Down to Birth

#275 | How to Interview Your Pediatrician with Dr. Joel Gator Warsh

• Cynthia Overgard & Trisha Ludwig • Season 5 • Episode 275

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Dr. Joel Gator Warsh is a classically trained integrative pediatrician with a holistic health practice in California. His approach to care puts parents at the center of the decision-making process. In today's episode, we discuss the key questions parents should ask when interviewing a pediatrician (and yes, you should interview numerous pediatricians before choosing the best fit for your family), including: 

  • How to talk about the vaccine schedule; 
  • The benefits and risks of Vitamin K; 
  • Does where you give birth affect how your pediatrician views you, and, if applicable, will they support your having a home birth;
  • What are the most common reasons a pediatrician would release a family from their care; 
  • How important are growth curves; and
  • Are there alternatives to antibiotics for an ear infection?  

Dr. Joel delves into these questions and helps us understand the most effective relationship dynamics between a family and their pediatrician for a child-centered, holistic healthcare experience. Keep an eye out for Joel's new book: Parenting at Your Child's Pace: The Integrative Pediatrician's Guide to the First Three Years.

Episode #169: Protecting Today's Children with Integrative Pediatrician Dr. Joel Gator Warsh
Dr. Joel Gator Warsh
Dr. Joel's Website
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I've used a very multifaceted approach for my kids. I have a excellent integrative pediatrician, but she's very far away. So we only see her on the annual exam schedule. Basically, if my kids have an urgent need, like I already care, urgent care something that they need something quick, and then we have a naturopath, when we need to dive deeper into something that I know that even my holistic minded pediatrician may not be as familiar with. Sometimes you have to tailor your own program.

Who rubs you the wrong way? Is it is it the couple that's too anxious is the couple that's too defensive, is it the couple that puts you on the defensive too much?

I think it's people that don't want to have a mutual relationship. So it's people that don't respect you or your team. Sometimes people are way overly anxious. And that can sometimes be a bad fit. So that is every so often the reason why we would have to discharge somebody if they're so over anxious that they're not trusting of things. And I feel like at that point, you'd have a discussion you talk about it, you say what you what you're comfortable with and why and if they're still wanting more than you, maybe you're just not the right doctor for them.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Hi, I'm Dr. Joel Gator Warsh. You might remember me from Episode 169. And I'm here to talk about interviewing a pediatrician, especially for the naturally minded parent, I actually recently wrote a book and it's going to be coming out in August of 2024. So if you're hearing this before August, then it's available for presale if after the midst of this, you know, maybe you're in the future somewhere and then you know, it's available. But books out anywhere you can get it books, and it's parenting at your child's pace. And we chat about the first three years and everything that a naturally minded parent might be interested to know and ask their pediatrician about in those first three years. So thanks for having me back on.

We are delighted to have you back on. We loved speaking with you the first time around in Episode 169. And we agree with everything you are as a pediatrician, we wish you were in our area, we wish you were everywhere. But one thing that a lot of parents in our community struggle with is finding a pediatrician that is going to support their more natural minded parenting style, especially parents who are choosing to have like a home birth. Many pediatricians won't even take on a family who chooses home birth. So can you start off by telling us your philosophy and how parents can find a pediatrician that's going to support their family goals?

Definitely. So for me, I guess taking a step back first, I'm an integrative minded pediatrician. So I did all the regular training, I trained at a great western program. But I started getting really frustrated with the regular system and super sure visits medications for everything and started seeing patients and family members and friends go to natural providers get better from things that they had been diagnosed for life and started wondering what's that about, and then started learning on my own about natural medicine. And it's really interesting, because you don't learn anything about integrative medicine or natural medicine, when you go through the regular medical training, just like you mentioned with with home birth, you don't really learn anything about it, it's almost a little bit woowoo and out there. And so I think there's just a fear around it for a lot of pediatricians because they're not familiar with it, they're worried that there's increased risk, increased liability, whatever it is, and they're just not very used to it. So they're not comfortable taking on those patients. And I was actually very surprised with that, as I went into practice, because that wasn't something that I really thought made any sense. I mean, we take care of kids, so we should really take care of kids, wherever they're born. And of course, if there's an issue, then you deal with it, you know, regardless of where they were born, but that's not been the case, from what I found. How is it the pediatricians business? Where baby was born? Do you really think that? What what is really going on? Are they actually thinking oh, it's one of those couples, and they're gonna give me a hard time about vaccines and about anything I recommend. And it's because frankly, it's typically like an ultra informed research based couple who takes the energy to go make their own decisions with a lot of responsibility and no doubt those are less compliant on average and more potentially difficult from a pediatricians perspective to work with. Because if it's not for that reason, I really can't understand how it's their concern or their business how the baby came to be. I mean, if a baby was born accidentally in a car I don't think they would turn someone away as the couple who planned and had a home birth with an attendant midwife.

