Sunday, February 18, 2007

Rules to Blog By

Whether the original Trainwrecks site was harmless or evil (which I do NOT, NOT, NOT want to discuss—I’m very bored of that topic), it served one useful purpose for me: it gave me rules to blog by. Until its demise, I was a little afraid to check my “came from” stats, waiting for the day that the telltale “trainwrecks.net” would appear. So I scoured their site, looking for blog behaviors that were most likely to trigger a trainwreck pile-on. Some things weren’t too hard to avoid; I’m not about to run off with someone else’s spouse and brag about it, my pets are all neutered, and I’m not running any financial scams. Other things I wasn’t about to stop doing even if I was risking a trainwrecking; I wasn’t going to wean my toddler just because some people think extended nursing is disgusting, and I won’t say that my husband is anything but outrageously wonderful, because it’s the truth—but there were a few things that I thought might be good for me to keep in mind. Here are my Rules to Blog By:*
  1. Welcome dissent. Introducing a controversial topic without expecting readers to have some ideas that differ from my own would be foolish, and would deprive me of opportunities to have my own viewpoint evolve. This relates to the next rule:
  2. Never delete comments (unless they are dangerous—i.e., could reveal my identity, or consist of hate speech). Having dissenting comments deleted really ticks people off. (I haven’t yet been tempted to delete a comment I didn’t like, but I think I need to keep this rule in mind just in case.)
  3. Do not insult readers. If someone misunderstands me, I will err on the side of assuming that I phrased something poorly rather than that the person is stupid.
  4. Do not complain about something over and over, yet reject all suggestions for improving the situation. I admit this is occasionally hard to resist.
  5. Do not post pictures of your kids—unless they’re really, really cute. Obviously, I wrestle with this one.
  6. Do not brag about something under the pretense of complaining about it. For example, I should not say “The problem with having a child who is toilet-trained early is that they yell embarrassing things in public restrooms like ‘No touching the poop, Mama!’” If I’m going to brag about my child being toilet trained, I should just say “My kid poops on the potty, and that rocks.” Except that would violate the next rule, which is
  7. No talking about poop—unless you are funny enough to pull it off. Which I’m not. This last statement may look like a violation of the next rule, but it’s not.
  8. Don’t put yourself down in the hopes of having readers disagree with you. So please do not argue with me: I am not funny enough to tell a worthwhile poop story. If I am looking for validation, I will ask for it; if I get insults instead, I will remember my final rule:
  9. Don’t take it personally. A good rule to follow in life as well as in blogging, and hard in both worlds.
*Please note that I am NOT saying that all of these things are necessarily wrong, nor that everyone should follow my rules; these are simply the things that I might be tempted by and want to avoid.

Saturday, February 17, 2007

What’s Got My Knickers In a Twist

As I alluded to previously, I’ve been a little stressed lately. The reasons are pretty boring, but just so that everyone knows it’s not you, it’s me, this is what has had me staying awake nights:
  • I have a new boss. I do not yet know if he will be a bad boss or a good one, but he’s new. I do know that he’s more focused on “the bottom line” than the prior boss, and this could work against me, because much of what I do—teach and mentor—is not accurately reflected on the bottom line.
  • My new boss likes to have 7 am meetings.
  • So far there have been two 7 am meetings at which my presence was requested. I was 20 minutes late to BOTH of them.
  • My assistant is out on maternity leave, right in the middle of a HUGE project, and her replacement is astonishingly helpless. Examples:
    • She does not know how to revise a Word document. I couldn’t figure out how she kept introducing new errors into documents I was giving her to correct until it dawned on me that she was retyping them.
    • She does not know how to find a “sent” email. She sent me an email announcing that there was a room change for a meeting. She did not tell anyone else about this room change. When someone asked where they were supposed to be, she asked me to send her the email she had sent me.
    • She does not know how to page anyone. If you dial the numbers for her, she does not even know that you should stay by the phone to wait for the call back.
  • And on and on. I am spending most of my time doing her job these days. This is not an exaggeration.

  • When I was expecting a rejuvenating couple of days last weekend, my in-laws showed up with—surprise!—my sister-in-law and her infant and her two-year-old in tow. Eight people, three of them under age three, in 1300 square feet, with one shower. Then the grandparents ditched everyone and went shoe shopping for hours. Somehow I spent most of my weekend babysitting the four-month-old.
  • Tuesday I broke out in an itchy rash from my neck to my ankles. It turned out to be a systemic reaction to an antibacterial ointment, but I spent a terrified couple of days thinking it was one of my antidepressants. (It was bacitracin, by the way, and about 30% of people who use it for any length of time can become allergic. Interesting fact: bacitracin got its name because it was originally isolated from a bacteria grown from a wound from a girl named Tracy.)
There’s more, but you get the gist. Some of it’s better already (this weekend is much more relaxing, and the rash is almost gone) and some of it will be better very soon (my assistant returns in two weeks), but if someone in cold-weather running gear runs past you in the next couple weeks muttering “Serenity Now,” it’s probably me.

