Nora Redulla M.D. - Pediatrician

28/03/2024

ARE YOU BUILDING? OR ARE YOU TEARING DOWN?

In medical school, I was so sure I would specialize in Internal Medicine. Then reality descended on me during my clinical clerkship and Postgraduate Internship. My heart ached when I saw patients suffering from chronic diseases and I would burst into tears when one of them died. That’s why I became a pediatrician. I focus on keeping my patients healthy from birth (even from conception, if I get to advise pregnant women). I tell parents that I want their kids to live until old age with no need for maintenance medications!

Vaccinations and access to clean water have prevented countless illnesses and saved millions of lives. Numerous social media warriors, conspiracy theorists, and various know-it-alls have been attacking vaccines for some time now. Who knows how many unnecessary deaths have resulted from their efforts?

In the early eighties, the government’s vaccination program was in its infancy. I always asked parents about their kids’ vaccination status, and it was common to get the reply, “Wala” or nothing. It felt like an uphill climb convincing them, one family at a time. One day, my husband (pediatrician Dr. Vidal Redulla) and I decided to produce mini-skits for radio broadcasts. It was my first and only foray into acting. With our 6-year-old daughter and another pediatrician, my good friend Dr. Janet Porcia, we taped scripted dramas about different diseases and the vaccines that could prevent them. Looking back, it makes me laugh how we used our little portable tape recorder and cassette tapes. Then we made the rounds of radio stations, successfully begging them to air the brief skits for free. Many listeners heard them. I am convinced that God blessed our efforts and many went to the health centers to get their children vaccinated.

The social media warriors, conspiracy theorists, and various know-it-alls are still at it. They did not help build, but they are zealous at tearing down. Please get your information from your physicians. If your physician is an anti-vaxxer, he/she needs to learn evidence-based medicine and review what he/she either never learned or forgot about. I guess I’m going to get bashed now!

27/03/2024

Reposting this with update

P is for Pertussis

I’ll never forget the babies I saw with pertussis. They would cough non-stop with their eyes bulging, not taking a breath until their faces turned blue. Their mothers would be terrified as they (and we) watched helplessly. Sometimes the coughing was so violent that blood vessels in the whites of their eyes would burst.

Some very young infants stop breathing for a length of time after a bout of coughing. This is extremely frightening. Many will vomit after a coughing spell. Some babies will have brain hemorrhage. Another cause for concern is that the illness lasts for many weeks, even with treatment. It used to be called the 100-day cough. In fact, bouts of coughing spells can occur throughout the first year of life after a baby has pertussis.

The word pertussis means intense or violent cough. It is also known as whooping cough, but most patients do not actually whoop. Early in the 20th century, 5 out of every 1000 children died of pertussis before their 5th birthday. Most were below a year old. By the middle of that century, pertussis vaccine had become widely given, usually together with Diphtheria and Tetanus toxoids (DPT).

Pertussis is extremely contagious. Like Covid-19, it can be airborne and is also transmitted through aerosol droplets. I am so grateful for the vaccine that put this disease under control. Unfortunately, with the fall in vaccination rates during the pandemic, this disease is having a resurgence.

Update your family’s DPT or TdaP vaccinations, especially if there is an infant in the home. Pregnant women should receive Tdap (Tetanus, Diphtheria, Pertussis), not just tetanus toxoid, to provide antibodies to the fetus before birth. This practice is called cocooning – surrounding babies with vaccinated household members because they are too young to be fully vaccinated.

Let’s make pertussis a disease of purely historical interest.

07/03/2024

Reposting this article I wrote in 2020:

As children, we all learned the rhyme:
Mother! Mother! I am sick! Call the doctor very quick!
Doctor, doctor, shall I die? No my darling, do not cry.

Indeed, we should call when we are sick; but it is even more important to visit the doctor when we, especially our children, are well. WHY?

1. DISEASE DETECTION

A trained physician does not just know how to diagnose and treat an illness; he or she can detect early signs of disease before you even notice them. Your pediatrician will monitor your child’s growth and development to allow early intervention when necessary.

2. DISEASE PREVENTION

Beginning at the birth of a child, parents must be guided on how to raise one who will have lifelong health. Breastfeeding, good nutrition, immunizations, and exercise are only some of the areas that every pediatrician must emphasize. I joke with parents that my goal is for their child to grow old without serious health problems. I say that their internists will think they are very boring patients!

3. HEALTH PROMOTION AND ANTICIPATORY GUIDANCE

Each visit should include discussions about how to promote health at every stage of the child’s development. Parents should ask questions if they have any. For example, care of the teeth, understanding of behavior, mental feeding, and accident prevention are essential aspects of child care and should never be neglected.

Trust is built over the years when there is a good relationship between a child and her pediatrician -- a trust that will extend into her teens and even way into adulthood!

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If you have any pedia-related questions, feel free to post a comment below!

