Natural health and family

Toy puppy joining in with sleep-time bubu

My  amenorrhea has sadly ended. I should count myself lucky, however, as I have enjoyed 27 period-free months (9  months of pregnancy followed by 18 months of amenorrhea). That was even longer than after the birth of my first son, when I didn’t get my periods back for 16 months.

This is just another great benefit of breastfeeding, as it helps delay the resumption of periods after pregnancy. How long for, though, depends on each individual. Some women who breastfeed exclusively, day and night, get their periods back after only a few short months, while other women cut breastfeeding right back in the hope of getting pregnant again but have to wait for many more months before their period returns.

On average, however, breastfeeding will delay the return of your period for around 14 or 15 months and is nature’s way of ensuring some spacing between children. Dr. Herbert Ratner* said a baby’s sucking controls the mother’s ovulation. The more the baby has a need to suck, the less ready he is to be displaced by another. The less baby has a need to suck, the more ready and able he is to cope with a new brother or sister.

Even better, many scientists believe a long period of lactational amenorrhea may help explain the lower rates of ovarian, endometrial, and breast cancer found in women who breastfeed.

In hindsight, there were some signs that my dreaded periods were returning last week. Oli declared that my milk was ‘yucky’ and would pop off almost right away. I was hoping that he was starting to wean himself off the breast, but unfortunately no. Apparently the milk is delicious again. Also, Charlie has been breastfeeding A LOT these last few days. I was actually getting quite annoyed at how demanding he’d become and was thinking it was time to place some limits on Charlie’s breastfeeding - I do need a break sometimes!

But these are two common signs of upcoming menstruation caused by changing hormones - the milk changing taste (Oli’s reaction) and lower supply (hence Charlie wanting to breastfeed more).

It’s actually been so long since my last period that tampons have now advanced in design. There I was, trying to find the little tab to rip the plastic off, when I discovered that these days you actually ‘twist’ the cover off. I quite like this new idea. One bright spot in my loss. 

* www.llli.org/NB/NBSepOct06p196.html

This evening Charlie came to me and asked me to change his nappy. So I happily followed him to the bedroom and took off his still-quite-dry nappy and put a new one on. But a few minutes later he was back on my lap complaining about his nappy. I checked that it was adjusted properly but nothing seemed to help, so David and I took Charlie’s nappy off and noticed his penis was swollen on one side and quite red. When we touched it Charlie cried – so it was obviously sore.

David did a quick Google and found that it could be an infection that requires antibiotics, so he quickly called the doctor and we had 10 minutes to get there before they closed! 

At the doctors

The doctor asked Charlie to lie down on the bed and Charlie did so without complaint. I was quite impressed that Charlie co-operated as the doctor took a look at him and said, ‘Charlie is such a good boy!’ and that set Charlie off and he started crying. 

I went to hold his hand and tried to re-assure him and he continued to lie there even though he was now a bit upset. Bad move on my part! Just shows that kids do what you expect them to do i.e. be scared of doctors, not what you tell them to do. I should have just acted normally, like I expected Charlie to not be scared of the doctor.

The doctor said Charlie had a skin infection and needed antibiotics, but said it should clear up quickly because we had caught it so early.

Here’s your medicine, Charlie!

We went straight to the chemist and bought Charlie’s medicine – which we have to give him four times a day. We weren’t quite sure how to entice Charlie to take the medicine, but I did remember that after lots of trial and error, we managed to get Oli excited about taking his medicine when he was about the same age as Charlie is now.

Attempt no 1.

First we filled the syringe with the dose and asked Charlie if he wanted to drink it. He smelled it but kept his mouth closed. We coaxed him but Charlie kept resisting. Then David pried his mouth apart and shot the medicine in. Not only was Charlie in shock (as well as Oli – so both of them start crying terribly), but most of the medicine was lost on Charlie’s jumper. Not a good plan…

Attempt no 2.

Once the boys settled down our next idea was to give Charlie the medicine in a cup so he could drink it himself. Once again, I tried to encouage him to drink it. Charlie would put the cup to his lips with a cute smile but refuse to open his mouth. David tried to catch him out by giving him drinks of water, but then when we try again with the medicine Charlie says no.

Attempt no 3.

David thinks mixing the medicine with lemonade might do the trick, but Charlie takes the cup and tips it all over the kitchen floor!