So I would say, I would say that that's my opinion, I think that's largely true. One of the biggest frustrations I have with medicine these days overall, is that it seems like it's moving towards fuzzy physicians telling people what to do, instead of being a partner in their care. It's like they forgotten that the word doctor comes from doTERRA, meaning teach, like our job is to teach. And our job is to inform. And I feel like as a doctor, within the bounds of reasonable and safe, it's to provide information so people can make the best decision for their own family, not to tell them what to do, and certainly something like home birth, it has risks, just like hospital birth has risks. And I think that you, you go and you discuss what the different risks are. And there's positives and negatives, depending on whatever you do. And if individuals feel like that's the right decision for them, then there's no reason why you shouldn't be involved in that care. Because again, just like you said, it shouldn't matter, right? It shouldn't matter. People, you know, babies can be born anywhere. And the care isn't necessarily different. If anything, a home birth, obviously can have much better care than if you get birth in a car or something like that. So there's no logical reason that you really shouldn't take them on. But I think there are many physicians, like you said, that either have very strict rules that they want people to follow all sorts of CDC guidelines, or every single thing, which is up to them, that's their choice to do it. And so if you're doing a home birth, maybe you're more likely to not do some of those things, or that's just not following the standard. So therefore, you're more likely to not follow the standard on everything else. And then they are uncomfortable with that, or just don't want to deal with it.

Or they might just have a personal objection to parents who choose to give birth at home because they're slightly uninformed themselves and think that it's, you know, risky and dangerous, and they don't agree with it. And but it's not their business. No, I agree. I'm just I have their baby where they want and that is what I don't understand, how does it become everyone else's business? Why did they have to approve of your life choices?

I don't know why. And I don't agree with it. But I also think that you shouldn't, if you're going to do a homework with a doctor that's not comfortable working with a patient that does homebirth, because they're not going to give you the best care anyways. Yeah, because that kind of expect you dodgy and not respecting your decisions regardless. So I I don't think it's like, doctors shouldn't be able to decide who they can work with. I think that's reasonable. I mean, it should go both ways that you should be able to work with the providers that you want, and FEDERSPIEL to work with patients that want to work with them. I just think that it's very frustrating where we are in medicine, that there are a lot of providers that think something like that is Whoo, or it's not properly trained, or are a part of the discussion. I think that's where the issue is other than that, I think if you don't agree with somebody's decision making, you're probably not the right doctor for them. And I think that's a big part of the decision making that parents don't realize is they have to really put in some effort to find the right kind of doctor for them. So that way they find someone that's respecting their decisions.

And my experience as a homebirth. midwife, what I did find was that pediatricians sometimes didn't like the logistics of what would happen in a hospital birth, they would come to the hospital, and they would see the baby, and they would be the first point of care with the baby. Whereas in a home birth, the midwife is in charge of the baby for the first two weeks, the midwife is the pediatrician for the first two weeks, they do the whole comprehensive newborn exam, they follow up with the baby on day three or day four, and the mother, they're taking care of both the mother and the baby really, for the first two weeks, and the parent may not see the pediatrician for two weeks, because of course, we want mothers and their babies to stay in bed and not be running off to pediatrician appointments, because that is in the best interest of the mom and baby for healing, recovery, initiating breastfeeding, establishing milk supply all of those things. So I do think sometimes the pediatricians don't like that piece of it that somebody else is sort of in charge of their patient. Initially,

I think that's true. And I think that medicine, especially hospital care is very, you know, it's very formulaic, it goes through a certain pattern for good and bad. I mean, there's a lot of good that kind of comes from doing things over and over again, so you don't miss anything, but at the same time, obviously becomes very medical and not very human, when when you're doing the birth. And it's not very personal to your situation. But doctors, especially doctors these days, many of them are very used to that kind of systematic formula. And so if anything that gets outside of that, then they're worried that something was missed, that something wasn't tested, something, you know, would have been like a hearing screen or some like that they wasn't done and then the patient never gets it done. And they forget to do it. So I think a lot of doctors just like things being exactly the way they are just like shots. You know, there are a lot of doctors that just want things on the schedule and anything outside of that they won't do it. And that's their choice and their comfort level. I just think that's very unfortunate that we're not at a point where we can work with families where they are.

