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#1 of 24 Old 03-08-2006, 07:33 PM - Thread Starter
 
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I am actually feeling rather down on myself and embarrassed about this, but I guess I will share it in case someone else finds themselves in a similar situation, and to get some feedback on it as food for thought and in case I find myself in a similar situation. I might was well try to learn from my mistakes!

We are a non-vaxing family. We did selective vaxing from birth-4 months (no Hep b, no Hib) and then stopped vaxing dd. Part of my problem is that intellectually I go back and forth on whether vaxes don't work AT ALL versus they do work somewhat but at great cost in terms of the toll on the immune system, injection of toxic substances into the body, etc. That bit of uncertainty is what got me into trouble recently. I have no qualms about not vaxing for acute childhood illnesses and Polio (one of the vaxes I don't really think "worked" persay except to spread Polio) but have always had a fear of tetanus, since hearing various "scary stories" in my childhood and having a puncture wound and getting a tetanus booster as a teen.

Monday evening last week my 27 month old dd was jumping on our bed and fell off, hitting her face on a side table with a sharp edge on the way down. She was bleeding profusely, and I had a feeling it was a deep wound so we threw shoes on and took her to the ER. Once there we got the usual round of questions, including the "is she up-to-date" on vaxes. I was honest and said we had stopped at 4 months (maybe part of the problem right there?).

Her wound was assessed, and it was agreed she needed stitches (it GAPED open when the doctor checked it, I just gasped, it was a couple of CM below her eye on her cheekbone.) So of course, the doctor then started in about the vaxes. I did not know this, but there is not a tetanus vax alone for young children, to get tetanus you *must* get DT or DTaP? My first response was to say "No!". He kept stressing the seriousness of it, including some info I knew to be false (that the only reason we don't see so much tetanus is b/c of the shot), so I said, Maybe. He left us for a bit before we did the stitches. As I sat there, I was thinking about how after I read Romm's book that I still wasn't certain about tetanus and possibly wanted it for my kids when they were older, that I needed to research it more. I was also thinking about the location of the wound being near the CNS. Then I thought about how we didn't have a negative reaction to DTaP with her first two doses, but that tetanus is very scary. Dh generally trusts me on this issue- he is overall against vaxes (wasn't vaxed as a child either- his parents are Christian Scientists), but acknowledges he hasn't researched the issue as much as me, so left it to me to decide.

So the doctor comes back, and I agree to the DTaP rather than the DT (I thought b/c DTaP was given more it *might* be safer than the DT). Then we get the stitches in, which was a nightmarish experience... dd was wrapped in a papoose so she couldn't move and her head was held down by a nurse and she screamed "I want nurnee! I want nurnee!" (I want to nurse) practically the whole time. She got 6 stitches in and it took forever it felt. By the end of that, dh didn't want to stay to get the DTaP shot and suggested that I think about it more and take her to her own doctor if she still needed it. We told a nurse we had changed our mind, but the ER doc came back and plead his case again, that it was a deep wound on the face and he really didn't feel OK about us walking out of there without it. We gave in, again. Then it took forever, b/c they had to get the pharmacy to make it or something b/c of her peanut allergy.

The actual shot was not a problem, she didn't freak out too much. However, she spent all last week in a definite "recovery", nursing 3-4 times as much, sleeping a lot, talking through everything. I was unsure whether she was recovering from the trauma of the experience, or the DTaP. I couldn't even bring myself to read anything about tetanus or the shot for a few days.

I finally re-read what Romm said about tetanus and for a while felt OK about my decision... but I've been reading more here and elsewhere about it, and now I'm feeling like it wasn't a good decision and that I should have stuck to my guns. I really don't think that dd would have gotten tetanus. And I hate that I gave her DTaP. OH! I forgot to type this above- the final deciding factor for me was when I was thinking about the fact that she had spent a good part of the afternoon playing in her sand table and who knows WHAT lives in there, it's not sterile for sure. The doctor mentioned that tetanus could live on the skin, and after he said that I thought of the sand table and said yes to the shot (even though she had just taken a bath before the accident.). So it was a fear-based decision.