Time to regroup

David is now quite frustrated and Googles how to give medicine to toddlers (as you do!). He tells me some guy wrote that the only way he managed to do it was by tipping his son upside down and forcing the medicine in his mouth. I wasn’t keen on this at all, particularly as we need to do it four times a day for a week. I get out my journal and try and find out how we got Oli to drink his medicine. Luckily, I find the entry and read all about how Oli had refused his medicine even though we tried all the same techniques we used with Charlie. Then, after much research, I found a way to get Oli to drink his medicine. We simply put it in a cup on the table and got all excited about Oli drinking it. When Oli drank it we clapped and laughed and gave him big hugs. He took the rest of his doses happily and without a problem. We decided to try this approach with Charlie.

Attempt no 4.

I set the scene by asking Charlie whether he wanted to try to drink his medicine again to help make his penis better. Charlie kind of gave me a half nod with a cheeky smile, so I decide I may as well try.

I measure the medicine into a small cup and put it on the table in front of Charlie. Then David and I both get super excited about Charlie taking a drink.

“Have a drink Charlie!”

“Yay Charlie, take a drink to make your penis better!”

A bit of excited cheering and clapping.

Charlie picks up the cup.

“Good boy Charlie. Come on, have a drink! Yay Charlie, good boy”

Lots of clapping, laughter and happy, excited cheering.

Overwhelmed, Charlie takes a drink.

“Yay Charlie! You had a drink!!! Was it yummy?”

Charlie nods his head, ‘yes’. Lots of clapping and cheering. I give Charlie a hug and notice there is still a bit of medicine left.

“Look Charlie. There is still a bit more left. Drink your medicine Charlie!”

Charlie drinks it all up and asks for more!

Now I have to disappoint him.

“That’s all for now Charlie. You can have some more later.”

Foolproof!

After the super-fast and issue-free birth of my second son, Charlie, I am seriously contemplating having my third baby at home (that is, if I am lucky enough to have another!). However, new legislation in Australia may mean I won’t have that option.

This month new laws have come into place that require midwives to have indemnity insurance to practice under the National Registration and Accreditation Scheme (NRAS). However, midwives cannot be insured for home deliveries, effectively ruling out homebirth as an option for women who want a midwife present. 

Due to the obvious concerns about this legislation, homebirth is subject to a two-year exemption period from the NRAS insurance requirements. However, what will happen after that?

Limiting women’s birthing options is unthinkable!

I haven’t really been concerned about the lack of homebirthing as an option, as I can’t honestly believe that the government will follow through with this legislation. I feel I have some standing in my view by the fact that there is a two-year exemption for homebirthing. I expect that before the two-year exemption runs out, there’ll be another exemption or changes to legislation or something. I can’t believe that in two years time homebirth will be unavailable – leaving either the two extremes of hospital birth or free birth as viable options. I hope I am right.

Why I want to homebirth?

I’ve never been keen on birthing in a hospital and wasn’t confident enough to birth at home (plus I wanted to avoid paying $5,000 to hire a homebirth midwife because I wanted to save as much money as I could to maximise the time I could spend with my baby before going back to work ). So when I first became pregnant I booked into a birth centre, which seemed like the best place for me.

Unfortunately towards the end of my pregnancy I discovered the birth centre was ultimately under the thumb of the hospital in which it was located. In the end I may as well have just booked into the hospital with all the negative elements it presents to pregnant and birthing women (pressure for induction at five days post dates? How ludicrous!).

During my second pregnancy I wanted to book into an independent birth centre that wasn’t run by a hospital. It was a 25 minute drive away from my home, but I thought that was preferable to birthing at the hospital again. The birth centre admitted me after reviewing my medical history (I had minor complications during Oli’s delivery) and were of the view that it was safe for me to birth with them. My midwife was fantastic. Not only did he support my views, he was on call 24 hours and would be the only person I would have to deal with.

 A few weeks later I received a phone call saying I would not be able to birth at the birth centre, as all admissions are screened by the hospital – the very hospital I was trying to avoid – and the hospital decided I was too ‘high risk’ to birth at the birth centre. I was fuming but didn’t feel I had many options. I looked into homebirth but the expense, plus the new fears my first delivery had instilled in me, put me off the idea.