So with that said, I teach HypnoBirthing to many, many couples, year after year and one of the biggest things that occurs to them late in pregnancy is they're going to have to hire a pediatrician. Somehow we go through pregnancy See, our first time around, and we forget, there's a whole other life after birth coming. And it's a, it's daunting. This, this is a relationship they haven't had before. And they are aware when they're naturally inclined in a world that isn't in a society that isn't. And then they have the weight of finding someone in the western medicine community who's going to support them, as we're talking about. So you You're, you're deep in this, you're a naturally inclined pediatrician, you know, both worlds really well, and you know, 1000s of families. So in your opinion, we were hoping to get your opinion today on what you think are some of the most important questions, those couples could ask pediatricians when they're screening them or interviewing them. And I want to remind everyone that you can also change pediatricians later, you can switch, grab your records and go to another it's don't put all the weight of the world on your shoulders, you can always decide, I don't think this feels right anymore. I've hopped around a bit. So yeah, but I would love with we'd love to hear your thoughts on this and where where to begin? Well, I think what you said is where you begin in terms of interviewing a pediatrician, I think a lot of people don't even think about that. They don't think about getting to the interview. And that is the biggest step in having making a happy choice. I mean, doing a little bit of research, and then interviewing and asking your questions. And we certainly can go through some of those questions in a minute. But there are lots of people that just kind of go with whoever shows up at the hospital, or that that just it's the closest one to them. And they don't really think to have any sort of discussion with them. And especially if you're a naturally minded parent, it's insane to me that you would not interview pediatricians because I can guarantee you that you're not going to be happy with 95% of them. So you got to pick one that is going to be respectful of your decision making. And that's just kind of, you know, what do you want to call like preventative care or thinking ahead of the game. And that's, again, why I wrote the book. It's like a lot of people think about these things after they get worried as something comes up, and we need to be getting ahead of it. So that way we can make the best decisions for our kids and for our family moving forward. So that's the first step number one, I would say not like the day before you're going to give birth last couple of weeks are are less fun, usually for most parents. So it's not necessarily the time you want to be doing interviewing. If you haven't done it yet. I think that's a good time. But usually a good time is like, two, three months before, not like a year before science. I get people that call me and they're like, Hey, I'm thinking about getting pregnant. I wanted to interview him like let's let's talk when we were a little bit farther along, you know, but I think somewhere in the middle of the pregnancy to the you know, later Later half is a good time to start looking into it. So how do you look into it? Number one, you can just Google it right? You can google like integrative Doctor holistic mind a pediatrician, any any any of those kinds of key searches and look and see what what comes up depending on the level. But well, a pediatrician just set an appointment with you like free of charge to discuss an interview, every office is different, it kind of depends on how big they are smaller offices tend to do meet and greets or phone conversations, the bigger offices either don't do it, or they might do like group sessions, you know, whatever it is, but most offices, especially private practice, do that. So I think that's important to look into. If you are not sure that going online can be really helpful. There's a lot of naturally minded, you know, Facebook groups and parenting groups and things like that, you can just jump into a local one and ask around and say, hey, you know, we're having a baby, and we're looking for a natural minor pediatrician, who do you guys work with? That that can be helpful, it's easier if you're in a big city, most big cities have some, it's not necessarily as easy if you're living more rural, but at least you can still, even if it's not a integrated pediatrician, there are a lot of pediatricians that are more open minded. So at least at a minimum, you'd rather have somebody that's okay with what you're doing versus, you know, super supportive, but you don't want someone that's not supportive of it. So you can find somebody in the middle. And then if you do need an integrative practitioner, there's other individuals like a naturopath or something like that you can also work with so that's usually what I recommend is trying to interview around, find someone that at least is supportive of your decision making. And then you can at least pick a pediatrician that works with your family. So I think that's the first step. I've used a very multifaceted approach for my kids. I have a excellent integrative pediatrician, but she's very far away. So we only see her on the annual exam schedule. Basically, if my kids have an urgent need, it's like a ready care, urgent care something that they need something quick and then we have a naturopath when you need to dive deeper into something that I know that even my holistic minded pediatrician may not be as familiar with. Sometimes you have to tailor your own program.

Exactly. And that is where it kind of depends on where you're located and what you're looking for, because I still think it's very important to have a pediatrician. Regardless, you want to have somebody that you can go do because a pediatrician has very different Training that a naturopathic doctor. And especially Western medicine is still very good at treatment, still very good at identifying serious things. And so you want to have that available if you need it, but you usually just don't need it. And you can work with other practitioners, like you said, an urgent care if there's an ear pain, they can take a quick look, you can go to the naturopath or something more natural. And then the rest, you go to your pediatrician for your checkups in any major concern. I think that's totally fine. And lots of people do that, though. What are some of the questions you think couples should ask first?

Well, I would say the the first big one, if you're thinking about doing a natural birth is to ask if they're comfortable with that. I don't think you should beat around the bush with some of these questions. I think if you have concerns, or there are specific needs for you that are naturally minded, then you should ask them straight up. So if you're going to do a homebirth, ask about homebirths. Say we're planning to do a homebirth. Are you comfortable with that? What have you worked with people that have done a homebirth? before? And you know, if they say yes, then Okay, so what's your schedule? When do you want us to come in? Are you comfortable with the midwife taking care of us on their own? Or do you want to visit within a couple of days? Do you do house visits? You know, all those things are questions that you would want to know. So that way, you can come up with a plan because some some even some midwives are different, right? Some midwives are not comfortable taking care of the child on their own, and they want a pediatrician to see them within the first couple of days, and others are comfortable being the only person taking care of that kid for a few weeks. So it just depends on that. So that's number one, I would say the other huge question we get asked about his shots all the time. So depending on what you're planning to do, whether that's no shots, all the shots, slow schedule, then I mean, if you're gonna do all the shots in the regular schedule, probably don't need to ask. But if you're gonna do anything else, then that would be something that you would want to check in with them and say, well, here's what we are thinking. Are you comfortable with that? Are you okay with us going on a slow schedule, what's your requirements? Now, this because there are many, many pediatrics offices where they want you to go on the CDC schedule, and that's it. And if you don't do that, then then they're not going to take you or they're going to kick you out. And that's their choice to make whether you agree with or not. But you should know that before you go in there, because if you want to do a slow schedule, and they only go on the CDC schedule, and that's not a good fit for you. To lose with that big biggie.

