Health

**Warning: While I attempt to avoid vulgarity on my blog, I am one to speak frankly. While I do not go into details about “how babies are made”, this post contains mention of sperm and x and y chromosomes. If this is something you are uncomfortable with, please accept my apologies and feel free to not read further.**

Davene is 36 weeks pregnant with her fourth. After three boys, they’ve decided to not find out this baby’s sex in advance. Debate has been raging as to whether this baby is going to be a girl or a boy. Many of Davene’s blog readers think this one’s going to be a girl. To which Davene replies, “Do they realize what the odds are?”

I mentioned this to my sister, a newly minted Physician Assistant, and she said, “50-50”. Because the odds for a baby’s gender are just like the odds for tossing a penny and having it land heads up. Every time you toss a penny, the odds are 50-50 as to which side it’ll end up on, regardless of what’s gone on before. This is statistical fact.

I can think of plenty of couples who have thought their hopes were gone for a child of a certain sex–but who ended up with one nonetheless. One aunt and uncle had four girls–and were surprised when their fifth (a true surprise baby) turned out to be a boy. I’ve seen even more cases where the fourth was of the opposite sex than the three going on before. Another aunt and uncle, my former pastor’s family, Davene’s neighbor Wilma, to name just a few.

But that doesn’t stop me from thinking, in a radically unscientific way, that a certain sex does “run in the family.”

Take for instance, my dad’s family (4 boys, 1 girl). Three of the boys have children. One has 6 boys and 1 girl. One has 3 boys. My dad has 4 boys and 3 girls.

Then there’s my mom’s family (10 girls, 2 boys). Both of the boys have children. One has 4 girls and 1 boy. The other has 2 girls and 1 boy.

Notice that I’m only mentioning the boys. That’s because ultimately it’s the man that determines whether a baby’s a girl or a boy. Women have xx chromosomes, Men have xy chromosomes. Mom always contributes an x to baby, Dad contributes an x to make a girl baby or a y to make a boy baby. That’s why I haven’t mentioned the girls on my Mom’s side of the family.

But even those tend to support my theory that a certain sex “runs in the family”. My mom married into a family of boys–and has 4 boys and 3 girls. My aunt Rachel married into a family of boys and has 4 boys and 2 girls. My aunt Janet married into a family of boys and has 2 boys and a girl.

So I tend to think that maybe a certain sex does “run in a family”. I’ve thought that for quite a while. It’s just today, though, that I thought of something to take my unscientific theory to even higher scientific heights: “I wonder why a certain sex might ‘run in a family’. Is it because a certain family tends to have more x or y containing sperm–or is it because the x or y sperm in a particularly family have a competitive advantage?

Wow. Talk about stretching out pseudo-science. (Although, if you happen to know any real science concerning whether certain sexes “run in families”, please let me know so I can apply some real science to my hunch.)

**Note on the use of the word “sex”: I realize that by using the word “sex” rather than the more socially acceptable “gender”, I may have inadvertantly caused offense or caused this page to lose its family-friendly rating. However, according to Merriam-Webster, sex means “either of the two major forms of individuals that occur in many species and that are distinguished respectively as female or male especially on the basis of their reproductive organs and structures.” Gender, on the other hand, means “the behavioral, cultural, or psychological traits typically associated with one sex.” Thus, sex is a biological term and gender is a cultural term. When I speak of a baby’s sex, I am referring to the child’s biological category, not to his or her cultural identification with a particular sex.**

What should I be eating now that I’m pregnant? Everybody talks about eating for two, but what does that look like? My friend’s doctor said she could gain as much weight as she wanted–but then I’ve seen her struggle to lose weight after she had the baby. And then there’s this pregorexic thing. I mean, I don’t want the baby to make me fat, but I certainly don’t want to become anorexic or anything–especially not while I’m pregnant.

So…

Did I manage to scare all of you who read the first paragraph of my every post in your feed burner or on Facebook? You needn’t be afraid. I am not pregnant. I am still a virgin (that’s for my few brave high school readers–you can do it!).

Instead, I’m taking an online course in Life Cycle Nutrition. As part of that course, I have been asked to review the USDA’s “MyPyramid for Moms” website. While all I have to do for class is review the site and discuss it on the class discussion forum, I thought I would share my thoughts with you all as well. So here goes…

MyPyramid for Moms

Advantages:

• Calculators Galore-You can calculate a personalized MyPyramid Plan that tells you how much of each food group to eat during each trimester. You can compare what you’re eating to the recommendations. You can even calculate how much weight you should gain during your pregnancy.
• Understandable information-What information is present is written in a fairly easy to understand style.
• Personalized Plan-The MyPyramid Plan for pregnancy and for breastfeeding is personalized to your height, weight, activity level, due date, and whether you’re breastfeeding completely or partially. It’s further broken down into trimesters of pregnancy and months after delivery.