01/11/2022

Sharing an article written by my daughter to help other moms

I'm not going to bombard you with a ton of mama and baby "MUST-HAVES" because Lord knows you can find enough of those online. I think you can actually do without most of the products that are recommended in those, especially since majority of them cost an arm and a leg. Not to mention

11/10/2021

24/08/2020

It always made my heart sink when a mother would come to my clinic saying that the infant in her arms was having vomiting and watery diarrhea (gastroenteritis). Little babies get dehydrated so easily and they usually end up in the hospital with intravenous fluids because the vomiting makes it so hard to hydrate them orally.

Isn’t it tragic that, every day, diarrhea kills more than 2,000 young children worldwide? In early childhood, the most important cause of severe diarrhea is rotavirus infection. Practically all children will be infected with rotavirus by the time they are 5 years old, even in developed countries with good hygiene and sanitation. It’s good if they get only mild diarrhea or if they are older. The most severe disease typically occurs among children 4 to 36 months of age. I remember the days when the pediatric wards were full of dehydrated babies and small children with IV fluids dripping into their veins.

The best way to treat rotavirus gastroenteritis is by preventing and treating dehydration. There is no benefit from giving medication. In fact, harmful adverse effects may occur.

Science has made a great contribution by developing safe and effective vaccines against rotavirus. Most cases of severe gastroenteritis can now be prevented. The first dose of rotavirus vaccine must be given at 6 weeks to less than 15 weeks of age. The last dose (2nd or 3rd, depending on the manufacturer) must be given before 32 weeks of age.

I like to tell my patients that this is one of my favorite vaccines because the effect was so obvious in such a short time. Pediatricians used to have numerous hospital admissions a year because of gastroenteritis. But in the 14 years since I started giving this oral vaccine to infants, I have had ZERO admissions for gastroenteritis among these vaccinated children. Isn’t that great?

10/08/2020

IS POLIO BACK AGAIN?

There was a family with 10 children, the youngest of whom was a 3-year-old who could only crawl around their hut. It was my community medicine rotation in the hills of Naga, Cebu. Months before, the nearby health center had urged parents to get their children immunized against polio because of an epidemic. The zone leader, Nang Narit, stopped by that hut to inform the mother, who scoffed and said that none of her children had been vaccinated and they were all healthy. She would not allow Nang Narit to bring even the youngest child to the health center. Tragically, the little boy got polio. He must be in his 40s now, severely disabled.

During my pediatrics rotation, I admitted and monitored a 1-year-old baby whose polio affected the breathing center in his brain. He died.

Closer to my heart is my 76-year-old brother who developed polio when he was 4 years old, before the polio vaccine was developed. He walks with a bad limp and often has to use a wheelchair.

Poliomyelitis or polio is an ancient disease that crippled hundreds of thousands of children every year until effective vaccines were discovered in the 1950s. The world came together in the 1980s to bring about the eradication of this now preventable disease and reduced the global incidence by 99%. The only way to do this was by consistent and widespread vaccination with oral or injectable polio vaccines.

I remember our national polio eradication campaign when the late Dr. Juan Flavier was our Secretary of Health (1992-95). He talked about the heroic municipal and barangay health workers who fanned out to the remotest areas of the country to administer polio vaccine. A few workers even died in accidents. But the success story is that the Philippines was declared polio-free in 2000. However, because of the decline in vaccination rates, this disease is happening again.

Our country was doing so well in the fight against this crippling disease. Let’s make the Philippines polio-free again by having all children completely vaccinated!

13/07/2020

T is for Tetanus

She was an 18-year-old single mother who had just watched her newborn baby die a painful death because of tetanus. My heart ached for her. In those days, many women delivered their babies at home, assisted by a traditional birth attendant or hilot, often in unsanitary conditions. Newborns could get tetanus through the cutting of the umbilical cord. Now the Philippines has virtually eliminated neonatal tetanus. How? Better birthing conditions certainly helped, but a major factor is tetanus vaccination of women of childbearing age. Protection against tetanus is transmitted to a baby in her mother’s womb.

We often associate tetanus with a wound caused by a rusty nail, but rust has nothing to do with it. The germs that cause tetanus are found in soil and in the intestines of various animals. Rust simply means that the object has been exposed outdoors and is therefore likely to be contaminated. Animal bites, tooth abscesses, burns, and other factors can also lead to tetanus.

The tetanus germs produce a very powerful toxin that is absorbed into the nervous system. The patient will suffer the following:

• painful and often violent muscular contractions throughout the body
• spasms triggered by sounds, sights, touch
• other nervous system abnormalities

The worst part is that the patient remains conscious and aware of what is happening to him!

Tetanus is a totally preventable disease. The vaccine or toxoid is given together with other vaccines as DPT. Five childhood doses and a dose in adolescence will maintain immunity. After that, protection can be kept up with a booster every 10 years. If you have documented complete immunization, there is no need to get a tetanus shot for wounds.

There were still 690 reported deaths from tetanus in the Philippines in 2018. With the availability of vaccination, this is unacceptable. Let’s make this zero!