The doctors make a lot more money for every vaccinated child. Not really not that they bill for the shots, a few 100 each, and there's 72 of them.

So you do bill for the shots, I would say by and large, not making a ton of money on shots. I mean, you've certainly sounds like it sounds like potentially five figures to me.

I mean, it depends. So you have to keep in mind that doing shots is a huge process, there's a lot of waste problems, you're still doing administration, it takes a lot of time. So you know, when you when you end, the shots are very expensive to get. So yes, you get paid for them, but you always have to buy them.

So you guys, the revenue is high, but the expenses are high. And it's hard to say what is not is not very high for most for most doctors, so I guess for in some bigger groups. And so I'm gonna say this in terms of keeping people up to date, but it's not. It's not huge. And it's not the reason that doctors are giving shots. Like I know people think that but you don't think you're getting a bonus per fully vaccinated child is motivating to at least some doctors, I mean, they have 1000s of kids in their practice that amounts to a ton of money. I don't see how that would I think it's motivating. But it's not, it's not the driving thing. That's I think if you took away all the bonuses, nothing would change. I would just think that the insurance companies or the pharmaceuticals, paying those bonuses wouldn't bother spending that money if it didn't show if it didn't show that it actually changes, how many vaccines are sold. Anyway, you're not that typical doctor, so it's hard for you to comment on it is I'm just I think you're correct the degree but I think that just keep in mind that the vast majority of doctors are employed. So their salaries, their salary. So regardless of how many shots they're giving, or whatever they're doing, that's what they're getting. And then the system gets bonuses because the they call it quality of care. And so the more people that are up to date, the more quality of care, the more that they offer it. So that's kind of how they spin it. Now, does that incentivize people? Of course, anything money will incentivize people to some degree, but but the vast majority of doctors give shots, it's because they believe in it. It's actually very like, I think it's actually quite similar to what goes on in birth and hospital institution where, you know, the provider who gets paid more for a C section isn't pocketing those extra dollars, but the system overall is making more money. So the incentive is the system makes more money, maybe then salaries go up over time. And liability is lower because everybody's doing the thing that's recommended.

So I think that's exactly correct. Because I think that the incentive is in like your boss, who's coming to the doctors and saying like, Hey, I noticed your numbers are a little low. Let's get those up. So I think that's more of the incentive than specifically financial but obviously money indirectly can affect it. What are some of the other questions you think couples can ask? After this two people ones that you started with.

So those are those are big ones. If you are doing a home birth or even hospital birth, I think the stuff that happens in the hospital, the big procedures is a good thing to kind of chat about a lot of people, a lot of parents aren't necessarily aware of what you're going to be offered, or have questions about it, and you're not going to really have a chance to talk to anybody before then. So your interview is a good time to talk about it, meaning like the Hepatitis B shot the vitamin K shot, and then the antibiotic, Iommi. And those are the three big things that I talked about in the interview. Because when you are in the hospital, or home birth, or whatever you're going to do it, it's usually within the first day that most of those things are done. So you're may not even see the pediatrician at that point. So you can certainly talk to the midwife they can they can answer those questions too. But if you're going to be in the hospital, you're going to be maybe seeing a different doctor or just the hospital doctor. So you kind of want to know what your plan is, before you go in. And that's another big tip for the hospital, if you're going to the hospital, know your plan for those things, you know, know what you want to do be flexible, because sometimes people can talk about vitamin K a little bit. But sometimes people say they don't want to do vitamin K, and they have a pre traumatic birth, and they change their mind. So understand what it is for. But come in with a plan. So that way, if they say, you know, we're gonna do this, this and this, you can say no, I don't I don't want to. And if that's your choice, and the so the the hardest one, I think for most families is vitamin K, I think Hepatitis B and the IO mint, you're offered Hepatitis B to prevent transmission from mom to baby, that's a CDC recommendation. So I can't recommend against it. But realistically, people are tested these days. So it's one of those things where you know, if you have it or not you, you can't recommend against it. But I can say, whatever I want really -- fair enough, you say what you want, and I will -- you can you can, you can choose respond. But it is fair for any reasonable person on earth to know that if the mother doesn't have hepatitis, there's a 0.0% chance her baby will be born with hepatitis.

There, well, there is no chance you'll be born with it, the your transmitted by somebody, but then -- that would be like, that would be like needles that were already shared, which is not going to happen. Or it would be a blood transfusion. But aren't those tested, those will be tested. But you could theoretically big into somebody, somebody could bleed on you, you know, there, there is theoretical ways you get it. Maybe you could have like a baby could have an open wound, like a circumcision and someone who's waiting trips and the blood could get into the open wound. Right, right, exactly. So when parents asked me that, it's like, well, you know, your baby could go to well, baby party, you know. So boy, right? If you can't say never, so I can never say never just like I can ever say you're not gonna get polio, even though we have polio cases and have many years. But but you the recommendation is a recommendation. So you know, as a physician, I cannot speak against it, like people have to make their own decisions as to what they're going to do. And that is the recommendation. But of course, your risk is very, very low. If you, you know, if the test was correct, obviously, that's gonna be incorrect to do but if you don't have it, then you're not passing it on to your baby. So can we touch on the vitamin K for a minute, I know, we don't want to go too deep on this. But if you have a family who is well informed and has made the choice to decline, oral or injectable vitamin K, and then something happens in birth, that you would advise them to change their mindset, what would that be?

