced but I did stagger it a bit. I personally had reactions to vaccines.

 

However, I personally think that not vaxing all together is really dangerous and I can't understand making that decision.

 

If it weren't for an amazing doctor, my DD would be nowhere near as healthy as she is. He was able to detect endocrine issues with no real symptoms. I'm so thankful for him to this day.

 

I vote yes for well child visits and at least somewhat regular checkups. I love having that history with her doctor. She has been seeing him for years.

Edited June 10, 2011 by YLVD

[Tarreymere]

Are you serious??? There are a multitude of developmental milestones that need to be watched for and physical changes as well. If you want a doctor to permit you to be under a physicians care not a pseudophysician then you might as well stop looking. I do understand staggering the vax schedule or having them administered with a crash cart nearby due to allergy to components or growing medium(eggs) but expecting an MD to rubberstamp your particular mode of thinking is going to be interesting. Neglect is neglect no matter what the intentions. You need to find an MD who is willing to discuss the realistic risks with certain vaccines and have a discussion along with the well baby check up. They check for vision, hearing etc I cannot imagine pretending to live in a third world country medically in order to accomodate my irrational fears.

 

Oh, for heaven's sake calm down. They certainly do not check a four month old for vision and hearing, nor are there many milestones a four month old is supposed to be meeting, this mom has valid concerns and is doing the right thing to take the time to find a doctor who will talk to her like a rational human being instead of trying to frighten her like you are. I am an RN with a master's degree in Maternal Child Health, so go try to scare someone else with your nonesense.

[YLVD]

I'm not even sure what to say to this it's so wrong and offensive. Suffice to say that almost every medical specialty thinks they know more than every other. In my experience doctors who think they know the most and are the most insulting of others are usually the ones who should be practicing a little humility.

 

If you don't want to do well checks or you've had bad experiences with pediatricians, fine, but it would be nice to stay civil.

 

 

 

We deal with this by having our most medically fragile kids (post-transplant for example) come at separate times. The reality is though that most parents who don't vaccinate take offense at being treated differently. Maybe some here wouldn't, but it has been my experience that many do. For example, if we have a baby who has received no vaccines and has a fever we are much more likely to recommend bloodwork and possibly other tests that we wouldn't in a child who was vaccinated. I've had parents get very angry at me about that.

 

Many of the kids at risk are simply the ones who haven't yet been vaccinated (newborns, kids under a certain age). I don't see it as feasible to ask all unvaccinated kids coming in for a sick visit to sneak in the back to avoid possibly meeting a baby.

 

 

 

Unless the ventilation systems are separate and things like all doorknobs/door/examining rooms are separate these separate waiting areas are mostly for show. It looks nice but doesn't really do all that much.

 

Yes, it's true that you can be exposed anywhere (an argument for vaccination perhaps). But it's also true that as a pediatrician I'm only really responsible (and able) to protect my patients in my own office. I can advise parents on how to limit their 2 day old infant's exposure to illnesses but I can't do much about it if they decide to go to a mall. However, if I'm asking them to bring their baby in to see me for a weight check I do have the abiltiy (and some would argue the responsibility) to limit their exposure in my office as much as possible.

 

The recent measles epidemic in California was partly spread through contact in a pediatrician's waiting room (it was Dr. Sear's office, in fact).

 

Here is part of the mother's account from the CDC website:

 

"We spent 3 days in the hospital fearing we might lose our baby boy. He couldn’t drink or eat, so he was on an IV, and for a while he seemed to be wasting away. When he began to be able to drink again we got to take him home. But the doctors told us to expect the disease to continue to run its course, including high fever—which did spike as high as 106 degrees. We spent a week waking at all hours to stay on schedule with fever reducing medications and soothing him with damp wash cloths. Also, as instructed, we watched closely for signs of lethargy or non-responsiveness. If we’d seen that, we’d have gone back to the hospital immediately."

 

In their case they were lucky and the baby survived.

 

I know this got off topic, and I apologize to the OP.