Thursday, February 08, 2007

Why Ask Why?

Humans are wired to constantly search for causes for (and solutions to) every problem. This is probably our most useful adaptation, but it can lead to certain difficulties, especially for doctors.

Take flu shots, for example. It has been shown conclusively that flu shots do not give you the flu. (They couldn’t give you the flu due to the way they’re designed, but people went and did studies on it anyway.) Yet there are many people out there who swear that flu shots give you the flu. Why?

Flu shots are given during cold and flu season. A certain number of people will come down with an upper respiratory infection in any given week. If one of those people happened to get their flu shot that week, it’s easy to see why they would assume that the shot was to blame. Forever after, they will attest that flu shots give you the flu—and will probably convince a few other people of the same. Trying to argue against this is nearly futile. I attempt a preemptive strike with every flu shot I give, telling them that the shot won’t fully protect them for about two weeks, so they could still catch the flu in that time, but I’m not sure how well this works.

Trying to bring on labor is another example. Studies have shown that NOTHING works to bring on labor, with the exception of the drugs used for formal induction in the medical setting. Castor oil? Doesn’t work. Having lots of sex? Doesn’t work. Scrubbing the floor on hands and knees? Doesn’t work. Nipple stimulation? Doesn’t work. Acupuncture? Doesn’t work. Ankle massage? Doesn’t work. Walking/jumping? Doesn’t work. Stripping the membranes? Doesn’t work. Primrose oil? Doesn’t work. Raspberry tea? Doesn’t work. And so on and so forth.

But wait! I can hear a lot of you (probably most of you) thinking. My doctor recommended having sex, and it worked for me! My best friend used castor oil, and it worked for her! My midwife swears that several of her patients have gone into labor after drinking raspberry tea! I know these things work!

But think about it. No matter what, every pregnant woman eventually goes into labor. And whatever thing she did just beforehand will always be credited with doing the trick. Therefore of course all of these things have “worked” for some people. But when they’ve been formally studied—having fifty pregnant women do nothing while another fifty twiddle their nipples, for instance—the rate at which they go into labor is exactly the same.*

Birth defects are yet another example. I was talking with a pregnant friend recently about how nutty everybody gets about pregnant women doing anything—taking medications, drinking coffee, having a little alcohol, lying on their backs. This hysteria seems to be getting worse and worse. Partly this is just part of the whole trend toward fetishizing pregnancy, I believe, but partly it’s because of the way birth defects occur. There are only a few things that are known to cause terrible birth defects—thalidomide, oral isotretinoin, and a couple other uncommon things—but even if you don’t have exposure to one of those, there is a 2-3% risk of major birth defects. And when one of these spontaneous defects happens, of course everyone starts wondering what caused it, and remembering every cold tablet and cup of coffee and hot bath they took during pregnancy. If you do a retrospective study looking at birth defects, the mothers of babies with defects always remember more exposures to everything than the mothers of healthy infants. But if you do a prospective study, following people through their pregnancies and documenting exposures, there’s no difference between those in which defects occur and those in which they don’t.

If something happens often enough—a colicky baby being fussy, for instance—it’s easier to figure out (by trying a lot of things that don’t consistently work) that nothing you do causes it or cures it, and it just needs to be waited out. Relatively rare things that can occur randomly (getting pregnant, birth defects, most cancers) or that inevitably end with time (pregnancy, a chest cold) are the things that really lend themselves to myth-making about causes and solutions.

The belief that every phenomenon can be explained and every problem solved is a wonderful thing much of the time. It’s great when someone with diabetes understands that eating carbohydrates causes their blood sugar to rise or that taking their medicine brings it under control. But it’s frustrating when someone can’t accept that doctors don’t have the solutions to everything. (The doctors who can’t accept that—and there are many—are even more frustrating.)

I wish I had a better way of explaining this to patients. Sometimes when people ask me “Why did I get this disease?” I’ll answer, “Just bad luck,” and they look at me like I’m crazy. I suppose if I were religious, I could answer, “Only God knows the reason,” but 1) I’m not, 2) my patients might not be either, and 3) even if they are, it could be an annoying thing to hear (“I’m sure God has a reason for why you had this miscarriage!”).

How do you deal with things that can’t be explained?

*UPDATE: OK, I should know better than to use an inflammatory example such as this. I say the following in a comment below, but I’ll add it here too: the induction of labor example was meant mostly as an example of a perfect setup for fallacious beliefs to take hold. Yes, there are studies here and there that suggest that a couple of these things might increase the odds a little bit of delivering earlier (though several of those studies were actually done in conjunction with oxytocin, so I’m not sure that you can count them). But having looked at the evidence, I’m standing by my assertion that none of those things is worth having anyone put themselves out in any way to do, because if they work at all, the effect is teeny-tiny. Remember, negative studies mostly don’t get published, so if there are a few weakly positive studies—or positive weak studies—chances are very good that there are at least a few unpublished negative studies.