Disadvantages:

• Wordiness-You’ve got to sort through a lot of text to find what you really want to know
• Not very specific-for example, the site proclaims that “when you are pregnant, you have a higher need for some vitamins and minerals”, but fails to mention which vitamins and minerals you need more of.
• Skirts the issues-MyPyramid never actually says how much your nutrient needs are increased during pregnancy. It has an eating plan–but you’d never know from MyPyramid that for most women, “eating for two” means only an additional 300 calories per day (about the calories in a large candy bar.)

Please take a look at the MyPyramid for Moms website and let me know what you think. Was my assessment correct or am I way out there? Even the non-Mom’s can participate in this one. Just do as I did–enter 12/01/09 as your due date for the pregnancy calculators and enter 05/01/09 as your child’s birthday for the breastfeeding calculators. I’d love to hear what you think (and your insight might add something worthwhile to my class’s discussion of the topic as well!)

Anyone who’s walked with a loved one through Alzheimer’s knows that it’s a challenging path to trod. It’s tough and frustrating for the sufferer–and tough and frustrating for those who love them.

My experience walking with my Grandma through Alzheimer’s has convinced me of one thing: I’m going to do everything within my power to keep my children and grandchildren from having to experience that kind of anguish. I’m going to do everything possible to prevent the onset of that disease, a disease of relationships as much as it is a disease of the mind.

Which is why I’ve been collecting research (and pseudo-research) on Alzheimer’s prevention.

Risk Factors for Alzheimers

Can’t modify:
• Age
• Female sex
• Biological markers of inflammation

May be able to modify:

• Hypertension
• High BMI
• Stroke
• Diabetes
• Low Mood (depression or anxiety)
• Effects of chronic illness
• History of head trauma
• Functional/physical disability
• Sensory handicaps
• Neuroticism

Can modify:

• Lack of physical activity
• Stress
• Poor sleep

Preventative factors for Alzheimers

May be able to modify:
• Higher socioeconomic status
• Better lung capacity
• Good health
• Better cognitive function
• Self-efficacy in instrumental aspects of life

Can modify:

• Higher levels of education
• Moderate alcohol use
• Social engagement and support
• Use of vitamin supplements

That was mostly science. Based on epidemiological studies, people who have such factors are either more or less at risk for developing Alzheimer’s. The pseudo-science comes in when you ask if and how you can impact your risk of developing Alzheimer’s by changing your behavior.

But I’m willing to jump on the risk-avoidance bandwagon–or the proactive prevention bandwagon, if you’d rather.

Which is why I’ve pulled my recorder off the floor and started playing.

I can hear your “Huh?” loud and clear.

Well, it just so happens that “better cognitive function” is a preventative factor. And one of the proposed means of increasing cognitive function is playing an instrument. It also just so happens that “better lung capacity” is a preventative factor. And one of the means of increasing lung capacity (along with aerobic activity) is playing a wind instrument.

It just so happens that I have a wind instrument–a little plastic recorder I received as part of a white elephant gift exchange at my life group. That recorder has been sitting on my bedroom floor since the day I pulled it out and tried–very unsuccessfully–to teach myself to play.

But, bolstered by the thought of saving my grandchildren from the agony that is Alzheimer’s, I grasped hold of the recorder, googled “how to play the recorder”, and began my education.

Amazingly enough, despite my initial failure, I was able to successfully play “Mary had a little lamb” last night–and to still play it again this morning. Turns out you don’t just blow one endless breath into the recorder–and you don’t hold the recorder at a right angle to your face either.

Ah, thank goodness for the internet! What would I do without handy self-teach websites like this one? I’d probably already be senile–and terrorizing the entire world!

Once upon a time there was a girl who had a depressive episode. It wasn’t the first time she’d experienced depression–in fact, she’d experienced it many times before. But this time was different than all the rest. Every other time, the depressive episode occurred in the autumn as the days were growing shorter. This time, the depressive episode occurred in the spring as the days were growing longer.

Because this time was so different than all the other times she’d had a depressive episode, this girl didn’t realize that was what she was experiencing. She just knew that something was wrong with her.

She went to the doctor and told him all about her symptoms: extreme fatigue that persisted regardless of how much sleep she was getting, unexplained bruising on her legs, very dry skin, itchy scalp, acute colds that came on suddenly almost every week and lasted for a day or two, and persistent chest pain.

She explained to the doctor that she’d experienced most of these symptoms before–but that they seemed extraordinarily severe this time around, and right as circumstances had changed in ways that should CORRECT the problems rather than worsening them.