03/07/2020

P is for Pertussis

I’ll never forget the babies I saw with pertussis. They would cough non-stop with their eyes bulging, not taking a breath until their faces turned blue. Their mothers would be terrified as they (and we) watched helplessly. Sometimes the coughing was so violent that blood vessels in the whites of their eyes would burst.

Some very young infants stop breathing for a length of time after a bout of coughing. This is extremely frightening. Many will vomit after a coughing spell. Some babies will have brain hemorrhage. Another cause for concern is that the illness lasts for many weeks, even with treatment. It used to be called the 100-day cough. In fact, bouts of coughing spells can occur throughout the first year of life after a baby has pertussis.

The word pertussis means intense or violent cough. It is also known as whooping cough, but most patients do not actually whoop. Early in the 20th century, 5 out of every 1000 children died of pertussis before their 5th birthday. Most were below a year old. By the middle of that century, pertussis vaccine had become widely given, usually together with Diphtheria and Tetanus toxoids (DPT).

Pertussis is extremely contagious. Like Covid-19, it can be airborne and is also transmitted through aerosol droplets. I am so grateful for the vaccine that put this disease under control. Unfortunately, with the fall in vaccination rates during the pandemic, this disease is having a resurgence.

Update your family’s DPT or TdaP vaccinations, especially if there is an infant in the home. Pregnant women should receive Tdap (Tetanus, Diphtheria, Pertussis), not just tetanus toxoid, to provide antibodies to the fetus before birth. This practice is called cocooning – surrounding babies with vaccinated household members because they are too young to be fully vaccinated.

Let’s make pertussis a disease of purely historical interest.

24/06/2020

During my internship and pediatric residency in the early 1980s, I encountered cases of a terrible infectious disease: Diphtheria.

In those days, the government’s immunization program was in its infancy. Most children who did not have private physicians were unimmunized. I saw babies noisily gasping for breath because of the obstruction of their airways by a thick coat of pus and dead tissue. Their neck lymph nodes were often so enlarged that this finding was called a bull neck. Sometimes we had to do a tracheostomy – an operation to slice open an airway in the neck to allow them to breathe. Not only that, the diphtheria bacteria produces a toxin that affects the heart and the nervous system.

To summarize, these are the worst effects of diphtheria:
• Obstruction of the airway
• Paralysis of the pharynx (throat)
• Damage to the heart muscle
• Damage to nerves

Antibiotics can kill the germs that cause diphtheria, but it is the toxin that causes the most harm. Antitoxin must be given as soon as possible before the toxin can enter the cells and damage the heart and nerves. We used to have stocks of this in the hospital pharmacy. But now that diphtheria has become uncommon, it is important to know that DIPHTHERIA ANTITOXIN IS NOT AVAILABLE ANYMORE except through the WHO. Therefore, if your child gets sick with diphtheria, it is unlikely that her physician will be able to administer the Diphtheria Antitoxin in time.

In a 9-month period in 2018, there were 122 reported cases of diphtheria in the Philippines, with 30 deaths. These had increased to 167 cases and 40 deaths in the same period in 2019. The vaccination rates in the country are dropping. Because Diphtheria germs can be transmitted by apparently healthy carriers, we will soon see a resurgence of this horrible and deadly disease.

Why risk losing your child to diphtheria when there is a vaccine (DPT) available?

16/06/2020

WHY SHOULD I HAVE MY CHILD VACCINATED?

Have you attended birthday parties where the celebrant is not aware of the festivities and even asleep because he is only 1 year old? In many cultures, a baby’s 1st birthday is cause for much rejoicing because, throughout most of human history, it was common for babies to die before that milestone.

As a child, when I told people that I was one of 9 children, many would ask if all my siblings were alive. My best friend, the 11th of 13 children, would get upset when asked the same question. Why the curiosity about the siblings’ survival? It was much later that I learned that there had been a time when almost half of babies did not survive to reach adulthood.

• In the year 1900 when health records were already being kept, global infant mortality (the number of babies who died before reaching the first birthday) was 165 per 1000 live births.
• In 2017, that had dropped to 29 per 1000 -- quite an achievement, although it needs to be reduced more.

So why the improvement in survival? Clean drinking water, improved sanitation, and better nutrition certainly played major roles. However, there was another important contributor: WIDESPREAD VACCINATION PRACTICE. It is thus a cause of great alarm for the health professions that there are campaigns to stop vaccinations.

I am old enough to have seen in my professional life patients with the following diseases:
• Diphtheria
• Whooping cough
• Tetanus
• Poliomyelitis
• Bacterial and tuberculous meningitis
• Measles and other infectious diseases

Young physicians rarely see these now, if at all, because of the vaccines that are available. Definitely no one wants to see them again, but they will surely return to plague the human race if the anti-vaxxers have their way.

This is the first of a series of articles about vaccines and the infectious diseases that they prevent.