Saturday, December 5, 2009

A Bit of History That Gives Me Chills

Yesterday one of my favorite bloggers, The Unnecesarean, posted an excerpt from a history text about birth in the early 20th century. The excerpt presents the practice of putting women under "twilight sleep" for labor and delivery as a way to convince WASP women to have more babies because "modern" birth practices render it painless-- or at least without the memory of pain. I had never heard of this racist/classist perspective of twilight sleep before. But it got me thinking, especially since I recently read that the tv show Mad Men featured a character giving birth within the haze of twilight sleep.

I can't remember the first time I heard about women being "put under" to have their babies- it was probably as a child or teen. Until a few years ago, I guess I thought it was a benign but clumsy attempt to spare women the pain of birth. No big deal. But then I happened to see "The Business of Being Born, " a documentary by Ricki Lake that covers a little bit of the history of birth in the US. The historical aspect was eye-opening, to say the least. When you start to think about the fact that this is the way many of our parents came into the world (and maybe even some of us, considering twilight sleep was prevalent well into the 60s and even the 70s in some hospitals), it can be downright scary.

Beginning in the 1900s, a combination of scopolamine and morphine was administered to all women entering the hospital for birth. Women had no recollection of the birth, and certainly no recollection of any pain. Feminists heralded this as a fantastic medical breakthrough, and demanded its widespread availability for birthing women. As word spread of this wonderful new pain-free way to give birth, women across the country chose to deliver in hospitals offering twilight sleep. In fact, there are reports of women being put under for delivery whether they wanted it or not, even against their own explicit refusal. But since women had no recollection what actually happened during their births, and husbands at that time were not part of the birth process, it was years before the true horror of twilight sleep was exposed.

Since the women were not fully sedated, and not fully relieved of the pain of labor, they had to be placed in restraints in their hospital beds so as not to thrash themselves onto the floor. When husbands started questioning the marks on their wives' wrists and ankles left behind by the leather restraints, the practice of restraining was not abandoned. Instead new restraints made of lambswool were designed so as not to leave any marks. Women were left, tied down, to writhe through their labors until the doctor arrived with forceps to extract the baby. (See photo at top.)

When the effects of the medicine wore off, women were presented with a freshly bathed, blanketed bundle of baby. Some women complained of feeling detached from their babies, like they weren't even sure it was their own child. The drugs also crossed the placenta and often sedated the baby, resulting in breathing problems. Over time the method was eventually abandoned, as a result of the negative side effects and the second wave of feminism. As women reclaimed control of their reproductive lives, including access to birth control pills, they also began increasingly demanding unmedicated births and fathers' involvement in births. The development of epidural anesthesia also played a role in the demise of twilight sleep.

Maybe it's my own personal bias against hospitals, but the thought of literally being dropped at the door of the maternity ward by my husband and literally having no recollection of anything else until being handed a baby two days later utterly horrifies me. I don't think the method would have taken off if husbands had been allowed in- I cannot imagine any man permitting such barbaric practices to be visited upon his wife. But they didn't know, so they couldn't help.

There was (and I think there still is) a certain mystique around birth: We don't know exactly how labor starts, and can't predict when it will happen. Regardless of a mother's weight gain or belly size, we don't know the size of the baby until it's born-- even ultrasound measurement can be off by a pound or more in either direction. This mystique allowed generations past, and still allows many people today, to maintain a certain degree of ignorance about birth. It's very easy to assume that the doctor has all the knowledge, the hospital has all the equipment, so all the expectant parents need to do is show up when it's time. I think that is a dangerous attitude. The same people who wouldn't hesitate to seek a second opinion from a doctor who said they need a heart transplant... the same people who would consult with three different orthopedic surgeons about a knee replacement... don't think twice about their choice of care provider, birth place, or pain management options. I could write a whole other post on the topic of informed birth choices... But suffice to say for now, If you don't know your options, you don't have any.

Friday, November 20, 2009

Vitamin D Confusion

Until recently, I'd never given vitamin D much thought. I mean, rickets? Isn't that a disease that pirates and other seafarers got, along with scurvy and beriberi? It seems like every time I turn on the news lately, vitamin D deficiency is linked with other health conditions, such as cardiovascular disease, prostate cancer, diabetes, depression, even H1N1 influenza. The problem isn't limited to adults, either. New research has indicated that children are vitamin D deficient as well.

It's possible we've taken the "safe sun" message too much to heart. We've become so accustomed to slathering on sunscreen every time we step outside that we're blocking our bodies' natural vitamin D production from the UV light of the sun. Ironic that by trying to prevent one disease, skin cancer, we've potentially put ourselves in the path of other diseases.

The NIH recommends 400 IU of vitamin D supplementation for adults, assuming an individual is not synthesizing any vitamin D from sunlight. But is that enough? Recent evidence makes the case for higher amounts, up to 5000 IU per day. There is also a case for modest sun exposure, 5-10 minutes of full sun (without sunscreen) on the arms/legs/face, 2-3 times per week. But the amount each individual needs varies based on age, race, time of year, and latitude. So how to know if you're getting enough?

I was surprised to learn recently that a simple blood test can tell you if you're getting enough vitamin D. (And with my annual physical coming up in a couple of weeks, I'm definitely asking for my D to be tested as part of my labs.) If you'd like to ask for it too, it's the 25-hydroxyvitamin D test, also known as the 25(OH)D test. Note: This is different from the 1,25-dihydroxyvitamin D test [1,25(OH)2 D], which will not give an accurate portrayal of vitamin D status. According to the Vitamin D Council, a healthy level is 50-80 ng/ml, which should be maintained year-round.

Another bit of information of note: Athletes may need more vitamin D than the general population. This is an area of research that needs more study, but initial recommendations are on the upper end of the intake range. One writer chronicled her experience with D deficiency and its effects on her athletic performance. If your performance has been lagging for no apparent reason, it might be time to check your D level.

I think this is as good a reason as any for me to pack it in and move to the Caribbean. "Sunshine Vitamin" anyone?

Monday, November 2, 2009

Exercise and Breastfeeding

A new study from the University of North Carolina-Greensboro concludes that breastfeeding mothers who exercise lose less bone density and less lean body mass than non-exercising women. Although the study is small and the topic warrants further exploration, the results are promising. Bone loss is normal during pregnancy and lactation, as the baby depletes some of the mother's calcium stores for skeletal development. Bone density generally rebounds, at least partially, after a woman ceases breastfeeding. But concern over osteoporosis could lead some women to decide (or be convinced) to wean prematurely.

