The radiation officer at Multicare, Eric Hooper, called me back yesterday, and provided me with some more helpful information than the crazy numbers I'd extrapolated myself from the numbers given by the radiology technician. He said that the estimated amount of radiation for an upper-GI swallow study for a baby would be around 3 millisieverts. To give some comparison, the natural background radiation for most people in the United States is about 3 millisieverts per year, and a chest X-ray is about 0.1 millisieverts. So, this would be the equivalent of about 30 chest x-rays, and, if this were his only procedure this year, would effectively double his radiation exposure.
He said that trying to figure out the long-term effects or risks of a 3 mSv exposure was difficult as there aren't many studies out there of the effects of radiation. Most of what we know on the topic comes from survivors of Hiroshima and Nagasaki, and the doses received by those people started in the 1000 mSv range.
I asked a couple more questions, including: is there any way to measure the extra risk he'd endure because he's 5 months old? Not really. Is there any way to measure the extra risk of having his thyroid in the direct line of fire? Also no.
He said that when doctors are getting ready to order tests that involve radiation, they need to think about whether the risk of the test outweighs the risk of the condition that the patient has. Also, they need to think about whether the test would yield useful information, and to get the title "useful", there had to be good course of action that could be determined from the information.
In this case, I don't think we have those conditions met. When I asked the speech therapist what we could do with this swallow that we can't do with trial and error, the answer was long-winded, but didn't actually come up with anything better than trial and error as a way of finding a better feeding set up.
So, it was a nice talk we had, I learned things, but it also made me a little suspicious -- medical professionals keep saying "minimal" when it comes to radiation exposure and risk, but really, they don't have a good sense of what that means. I also read somewhere else that if you give two dentists the same set of dental x-rays, only about 50 percent of the time will they agree about the cavities . . . which also makes me wonder if they ought to be doing dental x-rays.
Sigh. I hope I'm not turning in to a helicopter parent.
Thursday, January 31, 2013
Tuesday, January 29, 2013
Applesauce
By Thomas Eric -- Dad
Today Gabriel had his first experience with applesauce. The idea behind introducing solids is to get the child comfortable with it. An old trick is to put it on the baby's hands and then wait for him to put his hands in his mouth. Gabriel was fine fingerpainting, but he wasn't tasting, so then I took my hand and put some applesauce on it. He thought chewing on my fingers was a great idea.... and went straight for my one clean finger. And then attempted to take off my wedding ring.
But later he did take some applesauce from the spoon. He seemed to like it and didn't do the "Hey what is this stuff?" look like he did with the rice cereal last week.
We've got another month of playing with food ahead of us, and then at six months' corrected age, we start looking at this from the perspective of making him work and get serious calories this way.
Also, today, it occurred to me that I when I called up friends and family, I no longer had to preface the call with "I am calling about nothing in particular; everything's fine." Back during our antepartum and NICU time, I had to do that to keep them from thinking that something really serious had just happened. Now I can just say, "Hi."
Today Gabriel had his first experience with applesauce. The idea behind introducing solids is to get the child comfortable with it. An old trick is to put it on the baby's hands and then wait for him to put his hands in his mouth. Gabriel was fine fingerpainting, but he wasn't tasting, so then I took my hand and put some applesauce on it. He thought chewing on my fingers was a great idea.... and went straight for my one clean finger. And then attempted to take off my wedding ring.
But later he did take some applesauce from the spoon. He seemed to like it and didn't do the "Hey what is this stuff?" look like he did with the rice cereal last week.
We've got another month of playing with food ahead of us, and then at six months' corrected age, we start looking at this from the perspective of making him work and get serious calories this way.
Also, today, it occurred to me that I when I called up friends and family, I no longer had to preface the call with "I am calling about nothing in particular; everything's fine." Back during our antepartum and NICU time, I had to do that to keep them from thinking that something really serious had just happened. Now I can just say, "Hi."
Friday, January 25, 2013
Radiation and babies
This post is by Gabriel's dear old Dad, Eric. One of the recommendations of our speech therapist was to get an upper-GI barium swallow study done, which is a series of X-rays performed while the baby is swallowing. I was concerned about the radiation dose of such a procedure, and wasn't able to get an answer I could understand. This letter I wrote to the head of the imaging department at Tacoma General Hospital explains the process if you're interested in learning more...
Jim Sapienza
Imaging Administrator
Mail Stop 315C3IAD
315 Martin Luther King Way
Tacoma, WA 98405
Dear Mr. Sapienza:
I am writing you to give some comments and suggestions about the experience of a parent trying to get information about radiation doses that a child might receive while getting x-ray procedures performed. A month ago, we scheduled an upper GI barium swallow study at Tacoma General for our 8 ½ month-old son, but I wanted to get information about how much radiation he would receive in such a procedure, or to put it bluntly, how much the child would be zapped? I was not able to find the information.
