Another Story About The ER

The following is an email sent by a friend who reads the blog in response to the recent posts about my visit to the ER. It is about an experience he had with his infant daughter and I got his permission to share it as it is illustrative of many of the principles touched upon in my earlier posts:

When [my baby] was 9 days old she presented with what appeared to be an infection in her right eye (eye lid swelling, puss coming out the side, dark skin around the eye [picture attachment omitted]).

I think we waited overnight (details are a little fuzzy now that it’s been over 2 years) before doing anything because we were hoping it would resolve itself without having to go to a doctor, who might urge us to go to the ER, which we wanted to avoid if at all possible.

The next day it didn’t look better so we took her to the pediatrician, who was particularly concerned and brought another doctor into the room to examine her, we expressed our concern that we really didn’t want to go to the ER if at all possible, both doctors said we should go. They were concerned “because she’s so young” and “because the infection is so close to the brain.”

We got to the ER and it took for fucking ever to even get a room, of course you’re shoved into a massive environment of sick people dying to infect you with god knows what disease they have from living a terrible unhealthy life. It was literally like 6 hours before we finally got a room. At this point it was late at night and I kept thinking, “man, her eye looks better, if it looked like this 6 hours ago I don’t think we would’ve been sent to the ER.”

But the doctors kept saying shit like, “yeah we’ve seen things look better but actually be getting worse.”

The doctors wanted to do a blood test to see what the infection was and start her immediately on IV antibiotics. Additionally, they wanted to do a spinal tap (some advanced way of determining what the infection might be). I wanted to push the IV antibiotics back until we knew what the infection might be (as the results of a blood test might indicate), but they kept pushing and saying, “these things can move fast, we really think you should get IV antibiotics ASAP.”

Eventually we caved and agreed to the IV antibiotics (which was an awful experience in their own right because [my baby] was so small, and her veins were difficult to find, took literally 4 practitioners before they could finally access her vein — [my baby] was screaming like crazy and we were saying, “can’t you find someone else to do it?” And the girl said, “don’t feel bad, she won’t remember it.” Who says that?!) As a side note, god forbid you have to go through something like this, but if you do immediately ask for a practitioner from the neonatal intensive care unit (NICU) to insert any IV into your child, they can find a needle in a haystack.

At this point they were still pushing for a spinal tap and I said, “If the blood results come back negative, is there ANY reason to do a spinal tap?” The doctor said typically no. I said, “Well let’s see what the blood results say then.” The results came back negative, so I said I’m not doing the spinal tap. The doctor kept saying, “well, sometimes things can slip by the blood tests.” But I refused. I left to go home and get changes of clothes for me and [my wife] since we didn’t realize we’d be at the hospital for 2 days, and while I was gone [my wife] said that they sent in some other doctor (female this time) to pull at her emotions to try and get her to agree to a spinal tap, but she refused, we didn’t do it — the infection just looked so much better already (even before the god damned antibiotics).

We stayed with [my baby] in the hospital like 36 hours, during that time we were regaled with fantastical tales of babies contracting Hep B and why we should really give her the Hep B vaccine. I kept asking the doctor to give me a realistic example of how [my baby] would contract Hep B at this age. His examples were literally so absurd they’re not even worth typing them, one involved a syringe with Hep B on it being mistakenly inserted into [my baby] by someone in the hospital, it was so ridiculous I could barely listen to it. We didn’t get her a Hep B vaccine, and still haven’t, and she’s miraculously Hep B free! I also mentioned to the doctor, “even if we agreed that [my baby] should get a Hep B vaccine soon, wouldn’t this be a BAD time to give it to her given that she’s obviously fighting off some infection?” The doctor wasn’t fazed by this logic, they’re total vaccine zealots, they’d vaccinate a cadaver given the opportunity.

In any case, in thinking back on the whole situation and what I would do differently, I think I would just wait an extra few hours before going to see the doctor, and when it looked better pre-IV antibiotics, I would’ve said, “let’s wait another few hours and see how she’s doing.” I just don’t buy their insane logic that something is visibly getting better but somehow actually getting worse. I’m sure there’s some textbook case of this happening to 1 in 1,000,000 babies, but doesn’t seem worth the known risks of IV antibiotics at such a young age.

It’s so sad and frustrating that you can’t simply take a doctor’s advice and trust that he’s already thoroughly immersed himself in the risks and benefits of the trade-offs between treatment / non-treatment. All they know is how to limit their own legal liability.

Hopefully you can avoid such a mess from happening to you!

He adds in an addendum:

Since doctors in large hospitals work in shifts, you naturally see the same doctor for awhile, and then see a new doctor for awhile. When it was time for [my baby] to be released, we were given an older doctor (maybe late 50s, early 60s). Not only was he WAY more respectful than pretty much every previous doctor we had, but he literally said something to the effect of, “if you’d gotten an older doctor, you may never have been admitted to the hospital, probably would’ve suggested you wait and see how the infection progressed.”

It seems that the doctors being minted today are inculcated with one-off horror stories starting on day 1 of their education.

My Trip To South Africa & Dubai

In early November I had the opportunity to travel to South Africa for the first time in my life, which included a visit to a private game reserve, Sabi Sands, in the Kruger National Park region. My prior knowledge of Africa in general and South Africa in particular was derived from things like the autobiography of Roald Dahl, the novel The Power of One, various history lessons about European colonialism and WW2 and assorted contemporary news articles about violence and poverty in post-independence South Africa. Clearly, none of it could really prepare my mind for what South Africa was as I experienced it, and certainly it couldn’t capture the majesty of experiencing exotic wildlife up close (sometimes as close as 6 feet away, protected only by the elevation of an otherwise open vehicle) in its natural habitat, much better than the idea captured by a “living zoo”. As a collection of experiences packed into 11 days of travel, it would be exhausting to fully catalog as a blog post, so I’ll try to stick to some high level perspectives and recollections as far as piecing this entry together goes.

Our trip started in Cape Town, which we transited to through the UK and which involved two day/night cycles which made for truly disorienting jet lag on arrival. Despite being an international airport capable of servicing large, long-distance aircraft like ours, the terminal was “sleepy”, with little people and activity aside from the recent arrivals. Security and customs was a joke– no disembarkation card to fill out, no questions, just a quick stamp in the passport book and then on our way. It suggests South Africa is either quite welcome to having visitors and tourism, or doesn’t take border security seriously. Either way, I appreciated it as a traveler.

The ride from the airport to our destination downtown took us by numerous shantytowns along the roadside. I learned later that these shantytowns are normally populated by recent immigrants from bordering African countries which are even more poor and unstable than South Africa. South African law allows for squatters rights after some short period (may have been 90 days) at which point the shantys can’t be removed. It doesn’t seem like there is a concerted effort to remove them in the meantime as the towns were numerous and expansive. Trash develops along the roadside wherever they spring up but they otherwise appear to be orderly places, with electricity, running water and satellite TV. I don’t know if satellite TV would be the most important use of my funds as an impoverished immigrant and I am always surprised to see how the “destitute” manage to be able to shell out for what appears to me a luxury item. But who am I to judge?

Something that struck me being in and around Cape Town was the number of construction cranes on the skyline! Cape Town by no means has a “scenic” skyline. The architecture is largely dreary and uninspired, it looks like the kind of semi-Soviet concrete structures that populated many Third World countries during itinerant booms in the 1970s and 1980s. But it seems that Cape Town is participating in the same global boom in downtown real estate prices and thus experiencing the regenerative development patterns that can be seen in every other major metro from LA to London to Tokyo. From my hotel balcony near the water front I could see 8 different construction cranes, and I did not have a full 180 degree view looking back toward the city. Surely there were more that escaped my notice.

The other thing I noticed about Cape Town is that it is geographically scenic. Framed by Table Mountain in the background, Cape Town appears to offer many retreats and activities for the active bodied resident. And standing on Table Mountain you can see all that you might like to see– Cape Point and the southernmost part of Africa, the Stellenbosch wine region and dramatic, glassy ocean blue views. With international shipping routes converging at the cape, the horizon is peppered with interesting long-hulled ships here and there. There are opportunities for ocean sports, hiking, climbing, air sports, “extreme sports” and more.