 

But since the thread was going in that direction I just wanted to give a little idea of why some pediatricians choose to not see patients who don't vaccinate. It's a difficult decision and not one made lightly.

 

I agree that it's offensive. I'm not a doctor but I know and have seen many amazing doctors.

 

I also agree that this is a reason not to see un-vaxed kids. It may seem unfair but it's a lot of liability if a child becomes ill.

[Tarreymere]

There are compelling reasons to take your baby and toddler to the Dr. If not vaccinating, it does not have to be on "well baby" frequency, but I do believe their are a lot of reasons to go:

 

 

1. A medical paper trail, in case someone in you life reports you for what they think is wacky parenting, abuse, or neglect

    

2. In case you are not fully trained as a pediatrician

    

3. To establish a relationship, rapport and history in the case of medical issues emerging

 

A dear friend of mine took her step son (11) to the eye doctor. He had some trouble in school, and was a bit clumsy. Within 10 minutes of the exam, the Dr. told her and her DH: take him immediately to the MD Anderson ER.

 

Young man had an aggressive brain cancer. He was in(brain) surgery within 48 hours of crossing the ER threshold.

 

This is not an urban legend, "I know someone who knows" story. This is a child my children have met, played X Box with, and for whom we recently organized and hosted a benefit. (Dad is unemployed, family is uninsured)

 

I used to be fairly anti-vax myself, and, at times, anti-routine well visits. I'm not either of those anymore.

 

 

I wouldn't plan on trying to develop a rapport with a doctor, likely they will not be the same doctor you will be dealing with in the event that you do go to an ER or need immediate help. People seem remarkably ignorant about how doctors work, they are not available to see 'their' patients 24/7, they do have nights off and even days off and often you won't even get to see 'your' doctor during a scheduled office visit. Taking the trouble to develop a rapport with a doctor is a waste of time. Don't try to tell me any different, I am an RN and very familiar with trying to track down which doctor is covering which other doctor in the middle of the night (and no, they don't 'pick' their covering doctor to have the same practice philosophy, they take whoever they can get for love or money or blackmail to cover them).

[YLVD]

Oh, for heaven's sake calm down. They certainly do not check a four month old for vision and hearing, nor are there many milestones a four month old is supposed to be meeting, this mom has valid concerns and is doing the right thing to take the time to find a doctor who will talk to her like a rational human being instead of trying to frighten her like you are. I am an RN with a master's degree in Maternal Child Health, so go try to scare someone else with your nonesense.

 

They may not, but they do check the ears. My DD had lots of ear infections and there were pretty obvious symptoms. That was not the same for my aunt. Her son ended up with blown eardrums from an ear infection that had no symptoms. He was only one year old. His hearing has never been the same.

 

I don't say that as a scare tactic, as I understand why the OP has concerns. Just to say that hearing and vision are not the only parts of the ears and eyes that are checked.

[YLVD]

I wouldn't plan on trying to develop a rapport with a doctor, likely they will not be the same doctor you will be dealing with in the event that you do go to an ER or need immediate help. People seem remarkably ignorant about how doctors work, they are not available to see 'their' patients 24/7, they do have nights off and even days off and often you won't even get to see 'your' doctor during a scheduled office visit. Taking the trouble to develop a rapport with a doctor is a waste of time. Don't try to tell me any different, I am an RN and very familiar with trying to track down which doctor is covering which other doctor in the middle of the night (and no, they don't 'pick' their covering doctor to have the same practice philosophy, they take whoever they can get for love or money or blackmail to cover them).

 

This has not been my experience at all. I must live in an area with amazing medical care or something. My doctor has become a trusted friend and ally for my DD. Your experience does not cover all of ours. Frankly, I'm shocked that other people have not had this kind of experience.

 

The only time we didn't see our doctor was when he was out of the office and we were told before even making the appointment. That has hardly ever happened and I was told and able to make an appointment on that date or not.

 

I don't know why you think that your experience is that of all RNs. I have a family of them and I assure you that they would all have different opinions on this.