I apologize for the long post. I guess my decision is, would this have been an easy decision for everyone else? (to either say yes or no.) What other factors would you have considered? I am now thinking I made the wrong decision- I assume that non-vaxers are agreeing that I did (Jen123!) but maybe selective vaxers would have possibly made a similar decison? If I find myself in a similar situation again with the tetanus issue and an unvaxed child, what are other steps or precautions that I can take other than just saying yes to the vax?

Also, part of my fear was that CPS would be called on me or something for medical neglect... was I irrational to feel that way?

Thanks in advance for any responses.
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#2 of 24 Old 03-08-2006, 08:06 PM
 
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I would have said no and been pissed at being bullied. I have studied up on tetanus and the injury your dd had basically posed NO risk of tetanus. Tetanus needs a wound without oxygen. And because of that in people with good circulation it is nearly unheard of.

to you. I hate the way they attack mamas when they're scared.

-Angela
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#3 of 24 Old 03-08-2006, 08:09 PM - Thread Starter
 
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Can you elaborate on that? What would a wound without oxygen look like? Is it the classic deep puncture wound rather than a gash like dd had?

I was angry at the time at being bullied. But I still allowed it to happen.

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#4 of 24 Old 03-08-2006, 08:15 PM
 
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The ER administered DTaP in order to prevent tetanus from this wound? Is this what they lead you to believe?
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#5 of 24 Old 03-08-2006, 08:18 PM
 
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I can see myself in your very shoes. I've studied and studied, and tetanus is the one I keep sitting the fence about, then going back to read again, and again, and again. I've educated myself out of every other vax out there, but keep needing refreshers about tetanus (was just going to do my reading here again tonight!) I've had several conversations with out Ped about getting Td (as I think T is only tested for use in those < 7 years) for both my dc later this spring and though I don't plan too, I kep wondering if I *should*. I agree with alegna, though, that the wound you describe your dd having seems to pose almost no risk for tetanus, especially if it bled profusely. I am very sorry you were bullied, and wish your dd a speedy recovery with no adverse reactions to any of it.
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#6 of 24 Old 03-08-2006, 08:20 PM
 
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Quote:
Originally Posted by LongIsland
The ER administered DTaP in order to prevent tetanus from this wound? Is this what they lead you to believe?
That's true, wouldn't you need the immunoglobulin to provide protection for a current wound?
~~please excuse any typos and/or stupidity, my dd does not let me sleep lately and I function at a low level these days : ~~
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#7 of 24 Old 03-08-2006, 08:22 PM
 
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Oh yeah, LI is right- if they gave the regular vax it was no protection for this wound. For this wound they would have had to give the immune-globulin (sp, sorry...)

A wound that bleeds is generally at NO risk for tetanus. The only exception IMO would be something traumatic like a car wreck with damage to bones also that heals from the outside. As long as there is circulation, oxygen will get there. Tetanus is a disease of the elderly and those with poor circulation.

-Angela
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#8 of 24 Old 03-08-2006, 08:23 PM - Thread Starter
 
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Yes- he said it would protect for the wound she was being treated for. A lie?

It bled *very* profusely. So that's good? I am feeling terrible right now. I wish I could take it back. I thought I was informed, now I'm realizing not enough obviously.
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#9 of 24 Old 03-08-2006, 08:26 PM
 
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Oh mama

I would have said no. IIRC, the fact that it was bleeding was a good sign. Deep puncture wounds with no oxygen bleed less.