As it turned out, my second birth was super-fast with absolutely no complications. It was perfect, wonderful and just how I would have wanted it (so much for the hospitals over-blown assessment). The experience provided me with confidence in my birthing ability, making it possible for me to contemplate birthing at home. But the biggest reason I am keen to birth at home is because instead of enjoying my labour I was crazily rushing to get to the hospital, arriving just before transition, with my baby being born just 20 minutes later! Even though I started getting ready to go to the hospital as soon as my waters broke (I timed the first three contractions and they were already 3 minutes apart) it was a hectic, mad rush and I am worried that next time I may not make it and end up birthing in the car!

Will freebirthing be my only option?

I don’t want to contemplate freebirthing, but even more so, I don’t want to contemplate birthing by the side of the road. So if homebirth is illegal the next time I fall pregnant, what options will I have? 

Although homebirth is not a popular option (less than 1% of Australian births take place at home) it does not mean it should not be an option. I also agree with Homebirth Australia secretary, Justine Caines, who says that home birth would probably be more popular if it was an easier option. I imagine that if homebirth was supported by the government the way birth centre and hospital births are (widely available and provided for free) than I may not have had such reservations about it the first time around.

When I was preparing for my first birth I did a lot of reading. Luckily one of the first books I read was Misconception by Naomi Wolf. This book introduced me to the politics of birth. After this I decided to do everything I could to have a natural birth.

Planning for a natural birth

I did a hypnobirthing course, doing the meditation exercises religously each night and having my partner practice his role in the birthing process several times a week (which involved practicing the visualisations with me and giving me massages). I read positive birth stories. I avoided the pre-natal information provided by the hospital, as I was informed that it was too focussed on a medicalised birth. I disregarded negative comments people made about birth. I booked into a birth centre for my birth, rather than the hospital (even though they were in the same building, I was under the impression that they were separate institutions…a little misguided of me!).

Why can’t I birth like my grandma did?

However, as positive as I tried to remain, the massive 30% cesarean section rate kept staring me in the face. And the rate was increasing each year. I couldn’t understand why this was so. Why couldn’t I birth like my grandma did? My grandmother, who lived in a small farming village in Poland, gave birth to three children at home. No complications, no worries at all.

During one of my regular appointments with the midwives at the birth centre I asked why birth was such a medicated process, why were there so many complications and why the high cesarean rate. I was told it was because women didn’t move around enough. We had become sedentary creatures and our bodies were not strong enough to birth the way nature intended.  Today I came across an article that pretty much makes the same point www.katysays.com/2010/03/30/the-hunting-and-gathering-mama/.

Trying to get physical

I thought this was probably as good an explanation as I was going to get, so I started a pre-natal yoga class, walked to work (a good four kilometer walk. It took me over the Sydney Harbour Bridge, so very enjoyable at the same time!) and squatted my way to birth.

My natural, but not so healthy, birth

Unfortunately this was not enough. While Oli’s birth started well, it all went a little wrong after transition. The midwife noticed my baby’s heart rate was dipping and thought the best thing to do was break my waters. When she did this she saw meconium and so I was wheeled off out of the birth centre and into the hospital across the corridor. After an hour or so of horribly painful pushing, my son was born – not breathing. He’d had shoulder dystocia, which is when a shoulder gets stuck in the mother’s pelvis, although I thought it had more to do with the fact that I was forced to push him out on my back due to his low heart rate. He was resuscitated and all was well after that, until he developed newborn jaundice. We had to put him on a bilibed, which meant he was stuck lying alone on a plate of glass for 24 hours. I was only allowed to feed him every four hours. Because my milk hadn’t yet come in there wasn’t enough to hydrate him so he was given formula.

Why?

I was glad when I could finally take Oli home, but after idealising what my birth would be like I was very angry at all the complications. Why, after educating myself, focusing on a positive experience and doing all I could to have a healthy and natural birth, did all these things go wrong? I went through the details over and over, trying to work out what had caused the problem. I even went back to the hospital to ask my midwife what had happened, but she didn’t have any answers. She just said I had done extremely well and shouldn’t feel upset about my experience.

In the end I blamed my baby! All was going well until Oli became distressed during transition. I guess I’ll never know why and I am now at peace with that. What really helped me get over it was the wonderful intervention-free, perfectly natural and easy birth I had with my second son. It was so perfect I am now very confident to have a home birth the next time (disclaimer – if there is one!).