She’d had dry skin before–a combination of allergic reaction and having to wash her hands constantly in her position in food service management. But just as she switched from the food service management position to a desk job, her skin grew worse.

She’d had colds before–well, actually, she has chronic allergies. But the allergies have been under great control for quite a while. And now suddenly, just as she left her hospital rotation (in which she was regularly exposed to sick people), she was experiencing multiple short-term colds.

She’d been tired before. But she hadn’t been tired at all while she was waking up at 4:30 to be at work by 6:30am–and now, just as she was switching to a more moderate 6:00 wake up call, she was exhausted.

She’d had chest pain before–and she’d attributed it to stress. After all, the chest pain was occurring while she was going to school full-time and working three different jobs and volunteering for a total of 70 hours a week of commitments at more than five different locations. Why would chest pain like that be occurring right as she was switching to a cushy 42 hour a week desk job with practically NO additional commitments?

The doctor listened to her complaints with half an ear and gave the girl some advice that stressed her out even more. But at least he agreed to run the blood tests she wanted.

Trouble is, her blood test results came back with “Within Normal Limits” written on almost every value. She wasn’t hypothyroid. She wasn’t anemic. She didn’t have mononucleosis. Her glucose was normal. The trail was dead. The girl had nowhere to turn. What was wrong with her?

Then one day, the girl was sitting at her computer, typing on Facebook that she was “sick and tired of being sick and tired” when a germ of an idea hit her. “You know, I used to feel that way all the time,” she thought.

She mulled on the idea on her way to work–so much so that she missed her usual turn and had to go the long way ’round. But the result of her musing was that she had a direction to investigate. When was the last time she’d had chest pain like that? It was right before she’d started taking antidepressants to treat Seasonal Affective Disorder (SAD). When was the last time she’d slept for days on end and still been exhausted? It was right before she’d started taking antidepressants for SAD. Ditto on always having “colds” and other unexplained symptoms.

After she got home, she took a depression self-assessment and discovered that she most likely was depressed–even more so then she had been during her SAD episodes. From there, everything began to fall into place. She hadn’t recognized it because the normal seasonal cues weren’t there, but many of the symptoms were there. She hadn’t thought of it because she was still taking the antidepressant for SAD. But it made sense. The onset of symptoms coincided with three medium stressors that combined to pack a big precipitating whomp: a car accident that totaled her car, a need to buy a new car placing her in financial stress, and a job change (from what she’d been doing for almost three years to something COMPLETELY different.) It made sense.

Since the girl was still taking an antidepressant, she didn’t want to run back to the doctor for more drugs. And she didn’t really want to do psychotherapy either. Her insurance would demand a certain provider for counseling–and she didn’t think they would be able to give her any help. If lies needed to be replaced, she would much rather make sure they were being replaced with truth–instead of being replaced with different (humanist) lies. She didn’t feel that the insured providers could provide truth. So instead, the girl embarked upon a self-treatment program.

The first step in her program was to begin writing down her symptoms. She wrote down when she went to sleep and when she woke up and when she ate and what she ate and when she had chest pain. She discovered some interesting things. Every time she looked at her planner, she experienced chest pain. Every time she looked at her checkbook, she experienced chest pain. Every time she thought about money or time constraints, she experienced chest pain. If someone else mentioned time or money, she experienced chest pain. She discovered her triggers–and started working on decreasing them.

Since her planner is integral to her relatively fast-paced life, she knew that she would have to train herself not to have chest pain every time she looked at her planner. So as her first step, she placed some personal limits. She allowed herself five “to-dos” per day–three of which were firmly set. While she could do more in a day, she could not plan on or insist on more than that. That meant she could have two additional things to work on each day. Period.

The girl’s doctor had encouraged her with some sleep hygiene suggestions, which she’d initially blown off. The girl was unhappy with the doctor for not taking her fatigue seriously. She thought the doctor was blaming her fatigue on her own habits (she still kind of thinks so.) But encouraged by her roommate who happens to be a PA student, the girl began to put some of the sleep hygiene habits into practice. Two of the three set items on the girl’s list were 1) turn off the computer by 8:30 pm and 2) turn off the light by 11 pm. Slowly but surely, she began to be able to wake up to her alarm again in the morning.

The third set item on the girl’s list was “word washing”. She knew that since depression often involves inaccurate perceptions of the world, she needed to have some way of seeing the world clearly. While she felt sure that the counselors insured under her plan would be unable to provide her with truth, she was even more sure that the Word of God could provide her with truth. So she set a goal of spending time in the Bible every day.

As the girl followed these few simple steps, she discovered some amazing things. She was able to identify when she was being anxious–and was encouraged to cast her cares on Christ. She was able to relax her expectations of herself and stop living in false guilt (over things like failing to update her blog regularly.) And now, the hope that once seemed dead is alive again.