The UNC study demonstrates that moderate exercise, in addition to its many other benefits, can mitigate the effects of breastfeeding on a mother's bone density. It is important to note that the women in the study did not have a gym membership or attend group exercise classes- they performed a combination aerobic/strength-training routine 3 times a week in their own homes. In other words, the benefits of exercise are not out of reach to women unable to join a health club. For women who worry that exercise will affect their milk supply, there is no research that supports this myth. Furthermore, the additional caloric expenditure associated with both exercise and lactation (along with healthy eating habits) may help mothers shed their pregnancy pounds more easily.

Wednesday, October 7, 2009

Are Motherhood and Feminism Incompatible?

I have never considered myself a feminist. I'm not "anti-feminist." I support many of the aims of feminism, such as gender equality in the workplace and advocacy for victims of discrimination, violence, and sexism. But I just haven't felt like I fully identified with the socio-political group of "feminists."

What comes to mind when you think of the feminist movement? Maybe it's women like Gloria Steinem and Betty Friedan. Maybe it's politics, like the Equal Rights Amendment and Roe v. Wade. Perhaps it's social issues, such as sexual harassment, domestic violence, or rape. Or maybe it's just Girl!!! Power!!! I'd say all of those are pretty valid answers.

But when you think of feminism, do you think of moms? Probably not. Do you know why? Because the feminist movement doesn't think about moms either.

In the United States, something like 80% of women will have at least one child. That's more than the number of women who obtain bachelor's degrees (26%) and more than the number of women participating in the workforce (60%). But where is the feminist activism on behalf of mothers?

I started with perhaps the most well-known feminist group, the National Organization for Women (NOW). The "Top Priority" issues that NOW works with are listed on the front page of their site: Abortion and Reproductive Rights, Economic Justice, Ending Sex Discrimination, Lesbian Rights, Promoting Diversity and Ending Racism, and Stopping Violence Against Women. Worthy causes, all. When I clicked on "Many more" at the bottom of the list, I found, way down on the list of "Other Important Issues" a link to the Mothers [sic] and Caregivers [sic] Economic Rights page. The issue as NOW sees it is paid parental leave. Their action plan on this issue consists of.... a petition. Oh, and encouragement for women to contact their Senators. Wow, great plan. Things weren't any more promising on the Abortion and Reproductive Rights page. Apparently, the only reproductive rights that NOW supports are the ones that assist women who DON'T want to be mothers. The agenda is abortion, emergency contraception, and birth control access for all women. These are important issues, but do nothing for the women who choose to carry a pregnancy to term.

I next decided to head over to NARAL Pro Choice America. This was another bust, as their platform of issues encompasses only abortion rights, birth control access, sex education, and "Women of Color." Nothing about being pro-choice for women's childbearing options as opposed to pregnancy prevention and termination options.

Surely the ACLU must be working on behalf of mother's rights, right? Wrong. While they have a Women's Rights Project (started by Ruth Bader Ginsburg), the project only focuses on four areas: Employment, Violence Against Women, Criminal Justice, and Education. Again, all important issues, but nothing that directly advances the position of mothers.

I wandered over to the Obama Administration site, There is a Women's Rights page, but it looks like news stories, blog entries, and job postings. Nothing resembling any kind of national movement of any type.

This is getting discouraging.

Isn't anyone fighting for better maternity leave policies? For breastfeeding women who are returning to work and need time and a place to pump breastmilk? For women who want to be attended by a homebirth midwife (still illegal in 10 states)? For women who want options other than a court-ordered cesarean section?

Well, how about the National Advocates for Pregnant Women (NAPW)? Now we're getting somewhere! The NAPW includes the following in its mission:
  • By focusing on the rights of pregnant women, including those who are continuing their pregnancies to term, we hope to broaden and strengthen the women’s rights and progressive movements in America today... While it is generally recognized that people have a right to bodily integrity and the right to procreate, women face an array of restrictions on their reproductive decision-making, from restriction on access to abortion services, to restrictions on alternative birthing practices to a wide variety of health and welfare polices that devalue and undermine motherhood for some women, including low income and women of color. Although it is generally accepted that adults can decide what medical treatment they will or will not have - once a woman becomes pregnant others may be able to make that decision for her.
Now that's what I'm talking about. While the NAPW doesn't address issues beyond pregnancy (such as maternity leave and breastfeeding rights), it's still a great agenda. However, they do not specifically bill themselves specifically as a "feminist" or "women's rights" organization. They consider themselves a reproductive and human rights organization.

The National Partnership of Women and Families works toward family-friendly employment policies, such as flexibility in the workplace and paid sick leave. In fact, the National Partnership helped draft the Family Medical Leave Act legislation. Their agenda is great for working mothers, though I would like to see them go even further by adding support for breastfeeding/pumping moms. And in the reproductive health arena, they only scratch the surface, by supporting general ideas of affordability, quality, evidence-based and patient-centered care. It would be good to see

The other problem: Have you ever heard of the National Partnership and/or NAPW? Most people probably have not. They don't have the prominence of (and the political weight that goes along with) larger organizations like NOW and the ACLU. Women (and men too!) need to know about the NAPW and the National Partnership in order to give the organization a broader base of support and more political sway.

To be fair, there is a patchwork of different groups that support specific mothers' rights issues. For example, The MAMA Campaign and The Big Push for Midwives support choices for birthing mothers and pro-midwifery laws. First Right works to end breastfeeding discrimination. Over the past few decades the feminist agenda has not adequately included the rights of mothers. As it stands now, there isn't one umbrella organization to encompass ALL of the personal, political, social, and economic issues mothers face. Maybe some would say it's not necessary, that the other groups, small and large, that have a piece of the "mommy agenda" will be able to get the job done. I wonder, though, if it's an idea whose time has come.

Sunday, September 20, 2009

Health Care: Why It Will Still Suck After They "Fix" It

I admit I am getting annoyed. I tried to be patient with this process, but as the days and the weeks and the months tick by, it becomes more and more clear that 300 million Americans are about to get a giant Congressional rectal exam.

