More of the Same

This month has been full of doctor's appointments. Between both children, we have been to the doctor's office eight times this month. Thankfully, most of the appointments were scheduled. At the beginning of the month, Theo had an appointment with a pediatric urologist here in Fukuyama. They took a blood test at that time and noticed that his white blood cell count was higher than normal.  He didn't have a fever, was acting pretty normal (or as normal as he ever acts), and his urine test came back clean, so I didn't really think much about it.

Powder packets of medicine

That night Theo woke up with a fever and complaining that his ear hurt. The mystery was solved, but now I was faced with the problem of finding a pediatrician and trying to communicate with my limited language skills. I located the closest pediatrician from a list of doctors that we had received from city hall and walked over with the kids. The appointment was actually fine, and between my few words of Japanese, the doctor's few words of English, and quite a bit of pantomiming, we established that Theo had a middle ear infection. I thought he would prescribe antibiotics and we would head home, but that would have been far too easy. Instead, he felt the need to refer us to an otolaryngologist even though he had already established that Theo had an obvious and uncomplicated ear infection. The children and I found our way to the next doctor who preformed all of the same checks that the pediatrician had and agreed that Theo had a middle ear infection. This time, at least, we were given a prescription of penicillin, acetaminophen, and antihistamine before leaving. When I had picked up the medicine from the pharmacy, I was surprised to find that it was all in powder form in little wax paper pouches. I have never given children medicine like this, since in Canada it is always mixed into a syrup by the pharmacist. After making call to a Japanese friend of mine, I found out that the powder is supposed to be poured into his mouth and washed down with water. The powdered medicine is mixed with sugar, so Theo had no problem taking it whatsoever.

Happily waiting for a CT scan

The next week, we went twice to the hospital that we had been referred to, Okayama National Hospital. One day we had an appointment with a pediatric urologist and the next with a pediatric neurosurgeon, who both spoke excellent English. One of the biggest concerns that I had before coming to Japan was that I wouldn't be able to communicate with Theo's doctors. I really didn't want to become uninvolved and uninformed about his medical condition purely because of the language barrier. I have been really fortunate in finding specialists that are all very easy to understand and communicate with in English. At those appointments, Theo had another ultrasound and a CT scan, both of which he found very exciting. He loves what he calls "doctor machines" and thinks it is pretty cool when he gets a chance to see them in action. Lucky for him, that happens often enough.

I managed to snap this shot before they kicked me out. He
is not drugged, just blinking!

It  took us about an hour and a half one way to reach the hospital from Fukuyama and this made for really long days hauling both kids back and forth. I was pretty proud that I managed to take the right trains and buses, and make all our appointments on time without losing anyone along the way or suffering through too many temper tantrums.

The boys playing in the hospital waiting room

Lastly, William had three appointments this month getting his vaccinations started. As I mentioned in an earlier post, we decided to wait until we arrived in Japan before beginning any vaccinations. After waiting for our health cards to arrive and just plain dilly dallying, I finally decided William's time was at hand. I brought him to the same pediatrician who initially saw Theo about his earache and he referred us to a vaccination clinic. I would really like to know what pediatricians do here other than refer you to doctors that they feel are better qualified to deal with your children's health. Last week, William received his first DPT shot, and on Wednesday he had the first of his Hib and pneumococcal vaccines. Needless to say, we have had a pretty sore and cranky baby for the past few days.

This month has felt very hectic so far and I am hoping that we are done with appointments for at least a few weeks. A little bit of peace on earth would be very welcome in our household over Christmas and New Years!

Vaccinations

Something else that we have put a  lot of consideration into is vaccinations for William. The US and Canada have very similar immunization schedules that start at 2 months of age. The first few shots (DTaP, Hib, IPV, Men-C, and RV) are given in 3 parts at 2, 4, and 6 months of age. The pneumococcal vaccine is given in 4 parts starting at 2 months. Since we will be leaving when William is only 5 months old, he will not be able to finish any of the series that we would start here. We have realized that we only have 3 options:

1. The boys and I will stay an extra month so that he can finish his first sets shots

2. We will leave when he is 5 months old, as originally planned, and have 1 month to figure out how to obtain the last shots he needs in Japan at an expat clinic.

3. We will not do any of his vaccinations in Canada, and begin him on the Japanese schedule once we arrive.

I really don't want to wait an extra month in Canada since that will actually be 2 months after Dustin leaves. Since our house will be sold by then, I will have to stay the extra time with my in-laws and spend every waking moment making sure that Theo does not break the multitude of knicknacks and tear their house to pieces.

I also don't relish the thought of running around trying to find Canadian vaccinations in Japan with only a one month time limit. I have read that getting imported shots at an expat clinic is super expensive, since it would not be covered by Japanese healthcare. I have no idea how expensive though, because every forum and website I have read fails to mention exactly how much they paid.

I have been reading up on the Japanese immunization schedule in the past month. There are a few differences from the Canadian schedule, the most important being the use of a non-attenuated or live polio vaccine (OPV), they do not immunize for mumps, and they immunize for tuberculosis (BCG). At first I thought it was a bit sketchy that they used the live polio vaccine compared with the inactive polio vaccine (IPV) that we use in the west. The live vaccine can actually cause someone to contract polio and there have been multiple cases of vaccine associated polio paralysis. After reading about it a bit more though, I realized that the US and Canada used the same OPV until the 1990's and only then switched to IPV. I guess if virtually everyone I know, including myself, got the live vaccine, and no one I know has contracted polio, I shouldn't worry about William. They also do not vaccinate for mumps like we do in the west. Mumps does not really affect young children too badly, but it can cause infertility if adolescent males contract it. So we can worry about that one in the future.

Japanese BCG vaccine

The last notable difference with their immunization schedule is that they vaccinate for tuberculosis instead of just testing for it with a mantoux like we do in Canada. The BCG vaccine uses a creepy looking 9 needled puncher device, leaves a scar, and makes you test positive on a mantoux. The scar isn't a big deal, I am sure William wouldn't be upset about an interesting arm scar, but testing positive for TB when you don't have it is annoying. My dad tests positive on a mantoux and has had to always have chest x-rays instead.

After thinking about our options and talking with our pediatrician, we have decided to hold off on starting any vaccinations in Canada and start him off the Japanese way. Hypothetically, he will be protected by my immunity anyway. I suppose that I will need to get my hands on  a Mother and Child Health Handbook (boshi kenko techo) when I get to Japan.

 We have not thought about this issue with Theo too much. At three years old he only needs two shots sometime between the ages of 4 and 6. We can always get them while visiting back home at some point in the next 3 years.