At lunch today, my dad suggested that perhaps my file at the University Health Center is flagged “Pain in the [deleted]”. If it wasn’t before this afternoon, it probably is now.

After all, my real Doctor’s office (where I see my Physician Assistants) has a slightly nicer flag that probably means the same thing: “Do not schedule for appointments less than 30 minutes long.” I saw the flag once, a giant yellow banner at the top of my computerized information. It lets the scheduler (and the PA’s) know that I’m going to be an involved patient.

And I am an involved patient. I consider myself to be the head of my health care team–whatever the physician may think of himself. No one else knows my body, my mind, or my medical history as well as I do. No one else knows all the information (and unfortunately, too many doctors would prefer I not give them all the information.)

And since I’m the one who knows me the best, I deserve to be heard in the doctor’s office.

Unfortunately, that’s not the way doctors always see things. Too often, I see a physician’s eyes glaze over when I start detailing my past medical history and current diagnoses. Too often, I get brush-offs when I raise a question about something the doctor tells me.

I probably don’t have to be as upset as I am about today’s visit. After all, he’s going to run the blood work I wanted him to do. I would have been happy if he’d just run the blood work and said “Let’s wait for results before I tell you anything else.” So why should I be so upset that he did what I wanted and then gave me all sorts of “free” advice.

He was just being a University Health Center- type doctor, giving his patient what he thought she wanted to hear. “Let me give you some self-help ideas to deal with your ‘dandruff’, ‘sleep problems’, ‘heartburn’, and dry skin.” What he didn’t realize or bother to find out was that I already know how to handle dandruff, sleep problems, dry skin, and heartburn. I also already know that I don’t have sleep problems or heartburn–and highly doubt that I have dandruff.

I say I’m fatigued and tell him that I haven’t had a consistent sleep pattern “since this started”. So he tells me to establish a consistent sleep pattern. He gives me all sorts of advice to help me sleep better. What he didn’t bother to do was give any answers for the problem I was there for–extraordinary fatigue that is keeping me from being able to perform my daily activities (working a job, keeping up with the laundry, and washing the dishes) DESPITE getting 7-8 hours of sleep every night.

I tell him that I’m having chest pain–which I’ve had before. I tell him that the chest pain is a stress response–I know it’s not heart problems (because I had a complete heart work up last year and got a clean bill of heart health). I tell him that I’m worried because I don’t think I’m experiencing enough stress to warrant this extreme physiological stress response. So he tells me I have heartburn and gives me advice for managing heartburn.

I brought up the dry skin, mainly to make sure he knows I need to have my thyroid checked. I point out that the dry skin has worsened even as I quit the job that had me washing my hands with drying soap several times an hour. He tells me this winter’s been bad for skin and that I should wear gloves when I wash my dishes. (Yes, I know. But did you miss the part where I said I’m too tired to keep up with the dishes?)

I don’t know why I brought up the itchy scalp stuff. Probably because it hasn’t responded to dandruff shampoo–even though I was leaving the shampoo on for quite a while (10-15 minutes a pop). Probably because my two PA roommates think it’s psoriasis. Probably cause I wanted to make sure I didn’t miss anything that could be potentially useful in making a diagnosis of my REAL problem. But the doctor took it as a serious problem and paid no attention to my assertion that dandruff shampoo had no effect on the itchy stuff on my scalp. He insisted that I had dandruff–and that I ought to wash my hair with dandruff shampoo once a week for (get this) 15 minutes before rinsing it off. Imagine that!

I got what I wanted–an order for a complete blood work-up including TSH (thyroid stimulating hormone). I just wish I didn’t have to go through the frustration of THAT to get it.

I miss my health care team. I miss my PA’s who let me tell them my whole story before they break in with questions, who tell me what they’re thinking when they’re doing their differential diagnosis, who take my questions seriously. I miss the team that already knows my meds, and understands why I’m on them. I miss how they always ask me for any last questions before I leave. I miss how they know to hand me a copy of my charts and laboratory values before I leave so I can put them in my personal medical file. I miss my pharmacists too. I miss seeing the same person every time I go to the pharmacy. I miss being able to get my prescriptions filled while I do my grocery shopping. I miss the pharmacy’s willingness to answer every question I have.

I guess I miss my Blue Cross Blue Shield insurance. Yeah, I didn’t have “free” visits to a clinic like I do with student insurance–but at least I got to see my team. I might not have the flexible scheduling of on campus health care–but at least I had confidence that my health care providers were practicing evidence based medicine. So there were more hoops to jump through back then–but at least then I was the head of my health care team. Here, at the Health Center, I’m just another dumb student who needs to use more lotion.

Medicine Schmedicine. Nothing worth stressing about, right?