The other morning I took my two boys to a playgroup where I met one of my friends and her son, who is one of Oli’s good friends.  

The two boys were off playing together for nearly the entire time. Charlie was having ‘one of those days’ (he was a little grumpy and at night I noticed one of his cheeks was hot and red – teeth???). He stuck pretty close to me most of the time, although he did run off to play or explore every now and then. However, he would often end up running to me crying for one reason or another. I would pick him up and when he felt better he would ask to be put down again and off he’d go again.

Charlie is rescued

While Oli and Charlie were off playing I was chatting with my friend. Then a woman came towards me, with a crying Charlie in her arms. I took him and thanked her. It must have looked like I wasn’t being sufficiently attentive to my baby. 

However, I consciosly don’t go to help Charlie when he gets into difficulty (unless of course he is stuck or in some kind of danger). I have never been one to hover over my baby – I much prefer for my boys to run off and do their thing while I hang back and watch, preferrably while engaged in adult conversation or reading an interesting book. This is one of the reasons I was strongly attracted to the book, The Continuum Concept, by Jean Leidloff. After reading this book I realised my lack of interest in following my baby around while he played was quite justified.

What Leidloff writes

The way the book describes it, the mother (or other trusted care giver) is a stable source of security for her baby. The baby runs off to explore and when he needs reassurance he runs back to mum in the knowledge that she will be ready to attend to him ‘if he asks’ for attention. This allows the baby the freedom to explore and build confidence, with the full knowledge that mum is exactly where he left her and he can go to her at any time. In an interview, Leidloff explicitly said not to go to your baby when he cries, but to let him come to you. To make the point she jokingly added that you are allowed to go to your baby if he has broken legs.

Charlie ‘checks-in’

I have embraced this philosophy, as it really fits the way I like to parent. After reading the Continuum Concept I understood how to meet my baby’s needs for security and independence and my own needs for adult interaction and persuing my own interests. I starts when your baby is born. You hold your baby constantly – giving it total confidence in your love and presence.

Eventually your baby will be ready to leave your arms. Charlie started doing this at around five months. He would sit on my lap and wriggle around, asking to be put on the floor next to my feet. There he would sit and then not long after would ask to be picked up again. As Charlie got older he started crawling away from me and would then come back. Eventually he learned to walk, and would go off further and further for longer and longer periods of time. Each time he would return to me – and I would embrace him – reaffirming to him that I was there whenever he needed me.

I loved watching this play itself out when we were out. Charlie would run off to play and then run back to me to ‘check in’ on a regular basis. He would come up to me, ask to sit on my lap, maybe have a five second breastfeed, and then would immediately jump off and get back to playing.

So that is the philosophy behind the fact that I appear to be a neglectful mum! And while some people may not think so, I am sure many do. There have been several incidents when I have waited for Charlie to come to me, but before Charlie even had a chance to think about what he needed, a well-meaning person would ‘rescue’ him and either help him out or hand him to me. They must be thinking, ‘why isn’t she taking care of her baby?’

Scott’s article

I decided to write this blog today because I came across an article by Scott Noelle, who offers parenting advice based on the Continuum Concept philosophy. Scott wrote:

“If you realize you’ve been a compulsive “rescuer” — inadvertently blocking the development of your child’s ability to seek and find comfort — then I suggest a gradual transition from reactivity to availability. When your child is upset, focus immediately on attuning and opening your heart to her, but wait a bit before overtly offering help. See if she will come to you on her own. Give her opportunities to rediscover and enhance her comfort-seeking abilities, but don’t hesitate to offer comfort immediately when your intuition is that she needs you now. Babies especially need immediate comfort, which is one reason why they instinctively prefer to be in direct physical contact with a familiar caregiver, 24/7.”

You can read the full article here http://www.scottnoelle.com/parenting/child-centered.htm

Today was one of my two weekly work from the office days. Usually when I am away for the day and finally come home Oli greets me with an excited, ‘boobas!’ and then can barely contain himself while we get settled for a breastfeed.

So today after coming home from work I got changed and waited for my boys to come home, as they were taking a walk with their grandma. I didn’t have to wait long before I heard their excited voices (I guess they saw our car parked outside) and then before I knew it they burst into the kitchen with happy faces.

