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.

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.

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!

"Duodecaplets" Are a Hoax

Fox News report

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

"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?

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.

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.