[LittleIzumi]

Personal attacks are indeed not allowed, and it looks like the posts have been deleted by a mod. :)

[Guest]

Personal attacks are indeed not allowed, and it looks like the posts have been deleted by a mod. :)

 

Good, I was just about to say something about it, and report it.

[LittleIzumi]

I'm delaying our well child visit (well, the next one--I skipped the last one anyway) until after ds's allergy testing next month. I figure then the pedi & I at least have something to discuss, and I can see what, if any, vaccines are eliminated by medical necessity, etc. I really think I should look for a family doc after this thread though. I forgot how much I liked our old one.

[Clover11]

Kids die on BOTH sides of the vaccine choice. Period. Lives are affected on BOTH sides of that choice.

 

 

Both choices carry risk. This isn't a decision that most parents take lightly. Personally, I spend a lot of time researching and talking to people (including doctors) on both sides of the issue.

To say that the answer is a clear cut "just vaccinate", is wrong. Whatever you decide, just do the research. Make your decision based on facts & risks vs. benefits.

I have friends and family who fully vaccinate, selectively vaccinate, and do no vaccines; I respect each of their choices.

 

 

That's ok, I was just asking because I have several huge files where I've got all these downloaded studies (and someday I'm going to have to actually organize them), so I'm always looking to add to my collection. I collect abstracts and studies on all kinds of health topics, the way some people collect antiques. :tongue_smilie:

 

If you find them, please let me know! (You can stop laughing at my geekiness now.)

 

 

I have some links to some information if you have specific things in question. (Links backing up both sides.) I used to have hundreds of links & articles saved when I was first researching my decision. I've since lost most of it, unfortunately.

 

I agree completely with everything you said here. The chicken pox vaccine is one that could easily be argued in reverse as far as the impact of vaccinating on the rest of the population. The widespread use of the chickenpox vaccine is causing a dramatic increase in shingles, because people are no longer getting the natural "booster" effect of being exposed to active chickenpox by their children, grandchildren, neighbor kids, etc. Of course, now there is the shingles vaccine to address that issue, allowing the pharmaceutical companies to make even more off the problem they've created.

 

 

The main reason for the push in this vaccine, is because it is an inconvenient disease (since complications do happen, but are rare). Parents miss work & kids miss school.

 

http://www.cdc.gov/vaccines/vpd-vac/varicella/vac-faqs-gen.htm

Even with uncomplicated cases, children with chickenpox miss an average of 5-6 days of school, and parents or other caregivers miss 3-4 days of work to care for sick children.

 

 

:iagree:Pretty accurate assessment. What is interesting in our family is that our older child does not have autism and was exposed to the supposed thimersol people tried to connect with autism and vaccines. Younger son had the vaccines WITHOUT the thimersol and has mild autism. If vaccines were the cause, the opposite child in my home would have autism. Overwhelmingly, reliable autism experts believe vaccines and autism are not related.

 

A lot of people believe that vaccines can be a trigger in some kids that are susceptible to autism, auto-immune disorders, etc. I'm one of those people, but I also believe that chemicals in our food, drinks, makeup, shampoos, ect. also contribute to these things.

No one has proved that they don't.

 

 

 

What????? Please. Despite your beliefs, there are 3 pediatricians I can think of in a 5 mile radius of me that are fine with delayed, selective, or non vaccination. I go to one :)

 

 

We have a pediatrician, a chiropractor, & a midwife that supports parents who don't vaccinate. (Although, our pediatrician does like for parents to consider a few of the vaccines if they are at risk)

 

 

 

 

My duty is to my child first, society second.

 

I have to agree with this statement. I can't make decisions for my children based on what's best for other people. Especially when that decision could result in serious death or injury to my child :sad:

 

In response to this query:

 

Yes to both. Sadly I am immuno compromised due to steroid use for Rheumatoid Arthritis and have to watch carefully for exposure to disease as I can pick up all sorts of infections many that could put me in the hospital. My husband has completed radiation therapy for vestibular schwanoma

 

I'm glad you posted this so people can understand why you feel so strongly about this decision. People should be made aware that their choice can affect other people, and this should factor in how they choose.