Usually, it wouldn't be me advisement all, because it's usually between them, and it's usually right away. So that'd be between them that will be maybe the midwife is there, they'd be making that decision. Usually a discussion with a pediatrician, it'll be a four about just understanding what Vitamin K is for. And vitamin K, if you know, for those that don't know, it's, it's a, it's a vitamin, it's in your body, and it's used to help with clotting. And when you're born, you don't have a ton of vitamin K, because you get a lot of it from your food and eating it. And so usually don't have a lot of stores when you're born. And so they're at risk, in theory from vitamin K deficient bleeding for the first couple months, or certainly in the first few days. And, and if you do have a bleed in a baby, it's usually in the brain or in the gut, which if that happens can be very severe. The risk is very, very low. It's like used to be like one in 10,000, I think, but it's still there. And the thing with this is that if it happens, it's very severe. Right? So that's not a thing that you want to happen to your baby and it can be very scary. So that's where parents have a difficult decision. And I definitely get into this in the book because I think this is one of those very interesting topics where naturally minded parents say things to me like well, if you if you were meant to have more vitamin K then you'd be born with it. That's what it the way it is supposed to be naturally. And the counter argument to that as well. Pneumonia, you know, it's natural to but you could die from it or many things are are natural, but not necessarily good. So there is I understand the argument on both sides. And that's why I think this is one of those things where For my patients, we discuss it and we say, well, here's the pros and the cons, here's your risks, it's not a huge risk, but it's there. If it happens, it's a very serious risk. And if you do get the shot, it will decrease your risk significantly, you almost have no chance of bleeding. If you get the shot. If you do oral, then there's still a risk, but it's not as not not as protective as if you get the shot. So you're kind of balancing the pros and the cons there because again, it's a small risk, not zero, what are the risk from the shots? Nothing that's proven, but anything that you're giving potentially has some risks, especially long term. So I think that's something that you're balancing again, a lot of parents seem concerned because there's a blackbox warning with vitamin K, about the use of it intramuscularly, which is how it's given to babies. What do you what do you say to that?

A lot of things have warnings. And I think you just need to be mindful of it and make a decision based on on the pros and the cons, everything has risk everything, it can be allergic to everything as potential risks. And everything that comes from apart pharmaceutical has a lot of risks that we just don't know, because they weren't ever studied, or they're, they're long term. So you have to weigh the theoretical or known risks versus the potential benefits. And just because something is pharmaceutical doesn't make it bad, too, right. And there's a lot of good stuff that has come from pharmaceuticals, you know, again, like you can get a pneumonia and used to die. But now you can be back to your normal life in a day or two, you can get an MRI. So not everything that we have invented is bad. But we are very, in medicine, we are very pro all of the positives, theoretically positives of medications, and of all things that we have created. But we don't really speak about the risks. And I think the risks are certainly higher on most things than we we admit to or we even know about, because it's really hard to know what long term risks are for things. And obviously, companies are not going to study those. So it's it's never an easy decision for parents. But I think it's important to know and kind of weigh the pros and the cons for yourself and make a decision. Because if you choose not to do something like let's say not to get the shot, and there's a risk, you could have brain bleeding, there's a risk, your baby could die from that. And you just have to be aware that that's something that could happen. And if it does happen, then you took that risk, which you know, it's up to you, right, there are risks to doing everything. Again, that's why this is a very important part of the course I teach. And I say listen, you've got to be at peace with your decision. And vitamin K is the most difficult one, there's a very tiny, severe risk on both sides. The natural argument I do find to be a very interesting one, because babies are apparently born with low levels, and we call them low only because they tend to ramp up in the first eight days or so. And then they stabilize almost indicating that nature is saying, we need to start this low. And don't worry, I'm going to make sure the baby is getting this through breast milk. And yes, the formula companies supplement with it. But it is kind of fascinating. Just as it's fascinating. They're born with report like disproportionately tiny stomachs. And maybe they're supposed to have itsy bitsy, tiny marble size stomach's on the first day and not get too much milk on the first day. I do find that argument interesting that you know, me, I think it's very when you are naturally minded, there are so many arguments like this that I think get very interesting. Because when you come from the medical side, it's like, well, we don't want babies to die, right? Like that's obvious. Parents don't want that. Doctors don't want that pediatricians are not bad people, they want to keep kids healthy, right? So they're not giving you vitamin K, because they think it's going to harm you. They think it's going to protect you. Right? And there's certainly an argument to be made that that is true, because you can look to six, you can look at vitamin K deficient bleeding. And you can look how those numbers are basically zero at this point after giving the shot. But the question is, and the question that's not answered is, well, what is the negative from that? What Why is the baby born that way? And then what what are we doing to them with any sort of procedure that changes up their body in a way that we're we're doing to prevent one thing, so you forgot one thing, but then what is the downstream effects of that? And that is the question. Because at the end of the day, if there is no downstream effect, and you're completely healthy, and it makes no difference five years from now, and there are no side effects from it, then why would you not give something that is going to protect your baby and drinking service, but that's not reality. But we don't have any real data on long term anything for any of this stuff. So it's impossible to make an a completely informed decision without really knowing what these things do long term and how they affect everything. So it's just complicated because they don't have the answers for people when they asked me they'll

-- Shame on them. Shame on them for not because how many millions and millions of babies are getting every year and then they haven't done adequate long term study. You can't do it because it's unethical. It's unethical. It would be unethical to do a randomized controlled trial of babies who are randomized to get it and not because what they say I'm not getting it.

