Light and Momentary

Predictive Power?

"Your toothbrush is looking frayed," I said to my husband. "Wouldn't you like a new one?"

"Sure," quoth he.

"Great," I replied, "because I want to use your old one to clean the stepstools." Ooooh, it felt so good to get into every little groove and crevice and get them all cleaned out. Mmmmm, the memory makes me want to go scrub something else.

The stepstools were last cleaned when I was approximately this pregnant with Pete. I looked to see exactly when the nesting instinct had last whipped me into such a frenzy, and it turns out it was eleven days before his arrival. Now I wonder if I'm going to be having a baby eleven days from now, because it's a really bizarre urge.

The good thing about having a fifth baby is that we both know it's a temporary kind of insanity. In fact, all weekend I've been appreciating the familiarity that comes with years of marriage. We used to squabble a lot about holiday meals -- he thought I was too focused on the food. On Thanksgiving he mostly cooked while I mostly cleaned, and together we pulled off a delicious dinner with very little stress. (Let me say publicly that he was totally right about (a) the turkey, which should have gone into the fridge on Sunday and not Monday, and (b) the potatoes, because I wanted to be sure we had enough and insisted that he peel enough potatoes to feed the combined populations of Belarus and the Ukraine.)

Okay, I was going to say more mushy things about my husband, but he wants to go to bed and I asked him if he would wait until I was done with this post so we could do a Christmas present inventory. So I will wrap up hastily. The end.

Musing

So I was a wreck on Wednesday evening -- weepy, irrational, overwhelmed. Thanksgiving itself was very nice; the preparation was anything but. This makes me think I need a better plan for Christmas. I will be 41 weeks pregnant on Christmas Day (or perhaps newly postpartum, though I doubt it), and I have never found a state of such advanced gravidity to be in any way sanity-enhancing. Quite the opposite, in fact. And if I've had the baby, I'm really not going to be up for hosting.

Notes for my daughter, about Thanksgiving

So far none of my children will cook with me. I am not the most patient teacher, unfortunately. Last night I was in the kitchen wondering if this new baby will like to cook, and what she will be like next Thanksgiving. This, I wanted to tell her, is how we do a Gladly Thanksgiving.

The key is butter. Pounds of butter. It is a myth that Thanksgiving is about turkey or autumnal vegetables. It's really the butter.

<- Look

Over there, in the left sidebar. See what I just did?

The people with feed readers are grumbling, "No, your sidebar doesn't show up in the feed reader, silly." So I'll tell you: I just sent off my first two dissertation chapters to my committee. Two weeks until my prelim.

And she lived to tell the tale.

I just spent two nights sleeping alone for the last time in the foreseeable future.

My professional organization just had its annual meeting, in Chicago this year, and I was presenting my early research project. I had been dreading it because people in my discipline have been consistently skeptical about my hypothesis, and I imagined a long line of naysayers. I have the numbers to support my hypothesis and a pair of plausible mechanisms to explain the numbers, but I still wasn't looking forward to it.

It turned out really well. I was supposed to be there for ninety minutes but people kept talking for more than two hours. By the end I was thinking, "If I just lay down on the floor and closed my eyes, would they figure out that it's over?" Several people said, "I saw this in the program book and thought it sounded crazy, but it makes a lot of sense," which was gratifying.

Only one guy was obnoxious. He was asking me for more information about one of the mechanisms I'm proposing and I mentioned that some of the contributing evidence comes from animal studies. He leaned in and said, "Well, you see, animals don't talk." In response I said, "There's compelling evidence from performance in other domains," though what I thought was rather less charitable. When my project director came back she rolled her eyes -- I hadn't connected the dots but this is a guy who hates her work with an unflagging passion and probably stopped by the poster especially because she was the second author. He has a long history of trashing her wherever possible, so I won't get bent out of shape about it.

I stayed in Hyde Park with friends from college and we had a lot of fun together. (I wondered if I might spot Obama but no dice.) The last time I took Amtrak, the train caught fire and I was delayed by five hours; this was a peaceful trip with no firefighters in view.

Tomorrow I am scheduled to send off my dissertation chapters to my committee; last night I dreamed about the final edits. In my dream I was horrified by my verbosity ("This sentence doesn't even make SENSE!") and by the scrawled unfamiliar citations I had to put in the bibliography ("Why am I citing Leakey and Leakey when this dissertation has nothing to do with anthropology?"). Here's hoping the actual undertaking goes more smoothly.