I'm not one to join the Teabaggers (and really, with a name like that, how can you take yourself seriously?), and I'm certainly not one to take my AR-15 to an angry town hall meeting. But I think I have read enough on the subject of the health care reform fiasco to realize that we're not going to get the change we've been promised. What we will get is a piece of crap legislation that protects the interests of Big Insurance and Big Pharma and does nothing to improve access to and the quality of our healthcare.

We know that what we have now isn't working. The oft-quoted figure is 47 million Americans are uninsured, and the truth is that millions more are underinsured. In this country, we provide more "care" at greater expense and at worse outcomes than any other industrialized nation. The insurance industry and Medicare have a whole lot of influence how physicians practice. Insurers and Medicare set reimbursement rates for procedures. Basic care has a low reimbursement rate. But the more tests and procedures a doctor orders, the higher the reimbursement. As a result, they often provide more, often unnecessary care. I don't blame doctors for trying to make a living. They go through years of study and rigorous training to practice medicine. But we've created a system that incentivizes quantity over quality.

In the endless, exceedingly tedious debate about healthcare, a few major items have been discussed.

1) A single-payer system. Often compared to Canada and the UK, opponents argue that it will "ration" healthcare. And send your grandparents to the death panel. Certainly those systems have their drawbacks. It is true that some people have long waits for treatment, though my understanding is that those are "nonemergency" cases. If you're having a heart attack, it's not like they send you to wait in line. I also just want to point out that WE ALREADY RATION HEALTHCARE IN THE U.S.. Every time an insurance company denies a claim or refuses to cover a test, treatment, or procedure, they are RATIONING. And if they deny someone a treatment that could or would be lifesaving, well, that sounds an awful lot like a death panel to me. A uniquely American single-payer system (with salaried doctors and coverage for everyone) could be made workable if anyone cared to try. But try getting that past the insurance companies who have bought off Congress. This option is completely off the table at the moment, maybe forevermore.

2) "Universal mandates." Everyone has to be covered, no ifs, ands, or buts. Employers must offer coverage to employees. Those who are unemployed or otherwise don't have coverage through an employer are required to buy into insurance cooperatives (see #3) and/or a government-run plan (see #4). Sure, sounds great in theory. But small businesses will be hard-pressed to provide insurance to their employees, even if there are cooperatives to buy into. And large businesses could choose to cut costs by scaling back their plans- and if employees opt-out, so be it, they'll save even more money. So there is no reason for companies to provide anything but a bare-bones plan with minimal coverage. Employees can choose the lousy plan their employer offers, or pay more to the government plan or a cooperative. Which means we'd be in no better position than we are now. Furthermore, without underwriting reform (see #5) to ensure that no one can be denied insurance or be required to pay astronomical premiums due to pre-existing conditions, requiring everyone to be covered could put a lot of strain on a lot of family budgets.

3) Insurance cooperatives. This is an idea with some potential, but also with some pitfalls. The basic idea is that doctors, hospitals, and businesses band together to offer services to members. The model would likely be Group Health of Seattle, which covers about half a million members. The benefit is that co-ops are non-profit and member-run, with the goal of keeping costs low. In theory, such co-ops would compete directly with private insurers and force insurers to lower their own prices. However, co-ops have a less than stellar history, and there is no guarantee that they would be successful in significantly reducing premium costs to members. (Just for kicks, I went to Group Health's site and got quotes based on my own family of 5... They don't have a plan that matches our current health insurance. The co-pays are higher, they all have some kind of deductible, and all have at least 10% coinsurance. The closest plan to ours is $888 a month, which is more than what we currently pay out of our pocket, but my husband's employer picks up part of the tab. My guess is that the total cost is fairly similar, but Group Health's plan covers less.)

4) Government-run plan, aka "the public option." Sort of a third alternative to Medicare and Medicaid. The government obviously has the negotiating power to keep costs low. But would it just be Medicrap? Hard to say. The insurance lobby has been crying like a bunch of little girls whose kitten died about this one. They complain that they couldn't compete with the government keeping prices low. Well, they could start by not paying gazillion-dollar salaries and bonuses to their company officers. There are questions to be answered about any public option, such as who would be eligible and what kind of financial assistance would be provided to those at lower income levels. But what once was a mainstay of Obama's call for reform has been all but ditched.

5) Medical underwriting reform. At present, insurance companies can refuse coverage to, or cancel coverage for, anyone with a "pre-existing condition" or a condition that becomes too expensive to treat. Depending on the insurance company, a pre-existing condition can be almost anything, from seasonal allergies to cancer, from a being beaten by one's spouse to a prior c-section.* And watch out if you get sick: Your insurance company may drop you like a hot potato. This denial of coverage definitely needs to change. In 2007, nearly 2/3 of all bankruptcies were due to medical bills- in 80% of those cases, the folks who filed had health insurance. (Himmelstein, D, E., et al, “Medical Bankruptcy in the United States, 2007: Results of a National Study, American Journal of Medicine, May 2009.)

6) Tort reform. Supposedly our legal climate forces doctors to practice defensive medicine. I say supposedly because it appears that doctors are acting more as a result of the fear of lawsuits than actual litigation. A new report in Business Week asserts that malpractice suits do not add appreciably to the costs of health care. According to the New York Times, frivolous lawsuits and huge jury awards are not burdening the system. Those who favor tort reform point to Texas as a successful model. While it's true that malpractice lawsuits, malpractice judgments, and liability insurance costs have all been lowered in Texas since the reforms were implemented (all good things), Texas still has some of the highest healthcare costs in the nation.

Will any meaningful change actually be made in this reform process? I somehow doubt it. The smoke and mirrors thrown at us so far fail to impress me. I don't pretend to have the answers myself, but I can clearly see that the House and the Senate have done nothing but kill trees with their 1000+ page bill. I am disappointed that Obama has taken a weak and waffling standpoint on the whole issue. He has backpedaled on the public option. And he didn't give any real direction to Congress- a group of folks who have probably the best health care plan in the country and therefore could care less about anything but the campaign contributions they get from Big Insurance and Big Pharma. The bottom line is that as long as healthcare has a profit motive, we will never see any meaningful improvement in costs or in quality. Since there doesn't seem to be any likelihood of making insurance companies non-profit entities, I'm betting that real reform is nothing but an illusion.