Well, that's what they say it's unethical. But what if you have parents who opt not to have it, and those parents are all over the place? What if they want to participate? And being a long term study? I just think that it's a very convenient excuse to not be doing the data when they're making a bold recommendation for literally every baby.

Right. So that. So I agree with you, I think that it's ridiculous. I think it should be done. I think that the unfortunate part is, is like that kind of study should be done. There's no question about it. It's not a true randomized study, then. So you kind of lose something, because the people that are choosing not to do it are different. And they probably have a different lifestyle. So I think that's an issue. But it's the first step because I think, you know, yes, it's not perfectly random. But if you see big differences, then you can kind of, you know, move from there. And that can inform you that maybe we do do need to do this a little bit more. Because I think it's ridiculous as a doctor, that for every medication for every single thing that we do for patients, especially stuff that we give to kids and give it to them, often, we should have a ton of research on it, we should have independent research, we should certainly not be trusting companies to do their own research, because we're all on the same team. Like that's why it's so ridiculous. It's like doctors, you know, there's like this natural versus Westerners. And pediatricians are not bad people that go into medicine to help kids, right? It's just that there's the system, and it's moving this very bad direction. I think in terms of health and wellness, I mean, we see 50%, chronic disease, our health isn't getting better, it's getting worse, and things have changed over but medicine is way behind. In terms of catching up, we're very terrible, we're terrible at chronic disease and prevention, you're getting pretty good at treatment. But so many of the issues involve chronic disease and involve these kinds of questions. become more independent, we're never going to have true answers. And you know, who doesn't want to give somebody a magic pill that prevents them from getting all diseases? I mean, of course, that would be great. But at the end of the day, that's not reality, what's the side effects, and we need to know those things we can make informed decisions doesn't mean that everybody is going to stop doing X, Y or Z, it just means that they're going to have the data to to make an informed decision of what they should do versus what they shouldn't do. Some data would be better than no data. And pretty much right now what we have any data before we move on from vitamin K, because we could probably talk about this all day, I do have one more question that I'm curious your opinion on. If a baby does have a bleed somewhere in the body, the remedy is vitamin K. And that will stop the bleeding pretty quickly if it is identified. So parents who are choosing to decline vitamin K, but then choosing to do something like circumcision find themselves wondering if they're making the right choice, because as a circumcision going to increase the risk of vitamin K deficiency bleeding. It's not the bleeding from the circumcision, that would harm the baby, because that can be stopped that can be managed vitamin K could be administered if they were bleeding too heavily from a procedure like that. But does a procedure like that? Or let's say they get bruised, they fall and they get a bruise. Something simple, more simple like that, does that increase the risk of the vitamin K deficiency bleeding in the brain, which is the one that is most life threatening? Because it uses clotting factors and another area of the body?

I believe that any sort of bleeding, you'd be at higher risk, because you don't have the clotting to close it off as quickly. So I don't think you know, to your question on circumcision, that's not a huge risk. I mean, yeah, I guess you could bleed more, but you could put more pressure on it. And you would be aware of, because you're aware of a circumcision bleeding. So I think that's lower risk, it's more of the internal bleeding, that you may occur from just from birth, or may occur from some sort of accident, fall trauma, whatever it is. So that that, to me is the bigger issue. But I would disagree that you could just give vitamin K think that's, that's not true. Because it depends on what the bleed is. I mean, you certainly can do it. But it might be too late to really stop the bleeding and you know, have a brain bleed, you might have to like, go in there and do neurosurgery and release the pressure. And all those things, when we're getting way off into the extremely, extremely rare. These are not things that parents will be worried about, because this would be overly scary and extremely uncommon. But it's not something you can just do after in general, it's like this is something you would do before to prevent it. Because if you have a brain bleed, that's a pretty big deal. But again, it's just like super low risk stuff. And that's why I think, again, going back to this the general, this was frustrating, because you should be aware of the risks like the risk is super small. It's not zero, but it's very small. So that's something that should be aware, you know, to discuss, because you shouldn't be worried about brain bleeds, you should just be aware of it.

I have another suggestion for a potential question to ask a pediatrician. I want to hear your opinion on it. And then I have a question. I bet you've probably never been asked that. I'm curious to get your response to regarding that interview with a parent or with a couple. But the first suggestion I have for couples looking for a natural pediatrician beyond the ones we've discussed, is a hypothetical for example, like hey, Doctor, what would you probably recommend if my child had an ear infection because their children who grow up on chorus after chorus of antibiotics and their children who grew up with the garlic oil in the cabinet, when they get an ear infection, do you think that that's a pretty good example of, you know, to identify the difference between pediatricians and what their approach is overall?