To give you a little background, our son was born 17 weeks premature at Swedish Hospital in Seattle, and got a number of x-rays performed there (and I’m not interested in increasing his dose if it can be avoided). He has grown out of almost all of his preemie issues except for eating. He does not drink enough from his bottle and must be supplemented through a gastric tube. Our son’s speech therapist recommended a barium swallow study. We scheduled this.
A call to the GI clinic at Mary Bridge eventually got me transferred to Michael Smith, who was quite helpful in explaining how the procedure was done. He explained that he would shield his eyes and genitals, try to dodge his spine, but his thyroid would get a direct hit. I wanted to know how many millisieverts or millirems he would receive from the procedure.
To tell you a little bit about my own experience on the topic, I am a bookkeeper, and one of the employers I serve is a lawyer who represents workers at the Hanford Nuclear Reservation. This means that I don’t know a great deal about radiation, but I do know that we receive about 2.5 mSv of background radiation per year, and that the annual federal limit for additional radiation on a job is 10 millirem, or 0.1 mSv. I also know that the typical chest x-ray gives us about 0.1 mSv of radiation. I was hoping for an estimate that would compare to these sorts of levels.
Michael provided me with radiation doses from the last five patients to receive upper GI barium swallow studies. The numbers were:
81.7 cGy cm2 over 1 minute 51 seconds
177 cGy cm2, 3:43
168.8 cGy cm2, 1:52
206.1 cGy cm2, 0:49
73.9 cGy cm2, 3:22
Michael wasn’t able to tell me the age or size range of the patients receiving these doses, and he also wasn’t able to explain how the per-centimeter-squared thing worked. I know what a centigray is, but converting these numbers to something that compares to other experiences that a person might have with radiation was difficult. A friend of my boss’ explained that you needed to divide the number of centigrays by the number of square centimeters in the target area to get the correct dose. If you assumed that the target area would be 25 square centimeters, you’d end up with a dose between 32 and 83 mSv, which seemed awfully high. I doubted that I had the numbers correct, but that was about as far as I could get in finding an explanation that made sense.
I brought it up with the speech therapist who originally wanted the test performed, who assured me that the procedure involved no more radiation than a dental x-ray, but I knew that wasn’t close to true -- dental x-rays are a few snapshots that don’t hit the thyroid, while a swallow study is an animation, or a whole lot of snapshots that do hit the thyroid.
Unable to find an answer to my original question -- how much will the child be zapped -- I canceled the appointment. I don’t mean to be “that parent” who overreacts when a pre-school doesn’t use organic food in the meals, or who refuses the polio vaccine because he believes it will cause autism, but in this case, objecting does make sense. Radiation will increase cancer risk, and I didn’t want to increase my son’s dose, especially when I do not have any idea how much he would receive. A stock answer that medical professionals provide when asked about radiation is that it’s a “minimal dose,” which to me sounds like someone trying to assure me my house has “minimal flooding.”
So let me conclude by again speaking well of Michael Smith’s helpfulness, but advising you that parents need access to better information about radiation doses than is currently available. I am still open to the idea of performing this procedure which may provide information that improves my son’s eating ability, but I need accurate and comparable information about the expected radiation dose before I allow it.
I would appreciate hearing your thoughts on the topic.
Sincerely,
Eric Ruthford
Jim Sapienza
Imaging Administrator
Mail Stop 315C3IAD
315 Martin Luther King Way
Tacoma, WA 98405
Dear Mr. Sapienza:
I am writing you to give some comments and suggestions about the experience of a parent trying to get information about radiation doses that a child might receive while getting x-ray procedures performed. A month ago, we scheduled an upper GI barium swallow study at Tacoma General for our 8 ½ month-old son, but I wanted to get information about how much radiation he would receive in such a procedure, or to put it bluntly, how much the child would be zapped? I was not able to find the information.
To give you a little background, our son was born 17 weeks premature at Swedish Hospital in Seattle, and got a number of x-rays performed there (and I’m not interested in increasing his dose if it can be avoided). He has grown out of almost all of his preemie issues except for eating. He does not drink enough from his bottle and must be supplemented through a gastric tube. Our son’s speech therapist recommended a barium swallow study. We scheduled this.
A call to the GI clinic at Mary Bridge eventually got me transferred to Michael Smith, who was quite helpful in explaining how the procedure was done. He explained that he would shield his eyes and genitals, try to dodge his spine, but his thyroid would get a direct hit. I wanted to know how many millisieverts or millirems he would receive from the procedure.