I can't believe they gave her the DTaP for this accident! I think the doc saw it as an opportunity to get an un-vaxed kid vaxed...
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#10 of 24 Old 03-08-2006, 08:28 PM - Thread Starter
 
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Argghhhh... now I'm getting really angry thinking about this. :

Do y'all think that the doctor *knowingly* mislead me or is this some kind of tactic that they use to get non-vaxes to give vaxes? B/c he really scared me about it. I didn't have the info y'all just shared (oxygen, bleeding wound, immunoglobin) to feel confident enough to say no... I wonder if I had if that would have shut him up?

Okay, just saw curlyfry's post... argghhh.... :
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#11 of 24 Old 03-08-2006, 08:30 PM
 
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I think the Dr. knew that there was no risk of tetanus for this wound and played on your fear.

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#12 of 24 Old 03-08-2006, 08:31 PM
 
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Quote:
Originally Posted by BetsyPage
Yes- he said it would protect for the wound she was being treated for. A lie?

It bled *very* profusely. So that's good? I am feeling terrible right now. I wish I could take it back. I thought I was informed, now I'm realizing not enough obviously.

Yes. An absolute bald-faced lie.

Bleeding means that tetanus was not a worry. The traditional tetanus wound is one of two things- either a serious deep puncture with no bleeding that seals over and heals. Or a SERIOUS traumatic injury (car wreck, multiple injuries) where there is a wound all the way to bone that heals on the outside before the inside. Other than those two types, any other tetanus will only be found in those with poor circulation (and even those two types of injuries are very unlikely to end with a tetanus infection in ANYONE, least of all someone with good circulation.)

-Angela
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#13 of 24 Old 03-08-2006, 08:34 PM
 
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Originally Posted by BetsyPage
Yes- he said it would protect for the wound she was being treated for. A lie?
Yes a lie. I can't recall how long it takes for the vaccine to be effective, but if she were to get tetanus, she'd get it BEFORE the vaccine ever took effect. AND that is assuming that this was just a booster shot. Initially, I think it takes 3 shots of tetanus for it to be effective. They usually try and give you a booster shot at the ER just to get your booster shot in since you're there.

She would have needed the immunoglobin to protect against the current wound (not saying the wound needed it!).
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#14 of 24 Old 03-08-2006, 08:34 PM
 
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Quote:
Originally Posted by BetsyPage
Can you elaborate on that? What would a wound without oxygen look like? Is it the classic deep puncture wound rather than a gash like dd had?
Don't beat yourself up over it, what's done is done.

Would I have allowed the injection to be given under the same circumstances? NO

A deep puncture wound is one that you don't see because it closes over quickly and allows no blood to come out and basically nothing to get in. We associate it with a 'rusty nail' puncture. Although in a child I doubt that it would cause tetanus. Children don't die of tetanus poisoning.

Any wound that bleeds, even a few drops won't grow tetanus. Blood carries oxygen.

Tetanus does not live everywhere, only the spores. They have to enter the body and be encased in an oxygen free environment and grow in order to produce a poison. And that poison is what is dangerous.

It is not easy to get tetanus. I doubt that a young child could.

Also, the DTaP serves no purpose at that time. Tetanus spores can produce poison under the right condition within two weeks and the vaccine can not protect the person for at least three weeks.
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#15 of 24 Old 03-08-2006, 08:45 PM
 
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Also I wanted to add, one vaccine against a poison probably does nothing at all as far as protection. You have to build up to get the body used to the poison.

Just think of it as getting used to smoking. You smoke the first cigarette and get sicker than a dog. You do the second in a few days and it goes a little easier but still you feel sick. The third will not make you quite as sick and the fourth, voila! your body is used to the poison of smoking.

Same with tetanus poison. You have to build (actually destroy) the body's resistance to it.

One vaccine can not accomplish that. Not against a poisons.

Diphtheria is also a poison. Same story!
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#16 of 24 Old 03-08-2006, 08:57 PM - Thread Starter
 
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Thanks for this info, everyone. *sigh* I am pretty sure I knew this somewhere in the recesses of my brain, but couldn't think *how* I knew it and didn't feel confident enough to say no. I am kicking myself but dh just came home and he doesn't want me to beat myself up about it (I'm 36 weeks preggo, pretty emotional right now!) but I told him I will have to be upset and angry about this for a while. It has taken me over a week to be calm enough to even find this out.