*The c-section issue is a double-whammy, because those women who can't get insurance due to a prior c-section also face hospital and physician policies "prohibiting" VBAC . Which means that many of those women will not only essentially be forced to undergo major surgery, but they'll also have to foot the entire bill, to the tune of $15,000 or more.

Saturday, September 5, 2009

NYTimes Article: Froot Loops Are Health Food

Link to article

You may soon be seeing the new "Smart Choices" labels on products at your grocery store. Several manufacturers- such as Kellogg's, Kraft, and PepsiCo- have banded together to label certain products as "better for you" options. They formed a committee, including the dean of Tufts University school of nutrition and representatives of each the cooperating corporations, in order to decide which foods would meet their criteria to receive the Smart Choices green checkmark logo.

Now here's the problem. Can we honestly think that giant processed-food manufacturing companies are going to put consumers' best interests ahead of their own financial interests? I'm going to go with, "Uh, no."

So what foods have made the list? You can do a search online for products by brand or by category. It's rather amusing to look at the contradictions. All-Bran and Corn Pops are both Smart Choices? Or as the article points out, both regular AND "light" mayonnaise are Smart Choices too? So, according to the Smart Choices program, it seems there is no substantial nutritional difference between those products. Also included as a Smart Choice: Fruit Roll-Ups. Never mind that in a 14g serving, 7g is pure sugar. A Smart Choice can be made of 50% sugar? Seriously, did a group of 7 year olds put this list together?

By artificially enhancing a food with little to no nutritional value, manufacturers can slap a Smart Choice label on a product. (Coming soon to a store near you: Bacon! Now with added calcium!) And by doing this, they can still claim they are following federal nutrition guidelines. This is a complete scam on the American public and an insult to our intelligence. There's hope though: The FDA has written a letter to the Smart Choices program to put the committee on notice that they'll be facing regulatory scrutiny. Let's hope they're willing to put some muscle behind the criticism. No, it's not easy to altogether avoid processed foods. But as consumers we can learn to read nutrition labels and make better choices without some silly checkmark contrivance.

Saturday, August 29, 2009

Medicated Moms

Today I read this article about a mother who decided antidepressants were the answer to her parenting stress. Her anecdote about the kids bickering in the backseat of the car is a story all too familiar- Been there, done that, got the t-shirt.

But... Since when is getting angry and yelling at your kids a condition requiring medication?

I absolutely believe that there are legitimate uses for antidepressant and antianxiety medications. There are people who wouldn't be able to get out of bed in the morning without them. But by all indications, use of these medicines has greatly increased. Some would say they are overprescribed- even the author acknowledges it:

"My doctor said he prescribes mood-enhancing medications about 10 times a week... My friend called her doctor to make an appointment and talk about going on Paxil. The nurse said she would just call the script into the pharmacy. No appointment necessary."

No appointment necessary? Are you kidding me? I had to make 3 calls to my doctor, begging her to call in a prescription for antibiotic eyedrops for pinkeye without seeing me first. Why are there doctors handing out powerful psychotropic medications like they are candy?

Here is my biggest problem with the author:

"Maybe moms like me should do more yoga, cut back our responsibilities, see a therapist, exercise more, put duct tape over our mouths every day after 5 p.m. Maybe we should do anything to avoid relying on drugs to become calmer, happier people."

She outright acknowledges that there may have been other (non-pharmacological) ways to handle her stress and anxiety, but did she bother to try them? No, she didn't. It's easier just to pop a pill. Antidepressants have well-documented side effects. As far as I know, yoga and therapy do not.

I reiterate the fact that there are many people for whom antidepressants are nothing short of a godsend. Yet I have to wonder if we, as a society, have come to view any negative emotion as a sign of a mood disorder. Or maybe it's that we think we can use a pill to cure just about anything. Or maybe [conspiratorial whisper] the pharmaceutical companies' marketing tactics have convinced us we are broken and need to be fixed.

Tuesday, August 25, 2009

And I Didn't Come In Last!

Aflac IronGirl Columbia Women’s Triathlon

Race Report

August 23, 2009

I have Cortney to blame or to thank for this race. She was the one who, fresh off her own first triathlon, said I could “totally do one.” I was in the first trimester of my pregnancy, so maybe it was pregnancy brain that made me think it would be a good idea to do a triathlon at three months postpartum. I registered and then basically forgot all about it for about 3 months. In January, I began taking a lap-swim class at the rec center. I built a lot of confidence in my swimming technique and endurance that way, even though I was the only pregnant woman in the pool. I was also able to continue teaching spin classes up until a few days before Becca was born. And that left only running.

Ah, running. The bane of my existence. I've tried to like running, truly I have. I have made several attempts to become a better runner, starting in high school when I thought I would die doing 10 laps around the courts at tennis practice. The thought of taking it up again with a baby bump was too much to bear, so I put off training for that until Becca was a few weeks old. And it was just as lousy as ever. I have friends who are Runners, yes, with a capital R. I just don’t know how they do it.

So I got a new bike, got some new running shoes, got a new swimsuit, and went about my business. I felt positive that I could tackle the swim, even though I’m not accustomed to open water swimming. I was consistently doing 1k in 23-24 minutes in the pool, without overly tiring myself. On the bike, I could tell that all the spin classes had actually paid off, giving me the endurance to take on longer rides. It was the run that plagued me. Even on “fresh” legs, I never did better than an 11 minute mile. And when I did my bike-run bricks, it was always a 12 minute mile. If you’re doing the math in your head, that is approximately a snail’s pace.

We arrived in Columbia, MD around 1 pm on Saturday. After getting the kids settled into naps, I went to pick up my race packet as well as some goodies from the expo and then over to the park to rack my bike. I didn’t realize how close together the bikes would be on the racks- only about 6 inches apart. Analyzing the space, I realized there wasn’t going to be much room to set up my gear. Luckily, I had a pretty decent spot, in one of the center rows and not far from the main aisle towards the T1 exit. I then walked down to the lake to see the swim course. The lake was as swampy and slimy as I’d imagined.

I also drove the bike course in the pouring rain, and realized it was very hilly, even more than the map had indicated. Up to that point, I was uncertain if I would race in my bike shoes, with feet clipped to the pedals, or in my running shoes. I am nervous riding with my feet attached to the pedals, especially since I’d fallen (twice) when I lost my balance and couldn’t unclip from the pedal in time to put my foot on the ground. But with the hilly terrain, I knew I’d need the added efficiency of the bike shoes, which allow me to pull upward on the pedal instead of just pressing down.