To tell you a little bit about my own experience on the topic, I am a bookkeeper, and one of the employers I serve is a lawyer who represents workers at the Hanford Nuclear Reservation. This means that I don’t know a great deal about radiation, but I do know that we receive about 2.5 mSv of background radiation per year, and that the annual federal limit for additional radiation on a job is 10 millirem, or 0.1 mSv. I also know that the typical chest x-ray gives us about 0.1 mSv of radiation. I was hoping for an estimate that would compare to these sorts of levels.
Michael provided me with radiation doses from the last five patients to receive upper GI barium swallow studies. The numbers were:
81.7 cGy cm2 over 1 minute 51 seconds
177 cGy cm2, 3:43
168.8 cGy cm2, 1:52
206.1 cGy cm2, 0:49
73.9 cGy cm2, 3:22
Michael wasn’t able to tell me the age or size range of the patients receiving these doses, and he also wasn’t able to explain how the per-centimeter-squared thing worked. I know what a centigray is, but converting these numbers to something that compares to other experiences that a person might have with radiation was difficult. A friend of my boss’ explained that you needed to divide the number of centigrays by the number of square centimeters in the target area to get the correct dose. If you assumed that the target area would be 25 square centimeters, you’d end up with a dose between 32 and 83 mSv, which seemed awfully high. I doubted that I had the numbers correct, but that was about as far as I could get in finding an explanation that made sense.
I brought it up with the speech therapist who originally wanted the test performed, who assured me that the procedure involved no more radiation than a dental x-ray, but I knew that wasn’t close to true -- dental x-rays are a few snapshots that don’t hit the thyroid, while a swallow study is an animation, or a whole lot of snapshots that do hit the thyroid.
Unable to find an answer to my original question -- how much will the child be zapped -- I canceled the appointment. I don’t mean to be “that parent” who overreacts when a pre-school doesn’t use organic food in the meals, or who refuses the polio vaccine because he believes it will cause autism, but in this case, objecting does make sense. Radiation will increase cancer risk, and I didn’t want to increase my son’s dose, especially when I do not have any idea how much he would receive. A stock answer that medical professionals provide when asked about radiation is that it’s a “minimal dose,” which to me sounds like someone trying to assure me my house has “minimal flooding.”
So let me conclude by again speaking well of Michael Smith’s helpfulness, but advising you that parents need access to better information about radiation doses than is currently available. I am still open to the idea of performing this procedure which may provide information that improves my son’s eating ability, but I need accurate and comparable information about the expected radiation dose before I allow it.
I would appreciate hearing your thoughts on the topic.
Sincerely,
Eric Ruthford
9 months old
Today Gabriel is 9 months old. He seems quite happy and pleased with himself. We are on day three of no spit ups (hooray!), but he's still working on gaining back the 1/2 pound he lost while sick. I may get brave and increase either his food volume or calories soon, but right now it's so nice to have feeding not be akin to a ticking time bomb. I'm sure Gabriel enjoys not having his food come back up the pipe, too. He's currently about 14 lbs. 10oz. and 26" long.
Here he is working on his sitting up muscles. Jisa is waiting for the toy (out of frame) to magically fly through the air. For this month's photos you can go to http://min.us/mTRJUvxl4Qa0S
Here he is working on his sitting up muscles. Jisa is waiting for the toy (out of frame) to magically fly through the air. For this month's photos you can go to http://min.us/mTRJUvxl4Qa0S
Thursday, January 24, 2013
Unexpected Bright Side
Gabriel and I got sick last weekend. At least, I assume he and I had the same thing: stomach bug. Ick. Anyway, the result was that we took him off food for a day and fed him just Pedialyte and then slowly worked him back onto food. First plain breastmilk, slowly increasing the volumes, then breastmilk fortified to 22 calories, and finally breastmilk fortified to 24 calories. I guess I need to go back a week, though, and tell you that his spit-up episodes were starting to get really bad again. Half the feed would come back up at almost every meal. I was about to lower his meal volume when he got sick. What we discovered is that he can tolerate about 130mL volume per feed (he was previously at 140mL) and that he does okay on 22-calorie, but 24-calorie milk resulted in spit-up/vomit at most meals. So, we have settled onto 130mL of 22-calorie milk and we have had no significant spit-up for two days now. It's such a nice change. The dietician won't be super happy with me because she wants him on 24-calorie milk with a bigger volume than he's getting, but my thinking is that keeping more volume down on a lower calorie diet is better than being on a higher calorie diet and routinely losing half of it.