OK, I think it is finally clicking for me about building up the resistance. That makes sense, Gitti, thank you for explaining. I have always thought of the DTaP as in a different category as say the MMR anyway... I think I need to read more about this to understand fully though.
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#17 of 24 Old 03-08-2006, 08:59 PM
 
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Awww Betsy...we know each other from another board too. You know I love ya.

Quote:
I apologize for the long post.
Yeah , I've never written a long post before....heehee (side stepping lightening bolt)

Quote:
I guess my decision is, would this have been an easy decision for everyone else? (to either say yes or no.)
It would've been easy for me because I'm a bully. A big mean bully. And I'm really nasty to doctors. But that is me NOW. Me five years ago would've caved.

Quote:
What other factors would you have considered?
I would have considered an antibiotic cream or gel. I would've taken in to consideration how much the child bled , where the wound was , etc... But I would not have gotten the vaccine.

Quote:
I am now thinking I made the wrong decision- I assume that non-vaxers are agreeing that I did (Jen123!) but maybe selective vaxers would have possibly made a similar decison?
I say this in love and with the highest respect for you as a mother... I do think that the vaccine was the wrong decision. With that said , I know how it feels to be bullied by doctors who tell you lies and feed you garbage. I know how it feels to have a drug/vaccine pushed on you when you are most vunerable. Honest I do. I've made plenty of wrong decisions.


Quote:
If I find myself in a similar situation again with the tetanus issue and an unvaxed child, what are other steps or precautions that I can take other than just saying yes to the vax?
You can stand your ground. I liked when you said to the doctor "we'll see her regular doctor for that." Next time stick to it. I do not think taking your child to the ER was the wrong thing , I do not think stitches were the wrong thing....I said before , I admire you as a mother and think your instincts are right on. It's sticking to those instincts.

What I had to do in order to deal with doctors more efficiently...realize that they DO NOT hold authority over me and my family. Point blank. They have tools necessary to help us...but overall...it is MY decision. I've turned down many a procedure/vaccine/shot by saying "I'm feeling vunerable right now and I'd like to go home and research my full range of options. I will follow up with my regular doctor for that. Thank you for your help." If pushed I ask for pamphlets or handouts. They are always more than happy to go over pamphlets and printouts with me. They feel like they've done something and I get to go home and review my options. If pushed hard and ganged up on I put my foot down. " I won't stand here and feel bullied by four different people. I will talk with one of you. The rest , please leave. The one who remains will have to respect my final decision as a mother. Period."

When I feel truly harrassed , it's happened a couple of times over seemingly innocent stuff...( antibiotic shot for dd ) I demand a Patient Advocate. (someone the hospital employees to be the buffering agent between doctor and patient.)
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#18 of 24 Old 03-08-2006, 11:43 PM
 
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Originally Posted by TechnoGranola
Yes a lie. I can't recall how long it takes for the vaccine to be effective, but if she were to get tetanus, she'd get it BEFORE the vaccine ever took effect. AND that is assuming that this was just a booster shot. Initially, I think it takes 3 shots of tetanus for it to be effective. They usually try and give you a booster shot at the ER just to get your booster shot in since you're there.