 

I have a dear friend who is immuno compromised and we have had LONG discussions on this topic. (She feels the same way you do.) I fully realize that my decision can affect other people's lives. No, I'm not comfortable with it; I do worry about it; and it is something I stay aware of. But I'm also not comfortable doing something to my children that could harm them just so I can protect someone else.

 

I apologize if I have offended you, or anyone else on the other side of this issue. I do appreciate hearing both sides, as we are always open to change.

Just as I would never forgive myself if something happened to my child for vaccinating, I would feel the same if my choice to not vaccinate caused someone else harm. It hasn't been an easy decision we have made, and we do not consider ourselves closed to changing our minds.

 

ETA: We are currently not against ALL vaccines. There are a few we are considering. I do think it depends on where you live, if you travel, and your particular risk factors.

[Audrey]

I would encourage you to seek the well-baby visits, even if you choose a delayed schedule. I do not buy the arguments that this is still putting others at risk. I would also encourage you to make sure that your child is able to be monitored within the first hour after administering vaccines. My son had a severe reaction to his first MMR. We ceased vaccinations after that seeking a second opinion from another physician (the first was... hmm... not sure I can think of a diplomatic way to say a _ _ h _ _ e).

 

The truth of the matter is that well-baby visits are not all about vaccines. Yet, you do need to be vigilant and careful in your decision making process regarding the vaccines. Every child is different and do not think for a minute that what works for most is necessarily going to work for your child. Be very aware in the hours following vaccine administration and keep notes in between visits so you can share any concerns with your physician. Again, this is not just about the vaccines -- make notes on when teeth come in, when crawling, walking, talking start, and about anything out of the norm for your child. If anything is amiss, you will be thankful for having those well-baby visits to check in with your doctor and catch anything early.

[Mrs Mungo]

You could make a case that skipping all vaccinations could potentially harm others. But, not all vaccinations are for easily transmitted diseases like pertussis (by the way *most* people who get and spread pertussis *are* vaccinated). HPV is a sexually transmitted disease. Hepatitis B is by blood or sexual contact. Those diseases are not spread by casual contact. That's where the "danger to society" argument fails.

 

I agree with Joanne, kids die on both sides of the argument. It would be heartbreaking.

[ktgrok]

I wouldn't plan on trying to develop a rapport with a doctor, likely they will not be the same doctor you will be dealing with in the event that you do go to an ER or need immediate help. People seem remarkably ignorant about how doctors work, they are not available to see 'their' patients 24/7, they do have nights off and even days off and often you won't even get to see 'your' doctor during a scheduled office visit. Taking the trouble to develop a rapport with a doctor is a waste of time. Don't try to tell me any different, I am an RN and very familiar with trying to track down which doctor is covering which other doctor in the middle of the night (and no, they don't 'pick' their covering doctor to have the same practice philosophy, they take whoever they can get for love or money or blackmail to cover them).

 

Not if you choose your doctor carefully. My current ped is in a one doctor practice. He personally handles on his own emergency calls. I know this for a fact, as I've called and always been called back by him. He has one nurse practitioner, who is excellent, who would take call if he was out of town, and refer as need be. I am always able to choose to see the doctor or the nurse practitioner. When my daughter needed to go to the hospital he personally called and spoke with both the radiologist and the orthopedist before I was even seen by them. When we lived elsewhere we saw a family practice doctor, that worked in a practice with her husband. Again, they handled their own emergencies. Where I lived before that it was a big practice, but we were always able to see my preferred ped (I chose her partly for that reason actually) and again, and in that practice the emergency line was a cell phone that was passed from doctor to doctor on a rotation schedule. So you got a doctor immediately.

 

I don't know where you live, or what doctors you work with, but I'm sorry for you.