We took a tour of the wine country, Stellenbosch, and I found it both scenic and idyllic. And the wine was fantastic. I chatted with a friend before my trip who is a wine snob, who insisted “South Africa doesn’t have any good wine.” I just don’t know what to say to that kind of ignorance, it is demeaning to the country to even treat the objection seriously.

When I visit some place new I always try to ask myself, “Could I imagine living here?” My biggest stumbling block is usually thinking about what value-added service I could provide to have a comfortable income in this new place. Nothing stuck out to me in terms of economic opportunities during my short visit in Cape Town. And while I don’t think I’d rush to find some place to live there, I could see myself enjoying my lifestyle there.

After a few days of acclimating in Cape Town, we were off to the bush for the safari. We took a small aircraft (jet) from Cape Town to a municipal airport in the northeast of the country, and from there boarded an even smaller aircraft (twin propeller) where luggage weight was a concern and flew directly to the game reserve’s air strip about 15 minutes away. Here we were picked up by our guides and trackers in their Land Rover trucks and proceeded directly into the reserve. Not knowing what to expect, I was quite shocked when a few minutes later we spotted a herd of elephants in the brush, thinking that we needed to drive to some “attraction” area to do some animal spotting. This would be a theme throughout the visit, the unexpected nature of animal sightings which occurred nearly everywhere.

Before going further, I want to talk about health risks in the bush. November in South Africa is the beginning of the summer rainy season, and the rains activate insects which have lain dormant through the dry winter period. The health recommendation for the trip was to take vaccines for Typhoid, Hep A and Malaria (and/or anti-malarial pills). According to the CDC, the country is a known risk factor for the first two and the particular area we were going to for the safari, near Kruger, is a known malarial zone.

Prior to the trip, I agonized about whether or not to take steps to protect myself. As a general rule, I am a vaccination skeptic. I also was trying to think about the risk of getting ill and/or bringing something home with a pregnant wife near term. After doing a lot of research and thinking about it, I decided not to take any vaccinations nor to take the anti-malarial pill regimen. My reasons were many. First, I found out that typhoid and hep A are extremely uncomfortable symptomatically, but they are not considered lethal nor do they cause lasting tissue damage, and a normal person can fight the disease and heal on their own if they contract the disease. I also studied the transmission mechanism for these diseases, which is contact with bodily fluids (specifically blood or feces) from an infected person. I was never going to be anywhere on the trip where I expected to be exposed to that kind of hygiene problem, and I didn’t see why I was at more risk of this transmission mechanism at home versus in South Africa. Googling and reading stories on TripAdvisor confirmed these suspicions– people with more competent doctors were laughed at for considering these precautions on anything but remote mission work, and even then.

As for malaria, I did a lot of research and realized that we were unlikely to encounter a lot of mosquitos at this point in the season. In addition, most people reported success in warding off bites (which are the only vector for the disease) with simple bug spray repellant. Finally, while malaria can be lethal, if it is contracted it is pretty obvious and can be treated with anti-viral medications at that time with a high rate of success. The side effects of anti-malarial medications are well known and include horrible nightmares, vomiting, diarrhea and other miserable flu like symptoms, which seem to occur with some frequency.

I decided to take my chances and I am really glad I did. I experienced my time in Cape Town as quite “civilized”, at no point did I feel there should be a reason for there to be a heightened risk of transmission of typhoid/hep A via food contamination, the most likely vector given that I don’t do intravenous drugs or hang out with prostitutes. In fact, many parts of Cape Town came across as very “hip”. I think hygiene is something they understand in this part of the world and the economy, which is so dependent on tourism, would really suffer if they were poisoning all their visitors with careless, avoidable disease transmission.

As for malaria, I didn’t see one mosquito the entire safari, nor receive one bite of any insect or spider (I saw many insects and spiders). The day we arrived was the first day of rain after the dry season, and we were leaving four days later, which happens to be the normal gestation period for the larvae once they receive water. So we lucked out in that sense. However, I spoke to the guides about this and they kind of laughed at the idea of taking anti-malarials. None of them took any and none even wore bug spray. They felt it was an extremely small risk and treatable if it occurred. These are trained ecological scientists (more on that soon) and wilderness survival professionals, not snooty dorks from the city that read anti-vax hoaxes on the internet. They just found operationally it wasn’t a risk in their area.

Meanwhile, many of the other people on the safari who had taken the meds had horrible side effects to the point that they were crippled with symptoms for several precious days. When the rumor got around that they might be experiencing side effects, they one by one stopped taking their meds and recovered instantaneously, enjoying the remainder of their trip in perfect health. Aside from spraying myself with a citronella bug spray before going out more out of habits back home than anything else, I did nothing to preserve my health on the trip besides eating well as I always do, getting sleep and being aware of my surroundings. This seemed to work just fine.

The safari experience is hard to describe to a person who hasn’t enjoyed it. It is not simply like being inside a zoo exhibit, because at a zoo animals behave differently than they do in an expansive habitat. They live on a kind of rhythm created by their feeding schedules and the coming and going of people as the park opens and closes. They lose their instincts, they stop mating, they no longer hunt to survive, they no longer have to avoid predators. Often times they become depressed or deranged. So going on a safari is not a “super zoo”, but a qualitatively different experience entirely. You now are watching animals do what they always do as if no one is watching and nothing disruptive has happened in their life. You are watching them be truly natural. Modern humans struggle to understand this, but what is natural is often fundamentally different from what is man-made.

On our safari we road around the massive acreage of this game reserve in a Land Rover, with our guide driving and our tracker sitting on a chair hanging off the hood of the vehicle. It is quite noisy and obvious moving along the trails (and quite ferocious in terms of mastering the terrain, able to climb and remain balanced in steep slopes, operate in deep water, crash through small trees and other brush as necessary) but it doesn’t seem to disrupt the animals. They perceive it as a large but unthreatening animal moving through their environment, as long as the humans all remain inside.

We’d start with a 430AM wakeup, gather for a quick snack and coffee and depart by 5 or 530AM. The sun rises around 330/4AM, so by this time it has been up for awhile but it is not yet warm. We would drive and see what we could see for a couple hours, stop on the trail and make a snack and second coffee on the hood, clean up and continue driving for another hour and a half, ending around 830AM. The rest of the day was to be spent at leisure at the lodge, until afternoon tea again around 4PM, followed by the afternoon drive at 430/5PM. A similar pattern ensued, with a break for a snack and the last half of the drive occurring after sunset at which point the Land Rover headlights come on and the tracker sweeps the horizon with a floodlight rhythmically, looking for the glint of reflection coming from a hidden animals eyes.

The “Big 5” on the safari that everyone hopes to see are the leopard, the lion, the rhino, the elephant and the buffalo. We managed to see all of these, and more. We were truly spoiled as we often saw some of them more than once, or doing unusual things (mating, recovering after a kill, with newborns, etc.) We were often so close that, while I never feared for my life because we were with professionals who understood the risks, my own instinct was to tighten up and remain still not wanting to make any sudden movement unintentionally. It felt like that sudden move could invite a beast to come lunging into my lap in one snap motion!

Things that can’t be communicated in photos, and only poorly in videos, are the sounds of the safari. Warning cries. Combat sounds. Horseplay noises. Mammals, birds, insects. And of course the smells! At this time in the season, the bush and the grass are well eaten away and some of the animals are on the verge of starvation. An entire season’s worth of shit of every conceivable species is littered over nearly every square foot of ground and while it doesn’t smell bad (even when it’s fresh, most of it is essentially grass and leaf material, it is the meat-eater feces which smell putrid) it adds something to the environment. So does the occasional rotting carcass, which can literally be smelled from a mile away and which is totally revolting at proximity when driving by.

And then there are just general landscape items that are hard to capture because they become almost monotonously mesmerizing as they are passed by repeatedly. Hundred year old termite mounds that look like small hills dotting the landscape every fifty or sixty yards. Trees being slowly consumed by strangling vines. The nearly endless variety of grasses, bushes, trees and other plants, some of which have still not been cataloged and fully speciated.