I’m not saying that everyone should be induced medically by any means; I think too many people get induced as it is, and if we just waited until babies were done gestating we’d have fewer c-sections. I also think childbirth has been overmedicalized in general—I even think that the evidence supports the superiority of (supervised) homebirth in multiparous women. But the things that I see heavily pregnant women doing to try and bring on labor just seem miserable, and the amount of advice they get about it could give anyone a headache. (Which doesn’t help bring on labor either.)

And yes, I’m having a wretched day, and week for that matter.

Friday, February 02, 2007

My Breasts 2, or, Haven't You Stopped that YET?

Yes, I’m still doing THAT. Yes, he is two and two-thirds years old. Yes, the end is in sight.

I have discovered that after a certain point, most people no longer ask if you’re still nursing. I’m not sure if they assume that no one could possibly still be nursing a child who is toilet-trained, or if they assume that I am out of my mind and will never wean him so there’s no point in asking, or if they’re too horrified even to ask, but the questions have pretty much dried up. Heh.

Until recently, I was fibbing a little about how much he was nursing, just to keep people off my back, I guess. People would say, “Oh, he still nurses a little at bedtime?” And I’d answer, “Something like that.” Which was only a lie if “something like that” doesn’t include also nursing 1) first thing when I got home from work 2) 4:30 in the morning 3) 7:00 in the morning and 4) pretty much all day on weekends.

The weekend days were the first to go, soon after his second birthday. It was getting so that Mondays I’d have to wear an industrial-strength bra to rein in two very confused and pissed-off breasts by late afternoon. He tolerated this restriction pretty well, so I moved on to: the 7:00 am snack, which was making me late to work almost every day. That change made him cranky, but he was cranky in the mornings regardless (this has changed since I, the ├╝ber-dork, got a sunrise clock—but more on that another time).

We were stalled there for a while; the habit of insisting on nursing the second I walked through the front door seemed unbreakable. Then something unexpected occurred: he learned that Weaning Happens.

I’m not sure if I thought that he already knew this (I had cut him back, after all), or if I thought it was too esoteric a concept, but it surprised me.

It happened one evening as I nursed him after work. I said, “You’re a lucky little boy, you know.”

“Yeah,” he said, and went back to the fount.

“Not every little boy gets to nurse, you know,” I said.

He paused for a moment, considering this. Then he started to list every toddler he knows who nurses.

“Sydney nurses,” he said.

“You’re right, she does nurse.”

“Baby Jake nurses,” he said.

“Yes, he does,” I said.

“Lucas nurses,” he continued.

“Actually, no, Lucas doesn’t nurse anymore,” I answered.

He stopped and stared at me in shock. Then his face crumpled up. He buried his face in his hands and started sobbing.

I realized that up until then, he assumed that some kids nurse, and some don’t. He hadn’t understood that it would someday stop, poor kid. I had just rocked his world.

“It’s ok, it’s ok!” I said, hugging him. “Lucas drinks milk from a cup now! He likes it! He’s happy!”

“Yeah,” he said, tearfully and doubtfully, and went back to the supply that he now knew to be endangered.

For the next few days, anytime anyone mentioned Lucas, he would announce, “Lucas drinks milk from a CUP!” But more significantly, he started to ask for milk in a cup. Up until then, he had always refused to drink milk from a cup unless he was at daycare.

The evening session disappeared not too long after that. I noticed that he also became less clingy; he’s not as unhappy to let go of me now that he doesn’t see me as a human binky, I suppose.

I had worried that the 4:30 session would be hard to quit, because he could find the goods on his own, after all (he has a toddler bed, which he stays in for a couple of hours before making the trip to our bed). But a couple of times I woke up enough to stop him and offer him a cup of milk I keep on the bedside table. This pissed him off at first—once, after refusing it, he actually went to the trouble of sliding out of bed, getting the cup from the table, flinging it across the room, then climbing back into bed—but he usually settled down pretty quickly. Soon, of course, he quit waking up at all.

Yes, people, I had to wait almost three years for my child to sleep through the night. Point and laugh if you will. I’m not ashamed.

Now the routine is, nurse for about two minutes, then drink some milk from a cup, then lie down and go to sleep. And that’s the only nursing we ever do anymore (ok, ok, I admit it, last weekend when a tile floor smacked him in the face and he got his first-ever nosebleed, my instincts took over and I yanked up my shirt. It startled him into stopping crying, too—he looked as if money had started to rain from the sky. Later he half-heartedly asked for it again, but didn’t seemed shocked when I said, no, only for bedtime).

I think we’ll hang here for a little while. No sense in rushing things, after all.