Dear Appeals Committee

[My HMO refused to cover chiropractic treatment, but I am appealing. I am posting a draft of my letter here, in part because a major reason I blog is to get the goofy out of my system, but also because the cites may be useful to someone else who is pregnant, in pain, and dealing with a similarly recalcitrant insurer.]

I am writing to appeal your denial of coverage for chiropractic care to treat an injury sustained on 11/9/08.  Your letter states that you cover chiropractic treatment involving manipulation of the spine when a significant improvement can be expected from this treatment. Your own guidelines, then, indicate clearly that I should be reimbursed for chiropractic care.

I was referred by Dr. Sarah Swipich (=She Who Is Persuaded I'll Catastrophically Hemorrhage) for chiropractic treatment to address symphysis pubis dysfunction (SPD, alternatively known as Serious Pain in the Down-theres). According to Jain, Eedarapalli, Jamjute, and Sawdy (2006), SPD is the result of spinopelvic instability (do note the "spino-") caused by pregnancy-related hormonal changes. Treatment primarily involves manipulation of the sacrum, which is, as you well know, part of the spine. (I refer you to a little-known verse of "Dem Bones": "the S-spine's connected to the... L-spine, L-spine's connected to the...T-spine.") Peer-reviewed research has described excellent efficacy for treatment of SPD via spinal manipulation, with 100% of treated patients in one study reporting improvement (Andrews & Pedersen, 2003). More specifically, 25% reported full recovery, 62.5% reported moderate recovery, and every patient -- every last one -- reported a decrease in pain. An article in the Journal of Osteopathic Medicine also recommends spinal manipulation as a safe and effective treatment for SPD (Cassidy & Jones, 2002).

Let me sum up. Etiology of the problem: spinopelvic, emphasis on the spinal. Treatment of the problem: spinal manipulation. Likelihood of improvement with appropriate treatment: extraordinarily high. Criteria met for coverage under my plan: 3/3.

If you elect, through doublethink or pure bureaucratic bullheadedness, to deny this appeal, I must insist that you recommend an alternative treatment modality that would be covered. (I presume you are not in the business of telling patients suffering from incapacitating pain that they should just suck it up.) In more than a week of resting, icing, and taking Tylenol I noticed very little change in the pain, though I noticed an alarming augmentation of the piles of dirty laundry awaiting my attention. Should I take narcotics at 8 months pregnant? Should I stay on the couch with my ice pack, awaiting a miraculous healing and perhaps the miraculous ministrations of the Laundry Fairy? Should I plan a C-section if I cannot stand to keep my knees more than eight inches apart? Surely you could not in good faith suggest one of those as an alternative.

After you denied coverage I paid out of pocket to see Dr. Susan Swioug (=She Who Is Owed Undying Gratitude), who informs me that I have sacroiliac dysfunction and lumbar subluxations. Her manipulations of my lower spine were followed by the first real improvement I had seen in this pain in more than a week. This was accomplished quickly, comfortably, and non-invasively, with none of the risks of, say, narcotics. I came home and did battle with the laundry. (It's still winning, though. I will require further treatment before I can entirely vanquish the armies of dirty socks marshaled during my spell of couchbound convalescence.)

I expect to be reimbursed promptly for my visits to Dr. Swioug, since spinal manipulation for treatment of spinal problems is a covered benefit. If you have an alternative point of view, I will read it with the keenest interest -- as will, I am certain, the good people in the state regulatory office. Please reply at your earliest convenience.

Yours optimistically,
CJ Most-Gladly

Andrews, S., & Pedersen, P. (2003). A study into the effectiveness of chiropractic treatment for pre and postpartum women with symphysis pubis dysfunction. European Journal of Chiropractice, 48, 77–95.

Cassidy, I.T., & Jones, C.G. (2002). A retrospective case report of symphysis pubis dysfunction in a pregnant woman. Journal of Osteopathic Medicine, 5(2), 83-86.

Jain, S., Eedarapalli, P., Jamjute, P., and Sawdy, R. (2006). Symphysis pubis dysfunction: a practical approach to management. The Obstetrician and Gynaecologist, 8(3), 153-158.