Yeah, I do get asked often about, okay, well give me like something similar to like, give me an example of where natural medicine would be useful, or how you use natural medicine, I think giving a specific example is a great one, ear infection is a really, really good one. Because even in western medicine, you don't need to treat it most of the time. So I think you'd be looking for something like an answer of, well, it kind of depends on the situation depends on how severe it is and how much pain they're in. But we try to avoid using medication as much as possible. So if it is happening, then you know, maybe we would take a look, we could give you a prescription, you could hold on to it, we offer you some some natural remedies, or even if they're not a natural remedy kind of doctor, they'd say, Well, we'll watch it for a day or two and see. So I think that's the kind of thing that you'd be looking forward that question and ear infection is a great example. Because even in western medicine, there's a naturally minded versus not so naturally minded approach instead of just giving antibiotics, so you can get a pretty good answer fairly quickly. I mean, not everyone's gonna say, like, oh, you could do garlic oil, and yada, yada, whatever, but but at least if they're not going to throw an antibiotic at you right away, that's a good indicator, you're going in the right direction.

So you made a good point earlier about how anyone in their own business, I think, I personally think one of the top advantages of being in one's own business is at long last, you get to choose who you work with, and who you work for, you don't get that in the corporate world, you work in the corporate world, and you have absolutely no say in who you're working on projects with, or maybe who's on your staff. But that's about it. And in your own business, it's beautifully liberating, that you really can love the people in your life, because you can love your clients. And you can care deeply about them and have a really rewarding, fulfilling relationship with them. And you do get to choose and recognize if it's the wrong fit, and there's no, there's, there's a lot to be admired about recognizing when it's not the right fit, and when two people shouldn't necessarily be working together in such an intimate capacity. So with with with that in mind, I'd love to hear your response to the question. How would you know, a couple isn't right for you? Or what would be even red flags? What kind of couple because there can be very difficult people to work with? What are red flags to you? How do you know when someone isn't who you want to work with?

Very good quick, is that the question you think I've never been asked before?

Yeah. Was I wrong? Was it just not very original? after all?

It's pretty original. But I don't even know if I've been asked before. So maybe it's the first time but it definitely is something that happens in our practice, too. I would say even before I answer that question, a big part of this question is going back to what you said before, and recognizing that you don't have to stay with your doctor, you hire them, you're choosing them as part of your family. So if you are not comfortable, if you've made a choice, and you don't feel like it's the right choice, you can always switch and I promise you, like people sometimes like feel bad, or they're like, No, we don't care. It's totally fine. Like, I mean, we care, we want people to be happy. But if we're not a good fit for you, then I want you to go somewhere else, I promise you there is no, there are no shortage of patients, you know, we get tons and tons of emails most doctors do, every doctor has way too many patients these days. So if you don't feel like it's a good fit, don't feel bad. Just send in your you know, find your new Doctor send in your form, we transfer the records, and we want you to be happy. So that's from your side. And from my side, it's the same thing. I don't want to have a family where I don't feel comfortable working with them, if they don't trust in my decision making. I've definitely had to discharge patients for not too often. But it certainly happens. And I do interviews with every patient before us. I'll do everyone in my office because just like you said, sometimes you get a bad vibe. Sometimes people are asking you things which you're not comfortable with or not comfortable doing. And so interviews are mostly for you. And and I think people don't realize that's mostly for the patient into the doctor. But every so often there are some things that really stand out as red flags like asking us to do illegal things, or being rude. I think, you know, for me, it's like that's a big thing, if you're really rude to the staff are really rude to me, even before we've met. And that's a pretty good sign that it's not going to be a good fit. We want people to be happy. So rudeness is usually the number one reason why people get discharged from an office. It's like billing things a lot of times people get discharged for but that's not like a you're kicking them out because they you know, that's a personality thing. It's just more like a payment thing or whatever rubs you the wrong way. Is it? What kind of couple? Is it a couple that's too anxious is the couple that's too defensive. Is it the couple that puts you on the defensive too much? Who is it?

I think it's people that don't want to have a mutual relationship. So as people that don't respect you or your team, especially your your team, it's not people that are anxious because there's a wide range of anxious and good parents could be anxious, too. Sometimes people are way overly anxious And that can sometimes be a bad fit. So that is every so often the reason why we would have to discharge somebody if they're so overly anxious that they're not trusting of things, and then that can become a you know, big issue if they're if they're messaging all the time or not trusted, it's really the trust rates, like they don't trust in your, your decision making or something that's basic and in common, and they want more and more and more done. And you just don't feel comfortable doing that. It's like it's a comfort level thing, if you're getting outside of your comfort level, if you're doing things that you don't feel is in the child's best interest, and the parents are pushing you to do it. And I feel like at that point, you'd have a discussion, you talk about it, you say what you what you're comfortable with, and why. And if they're still wanting more than you, maybe you're just not the right doctor for them. And I think that's fine. That's usually where it's put, it's like, we're just not the right family, right, we're just not the right fit for your family. And so you know, we'll support you in your move, if you know, we need to give them money back, I would always do that. And I like trading your resources. And they're just, it's like, what comes to my mind is like, this just isn't fun anymore. Like, ultimately, I want to enjoy my life. And I want to sometimes in medical care, it's not always fun, sometimes my life's a little easier than yours isn't always fun. But I do think that the foundation of trust, respect and kindness, like in any healthy relationship, you have to have those, those principles or it's not going to work well. And you can work through the days where the vibe is low. And it's tough, and you're trying to convince somebody to, you know, understand where you're coming from, because you really believe this as the right thing for your patient. And those days aren't fun. You got to work through them. But you can't work through rudeness and lack of respect and trust.