She would have needed the immunoglobin to protect against the current wound (not saying the wound needed it!).
I will check my facts on this, but since she had already had two DTaPs (right?) I thought this one COULD be protective. My understanding from Romm's book is that if you're completely unvaccinated the shot is no help after an injury, but if you've been vaxed in the past then a booster is effective. This might well apply (or the doc may have believed it would apply) to a child who's had two tetanus shots previously. No?
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#19 of 24 Old 03-08-2006, 11:50 PM
 
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Originally Posted by mavery
I will check my facts on this, but since she had already had two DTaPs (right?) I thought this one COULD be protective. My understanding from Romm's book is that if you're completely unvaccinated the shot is no help after an injury, but if you've been vaxed in the past then a booster is effective. This might well apply (or the doc may have believed it would apply) to a child who's had two tetanus shots previously. No?
If this was the child's 3rd shot, then this shot would protect them for the NEXT wound (and if it was anything less than their 3rd shot, it won't even protect them for that). As Gitti said, it takes the body 3 weeks or so to get the protection from the shot and tetanus can build spores in 2 weeks or less.

Now, I also seem to recall that even with 3 shots of tetanus, that may only provide 80% protection, but am not totally sure about this. Anyone else know anything about this?

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#20 of 24 Old 03-08-2006, 11:54 PM
 
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Quote:
Originally Posted by TechnoGranola
If this was the child's 3rd shot, then this shot would protect them for the NEXT wound (and if it was anything less than their 3rd shot, it won't even protect them for that).


According the Pink Book:

After a primary series (three properly spaced doses of tetanus
toxoid in persons 7 years of age and older, and four doses in
children younger than 7 years of age)
essentially all recipients
achieve antitoxin levels considerably greater than the minimal protective level of 0.01 IU/mL.
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#21 of 24 Old 03-09-2006, 12:35 AM
 
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Originally Posted by LongIsland


According the Pink Book:

After a primary series (three properly spaced doses of tetanus
toxoid in persons 7 years of age and older, and four doses in
children younger than 7 years of age)
essentially all recipients
achieve antitoxin levels considerably greater than the minimal protective level of 0.01 IU/mL.
Okay, I know I'm being difficult but this doesn't tell me how many children would have strong antitoxin levels after two or three doses. I'm not saying she needed the vaccine, just wondering whether the doctor had some reason for believing it might be useful.
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#22 of 24 Old 03-09-2006, 12:52 AM
 
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You're not being difficult, these are great questions.
According to the Pink Book:

Persons with wounds that are neither clean nor minor, and who have had 0–2 prior doses of tetanus toxoid or have an uncertain history of prior doses should receive TIG as well as Td toxoid. This is because early doses of toxoid may not induce immunity, but only prime the immune system. The TIG provides temporary immunity by directly providing antitoxin. This ensures that protective levels of antitoxin are achieved even if an immune response has not yet occurred.

*************
TIG = tetanus immune globulin

The OP's daughter didn't "qualify" for the TIG because the wound was managed properly and there was no threat of tetanus, even though she only received two doses of DTaP. If the doc thought there was a threat (or even a potential thread), he would have suggested the TIG as well.

The DTaP was neither necessary, nor was it useful in preventing tetanus for this wound.
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#23 of 24 Old 03-09-2006, 12:53 AM
 
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#24 of 24 Old 03-09-2006, 01:23 AM
 
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Just a funny aside:

When I was about 19(long before my research on vaxes started) I sliced open the back of my thigh and required stitches. We didn't have insurance so I was looking for any way to reduce the amout of our bill. So, when the Dr asked when my last shot was I said in 10th grade. He said I would probably be okay but he wanted to give me one just in case.
I asked him if it would cost more and he kinda looked at me...I said nevermind, I don't need it.
So, after discharge, I went home. My mom asked me if I got a shot and I says no. She starts flipping out on me.(Moreso because she was worried about tetanus and not so much the vaccine, I guess.) So I go online and start reading about the symptoms of Tetanus. Instantly, my body is thrown into what I am 200% sure is a raging Tetanus infection , sore neck and all.

So much so that, I DRIVE BACK TO THE HOSPITAL AND INSIST ON A TETANUS SHOT!! The receptionist at the front dest assures me that I will be fine and sends me home.

Talk about the power of suggestion!

Of course now I am blessing that receptionist who sent me home.

Ok, back to the OP.

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