I was waiting for my usual greeting from Oli, but instead he said, ‘look, I have a pump!’ handing it too me and telling me about how his grandad had helped him pump up his balls and bike tires. Now that the exciting news was out of the way, I was waiting for him to ask me for a breastfeed, but it didn’t happen.

Wow…I never imagined this day would come. I absolutely am glad that I am still breastfeeding Oli, but he does demand quite a lot of me. In fact, I have to limit his breastfeeds to only three times a day as he would gladly have many more. It has been an interesting experience breastfeeding Oli throughout pregnancy, when it became quite painful, and then after his baby brother was born. Suddenly I felt the need to push Oli away and we had quite a few difficult month where Oli wanted much more than I could give. We have now reached a happy compromise of three feeds a day. While I am happy to continue breastfeeding Oli I have been waiting for the day that he lets go a little more…and today was such a milestone. 

He did end up having his regular feed in the evening and I was more than happy to give it to him. But I am also looking forward to more days like today, when he can greet me with something other than ‘boobas!’

This morning Oli was being very challenging. David was getting the boys ready to take them to story time at the library, but Oli refused to get his clothes on and was just generally trying to annoy his dad.

After a while of this David had had enough and exclaimed, ‘if you don’t settle down I’m going to get the belt out!’

Of course, Oli had no idea what other uses a belt might have than holding up some one’s pants.

He sat still on the bed, with a worried face and quietly said, ‘I don’t want to wear a belt’.

I told David what Oli had said and David’s heart immediately softened and he told Oli, ‘wearing belts is not so bad. Look, I’ve got a belt on!’

Apparently, if you don’t lie you are a social misfit. Having always prided myself on being more honest than not, this idea is quite challenging!

The book, ‘The liar in your life’ by Robert Feldman makes some other fascinating claims. Apparently people tell an average of three lies every ten minutes. Who would have guessed? Luckily, most of these lies are pretty minor, such as:

• our dry cleaner telling us it was a pleasure to serve us as he hands over our clothes
• pretending you enjoy the same type of music as someone you’re trying to impress
• saying that you know where an obscure town is so as not to interrupt the flow of a conversation by having to listen to useless directions.

Feldman argues such lies are necessary for a pleasant society and people who use these types of lies the most usually are very successful socially. I guess that makes sense. I remember once I was having lunch with a friend and she mentioned a particular singer she liked. I said I wasn’t fond of that type of music and my friend took offence and our lunch ended quite abruptly. On the other hand, there was a girl I once knew who kept giving me Greenday tapes (she loved them). I couldn’t stand Greenday and never listened to the tapes, but I never told her. As a result we remained good friends. 

How children lie

What I found really useful about this book was the study of how lying develops in children. Most of us are probably not happy when we notice our children are lying to us, but the book suggests we should be estatic – it means they are developing normally and will be very socially successful adults. We should instead run to the doctor if our children consistently tell the truth, as this is a sign of mental developmental problems.

“…most children lie. Lying is not limited to any particular demographic…Children from upper-class, middle-class, and lower-class backgrounds lie. Girls lie as well as boys. Children at all IQ levels lie. And children of all cultures lie; there is nothing about modern Western society that induces more dishonesty than that found in children in the developing world or in Eastern cultures,” Feldman writes.

Apparently psychologists have found that verbal lies start in most children around the ago of three (yes, Oli fits the bill perfectly so far), though sometimes it can start at age two. Lying typically accompanies children’s understanding that parents have rules and there are punishments associated with breaking them. The first lies are almost reflexive attempts to avoid punishment (in fact, that was the exact situation of Oli’s first lie. See my blog (http://naturalhealthandfamily.com/?p=519). These first lies can be quite unsophisticated. For instance, a three year old will claim, ‘I didn’t do it,’ even in the face of clear evidence that they did.

Feldman says lies become more nuanced around age four of five (yay, something to look forward to!). ‘I didn’t do it,’ becomes, ‘the dog did it.’ It is also at this age that children begin to tell social lies. This is good to hear, since the other day when Oli was leaving his grandma’s house he waved bye-bye and said, ‘bye bye boring grandma’.

By kindergarten most children start to engage in flattery. For instance, in an experiment where children provided their opinion of drawings, with the artist present and with the artist absent, three year olds didn’t alter their judgement, whereas the five and six year olds praised drawings more when the artist was present.