All of this stuff we were whizzing past for hours every day for four days, all of it so different and unusual and unassimilable in my normal experience parameters that I was amazed at how quickly I became inured to it as a stress-induced response to being incapable of taking it all in in such a short period of time. Something funny that happened again and again was the way I’d get a photo of an animal, and then we’d come across another specimen of the same one I had photographed earlier, and I decided to set my camera aside and just watch because “I’d already seen this”, and the animal would proceed to exhibit some unusual or unexpected behavior and I’d be cursing myself for setting the camera aside! But simultaneously, I was fighting that urge to just be present and let my memories develop organically rather than trying to catalog everything at risk of missing out on actually perceiving it live and honestly.

The highest praise I can give the safari experience is that it is one I will be eager to share with my children at some point in the future. They can certainly live without it, anyone can. But it is a trip worth taking if you want to take a trip. It is just so different in terms of the sights, sounds, smells and sense you get in “being there” that it has no comparison to any other travel I’ve done up to this point in my life (and I think it’s taken the crown for most “exotic” from my trip to Japan in 2001, an experience that has not been surmounted despite a recent return trip to Asia that touched many other countries).

On our way home, we decided to stop over in Dubai for a day and see the sights. I will keep this brief. I was not impressed with Dubai. In fact, I was a bit offended with how impressed I was supposed to be. To me it was a depressing place– a false city of gilded monuments to a capability that doesn’t belong to the people who live there, constructed with resources that other people discovered and learned how to produce. It is the most sickening welfare society I have yet come across and I couldn’t get over how phony it was, with it’s attitude of “we’ve brought the best the world has to offer to one place, our city!” trying to paper over the fact that there’s nothing remarkable or noteworthy originating there.

I was really happy we only decided to spend a day there!

My Recent Trip To The ER

Three days ago I critically reflected on the idea of preventative medicine in a post where I talked about a troublesome health condition that I had developed and my experience of having it examined at a local doctor’s office. Today, I went to the ER for that same condition.

What happened?

Between Tuesday, when I first noticed discomfort in my leg, and Wednesday, when I decided to go get a doctor’s opinion before spending some family time out of town, the swelling and redness increased, but I did not develop any other symptoms. On Thursday, the swelling and redness had encircled my entire lower leg, down to my ankle (but strangely not affecting my foot) and up to my knee joint, but not beyond. On Friday, no one who had a look (and there were many prying family eyes beside mine) could tell a difference between Friday’s swelling and Thursday’s– it didn’t seem better, but it also wasn’t clear it was worse. On Saturday morning (today) we packed up and made for home, and the swelling seemed unchanged.

Some family members tried to look up bug bite sites to help guess at what caused my reaction. Others just expressed shock and concern that I wasn’t doing something, anything, to address the obvious symptoms. Suggestions were made that I visit the ER in town at our vacation spot, or at least do it when I got back.

Here is how I was thinking about this decision: the fact that the swelling wasn’t getting obviously worse seemed like a good sign, the way the body fights its fight against invaders and injuries is going on below the surface, and without some kind of evidence (increased pain, swelling, etc.) that it is slowly losing the fight, I assume it is winning it. The discoloration was more extreme and enveloping, but no increase in pain with it seemed less than frightening. I did not develop any other symptoms which suggested a spread of the condition to other vital organs– no dizziness, nausea, vomiting, confusion, etc. And as ever, I am an otherwise healthy individual who rarely experiences illnesses and generally makes speedy, fully recoveries on my own. I felt like I had a lot on my side in terms of weighing the wait.

When we got to town, I had lunch with a friend from high school who was in the area visiting relatives. His father is a doctor, and he mentioned my leg to him, to which his response was the predictable “He should get it checked out.” His dad is a good doctor and a thoughtful person in general, so I asked if he’d take a look at it to see if it was at all obvious from a visual inspection what was going on. He agreed and was surprised that I did not have tenderness or problems moving my toes up toward my shins, indicators for possible blood clot. Still, my leg looked “nasty” in his very medical opinion and he suggested I go to the ER and have them take a look. It could be a blood clot or cellulitis, an under the skin infection, both of which generally require medical intervention to treat.

The blood clot thing did concern me. I was exhibiting some of the symptoms (swelling, redness, soreness) but not all of them, and based upon my diet and exercise I assumed it’d have to be freak luck or a weird immunological response (say, to a bite?) to develop a blood clot in my leg. It seemed a really low probability, but the way to diagnose it is an ultrasound, which I’d rather not do if I don’t have to, but I don’t see as a health disaster for me for attempting.

A trip to the ER brings with it some risks– contracting an infection you didn’t come in with, incompetence in conducting routine medical exam techniques (blood draw, IV), “intervention spiral” where the medical professionals push you to treatments for diseases you don’t even have that just make your health worse, false positives. So I don’t want to go to the ER if I can avoid it. And I still think I could’ve avoided it. Aside from the swelling and redness, nothing else about my condition seemed to be getting worse and I wasn’t exhibiting any other symptoms, it seemed like it was worth taking a punt.

I decided to go to the ER based on the following:

  • second opinion of a non-specialist MD was that my reaction/condition was not “normal” and may be symptomatic of conditions that are potentially tissue-damaging or fatal
  • family was getting worried and doesn’t have the same mental and emotional framework for thinking about this as I do, so they’re going to increasingly see my approach as needlessly risky and stubbornly defiant over what could admittedly be a long self-recovery period
  • so far, no one including myself is able to diagnose what’s likely going on with any certainty
  • because I believe I am an otherwise healthy individual with a strong immune system, I think the specific risks of being exposed to an ER are pretty low for me, so I am willing to trade the potential cost of exposure to risks for gaining more certainty about my condition; my suspicion is that my condition is nothing to be worried about, but I am not prepared to take a gamble on it as we near the delivery date for our first child (best part about this, my wife was pretty skeptical and kept sending sarcastic texts to me as I explained what was going on along the lines of “What did you expect at an ER?”)

Getting admitted was even easier than going to the GP’s office on Wednesday! I filled out a half sheet of paper with my name, birth date, phone number and reason for coming to the ER. It was raining today and there were all of 2 people in the waiting room when I arrived, I got pre-screened in about 3 minutes and then walked to my private room in another 2 minutes and was seen by a nurse attendant in another couple of minutes. The doctor came in and talked to me while a scribe annotated the conversation about 5 minutes later. In total, I was at the ER from about 3pm to 6:30pm.

Before I go further, I want to make something clear: I don’t see myself as anti-Western medicine or anti-medicine in a general sense, and my observations are not supposed to be read as some unbridled skepticism or lowbrow guffawing at the “scam” of the system. I felt I was treated with concern and respect by everyone who I interacted with at the ER, and whoever is the equivalent of the General Manager of that operation is doing a great job because it runs smoothly and its clear customer service is something they’re trying to deliver. This ER is in the hospital I was born in, and which we may have to turn to in the event of a complication with our home birth plans in the coming weeks. I don’t think it’s necessary or reasonable to try to scandalize the people or the process. I simply want to illustrate my thinking about the interventionist mindset and how I experienced it at the ER.

And I knew exactly what kind of a jungle I was walking into. I made the decision when I went to the ER to also go along with (but question first) any routine intervention they’d attempt to administer unless I could get them to talk themselves out of it, or I seriously feared it posed an undue risk to my health. I’ll provide more explanation about this in a bit, but for example, they put me on an antibiotic IV– that wipes out my carefully cultivated gut bacteria and potentially exposes me to direct bacterial infection through intravenous contact, but I believe my full immunity and health profile make it statistically unlikely I will be unduly harmed by this specific intervention.

With that out of the way, I will say this: life is an uncertain enterprise.