Exactly correct. And it's always like the very, very small percentage like you love and enjoy 99.9%. And it's always there's no there's one or two here, there. And I think, as a good practitioner, as someone who gets on in their career, who kind of respects themself more and more than you get comfortable with knowing that that very, very small percentage is not worth it, not the finances are not worth it, the time is not worth the stress is not worth it. It's not good for either side. And so you just make that decision faster. And I think that's, that's a good thing. Yes. But you know, if you're a parent, and I think there's always a funny thing, but like, be very mindful, when you read online reviews of this stuff, go look at like 20 different practices. And you'll see that 99% of the people that are angry, you know, when you're looking into it, it's either a billing thing, or it's a person who writes a really long thing. And usually they're like, this office is horrible, and it's like, they were just so rude. And they don't even have the rooms or to the staff and you're like, you gotta Kick the Butt. You can't you can't respond online. So you can't respond.

I think rudeness is a big red flag.

Can I ask one more question of you? I'm really curious your opinion on growth curves for babies, the difference between breastfed babies and formula fed babies and how much you care about the growth curve? And when when you get concerned if babies are falling off their growth curves?

Yeah. So I would say you kind of answered the question there, too, if you're falling off your own curves. So the thing to understand with with development and milestones? And this is a great question again, because again, goes back to the stuff we chat about in the book and the things that people are nervous about. They're very worried about every buddy else and everything else. And the curves are good general indicator of what is the range of normal, but some people are short, and some people are taller, and people are big, and some people are small. So the curve is there to help you look at it against yourself. I mean, yes, if you are super big on, you know, super at the top, the high end or super at the low end, that's something to be mindful of, because maybe there is something going on. But if you're at three percentile, but you're kind of following along with the three percentile every time that could be very normal for you. So as a doctor, we are much more concerned if somebody is at the 90th percentile than they're at the 60th percentile, then they're at the third percentile. That doesn't even mean that there's something wrong, but it is an indicator that like well, okay, well, why is why has the percentiles changed? You know, so much and what else is going on? And that is a one marker to start your thought process around. Okay, well, their growth has gone off the curve. are they developing in other areas appropriately? Are they speaking appropriately? are they losing milestones? Are they socially acting normally? Do they have any dysmorphic features? Is there anything else to be concerned about? So it's, it's one, it's like a vital sign almost, it's like, you know, your heart rate or your your breathing, it's like not necessarily a problem. It could be your heart rate could be super high. And it could be a problem. But just because it's a little bit elevated, doesn't mean you just went on a run. Right? So it's just one piece of information to take note of, but it's not definitive in any way and especially if you're bigger or smaller, it shouldn't necessarily make you concern just just mindful. I'm very hopeful that we're going to move into more positive direction with with medicine and healthcare in general. A lot of the younger practitioners I've seen are reaching out to me they're getting more interested. We see a lot more online, have a push back against, you know, some of the pharmaceutical medicine more or thought around prevention, health eating, I mean, our chronic disease rates are skyrocketing. But people are starting to identify that and acknowledge that. And I think that's a good and positive thing. I think that parents are more stressed out than ever, mental health was probably at an all time low. But at the same time, we've identified this, and we are talking about it a lot more. So I'm really positive and hopeful that doing things like this will, will encourage people to ask more questions to seek out more practitioners and more parents that want to do this. I think that the more practitioners are going to start learning about it and doing it, you know, there's no question that integrative medicine and natural medicine and interest in that as at a far all time high, it's far exceeding, you know, what practitioners are available for it, and people are looking looking for it. So the more that that happens, the more that practitioners are going to learn about it, the more we're going to move the curve. And there are a lot of practitioners that reach out to me very quietly and say, you know, talk about the things that they think and it's like, it's not, it's not as crazy as we might make it seem, it's just that people can always talk about everything. And I hope that that changes over the long run, it really needs to we're not there yet. But it's, it's certainly at least better than a few years ago. And that's one of the reasons why I wrote the book, again, parenting your child's pace, because I wanted to write down that mix of wellness and health and reminding parents that they can do it and that we have those skills we've been parents parenting for a very long time, we have more access to many things than we ever have. But we need a balanced approach, thinking about prevention and understanding that there's a lot of ways that we can go about parenting and everything online and most of what we hear is very divisive. It's like you're crazy if you do what you're crazy if you're down and this site is right and this site is wrong and that's not true of most things. And so for me especially in the book I tried to bring things together present both sides and let people make their own decisions.

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Is Mercury in Retrograde again?

It's always in retrograde. It's always some planet but I think

my husband told me the same thing. He's like he thinks it's hilarious that there people were saying that.