[ColoNative]

Hmmm, quite a controversial topic you've brought up. When you look at the required vaccines now compared to 15 years ago, it's staggering how many more are given. And there are documented cases of vaccine injury in children so to just blindly proceed without at least considering the pros/cons is, in my opinion, unwise. We have children who are vaccinated and children who aren't. The ones who aren't are by far healthier than the ones who are....but that's another topic for another time.

 

We still take our children to our pediatrician for check-ups, maybe not on the recommended schedule, but I do like to maintain a relationship with him for emergencies. We have a wonderful pediatrician who respects our choices of not vaccinating and continues to treat our children without bias to his opinion. I would hope there are other doctors out there with this care and concern, and I hope you can find one.

 

Melody

[WishboneDawn]

I wouldn't plan on trying to develop a rapport with a doctor, likely they will not be the same doctor you will be dealing with in the event that you do go to an ER or need immediate help. People seem remarkably ignorant about how doctors work, they are not available to see 'their' patients 24/7, they do have nights off and even days off and often you won't even get to see 'your' doctor during a scheduled office visit. Taking the trouble to develop a rapport with a doctor is a waste of time. Don't try to tell me any different, I am an RN and very familiar with trying to track down which doctor is covering which other doctor in the middle of the night (and no, they don't 'pick' their covering doctor to have the same practice philosophy, they take whoever they can get for love or money or blackmail to cover them).

 

???

 

I think you might have a narrow view of the value of a good rapport with a doctor. It isn't always an ER visit. With my family doctor ( a GP, we don't really do the ob/gyn, ped, etc. thing) it's meant that shes knows not to be alarmed (like her practice partner once was) when my exceedingly skinny son is sick, loses a couple of pounds, and comes in looking emaciated. It's menat my kids are comfortable with her and will discuss issues with her when they might be reserved with someone less familiar. It means we can focus on health rather then sickness and my children come to see her as a partner in their healthcare rather then someone we only see in emergency situations. It's also meant she's been an advocate for us at times when we were navigating different parts of our health care system.

 

Maybe your experiences as an RN have given you a certain view but my experience as a patient and mom have reassured me that a good rapport is vital.

 

ETA: I should add that a good rapport meant that this Thursday when I arrived 10 minutes late for an appointment and apologized and the receptionist and my doctor informed me I was actually 2 days and 24 hours late that my doctor had a good laugh about it and told me not to bother rescheduling but to have a seat as she'd see me anyway in a few minutes.

Edited June 10, 2011 by WishboneDawn

[elizabeth]

Oh, for heaven's sake calm down. They certainly do not check a four month old for vision and hearing, nor are there many milestones a four month old is supposed to be meeting, this mom has valid concerns and is doing the right thing to take the time to find a doctor who will talk to her like a rational human being instead of trying to frighten her like you are. I am an RN with a master's degree in Maternal Child Health, so go try to scare someone else with your nonesense.

 

Nice. I will tell my dh that the radiation therapy is no big deal. Just cross your fingers babe and hope you do not run into some child at the store with measles, whooping cough or mumps. I suppose that applies to someone on 20mg of prednisone per day as well. No big deal. I am delighted to have those concerns waved away by ...dismissiveness. Obviously you have a certain predisposition on the issue. Thanks for the medical advice though. :lol:

[Parrothead]

Nice. I will tell my dh that the radiation therapy is no big deal. Just cross your fingers babe and hope you do not run into some child at the store with measles, whooping cough or mumps. I suppose that applies to someone on 20mg of prednisone per day as well. No big deal. I am delighted to have those concerns waved away by ...dismissiveness. Obviously you have a certain predisposition on the issue. Thanks for the medical advice though. :lol:

Not to be contentious, but is it not just the unvaccinated kids that could adversely affect your health? What about the guy with the beginnings of the flu? What about the mom who is carrying around the kid with the horrible runny nose?

 

And out of curiosity, why do you say you are immune compromised because of the prednisone? I've been on it for 5 years, and never has a doctor told me that my immune system is compromised because of prednisone.