Perfect knowledge and omniscience is not something any individual can obtain, nor need they try. We are always grasping at a little bit more illumination in our lives, more clarity when there was less focus, more understanding when before there was ignorance, and this goes for the practice of medicine as well. The contributions to the improvement of human life on this planet by innovations in medicine and physics over the last 200 years are truly astounding, so astounding that some people have concluded that we know most of what we can know about these subjects or that, at least, we need not question their conclusions. I just don’t share this conviction. I look at all actions in life as being about tradeoffs, and I see these tradeoffs being motivated by perception of uncertainty and a desire to gain more certainty. So I look at medicine as offering many answers, but not everything, and certainly not any answers that shouldn’t be questioned. Everything should be questioned, if you’ve stopped asking questions you’ve probably started to experience the knowledge dishonestly.

I went to the ER to try to relieve some uncertainty.

The nurse informed me that they planned to run a blood panel on me, which meant they needed to draw some blood. The reason for the blood panel was to see if there was any distress markers in my blood, particularly an indication of acute infection. The two theories that the doctor who saw me had were that I either had a blood clot, or an infection. Because they were going to put an IV into me to draw the blood, they decided they’d just hit me with an antibiotic drip right away as well. This was puzzling to me, because they planned to do this before confirming the results of the blood panel. The response I got from the doctor was (summarized) as follows:

MD: It’s better to be safe than sorry, don’t you think?
ME: Let’s say I have an infection, what are the chances my body could fight this on its own?
MD: (pauses for a few seconds) …mmm, 50/50. But if your wrong, and your body loses, you could lose your leg. I don’t want to scare you, but I’ve seen these things go fast, like if that’s what it is, you could be fine and then an hour later you’ve lost and it’s too late.
ME: I generally try to avoid antibiotics.
MD: Me too! I never give my kids antibiotics. Like, I won’t give them antibiotics unless they’re dying. Trust me, I wouldn’t suggest this unless I thought it was absolutely necessary, okay?

Of course, if I don’t have an infection, but a blood clot, then what good were the antibiotics? And if I have neither, what good are the antibiotics?

The nurse also informed me I’d get an ultrasound of my leg done to check for the possibility of blood clots. The doctor and the nurse worked together with a doppler to check my pulse in my legs and feet, which they were able to confirm, but their concerns about the heat emanating from my swollen leg led them to the “safe vs. sorry” compromise of ordering another test.

As the nurse walked me through the test regime I was about to run, I asked, “Any idea what this will cost me?” Of course he didn’t know, and up to this point, no one bothered checking with me about the cost of services. It ended up being $250 for the co-pay and I don’t know yet what it was for the tests. I also don’t know if the IV antibiotics costs more than an oral treatment. I asked the nurse about this and he went into a rationalization about not taking chances, etc.

The nurse was very good at drawing my blood. The injection was almost undetectable. The ultrasound technician was also efficient. We talked about her automobile purchase history and she had me all checked out in about 15 minutes. An orderly wheeled me around from room to room in my gurney bed, which enhanced my feeling that something was really wrong with me and at any moment I could crater. I noticed passing through the hall that the other patients at the ER were all males, either very elderly males probably near the end of the road who had had a fall, or gotten sick, or very young males who had just made a very poor judgment call and were now paying the price.

I couldn’t help but thinking, “What is wrong with this picture?” as my seemingly-healthy, 30-year-old trim frame was being shuttled from room to room. Two ideas came to mind: either nothing was wrong with me, and that’s why I shouldn’t be in the ER with these people, or something was REALLY wrong with me, and that is why I was suddenly in the ER with these people.

I waited another 45 minutes by myself on my bed gurney before learning of the test results. A financial admin came in and out to run my insurance and have me initial some boilerplate. I started initialing without reading it and got halfway down the list and saw something saying I agreed to have my medical history inserted in a state database. “Do I need to do this?” “No. I know, next thing you know you’re going to be getting called by a telemarketer…” (not really what I was worried about on that one). So I didn’t initial it, went back over the ones I did, finished the others and wondered what law or series of events had conspired to have a financial admin highlight for initialing the sharing of private medical data in a public database without comment or concern?

Ultrasound: no blood clot found.
Blood panel: no acute infection indicated, blood work looked very good including liver and kidney function (I made sure to ask my nurse for a copy of my blood panel so I could interpret it more fully later, since a blood panel costs $$$ and I planned to do one eventually anyway, this helped me recoup some of the cost on this unnecessary intervention visit)

So, what was wrong with me? The doctor admitted she really didn’t know. Her suspicion was that I was bit by something and it either had some bacteria on its fangs, or it triggered a strange reaction. She told me she wanted me on an antibiotic regimen “just to be sure”, and to come back immediately if my leg felt tingly or numb. She said I could take some Benadryl to try to treat the inflammation as well.

I asked the nurse to help me interpret my blood panel. How did it look? “It looks great, really good panel, no indication of acute infection…” “So then why am I being administered an oral regimen of antibiotics if there is no infection indicated?” “Well, the body is funny, it COULD be infected and it just hasn’t shown yet in the panel, but anyway, we’ve seen a lot of crazy stuff, better safe than sorry right? I mean it can’t do any harm to get the antibiotics, it can only make it better.”

He grabbed my checkout paperwork and had me look over it and sign. The paperwork says that I acknowledge the diagnosis and the treatment being recommended. The nurse says, “We don’t know what you have, but we’re calling it ‘cellulitis’.”

I gained some additional certainty that I don’t have a life-threatening blood clot and that I am not at risk, as of this very moment, of losing my leg to a bad infection as one doesn’t seem to exist. My experience led me to conclude that allergy and immunology medicine are perhaps younger, frontier sciences within the practice of medicine with higher levels of uncertainty than the practice itself. Everyone’s still uncertain about what actually happened to my leg!

Why I Try To Avoid Visits To The Doctor’s Office

I don’t go to the doctor much. I think that’s a good thing, but people who believe “an ounce of prevention beats a pound of cure” might be horrified to know that I don’t even do my so-called oil changes and other regularly scheduled maintenances with regards to my body– false positives, risk of complications from the cure that are worse than the disease, etc.

Generally, if I’m not in pain, I’m not going to see a doctor. And even sometimes when I am, I think, “This too shall pass” and carry on. I pay attention to my body, I’ve gotten pretty good at knowing when I’m in trouble versus experiencing discomfort that will resolve itself over time. I have a pretty high pain threshold I think, I won’t even mention I have a headache until I’m somewhere around a migraine for someone else.

And I do believe in prevention! That’s why I eat a nutrient rich diet, exercise (weight lifting) weekly and walk my dog daily. That’s why I work hard to keep a reasonable bed time and get as much sleep as I can. That’s why I try to think happy thoughts and help others do the same. And that’s why I listen to my body and take it easy when it tells me “No!”, rather than flailing myself before the altar of No Pain, No Gain and reveling in masochistic torture.

So I do my darnedest to avoid visiting a doctor. That’s why I’m bummed I decided to go in today, and that’s why I think this decision was yet again illustrative of my principles!

You see, where I live, medicine is practiced a bit oddly– legal liability dictates that the doctor does anything he can to avoid taking responsibility for your treatments and it’s consequences, as they don’t want to be sued for malpractice. But their medical school instruction plus their ever closer relationship with the State leads them to an aggravated mindset anytime you insist on thinking for yourself and following your own judgment. Think about that, they don’t want you to make your own choice, but they don’t want to be responsible for the choice you make.

I had some kind of strange reaction to an insect bite on the back of my calf last night. I don’t know how it happened or what bit me, I’ve never seen anything like this on my leg, nor felt this kind of pain, which is severe but within my tolerance levels. Normally, I’d just keep walking around and unless it seemed to worsen or I showed other symptoms, I’d just let time work it’s magic on healing it. Painful, yes, but nothing my body can’t handle.

Unfortunately, my plan was to travel out of town for the holiday this week to spend time with family. If my condition worsened, I might end up in an ER in a strange place. I don’t want to end up in an ER, and certainly not in a strange place. As a result, I decided to visit the GP at the last minute to see if they thought it looked dangerous. If it was going to kill me or save my tissue, I’d want to intervene, but anything short of that I’d just make do.

I should’ve just kept on going and took my chances.