‘In less than three years, they move from basically transparent attempts to escape blame to subtle maskings of their true opinions that reference the sensitivities and egos of others…the older children get, the better they are at lying, to the point where eventually their lies become indiscernible from the truth…children grow into lying, learning to become more thoughtful and more nimble liars as they make their way into young adulthood.’

At least Oli is developing appropriately!

That does make me feel better about watching Oli come out with more and more lies. Recently he has been coming to me, holding something behind his back. Then he’ll say, ‘I have a surprise! It is a ball!’ and then he’ll pull out something completely different, like a shoe. He finds it very amusing. I usually react by laughing along at his little ‘trick’. Sometimes when I tell him not to do something and he wants to do it anyway, he’ll tell me, ‘don’t look at me’. It is a dead giveaway that he’s planning to be naughty, but once again, a healthy sign, according to this book.

This morning I went to another pilates class. I have never enjoyed pilates as much as I do now! It lets me focus on myself for an hour, lets me stretch out and lets my blood flow. I feel great afterwards.

While we were all waiting for the class to start a woman near me was talking about her baby daughter. She said that the other night, when she put her baby to sleep, her daughter wouldn’t sleep and cried for ages, but she said she didn’t go to her because, ‘we do the close the door and leave thing. If you go to them then you’re creating a rod for your own back.’

She said her baby eventually went to sleep but woke up screaming again at 11pm and again at 1am. By then she said she was getting worried, as her daughter didn’t usually wake up during the night, so she decided to go in and check on her. When she found her daughter she had a 40 degree fever, so she took her to the doctor and it turned out that she had an ear infection.
 
“I’m such a bad mum!” she said. “I won’t do that again or people will start calling DOCS.”
 
I couldn’t really look her in the eye after hearing her story. I just don’t understand why people think that attending to a crying baby is a ‘rod for your back’. Is not having a baby itself a ‘rod for your back’?Who decides which activities are rods and which activities are not? Why is getting up at night when your baby cries or breastfeeding your baby to sleep or on demand a rod, but having to change pooey nappies, giving baby a bath, making baby lunch not a rod? If anyone can explain it to me that would be great, but at this point I don’t really have much respect for this argument, and every time I hear it, my blood pressure rises!

Only a few weeks after the Rotavirus vaccine was withdrawn, today I read in the paper that the seasonal flu vaccine has also been withdrawn from being given to children under age five due to bad reactions.

(http://www.smh.com.au/national/reactions-halt-flu-shots-for-children-20100423-tj3s.html)

The medical profession continues to profess that vaccines are safe (or at least safer than the disease they are trying to prevent) but maybe the anti-vaccine lobby has a valid point.

Apparently 60 children have suffered fevers and convulsions within 12 hours of receiving the flu vaccine. Even more scary is that the director of infectious diseases and microbiology at Canberra Hospital, Peter Collignon, said adequate data was unavailable for the seasonal flu vaccine. The vaccination lobby is so keen to vaccinate everyone that they don’t even ensure the vaccines are adequately checked first.

When I was getting Charlie vaccinated for the first time a lady was walking around asking whether we wanted to give our babies the flu shot as part of testing. I think Charlie was too young at the time but even if he had been old enough there would be no way that I would have consented. I have vaccinated against the scary stuff -tetanus, polio and for better or worse, the less scary stuff, like rotavirus, but I have stopped short at the non-scary stuff, like chicken pox and the flu.

Now that two vaccines have been withdrawn in only a few weeks, I have moved that little bit closer on the side of the anti-vaccination lobby.

And to make matters even more interesting, a recent study conducted by the Cochrane Collaboration (http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004879/pdf_fs.html) into the effectiveness of influenza vaccines in children found that:

• in children aged from two years, nasal spray vaccines made from weakened influenza viruses were better at preventing illness caused by the influenza virus than injected vaccines made from the killed virus, which only prevented 59% of cases
• in children under the age of two, the efficacy of inactivated vaccine was similar to placebo.

And not surprisingly following today’s headlines, the study found it was not possible to analyse the safety of vaccines as very little information can be found on the safety of inactivated vaccines in young children.

You have to ask why the government is pushing flu vaccines on children under age two, when they are no better than a placebo, and why they are using injections when a nasal spray is more effective.