[Ellesmere]

I wouldn't plan on trying to develop a rapport with a doctor, likely they will not be the same doctor you will be dealing with in the event that you do go to an ER or need immediate help. People seem remarkably ignorant about how doctors work, they are not available to see 'their' patients 24/7, they do have nights off and even days off and often you won't even get to see 'your' doctor during a scheduled office visit. Taking the trouble to develop a rapport with a doctor is a waste of time. Don't try to tell me any different, I am an RN and very familiar with trying to track down which doctor is covering which other doctor in the middle of the night (and no, they don't 'pick' their covering doctor to have the same practice philosophy, they take whoever they can get for love or money or blackmail to cover them).

 

I understand your experience, as we dealt with several practices where we rarely saw the actual pediatrician we were assigned to.

 

However, I am going to tell you differently and absolutely disagree that it is a waste of time. :) We have a wonderful rapport with our doctor. We see her (she's at a "traditional" practice affiliated with a hospital) at each and every scheduled visit. If we have an urgent need, we see one of two other doctors who know us well, by now. If we have need urgent care on the weekend, we go to a hospital-affiliated practice where doctors rotate in. I don't think it's unreasonable to expect not to see our PCP in this situation. We almost always have the same nurse at that place.

 

Yep, I resent being called ignorant. I may not be have the degree that you do (and I respect nurses -- my mom is a lovely one) but I can confidently say it is possible to have a good relationship with a doctor. Easy? No. But it is possible.

 

 

 

???

 

ETA: I should add that a good rapport meant that this Thursday when I arrived 10 minutes late for an appointment and apologized and the receptionist and my doctor informed me I was actually 2 days and 24 hours late that my doctor had a good laugh about it and told me not to bother rescheduling but to have a seat as she'd see me anyway in a few minutes.

 

Love that!

[TracieT]

Not to be contentious, but is it not just the unvaccinated kids that could adversely affect your health? What about the guy with the beginnings of the flu? What about the mom who is carrying around the kid with the horrible runny nose?

 

And out of curiosity, why do you say you are immune compromised because of the prednisone? I've been on it for 5 years, and never has a doctor told me that my immune system is compromised because of prednisone.

 

RA is an autoimmune disorder, so to treat it the immune system has to be suppressed. Maybe she is on more than Prednisone?

My BIL is on IV medication for Crohn's, but my he nor my sister have ever taken issue with us stopping vaccinations. I also have a SIL with RA who is on immune suppressing drugs who considered not vaccinating her son and has no issues with us.

[elizabeth]

Not to be contentious, but is it not just the unvaccinated kids that could adversely affect your health? What about the guy with the beginnings of the flu? What about the mom who is carrying around the kid with the horrible runny nose?

 

And out of curiosity, why do you say you are immune compromised because of the prednisone? I've been on it for 5 years, and never has a doctor told me that my immune system is compromised because of prednisone.

 

Actually steroids are definitely placing those who take them at risk for infection and it is harder to treat for infections. Not the only medicine I take as I have more than one auto immune disorder. They really stink.

[Parrothead]

Actually steroids are definitely placing those who take them at risk for infection and it is harder to treat for infections. Not the only medicine I take as I have more than one auto immune disorder. They really stink.

First I've heard this. Thank you for the information. You'd think when they are writing a 'script for 120 at a time, one of three (we move often) doctors would have said something.

 

I too have multiple auto immune disorders. II know how miserable it is.

[StephanieZ]

IMHO, well child visits are imperative for a baby, on schedule, no matter what. There are many medical conditions and developmental problems that a pediatrician can catch when they are easier and better addressed than if they are diagnosed later. The physical exam is imperative.

 

IMHO, vaccines are also imperative. I've delayed a few, skipped a few non-essentials at times (chicken pox back in the day when you still had hope of your kids catching it before age 10, and rotovirus when it was brand new & before it was recalled). . . and I've never had a pediatrician give me a hard time about delaying a bit or skipping new vaccines. . . Just find a good pediatrician, make your appt, and have your conversations. . . They aren't going to force a vaccine upon you at the appt, although I guess it's possible that they'd decline further appts, although I'd be shocked.