The doctor squeezed me in, which I’m very grateful for. But because I hadn’t seen them in over ten years, they subjected me to a battery of questions about my health, my family’s health, and so on. I spent 20 minutes talking about everything but my bite and about one minute actually discussing the course of action about the bite.

I got lectured about the need to do regular check ups. I got lectured about treatments available for some historical conditions, as if I was unaware, hadn’t tried them and was suffering needlessly (because the assumption is I don’t take care of my health). I witnessed the doctor exhibit some unhealthy conditions of her own and then was told not to worry, wasn’t contagious, etc.

The worst mistake I made was mentioning that my wife is pregnant and nearing her due date.

“When did you last get your tetanus shot?”

This is a terrifying question. Something innocuous like this, ostensibly asked our of concern for my health and the health of my family, could lead to a spiral where either the baby snatchers come for my kid, or I submit to vaccinations and other invasive treatments I don’t have any interest in.

She continued, “I don’t mean to alarm you, but EIGHT babies in the whole state died last year because of whooping cough connected to tetanus, likely contracted from a parent or relative who didn’t get their shots. I wouldn’t want you to be one of them!”

When she said 8 in the whole state, I wanted to laugh. Are you kidding? I probably have more risk driving my baby around in its car seat (don’t worry, she lectured me about that, too). And its probably not PC to say, but I doubt those babies had my socioeconomic background (ie, I’m wealthier and I don’t have relatives traveling back and forth to third world countries or other impoverished areas). It’s simply not reasonable to be worried about this risk, measured against the potential complications.

“It’s really quick and out nurse is great with shots, can I go ahead and get that taken care of for you?”

No, thanks, I’m traveling and don’t want to deal with it right now.

“Okay no problem, I’ll put a note in your file that you’re going to come back in two weeks and take care of it. Due to state mandate, they won’t let you go near your baby if you don’t have an up to date tetanus shot.”

I sure hope I don’t get that call.

Other Side Effects Of Pregnancy (Running List)

EDIT 3: December 12, 2016 12:32AM

  • Insomnia: I don’t think I have insomnia per se, but there have been many nights when I do not feel tired or feel too excited to sleep. Some of this is probably brought about by my constant need to use the bathroom, which leads to my next point…
  • Constant urge to pee: I am down to my last 3-4 weeks of pregnancy and am now needing to use the toilet around once every hour, depending on how hydrated I am. It is annoying. It also seems like a waste of water and toilet paper because my bladder can hold so little that it almost makes a trip to the bathroom not worth it. However, the pain (and potential damage) of holding it in scares me more than the utility bill and cost of TP.
  • Fetal movement: My baby moves a lot, and it is comforting and exciting, but it is also uncomfortable as the baby is growing larger and running out of room. Sometimes I feel out of breath from its stretches, mostly I feel the skin of my belly stretching, which can be uncomfortable. I can also coax my baby to move by scratching my belly, and I have noticed it moving/jolting when I first step into the shower and the stream of water hits my belly 🙂
  • Acid reflux: Worsening as the baby is growing, probably due to the increase in hormones as pregnancy is progressing. However, this does help curb my attraction to foods I’m not suppose to eat (e.g., processed foods like potato chips) during pregnancy anyway. Sometimes the acid reflux is strong enough to wake and keep me up at night, at which point I’d have to stumble out to the kitchen and make myself the ACV concoction (see below).
  • Sore/tired hips from sitting too long: As my joints are loosening to prep for childbirth, it becomes harder to rise from sitting in a chair for too long. I grunt and groan as I sit down and get up!
  • Fear of crowds: The Lion and I went to the mall the other day despite our distaste for visiting shopping centers during the holiday season, and my immediate instinct was to keep a wide berth from shoppers and children from fear of them bumping into me and my belly. Not sure if this was because I knew holiday shoppers can be merciless or if it was the mothering hormones kicking in.
  • Swollen ankles and feet: These have returned with a vengeance because I wore high heels yesterday and was probably dehydrated as well. Harmless for the most part but unattractive and slightly abnormal.
  • Posture restrictions: I have been trying to lay on my left side [when sleeping] or sit leaning forward in order to coax Baby over to the left side of my belly. Throughout pregnancy, B has enjoyed hanging out with its back to the front-right of my belly, but as we are nearing expected due date, the midwife recommended exercises and these positions to get B into a more ideal positioning for easier delivery. I am looking forward to being relieved of these positions because I miss sleeping on my back, and I miss reclining on the couch!

EDIT 2: September 22, 2016 11:47PM

  • Acid reflux: I had heard from girlfriends that despite not having acid reflux or heartburn ever in life before, they started experiencing it during pregnancy. My acid reflux has been relatively mild, and I wouldn’t consider it “heartburn,” usually just an acidic taste in the back of my throat. But it is annoying and uncomfortable enough to be noticed and sometimes keep me up at night. The nutritionist (who came and gave a talk one Saturday morning) had recommended taking some apple cider vinegar diluted in water, so I started drinking about 6oz of water with a splash of ACV (eyeballed because I was too lazy to get out the measuring spoon and then wash it after use) a little bit before bed. Surprisingly, it didn’t make me get up in the middle of the night to pee, and it did help to ease the acid reflux. Now, I drink that same amount whenever I feel the acid and/or before bed just in case.
  • Hemorrhoids: Prior to being pregnant, I would make dinners that consisted of a salad starter followed by a protein + veggie entree. When I had my decreased appetite a couple months ago, I stopped making the salads because I wasn’t hungry and because I physically felt I couldn’t eat that much (since I was feeling bloated anyway/because I feared acid reflux). The sudden decrease in veggies made my bowel movements much more difficult. I strained every time I had to go, and it was painful and resulted in bleeding. Fearing the descent into anal retentiveness, I began eating a small snack of raw veggies and dip because I remembered how this had eased my constipation earlier in pregnancy. Lo and behold, during the week that I made and ate this snack during the day, my trips to the bathroom were much more pleasant. This week, I ran out of sour cream and forgot to buy more, so I am suffering yet again. This is why it’s important to eat your veggies!!!
  • Bernhardt-Roth syndrome: This is a new one for me that just occurred in the last couple days. We recently relocated to a new house, and I have been on my feet many hours during the last few days watching the movers, unpacking, lining closets and shelves, laundering, washing, etc. etc., and it has taken a toll on my lower extremities. The bottom of my feet were very sore and hurt from standing so much, and yesterday evening, I noticed there was a patch of numb skin on the outer part of my right thigh. I didn’t think much of it, and it eventually faded away at bedtime, but when it resurfaced again this morning, I Googled it and called my midwife. Turns out, it is called meralgia paresthetica (or Bernhardt Roth syndrome), which is a condition that causes numbness, pain, tingly sensations, or burning in the outer thigh. It happens because there is too much pressure on the nerves of your leg. Right now, it feels like a cold burning sensation, like there’s an ice pack on my thigh (but not in a pleasant way…), and I can feel heavy pressure but not light touch. The nurse at my midwife’s office confirmed there has probably been too much pressure on the nerve 😦 I am trying to perform as much of my duties as I can while sitting, and I’m trying to prop my feet up as much as possible. Of course, the extra weight from the baby doesn’t help. I’m hoping as I adjust to our new place and things get finished up, this unpleasant side effect will dissipate…
  • Swollen ankles (edema): Relatively common side effect but it was still jarring to see it on my own ankles!! I have chubby ankles now, ew.

EDIT 1: August 26, 2016 1:40PM

  • Eczema/skin update: The eczema soap I linked to above has really helped me a lot. Some of it may be psychological, but my belly is finally smooth again and free of sandpaper-y skin. Some of that may be due to the weather finally cooling down too… I love this soap though!
  • Fibroids – This was a scary one for me when I first heard about it. I hadn’t come across this term in any of the books I’d read so far, so it was a shock. Fibroids are noncancerous (99% of the time) tumors that develop in/on the uterus. My four were discovered during my 18 week ultrasound. My midwife reassured me that fibroid development is pretty normal (about 80% of women develop them by age 30) and shouldn’t interfere with the pregnancy/baby as long as it doesn’t grow too large (only in about 20% of cases does it cause complications). Based on my own research on the internet, it seems like the worst fibroids could do to pregnancy/childbirth is block the cervix or prevent the baby from getting into a head-down position, which may mean that I’d need to have a c-section to have the baby. Apparently, until I develop further symptoms (extreme abdominal pain, heavy bleeding), it shouldn’t be a big worry for me.