Waiting

Last week I started to wonder if God was trying to teach me something about the blessing of health and the frailty of the human frame. When bronchitis laid me low I thought, "Once I am better I am going to get up every morning for the rest of my pregnancy and thank God that I can breathe freely." But it's easy to forget what a blessing good health is. I might have remembered for three days before I was taking it for granted again.

I haven't wanted to be a whiner but I have to say I'm looking forward to the return of a pain-free pelvis -- mobility is also a blessing. I thought about writing a post on the lighter side of a symphysis injury, about how I have to set my pants on the floor and wriggle my feet through the legs without lifting them. It took some serious contortions for me to get my stockings on for church this morning. And icing your symphysis? It'll wake you right up if you were feeling sleepy. I'd never tucked ice in my underwear before this week.

Tonight I was reading Lloyd Alexander to Joe while sitting cross-legged on the couch. When I got up to check on the potatoes baking in the oven, my feet were asleep. I started walking on my numb feet but apparently one of them rotated underneath me. I fell down, wrenching my ankle on the way. It hurt terribly -- for a minute I just sat there and keened. The boys leapt into action, bringing me ice (Joe and Marty) and patting my leg gently (Pete). After a few minutes of icing it I tried to get dinner on the table so the middle guys could make their pack meeting, but putting weight on that foot made me nauseated. Alex said, "Mom, you should sit down. I'll take care of the potatoes. I'll help you wrap your ankle in a minute." And he did. (Thank you, Boy Scouts.)

I was still trying to find some humor in it ("Note to placenta: Dial down the relaxin production already. If these ligaments get any looser, the baby's going to fall out on her head.") but the fact is I am feeling clumsy and vulnerable. Tonight Elizabeth Foss posted the story of her daughter's arrival and it made me cry and cry -- it is a beautiful story, but it underscored those feelings of vulnerability and uncertainty.

The fact is that I do not know what the future holds for me or my baby. (Inner control freak shrieks NO NO I HATE NOT KNOWING.) I cannot even predict how bruised and swollen this ankle will be in the morning. But I know that God is good, and sovereign, and that suffering offered up can be extraordinarily fruitful. And I know that I will be able to face whatever difficulties await me tomorrow more cheerfully if I go to bed instead of staying up and fretting. That's probably a better plan than sitting here and editing this post.

Oh, yeah, and some good news too

Baby's head was down today, though she still seems to be bouncing around like a Pong target. She likes to lie transverse and s-t-r-e-t-c-h out. The doctor did a quick ultrasound to confirm position and measured her head as a smidge smaller than average. (What she said was "Her head is 34-3," causing me to gasp, "34 CENTIMETERS??" That would be a big dang head for this stage of the game. What she meant was that baby's head measures at 34w3d, and I am exactly 35w today.)

(My worry, pervasive enough that I hesitate even to type it because it might seem like the foreshadowings of doom later on, is that she is tangling herself up in her cord with all these gymnastics. If she has worrisome decels in labor, of course we'll go right to the hospital. But what if she gets into trouble before that? Sometimes I poke her when she is sleeping quietly, just to make sure she kicks back.)

Also, I beat the anemia! I figured my hemoglobin was up because I no longer have that beaten-down feeling in the late afternoon, like I just cannot hold my head up until bedtime, but I wasn't expecting it to jump up by a whole unit. I am crediting the folic acid/B6 regimen, because I was taking plenty of iron before. I might be wrong but it wouldn't really matter -- some combination of things did the job. Let's hear it for normal!

An Earful

I wanted my insurance to cover chiropractic treatment for this symphysis trouble, which is much improved but still painful. (I am under strict instructions from my midwife not to do laundry, because carrying things up the stairs is a prime way to make it worse. Yes, ma'am! That's an instruction I'm happy to comply with. Now all I have to do is sustain an injury that sidelines me from washing dishes and I can kick back and lead a life of leisure.) I called my doctor's office to see about a referral, and they told me I'd need to come in first.