It also seems to have uncovered another problem. Maybe we're seeing this now because he's not losing half his milk right away, but he's started throwing up 30-60 minutes after eating. Not all the time, but we at least will generally hear a raspy "there's something in my throat" cough around that time frame. We are thinking he may have a mild reflux issue.We just didn't notice before because of the massive spit-ups. He has a GI appointment next week, so we'll definitely bring that up.
He has also started spoon feeding this week! Well, it's actually more like finger painting, but given that the bottle is still a trial and tribulation, it's nice to be doing something different with food. We just give him a little bit of cereal to play with and then put a little in his mouth with the spoon if he happens to have an open mouth. Hopefully over the next month or so he'll get the idea.
If you're on Facebook, Thomas took a bunch of photos of Gabriel's introduction to solid food with a wonky digital camera. It resulted in some interesting photo effects, but you'll still get the idea.
It also seems to have uncovered another problem. Maybe we're seeing this now because he's not losing half his milk right away, but he's started throwing up 30-60 minutes after eating. Not all the time, but we at least will generally hear a raspy "there's something in my throat" cough around that time frame. We are thinking he may have a mild reflux issue.We just didn't notice before because of the massive spit-ups. He has a GI appointment next week, so we'll definitely bring that up.
He has also started spoon feeding this week! Well, it's actually more like finger painting, but given that the bottle is still a trial and tribulation, it's nice to be doing something different with food. We just give him a little bit of cereal to play with and then put a little in his mouth with the spoon if he happens to have an open mouth. Hopefully over the next month or so he'll get the idea.
If you're on Facebook, Thomas took a bunch of photos of Gabriel's introduction to solid food with a wonky digital camera. It resulted in some interesting photo effects, but you'll still get the idea.
Thursday, January 17, 2013
Goodnight!
For the past week and a half, Gabriel has surprised me. I didn't want to say something sooner, just in case it was a fluke, but with this much time gone by I think I can tell you that we may have hit the end of the bedtime tantrum (at least until he's a toddler). For the first couple of weeks that we were home with him, bedtime was no problem, he would go to sleep quietly. Then, the noise started. He would cry as soon as we put him down to sleep, and no amount of rocking, pacifier, or general parental attention seemed to have much effect. So, we started just closing the door, turning out the light and letting him deal with it. It would only take about 10-15 minutes, if that, before he was asleep, but this was a nightly ritual until just recently. He would even start fussing when we put his blanket on him, knowing what was coming. We started story time after putting on his blanket, just so he wouldn't make the bad association between blanket and the bedtime tantrum. Anyway, one night about a week and a half ago, he just quietly went to bed. Not to sleep, he was watching us, but there was no fussy baby nonsense. And the next night was the same. And the next. And now we're here a week and a half later and he was just calmly watching us as we got his food pump set up, hooked up and left him in his crib. Cool.
As for everything else, well, his feeding ability still remains plateaued at around 20mL, but we decided not to do the swallow study since it seemed that the kind of information they could get from it wasn't worth subjecting him to another xray study. He's already had more xrays in his short life than I have had in my entire 33 years. He's still growing, though -- just shy of 15 lbs at tonight's weigh-in. Next week, his SLP will be starting him on solids! Yay! I am so ready to move on from the bottle, and I think he is too. At least if sitting up in his little chair for 20 minutes at a stretch and rolling from back to front and front to back are any indication. We bought a high chair this past weekend, so now he sits with us at dinner, too.
As for everything else, well, his feeding ability still remains plateaued at around 20mL, but we decided not to do the swallow study since it seemed that the kind of information they could get from it wasn't worth subjecting him to another xray study. He's already had more xrays in his short life than I have had in my entire 33 years. He's still growing, though -- just shy of 15 lbs at tonight's weigh-in. Next week, his SLP will be starting him on solids! Yay! I am so ready to move on from the bottle, and I think he is too. At least if sitting up in his little chair for 20 minutes at a stretch and rolling from back to front and front to back are any indication. We bought a high chair this past weekend, so now he sits with us at dinner, too.
Thursday, January 3, 2013
New Tricks
So, a few days ago, I missed the roll from front to back. This video was taken immediately after the event in the hopes that history would repeat itself:
He didn't do it again until the next day, but the finger puppet enticement was too good not to share.
Today's new trick was to suck his bottom lip and do this:
which made bottle time very hard on Thomas since he was doing it while he was supposed to be eating...
He didn't do it again until the next day, but the finger puppet enticement was too good not to share.
Today's new trick was to suck his bottom lip and do this:
which made bottle time very hard on Thomas since he was doing it while he was supposed to be eating...
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