Original post: August 10, 2016 3:35PM

There’s a lot more involved in pregnancy than just belly and boobs getting bigger, as I’ve learned. This is my list of some of the unexpected symptoms I’ve experienced. Thank goodness for Google!

  • Pregnancy rhinitis – As estrogen and progesterone increases, so does the mucus in your nostrils. This was very noticeable in my first trimester, as I was going through a box of tissues a week. I need tissues for my runny nose constantly, and it was difficult to lay down and breathe comfortably to sleep. I ended up using more support under my pillow to help keep my head elevated at night, but I lost some valuable sleep. Eventually, the rhinitis just dissipated.
  • Sore and tender breasts/nipples – Definitely one of the first things I’d noticed. It was uncomfortable to dress/undress, and I had to take greater care in not accidentally hurting them (especially with sports bras and bralettes!). Again, E&P at work here! They aren’t as sore now during my second trimester, but I still prefer to sleep with a full coverage top or a cotton bralette because…
  • Protruding nipples – This is what makes avoiding them as you take off sports bras difficult and what is annoying about sleeping in a triangle-top nightie
  • Extreme fatigue – I knew that pregnant women needed more sleep, but I wasn’t expecting just how tired I would be! I was napping basically after every meal in addition to going to sleep earlier at night. I was also going to the bathroom throughout the night, which meant I needed daytime naps to fill in the nighttime gaps. I maintained light exercise (daily dog walking, aerial fitness a few times a week), but paced myself on daily chores and errands. Everything took a lot slower to complete…
  • Montgomery tubercles – These little pimple-like bumps on your nipples or areolas are the visual part of the areolar glands (which are glands that secrete oils to help keep your skin moisturized), which help to keep your nipple and areola lubricated and protected.
  • Itchy belly (eczema flare up) – As the pregnant woman’s belly is growing and stretching, the belly skin can dry up and become itchy. Similarly, the change in hormones can affect the severity of dermatitis. My eczema seems to be especially bad this summer, probably a combination of the heat, hormones, and not being able to use my steroid creams. I’ve avoided hot baths and heavy, scented lotions. My friend recently gave me some baby eczema soap, which has helped immensely. The soap is so amazing that sometimes I don’t even need to use lotion! Sometimes, when it gets really bad, I’ll also use a cold compress for 10-15 minutes, which helps a lot too.
  • Decrease in appetite – I’d always heard the phrase, “Eat for two, now that you’re pregnant!” but I just couldn’t! Interestingly enough, I seemed to have a decrease in appetite. Quite the surprise for The Lion because now there’s enough for him to eat until he’s full! 😉
  • Round ligament pain – Quite possibly my most unpleasant symptom right now. There are many thick ligaments that surround and support the uterus, one of them being the round ligament. As the womb grows, the ligaments need to stretch to accommodate the weight, thus causing you to feel some dull, ache-y, cramp-y pain. I notice this pain the most if I shift positions too quickly and also when I stand up from sitting for awhile. The discomfort is persistent, although not debilitating, and will apparently be around until after childbirth!! *cries

Review – Your Self-Confident Baby

Your Self-Confident Baby: How to Encourage Your Child’s Natural Abilities

by Magda Gerber, Allison Johnson, published 1998

I read YSCB and Janet Lansbury’s Elevating Child Care in rapid succession; while this review will focus on the original work by Magda Gerber (founder of RIE in Los Angeles, CA), I may touch upon a few thoughts and ideas from Lansbury’s book as well.

The advice and ideas espoused in this book rest on two central premises:

  • Major premise; your baby comes built in with the tools it needs to learn and navigate its environment, and will create its own learning problems and discover its own solutions when given freedom to explore the world at its own pace
  • Minor premise; good parenting is less about what you put in early on and more about what you don’t, especially with regards to worry, anxiety and active interventionism

This doesn’t seem that controversial, but if you ask me it flies directly in the face of what I have routinely observed in both American parenting and Asian parenting, for example:

  • American parenting; your baby may be capable of great and wonderful things (which you implicitly choose for it), but like a Calvinist, you will only know for sure if you actively work to develop these talents and capabilities in your child. Failing to do so means risking that your child will turn out to be not one of the Elect, but a poor loser, or worse, quite average and content
  • Asian parenting; babies are stupid and a constant and confusing source of pride and worry for their parents, and if they are not condescended constantly almost from the moment they are born, they risk becoming ingrates, drug users, or worse, free thinkers, rather than guided automatons with eternal respect for their revered elders

American parents spend a lot of time getting wrapped up in the competition of their lives, which they impart to their children. Infant development is like a race– how quickly can the child progress from one stage to the next? And what burdens of guilt, anxiety, anger and frustration can the parents-as-pit-crew take on along the way to ensure the process is stressful and obsessive without wasting time reflecting about the race and why it must be won?

So this Resources for Infant Educarers (RIE) approach, developed by the Hungarian Magda Gerber after a chance encounter with a pediatrician named Dr. Emmi Pikler in 1950s Hungary, is not just an antidote, but a holistic approach for individuals and families looking to foster authentic self-discovery in their children and connection built on mutual respect amongst kin.

But it is NOT a silver bullet! Raising children is still a real challenge, it still involves difficulty and even moments of self-doubt.

Gerber offers these basic principles:

  • basic trust in the child to be an initiator, an explorer and a self-learner
  • an environment for the child that is physically safe, cognitively challenging, and emotionally nurturing
  • time for uninterrupted play
  • freedom to explore and interact with other infants
  • involvement of the child in all care-giving activities to allow them to become an active participant rather than a passive recipient
  • sensitive observation of the child to understand their needs
  • consistency and clearly defined limits and expectations to develop discipline

Gerber cautions parents to slow down, to develop the habit of observing before intervening. Many child troubles — frustration during playtime, an unintentional fall, conflict over a piece of property with another infant — can be resolved by the child on its own if they’re given the opportunity and support to meet the challenge with their own solution. Similarly, it is not the parent’s duty to entertain or preoccupy the child, children become present-oriented and externally directed primarily through the influence of their anxious parents. If left to their own devices to play and explore at their own pace in a safe environment, they will learn to focus and entertain themselves through their own creativity and exploration at length.

Another suggestion is to “sportscast” the infant’s life during caregiving activities such as feeding, diaper changes, bath time or preparation for bed. By narrating what is happening to the child and why, and what will happen next, the child learns about the meaningful sequence of events in its life and can begin to build expectations about the future and acquire a measure of predictability about its life and routines which creates security, comfort and trust in the parents and caregivers. Young children’s minds are “scientific”, they’re always trying to understand the cause-effect relationships behind observed phenomena and one of the primary cause-effect relationships they are exploring as they develop is the sequence of activities across time. Much like raising a dog, following a predictable routine reduces stress in the infant’s life and allows them to focus their attention and learning on other things than the fear of what might happen next to them.

According to Gerber, quality time means total attention and focus on your child. Holding your baby while you watch TV, or read, or run an errand, is not quality time and the child can sense that it’s not the priority. Quality time is watching your child play, uninterrupted, or reading to him, or giving sole focus to feeding him, or diapering or bathing him. Because of this, Gerber encourages parents to reflect on even the routine caregiving moments, because over thousands of repetitions over an infant’s life they will leave an indelible mark on the relationship and come to represent a sizable proportion of the total “quality” time spent together– do you want your child, even in their limited perceptual state during infancy, to see their diapering as a disgusting task you as a parent have to get over with as quickly and cleanly as possible several times a day, or do you want your child to see that you love them and are interested in them even when doing mundane things like changing their diapers?

Further, this approach has a transformative effect on the parent, as well. By treating the relationship respectfully and seeking to include the child in caregiving activities by narrating what is occurring and being present in the moment, the parent is slowly but surely training themselves to see their child not as an obligation to which things must be done, but as another person like themselves with needs and values and a personhood just like other adults they interact with. They will be modeling for their child the very behaviors they wish for them to adopt in how the child is expected to behave toward others.