When I got back to the hotel, we all went out to dinner at Clyde’s, still in the pouring rain. I was concerned it would be raining during the race, or at least that the rain would go on long enough to leave the roads wet- and slippery- for the bike ride. Luckily, the rain stopped overnight and the pavement was nearly dry by 6 am on race day. I didn’t get much sleep on Saturday night, between thinking about the race, hotel staff moving trashcans around right outside our window at midnight, and multiple awakenings by Josh, who finally wound up sleeping in bed with Jordan.

My wake-up call was at 5:15. That gave me enough time to get dressed, eat breakfast, and pump a couple of bottles for Becca. Then I grabbed my transition bag and headed out to catch the shuttle bus. At the entrance to the park, I got my body marked and then headed down the muddy incline to the transition area. I arranged and rearranged my gear in the tiny patch of grass next to my bike, trying to figure out where to put it so it wouldn’t be in the way of someone else’s bike or gear. Soon they were calling out just a few minutes to the transition area closing, and I headed out to find Bob and Lauren while I waited for my swim wave to start.

After I met up with Bob and Lauren, we waited at the swim start for Jordan to arrive with the kids. I was in wave 10, so there was plenty of time to stand around and wait. Finally it was time to line up with my wave. I made small talk with a couple of the women standing nearby as we slowly waded into the green water. The bottom was sandy and slimy, and I could feel strings of some kind of seaweed brushing past my legs. “Ew!” I said to no one in particular, “I’m such a girl.” A couple of the women around me laughed. When the water became waist-deep, I decided to swim out closer to the starting line and tread water, rather than keep walking and risk finding out what other unpleasantries the murky depths had in store. I seeded myself near the back of the pack, not knowing how fast the others would be swimming. We counted down to the starting time, and at 1, I pushed the button to turn on my heart-rate monitor and then began my swim.

From land, the swim had seemed so long, much longer than 1k. I guess it’s hard to judge actual distance by doing laps in the pool. I told myself that it was no big deal, just keep moving forward. Though I had practiced sighting in the pool, doing it for real in water that literally didn’t allow me to see 6 inches in front of my face, was totally different. I had practiced primarily freestyle, knowing it would be the fastest stroke. That plan quickly got dumped for a mixture of freestyle and breaststroke in order to stay on course. I remembered to emphasize my arm strokes to save my legs from getting tired. As I rounded the first buoy, I saw a woman from a couple of waves ahead of me hanging on to it (allowed for resting). After the second buoy, I passed several women from the previous wave, which was encouraging. I kept going, drafting off a woman ahead of me for a little while, until she tired and slowed down. One buoy passed, and then another, and another, and suddenly a guy in a canoe said there was less than 300 yards left. Sweet! I plowed forward, rounded the final buoy, and headed for the swim exit. As I ran up the ramp, I glanced at my watch and saw I was in the 24 minute range. I happily ran up the hill to my bike, grabbing a cup of Gatorade on the way.

I got my helmet and shoes on pretty quickly, but fumbled around trying to get my bike off the rack. The bikes on either side of mine were still there, and I caught my handlebars on the front wheel of another bike. Frustrated, I ducked under the rack a couple of spots over where the rack was empty and dragged my bike out from the opposite side. Doing that ate up some time, unfortunately, but I hustled up the ramp out of the transition area and mounted my bike as fast as I could.

I felt good, if a little uncertain, as I pulled out on to the road. There weren’t too many people in front or back of me at that time. Soon a few riders came and passed me. As I started feeling more confident, I passed someone. And then someone else. As I sped up to pass someone at the crest of a small hill, another rider came up behind me and passed me, saying, “nice move!” as I passed the first rider. For awhile it seemed like I kept passing, and being passed by, the same handful of people. As we got to the first really big climb, I saw several women walking their bikes up the hill, some of them huffing pretty hard. I said a few words of encouragement as I rode past them. There were several other hills like that on the ride, with people walking their bikes, but I am proud that I didn’t dismount and walk even once- it was never so difficult that I was even tempted.

All along the way, women were talking to each other, cheering each other on, and cracking jokes. At the turnaround, I grabbed some Gatorade and kept going. I was surprised that I was not feeling tired. My legs would feel fatigued on the climbs, but as soon as I hit the downhills and the flats, they recovered quickly. Race volunteers and local residents were out on the course, clapping and cheering. As I sped along the home stretch, I felt fine, but started mentally preparing for the hardest part to come. Entering the park, I could see Jordan, Bob, Lauren, and the kids on the sidelines waving. I got off at the dismount area and jogged my bike back to the rack. It didn’t take me long to swap my helmet for my hat and my bike shoes for my sneakers, and I was off.

I jogged along the trail, oh so slowly, as other runners passed me. There were some people walking, but I didn’t want to give in. I made it about a mile and a half, forcing myself up the “Gatorade Hill,” but soon after had to walk a short stretch. I ran the turnaround and then had to make it back up Gatorade Hill. This second time I walked. I ran the downhill part, and then walked one more time for a couple of minutes before running it the rest of the way in. Although most of the course was fairly shady through the wooded areas of the park, the last half-mile or so of the trail was in full sun. I’d had plenty to drink, yet I could feel a little lightheadedness setting in. There was nothing to do but push myself through it. In the last stretch, I was able to use a final burst of energy to get myself into the finishing chute. I heard Jordan call my name and waved at him and Josh and Alex, then went on to cross the finish line.

My final time was 2:35:39, a little more than my goal of 2 ½ hours, but overall not a bad showing for a first-timer. (I did post a better time than the 79 year old woman at least!) Some great lessons learned… for next time? I have some clear ideas on what I could improve, so yes, I think there will be a next time.

Friday, August 21, 2009

What Color Is Your Pee?

Yes, that's right, I just asked you the color of your pee. Go ahead to the bathroom and check. I'll wait right here.

Done? Ok.

Urine color is a great indicator of your hydration, which is important even if your most strenuous activity is couch surfing. The U.S. Navy has a helpful chart to help you determine if you are sufficiently hydrated based on the color of your urine. How did you fare? As the chart notes, sometimes vitamin supplements can affect the color of your urine, particularly B vitamins, which tend to temporarily turn it neon yellow. If that's the case, you can check again in a couple of hours.