This book is chock full of so much wonderful, important information for parents, caregivers and anyone interested in the world of small children. It’s too hard to try to summarize all the advice and concepts and it wouldn’t be worthy to try. Instead, I will simply observe that this is another philosophical work that goes much beyond how to put on a diaper or how to create a safe playspace, and instead says much more about how we can build a peaceful and encouraging society for all people to live in, adults and children (future adults) alike. And to the extent this approach is not recognized and its advice goes unheard and unheeded, it explains clearly why we witness the social problems and family and individual dysfunctions we do!

Here is a brief list of some of the more pithy wisdom I enjoyed from Lansbury’s “Elevating”:

  • As parents, our role in our baby’s development is primarily trust
  • Our relationship will be forever embedded in our child’s psyche as her model of love and the ideal she’ll seek for future intimate bonds
  • The secret to connecting is to meet children where they are
  • Grieving people want and need to be heard, not fixed
  • A nice bedtime habit to start with your child is to recapture the day… You can also mention what will happen tomorrow. This connects the past, present and future and gives her life a connected flow
  • Since our lifespan is getting longer, why not slow down?
  • We don’t think twice about interrupting infants and toddlers, mostly because we don’t think to value what they are doing
  • Babies are dependent, not helpless
  • “Readiness is when they [the baby] do it.” “When you teach a child something, you take away forever his chance of discovering it himself.”
  • Instead of teaching words, use them
  • “Don’t ask children a question you know the answer to”
  • Purposefully inflicting pain on a child can not be done with love

Saturday Morning With A Nutritionist

One of the required classes at the birth center is Nutrition 101. Now, readers who are family/friends of ours know that we have some “particular” opinions on what is optimal nutrition! We tend to eat a more traditional diet, and we have been eating this way for about five or six years now. Nutrition (and being more strict about it) has only increased in significance for us as we’ve prepared for conception and pregnancy. I went to this class with pretty low expectations because I’ve heard and read the basic guidelines about what to/not to eat during pregnancy, and they often do not parallel the research I’ve done on optimal nutrition. I was pleasantly surprised!

The nutritionist who came to speak to us introduced her philosophy as primarily “paleo,” and she included references to Weston A Price throughout her talk. She said that she used to be a fitness coach but also suffered pretty severe cases of acne and poor health, despite following all the recommended regimens in the fitness world and experimenting with vegetarianism. Both unfortunately and fortunately, she got into a car accident and needed to see a chiropractor, who introduced to her a different way of eating. He asked for her for a food journal, to which she boasted that she was super healthy, eating microwavable meals, whole grain bagels with low fat cream cheese, Starbucks with coconut milk, etc. She credits him with changing her life because he was the one who showed her that not all fats are bad, but all processed foods are! Oh, bonus, she was a really good and interesting speaker who kept me engaged throughout her two hour talk 🙂

The key points that I thought was interesting and that reinforced my own nutrition principles:

  • Eat organic and locally grown — The chemicals that are used to treat the soil and plants are toxic, avoid as much as possible. Eating local means you’ll likely eat what is in season and optimally nutritious at that time. Eating ripe fruit/veggies versus eating produce that has been picked long before they’re ready, flash-frozen, and transported across the country means less interference and less “processed”! I am very thankful we live in California where fresh, clean produce is valued and available to us!
  • Eat cooked AND raw foods — Eating foods in its natural state helps preserve its nutritious potency! Furthermore, overcooked and burnt foods are actually toxic.
  • 80/20 rule — If you are able to follow a nutrient-dense diet 80% of the time, then it’s okay to indulge once in awhile. It’s not worth it to be stressed about what you eat, and it’s almost impossible to eat 100% clean anyway. The nutritionist did emphasize that even treats should be of high quality. For example, whole-fat, creamy ice cream versus fake, man-made “skinny cow” ice cream bars. I follow more of a 90/10 (or 95/5, on a good week…) rule because… Why not eat cleaner if you can?
  • Eat a variety — Nutrients are everywhere in fruits, veggies, dairy, meats, so to ensure that we get all the good vitamins our bodies need, we need to eat a variety of foods! Additionally, many vitamins and nutrients need each other to be better absorbed by our bodies (e.g., protein, Vitamin C, and zinc all work together to build collagen, helping our skin to bounce back from stretching during pregnancy 😉
  • Water — Drink approximately half your body weight in ounces. Just as how standardized tests are lame, standardized water recommendations are also lame!
  • From dietary habits to lifestyle — As your dietary habits change to be more traditional, optimal, and “primal,” you may find yourself making other lifestyle changes to become more like Grok! 😀

Some other things I learned and found valuable from this Nutrition class:

  • Apple cider vinegar for acid reflux — 2 teaspoons of ACB with 1-2 cups of water to supplement the stomach acid in digestion. I also drink kombucha, which helps a lot too. The nutritionist recommends consuming ahead of time if you know you’re going to have a big indulgent meal.
  • Vitamin C binge before delivery — This helps strengthen veins and can be found in the white parts of citrus fruits.
  • Good sources of sulfuric veggies — …include broccoli, cauliflower, and kale.
  • RAW MILK — While she could not loudly proclaim her support for this (I’m assuming for legal/certification reasons…), she mentioned that if a woman is used to drinking raw milk and can find a reputable source, it is absolutely necessary and beneficial to consume for conception and during pregnancy (and for life, I imagine!).

EDIT:

Funny thing I noticed: The nutritionist had brought some snacks for us to munch on during the seminar because it was early in the morning, and I guess she figured pregnant women are always snacking. She brought in a box of Annie’s cheese crackers, a box of Cliff whole grain chocolate chip protein bars, and a container of pre-chopped veggies with a container of ranch dressing. And then later, she used her box of Annie’s crackers as an example of questionable organic choices (I guess not all ingredients in organic Annie’s cheese crackers are organic?), and she recommended against processed, whole grains (aka a box of granola bars…).  The nutritionist seemed have thought a lot of things through… But not everything yet, apparently! 😉

Why I Chose Midwifery Care

I am five months pregnant and have not seen a doctor.

The Lion and I enjoy a primal lifestyle. Of course, we also enjoy a lot of what modern technology has to offer (including running water, electricity, and the internet!), but we also appreciate the more primitive aspects of being human, like being outside and getting sun, avoiding processed foods, sweating, sleeping with the sun cycle, and generally being introspective and in-tune with our mental and emotional needs. Along those lines, a birth that is heavily medicated, in an unfamiliar setting, with hospital lighting bearing down and the smell of chemicals and sterility surrounded by strangers watching me pee/poop/fart does not sound like an experience that I would enjoy (I mean, if I’m going to pee/poop/fart with an audience then it might as well be with people I feel relatively more comfortable with, right? : )!

My first exposure to midwifery care was through a book called Baby Catcher, recommended to me by a friend who had a homebirth with their son a few years ago in LA. The book is a collection of stories and experiences by the author, Peggy Vincent, a California midwife. Baby Catcher made me laugh out loud and cry, and it really opened my eyes to the possibility of giving birth naturally, at home, with someone you trust, and with as little intervention as needed. Thus, when I became pregnant, I decided to research more about midwifery care and what it entails to determine if it really was the right path for me.

When I saw what the midwifery model of care entailed, I was hooked:

The midwifery model of care is based on the fact that pregnancy and birth are normal life events. The midwifery model of care includes: monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle; providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions; and identifying and referring women who require obstetrical attention. The application of this woman-centered model has been proven to reduce the incidence of birth injury, trauma, and cesarean section. —The Midwifery Task Force

The first sentence in the midwifery model of care struck me as unusual because I had never heard or thought of birth and pregnancy as “normal life events,” but indeed, birth is a natural “instinctive act.” Our bodies have evolved through million of years to provide the best possible outcomes for mothers and babies, provided that we understand and care for our bodies the way that nature intended during this normal physiological process. As many of you probably know, women’s hormones are changing drastically during pregnancy, and that’s no different for during childbirth and afterwards too. The brain is producing hormones related to excitement (epinephrine/norepinehprine), love (oxytocin), mothering (prolactin), and pleasure (endorphins) during pregnancy, labor, and childbirth to elicit instinctive mothering behavior in humans. Oxytocin also causes the uterus to contract, adrenaline increases heart rate and makes us feel courageous, giving laboring women the “power” necessary for the final pushes, and endorphins rise and help block the reception of pain.Physically, the laboring mama is driven to move more, and sometimes, even to sing, grunt, groan, moan, or to shower/relax in a bath. Those options are not always available to women who choose to give birth in hospitals (as Vincent recalls in Baby Catcher). Women who are feeling afraid or self-conscious [in front of strangers] tend to secrete hormones that delay birth. In quiet, semidark, private conditions, the laboring mama can let down her guard and let her instincts take over. I knew that working with a midwife was a first step to accomplishing this, where I would be allowed to have the lights lowered, to stay in a comfortable place (my home), to move about freely as needed, and to be with loved and trusted ones as I begin one of the most challenging times of my life.

I also knew that I wanted the individualized care of a midwife (or in the case of the birth center I’m working with, three midwives!), hands-on care, and postpartum support. I am a unique person who has had a unique health history and will have a unique pregnancy and birthing story, so why shouldn’t my care be tailored to me? My most recent experiences with doctors in the dental industry were not pleasant; my dentist told me that nutrition is unrelated to teeth health, that I shouldn’t believe everything on the internet (I read books, not webpages), and did not ask a single question about my dental history. The endodontists I visited seemed impatient with my questions and complimented me on being a “biochemical major” when I asked questions. One of the endodontists I visited had even started pulling out her tools, ready to perform the “routine root canal procedure” the day of my consultation! So, this was certainly not the type of experience and attitude I wanted throughout my pregnancy or at the birth of our first child. When I go to my prenatal appointments, I wait no more than 10 minutes in the waiting room. The staff at the birth center know me by name and face. They know The Lion by name and face. The midwives ask me how I’m feeling, they listen and commiserate, they host picnics and events for everyone to interact (the midwives, the parents, the doulas, the birth assistants, the staff), and they ask for my health and nutrition history. I get the feeling that they are mother- and baby-centric; I trust that when I go into labor, I can call them for help or advice, even if it isn’t during office hours. I trust that I have a choice and won’t be pressured to make a biased one. This is the kind of help and promise that I want and appreciate as a newbie mom. When I interviewed the head midwife of my birth center, I asked her what she expects of her clients. She responded, “I expect them to stay healthy, educated, and relaxed.” This is exactly the kind of pregnancy and childbirth that I want to have!!

As for minimizing technological intervention but also encouraging women who need obstetrical attention to seek it, this is a big point that I think many people have missed of midwifery. When I first told my family that I plan to birth with a midwife, they immediately became concerned of the risks of birthing out of hospital. Luckily, the midwives aren’t above asking for help when they (or the laboring mama) need it! The Lion and I live very close to a hospital, and we have discussed what will happen should I need to be transferred to the hospital. Furthermore, the midwives at my birth center are certified nurse midwives. In other words, they know and can perform the same duties as a doctor, except surgery. I hope to have an “undisturbed birth.” As described above with the hormonal processes, birth is a very complex physiological process, and it is extremely sensitive to outside influences. Many techniques that are used in hospitals to monitor a laboring woman is painful or uncomfortable and usually involve strangers overstepping personal/bodily boundaries. In addition to the distrust of a woman’s birthing ability and their body’s natural processes, these are ingredients for a difficult birth. This is not to say I will have a solitary or isolated birth. I believe that once I am in labor, I will need all the help and support (physical, mental, emotional) I can get to cope with the pain! But a midwife’s method to coping with pain is not to medicate, but rather to understand where the sensation originates from and whether a change of position, attitude, atmosphere in the birth room, or another factor can help mitigate this discomfort.

My main concern with this pregnancy and birth experience is NOT to avoid pain at all costs, but rather to have a healthy baby in the most natural, healthy, accepting way possible. I am so excited to have these midwives be my advocates and guardians during childbirth!!

(I don’t cover the risks of cesarean surgery, epidurals, opiate painkillers, synthetic oxytocin and other synthetic hormones, ultrasounds, early clamping, and inductions here because they require their own blog post and more astute meta-analysis. Buckley’s book (link below) provides a much more in-depth analysis of these and other common interventions of birth. I hope to write a review/summary of her book at a later date.)

Notes – Real Food for Mother and Baby

Real Food for Mother and Baby

by Nina Planck, published 2016

This was one of the first books I read on fertility/pregnancy because we already had it in our library (see The Lion’s review of it).  Planck’s book dispelled some commonly held beliefs on what pregnant can/cannot consume and further confirmed that the way I eat currently is optimal to maintaining good health. Some interesting/important points I found throughout her book:

  • Exercising during pregnancy is good for mother and baby. Walking, running, swimming, dancing, cycling, rowing, hiking–but never to the point of fatigue. Listen to your body and rest as needed.
  • In the second trimester, the growing baby needs protein and calcium to build bone and muscle, so take cod liver oil, eat protein and saturated fats, and drink milk and eat sour cream and cheeses. Raw is better than pasteurized, and supplements are not as effective. Drink the best milk you can afford.
  • Swelling in the hands and feet is a sign of protein deficiency, so try to eat 100g daily of meat/poultry (skin + bones), fish, eggs, and milk.
  • Salt your food freely (with unrefined sea salt) because blood and amniotic fluid are briny! And eat plenty of fresh produce for potassium
  • Keep up the calcium intake even though the baby’s skeleton has formed by six months because the bones are still bulking up. Eat oysters and beef for zinc, and eat protein (meat, dairy, eggs) to prevent swelling and prematurity. Obviously, drink lots of water and eat tons of fish to aid in baby’s brain development!
  • “Don’t avoid fish, just methylmercury.” No shark, swordfish, King mackerel, or tilefish. Two to three times per week, consume anchovy, common mackerel, salmon, catfish, trout, tilapia (wild caught and fresh) and be generous with the butter and cream (creamy clam chowder for days, yum…).
  • On Birth Day: the atmosphere should be dark, private, and quiet. After birth, hold the baby naked against your skin and ask to delay bathing and weighing. Let the baby look at you, smell you. Newborns aren’t dirty, but if bathing is necessary, do so gently without removing the white stuff (vernix). Try not to cut the cord until the placenta is delivered.
  • The mama’s hormones are working on realigning after birth, so emotions may still be up and down. Continue the diet of red meat, fish, and liver to prevent worsening the baby blues.
  • Get lots of help on practical matters so you can gently surrender to your baby’s needs, unpredictable as they are.
  • Breastfeed [exclusively] if possible (and for as long as possible! At least for 6-12 mos) because breastmilk contains probiotics, antibodies, amylase, and boosts immunity for the newborn. Keep eating well.
  • From four to ten months (once they can sit up), babies can try real food, as long as theres not vomiting or diarrhea. At seven months, the baby can eat seafood, pork and dairy. At one year, time for the baby to start his/her cod liver oil supplements!
  • Let the baby choose what he/she wants to eat, don’t micromanage/point/stare/direct. Do less, RELAX.
  • Surrender your old life temporarily to be the mother that nature intended. Ask for help (cooking, cleaning, grocery shopping), and nurse on cue (aka when the baby asks).
  • Watch the baby, not the clock! There is no schedule for breastfeeding.
  • Bread and chocolate (grains and sugar) are inevitable, so try to find ones with good, clean ingredients. Let your child know over time why you favor certain foods over others. Try not to let the child fill up on bread before fats and protein.

TL;DR Avoid trans fats and pesticides. Buy organics and avoid hydrogenated vegetable oils, margarine, vegetable shortening, and cheap fried foods.

TL;DR2 Breast feed your baby. Nurse after the baby starts eating. Delay or skip vaccinations. Spend time on farms and outside in the dirt. Touch animals. Drink raw milk.