Severe dehydration is, of course, a serious condition, and can be fatal. Even mild dehydration can cause symptoms that many people would not associate with fluid loss, such as fatigue, headache, or irritability. Ever just feel "blah"? It could be mild dehydration!

How much fluid do we actually need? Well, the bad news is that it's probably more than you usually drink. The good news is that any liquid, not just water, counts towards your daily intake. Yes, even coffee. Even wine! In general, we need about two quarts of fluid a day- that's the legendary eight 8-0z. glasses of water. But that's just for starters. If you are spending time outside in hot weather, spending time at high altitude, ill, pregnant, or breastfeeding, you'll need to drink two to six cups more per day. And you'll definitely need to drink more during exercise.

The American College of Sports Medicine recommends a fluid replacement approach to hydration during exercise. If you weigh yourself before and after a workout, you can determine how much fluid you've lost. An ounce of water weighs 1 oz., so one pound of weight loss would be 16 oz. of fluid lost. Aim to consume at least that replacement amount during exercise, as well as taking in extra fluids before and after a workout. Unless you are exercising for upwards of an hour, plain water is sufficient for hydration. If you are training for more than an hour at a time, you should consider a sports drink for electrolyte and carbohydrate replacement.

It can be a PITA to make sure you're drinking enough each day. Hence the question, what color is your pee? If it is clear or pale yellow, you can be sure you are getting enough fluids. If not, think about carrying a water bottle with you or keeping a big cup on your desk at work. And the next time you're feeling "blah," reach for some water before you reach for some coffee or a snack-- You might just be dehydrated. Drink up and then go get your pee on!

Wednesday, August 19, 2009

"Duodecaplets" Are a Hoax

Fox News report

I, for one, am glad this turned out to be untrue.

Monday, August 17, 2009

"Dodecamom" Doesn't Have Quite The Same Ring To It

Tunisian Woman Poised to Give Birth to 12 Babies: Reports
(Also reported here.)

I guess we'll learn in the coming days if this is a true story or a hoax. Stories of "extreme fertility" really get under my skin. I understand wanting to have children. And I can certainly sympathize with those who are unable to get pregnant or stay pregnant. I know from friends who have suffered fertility problems and miscarriage that it is frustrating, heartbreaking, and overwhelming. But the higher the order of multiples, the higher the risk to both mother and babies. Why take chances with your own life, or the lives of the children you so desperately desire? And where are the medical ethics?

It is a known fact that multiple gestations are at greater risk for premature birth and the potential accompanying health problems. Does bleeding in the brain sound like a great start to life? Even with the availability of selective reduction, there are plenty of folks who object to such practice, and others who would reject it based on the fact that it potentially puts all the fetuses at risk. But let's go back even further, to the fertility doctors who create these high order multiples, because 12 spontaneously conceived babies would be so rare as to be impossible.

Several European countries already limit the number of embryos transferred during IVF. While I believe that the majority of fertility specialists practice ethically, perhaps it is time for the law to step in and keep everyone on the same page. Any thoughts?

Sunday, August 16, 2009

Current Thoughts on H1N1 Influenza: "Swine Flu"

I've been following the news about the swine flu since it first started making headlines last spring. The media have repeatedly drawn our attention to the fact that the 1918 flu pandemic began much the same as the current one: With a mild version of the virus in spring and summer. And we all well know, by the fall of 1918, that strain turned suddenly deadly. It's difficult to escape drawing a very frightening parallel to the H1N1 strain making the rounds.

Although the government has been cautious about predicting the impact of swine flu this fall, the FDA is nonetheless putting the H1N1 vaccine on a fast track to approval. The call for the population to immunize may well happen before human clinical trials of the vaccine have been completed. And that, for me, is where things get very scary. Do I want to be in the position of being a guinea pig for a brand new vaccine? Do I want my children to be guinea pigs too?

The other concern I have with the H1N1 vaccine (aside from it being untested) is that it will be the first influenza vaccine to contain an adjuvant. A few other FDA-approved vaccines contain adjuvants, which help boost immune system response and allow less antigen to be included in the vaccine. That means the amount of antigen can be stretched to allow for more doses of the vaccine to be produced. And if you recall the flu vaccine shortage of 2004, this is a potentially fantastic development. But! The adjuvant in Glaxo's swine flu vaccine is not FDA approved, and while some clinical data exist from its use in Europe, it has not been studied here. More alarming: The government has made vaccinating pregnant women a priority, but the vaccine will go untested in pregnant women.

I am not anti-vaccination. I understand that vaccines are one of the most important medical developments of the modern era. My kids are fully vaccinated, with the exception of seasonal flu vaccines, mostly because those vaccines tend not to be highly effective due to strain mismatch. And (knock on wood) my kids have never had the flu despite being in daycare/preschool with dozens of other nose-picking little petri dishes like themselves. To my knowledge, I've only had the flu once, an unconfirmed case in 1999. I spent two days in bed, using copious amounts of NyQuil to maintain a semi-vegetative state until the worst had passed.

At present, H1N1 has not demonstrated itself to be any more virulent than any other strain of seasonal influenza. If the virus does not mutate into something more deadly, I have no plans to take part in what amounts to a mass clinical trial. If people start kicking the bucket left and right, however, I may be persuaded to get the vaccine. Let's not engage in mass hysteria and allow safety to fall by the wayside.

Tuesday, August 11, 2009

Choose the Right Shoes

If you're like me, you may have 10, 20, or... ummmm... 60(ish) pairs of shoes. Casual shoes, dressy shoes, sandals, flip-flops, flats, heels, loafers, pumps.... Maybe several pairs of each, in different styles or colors. But how many pairs of sneakers do you have? And by that I mean, actual athletic shoes... One pair? And when was the last time you replaced them?

If you are wearing the same pair of sneakers for step class, jogging, and doing yard work on the weekends, you are not doing yourself any favors. I see this all the time at the gyms where I teach. (And I know you wore those sneakers to mow the lawn because you tracked grass clippings into the spin room. Nice.) Would you play tennis in full hockey pads? Surely not. You already know it's important to use the right equipment for your chosen sport or activity. And that goes for your kicks too. Why risk an injury (like plantar fasciitis or stress fractures) that could sideline you for days or even weeks? Be sure you are wearing the right shoes for your workouts.

Here are 4 simple guidelines for selecting the right athletic shoes:

1) Be sport-specific. If you're going to run, buy running shoes. If you play basketball, get basketball shoes. Cross-trainers are a great choice if you vary your workouts, everything from group exercise classes, to weight training, to the elliptical trainer. But if you participate in a particular sport or activity 3 or more times a week, the American Orthopedic Foot and Ankle Society (yes, it really exists) recommends a sport-specific shoe.

2) Get the correct fit. Your sneakers should be comfortable from the get-go. As with any other shoes, try them on in the afternoon, when your feet tend to be slightly swollen. Try on a few pairs to see what fits best. Make sure your toes aren't right up against the end of the shoe, and that there is room to wiggle them within the toe box. A good rule of thumb is to buy your sneakers a half-size larger than your regular shoe size. Your heel should not slide up when you walk. And especially for runners, get the right type of support. Running stores and many sporting goods stores will analyze your gait for you to tell you if you over- or under-pronate, or have a neutral gait.

3) Don't use your workout shoes for anything but working out. If you wear them to go tooling around town to the mall and the grocery store, you'll wear them out faster and need to replace them sooner. And seriously, about the yardwork: Use your worn-out shoes for that stuff and please stop tracking grass and mud into the aerobics studio.

4) Replace your shoes every 6 months or 500 miles (for runners/walkers), whichever comes first. More often if you do long workouts or exercise more than 3-4 days a week. I can't tell you how many times I see people exercising with a beat-up pair of Reeboks they've been wearing since 1998. A decent pair of cross-trainers can be found for around $50, which is nothing compared to what an injury could cost you in medical bills and possibly lost work time. And what to do with your old shoes? Don't just trash them! Donate them to a charity in your area, or try a sneaker-recycling program, such as Nike's Reuse-a-Shoe. (Click on the map to see if there's a dropoff in your area.)

Choose your shoes wisely to make your workouts more comfortable and help prevent injury. One last tip: While having cute, trendy shoes is a worthy and admirable goal (at least in my estimation), keep in mind that the cutest, trendiest sneaker may not work for you. My running shoes make me look like Sasquatch, but they fit well and provide the support I need. Go for the brand and style that fit your feet best, even if the sneakers are hideous.

ABC News and the LA Times Agree With Me (Yay!)

I'm pleased to note that two major news outfits reached the same conclusion I did about the Time Magazine article, "Why Exercise Won't Make You Thin." Both ABC News and The LA Times ran articles today criticizing the Time piece. In addition, the ACSM put out a press release that also refuted the article. Score one for the gym rats!

Sunday, August 9, 2009

Article: Breastfeeding Nutrition: 7 Easy Dishes for New Moms

Did you know? August is Breastfeeding Awareness Month! (Interestingly, everything I have read about this campaign mentions it is funded by the US Department of Health and Human Services... Yet I can't seem to find a single mention of it on any HHS related website. Hmmm, am I missing something?)

Heads up: Babies R Us is offering free shipping on all Medela and Boppy purchases over $20 for Breastfeeding Awareness Month.

Link to article

Here are the recipe suggestions the author offers:

- Complete nutrition shake – 1 to 2 scoops protein powder, one handful spinach, parsley, romaine or chopped celery, 1-cup berries (fresh or frozen) and 1/ ripe banana. Add enough water or almond milk to get the blender going and have the consistency to your liking.

- Baked sweet potato – sweet potatoes are a delicious and satisfying sweet treat, loaded with good stuff. They also help increase milk production.

- Avo-Veggie Dip/Spread – Avocados are loaded with easily assimilated good fat and nutritious protein for nursing moms. This spread is a great way to get your veggies in. Making it: Process 1 zucchini, handful cilantro, 1 rib celery, 1 clove garlic in food processor until finely minced. Combine with 1 ripe avocado, mashed, and lemon juice. Roll this up in a large leaf of Romaine or whole grain tortilla.

- Roasted root vegetables – These are great to make in bulk and have on hand. They are nourishing and satisfying. Try beets, carrots, parsnips, onions, sweet potato, and daikon. A combo of three of these is nice.

- Amaranth and quinoa. This is a great complete protein grain combination. Highly nutritious, amaranth is loaded with minerals (more calcium than milk) and is a complete protein. It is a little strong and works well with quinoa, another super grain. Serve with steamed broccoli or a salad.

- Lettuce Wraps – Roll sliced turkey, chicken or tempeh in large Romaine lettuce leaves. You can spread a little mustard or avocado on as well.

- Protein dip – stir a good quality protein powder into plain organic yogurt or almond butter. Use to dip celery or apples. Sweeten with a little stevia if needed.

- Easy options – raw almonds with celery ribs, almond butter with celery or apples, carrots and humus[sic]. [I find that typo very funny. Who'd want to eat humus? Yuck!]

A mother's nutrition is definitely important during breastfeeding, and these dishes (though not very exciting, gastronomically speaking) sound pretty good with two exceptions: the "complete nutrition shake" and the "protein dip." Both require protein powder, of which I am not a huge fan. First, because I think it's better to get protein from "real" foods whenever possible, and second because it is definitely possible to eat too much protein. (According to the American Heart Association, Americans already eat too much protein.) Excess protein is stressful on the kidneys, and research indicates that a nursing mom's protein needs are only about 15-20 grams more per day above a non-lactating mom's. (The basic calculation for daily protein intake is 0.8 grams for every kilogram of bodyweight, or about 0.36 grams per pound.)

The site I like best for all kinds of breastfeeding information and advice is The site has compiled all the best research and distilled it into easy-to-read articles. I don't think I've ever had a breastfeeding question that isn't answered on Kellymom.

Saturday, August 8, 2009

Article: Why Exercise Won't Make You Thin- Time Magazine

The original article appears here:
Why Exercise Won't Make You Thin

This article is definitely worth a read, since it flies in the face of what almost all of us have come to believe: In order to lose weight, we have to exercise.

Author John Cloud asks the question, "Could exercise actually be keeping me from losing weight?" In my mind, there is no solid yes or no answer to that question.
"The basic problem is that while it's true that exercise burns calories and that you must burn calories to lose weight, exercise has another effect: it can stimulate hunger. That causes us to eat more, which in turn can negate the weight-loss benefits we just accrued. Exercise, in other words, isn't necessarily helping us lose weight. It may even be making it harder."

I think it is fairly apparent to anyone who has exercised that, yes, working out does increase your hunger level. Your body naturally wants to replace the calories it has lost, i.e., maintain a neutral energy balance. But we know that in order to lose weight, we need a negative energy balance. We must expend more calories than we take in.

So if you go to spin class for an hour and then hit up Dunkin Donuts for a cream-filled donut and a Coffee Coolatta, you've not only undone all your hard work in spin class, but also undone tomorrow's class and half the next day's too. If, on the other hand, you go home and eat a big salad drizzled with a little balsamic and olive oil, you won't undo your hard work, and you'll feel extra virtuous too.

The other problem is sports drinks. In case no one let you in on the secret, no amount of Gatorade will ever allow you to dunk it like Shaq, drive it like Tiger, or bend it like Beckham. Sorry to douse your dreams with a cold bucket of, uh, Gatorade. The fact is, for workouts of an hour or less, all you need is water for rehydration. (American College of Sports Medicine, 2007) Unless you are doing intense workouts of over an hour (e.g., marathon training, spending the afternoon cross-country skiing), save your money and your calories by drinking water. Regular Gatorade has 50 calories per 8 oz. So if you chug the 32 oz. bottle while you walk on the treadmill for 30 minutes, you've consumed about 200 calories, and expended only about 150. Whoops! In that case maybe exercise IS making you fat! (I used the calorie calculator here, using a 150 lb. person walking a 15 minute mile [4mph] for that calculation.)

Which brings me to the next point that the article makes:
"Many people assume that weight is mostly a matter of willpower — that we can learn both to exercise and to avoid muffins and Gatorade. A few of us can, but evolution did not build us to do this for very long. In 2000 the journal Psychological Bulletin published a paper by psychologists Mark Muraven and Roy Baumeister in which they observed that self-control is like a muscle: it weakens each day after you use it. If you force yourself to jog for an hour, your self-regulatory capacity is proportionately enfeebled. Rather than lunching on a salad, you'll be more likely to opt for pizza."
The solution to this problem is a fairly simple, two-pronged approach:
1) If you're trying to lose weight, keep the junk food out of the house. You won't consume an entire bag of Cool Ranch Doritos if you don't buy them in the first place. Yes, keep a couple favorite treats on hand (what's life without treats?!), but buy them in small quantities. Maybe even divide the package up into smaller quantities in plastic bags (or small, reusable containers, if you're eco-minded). You'll be less likely to eat 17 Oreos in one sitting if you've have to go back to the pantry again and again for a baggie with 3 cookies in it.
2) Prepare your post-workout snack or meal before your workout. Make a sandwich or a salad and stick it in the fridge. Cut up some fruit or vegetables. When you come home to that post-workout slump, you can grab your ready-made food instead of junk. And you'll feel better, physically and mentally, for having eaten something healthy after you exercise.

In the end, author Cloud makes the point, "In short, it's what you eat, not how hard you try to work it off, that matters more in losing weight." For all the sensationalism of the headline, the conclusion is pretty much the same thing it's always been: The only surefire way to lose weight is to consume fewer calories than you expend. Exercise has health benefits beyond weight reduction, so the combination of reducing calorie consumption and daily exercise to promote weight loss remains the surest path to success.

My Triathlon "Plan"

There are just 15 days left until my first triathlon. Although I bought a couple of books to help me prepare (which I may review here at a later date), I soon realized that there was no way I'd ever be able to adhere to a structured training plan with my crazy schedule of teaching classes and tending to two preschoolers and a newborn. More than once it has crossed my mind, WTH was I thinking signing up for this thing? Anyway, I realized I was going to have to make my own training plan, more or less on the fly.

The first step in making a triathlon plan is to assess areas of strength and weakness. Since I teach up to 5 spin classes per week, I knew that cycling would be the easiest stage of the tri for me. Running would clearly be my weakest link, since I have tried and failed a number of times over the years to convert myself into a runner. Swimming would be my wild card.

In theory, the most training should go towards the weakest discipline. I've failed that theory for two obvious reasons: I'm committed to teaching my classes, which means I would undoubtedly train most in my strongest discipline. And also, I hate running. I know there are people out there who are avid runners, who describe in lucid detail the joys of running, the freedom of hitting the road or the trail, the thrill of the runner's high. I am not one of them. I have to force myself nearly every step of the way. My body rejects running like a transplanted organ.

Swimming has turned out to be the bright spot in my training. Until I started taking a lap swimming/stroke improvement class at a local rec center this winter, I hadn't done any "real" swimming since college when I'd hit the pool once a week or so to get in a workout. I was as surprised as anyone to find that even in my 9th month of pregnancy I could paddle along at a pretty decent clip. (Not to mention I had little to none of the annoying aches and pains that plagued my dry-land workouts.) There is also something enjoyable about swimming: Most ambient sounds are blocked out (except for one's own breathing) and there's the weightless feeling of gliding through the water. I think swimming has regained a place in my regular workout routine!

With a just over two weeks to go, I will be focusing on getting in a few more bricks, particularly bike to run. I'll also be doing a few practice transitions for the sake of improving efficiency between stages and so I don't forget anything! I realize that the sum total of my training plan amounts to "um, like, fit stuff in when you can, or something" but this being my first triathlon, my primary goal is just to finish. If I decide to do another tri, I'll definitely focus my training more, since I'll want to improve on my performance in this one.

Friday, August 7, 2009

Gym Shooting

By now you've surely heard or read about the shooting at the LA Fitness club near Pittsburgh.

My suggestion to all gun-wielding homicidal/suicidal headcases is simple: Turn the gun on yourself first. After that, you can shoot anyone you want.

Thursday, August 6, 2009

First Post

Hello and welcome!

I wanted to start this blog to address some of the topics that interest me, both professionally and personally, as well as discuss topics or questions I hear from clients and friends. As an avid consumer of research, I am always trying to learn more about exercise science, health, and nutrition- as much for my clients as for myself and my family. I believe in an evidence-based approach to... well, everything! Posts will include everything from tips and tricks, to book and equipment reviews, to news items. Whether you are new to fitness or have multiple marathons under your belt... Whether you are a first time parent or have 11 kids... Or you are anywhere in between... I hope to post a little something for everyone.

Feel free to send me suggestions of topics to discuss or questions you would like to have me answer. I also appreciate feedback on how to improve this blog.

Thanks for reading!