Today I saw the other doctor in the practice, and OH MY GOODNESS is she different from her partner. Remember my conversation with him about the risks of homebirth? Lather rinse repeat, minus the friendly. The weird part about both conversations is that they've focused on the risks to me: I could die because nine years ago I had a not-enormous and easily controlled postpartum hemorrhage. Neither doctor has mentioned the risks to the baby, which take up much more space in my head. The studies don't support the idea that the risks to babies are greater in planned attended homebirth, but things do go wrong sometimes. I find myself thinking about that a lot just now.

Since I've had this conversation before, I responded pretty calmly. Nine years ago I had clear risk factors for postpartum hemorrhage: untreated anemia, long first stage, long second stage. This time my hemoglobin is solidly in the normal range (up a whole unit from six weeks ago! I am practically Popeye!) and it is very unlikely that I will contract hard for 24 hours or push hard for two (please God). I have had more babies than the average woman, which is an additional risk factor, but I have also had two perfectly normal third stages, with not a glimmer of trouble, since that hemorrhage. Hm, I'm thinking I probably said all this in that earlier post and you guys aren't the ones I want to argue with anyway. I'll spare you the part about the drugs my midwife carries and how close I am to the hospital where I have already pre-registered.

I am still a little wound up about our conversation, though. It made me want to come home and blast Enya while brewing a pot of red raspberry leaf/shepherd's purse tea and soaking plaster strips for a belly cast. I don't actually own any Enya or any belly-casting materials, but I think I will put the kettle on.

The Talk

Tonight I said, "We need to talk about this for five minutes and then we never have to talk about it again." He cried. Drama loomed. Drama is utterly counterproductive in a situation like this, because it encourages you to feel sorry for yourself ("my finches died and she's so unsympathetic") or adversarial ("how dare she suggest that I was responsible?") or other emotions that only get in the way of doing what you need to do. So I didn't take the bait. He said, "I know it was my fault."

I told him that he had an opportunity to let something good come from what had happened -- that it could be a spur to work on bad habits, to take a step toward being a person who does his duty cheerfully instead of avoiding it. I didn't want to do a lot of finger-pointing; I said, "We all struggle with sloth." (In thinking this over (and over and over) I have been acutely aware of my own willingness to walk past a mess that needs tidying, or an out-of-place object that needs to go back to its home.) I told him that I would love him no matter what mistakes he made, and that he never needed to be afraid to tell me he had made a mistake. But I urged him at the same time to let his mistakes teach him what he needed to do differently next time.

Once, years ago, I was avoiding something I needed to do and I said to Elwood, "I'm having one of those who-will-rescue-me-from-this-body-of-death moments." He had NO idea what I was talking about. I might have been speaking Croatian. But that passage from the end of Romans 7 speaks so clearly to me that I assumed he would have to know it: "I do not do the good I want, but I do the evil I do not want....For I take delight in the law of God, in my inner self, but I see in my members another principle at war with the law of my mind, taking me captive to the law of sin that dwells in my members." It is one of the central tensions of the Christian life. On the one hand, it is God who works in you to will and to act according to his good purpose; on the other, you can be more or less cooperative in that work. You can't tie yourself up in perfectionist knots, and you also can't kick back, reading a novel, and expect sanctifying grace to do all its work while you relax. I am bad at this balance, and so I am questioning my ability to teach it to my children.

Tonight I wanted to say two things to my son: you need to be more responsible, and I will love you unfailingly while you are learning how to do that. How I hope both halves of the message came through.

A Story

Once there was a boy whose teacher was giving away a pair of zebra finches.

Ouch

In an effort to counteract the time-change blues (and the evening frustrations of squirrelly kids who haven't spent enough time outside), I took the three younger boys to the playground today. "Let's play structure tag!" said Joe. I was a little reluctant but I agreed. I said, "Remember, I'm big and pregnant and I haven't taken my heart medicine today, so I won't be able to run very fast." We played for a bit --  I tagged him and he tagged me -- and then I guess he got warmed up. He ran off and I honestly couldn't catch him. How humbling is that, not to be able to tag a 6-year-old?

In structure tag you have to stay on the playground equipment, so there's a little bit of strategy involved. That's part of why I couldn't catch him, because it's easy to get yourself stuck in a corner as a first-time participant. But part of it is that I'm just not moving very fast, which makes me feel old and huge.

Oh, I almost forgot about a blog post that I dreamed this morning! When my husband was in the Navy and crossed the equator for the first time, there was this huge initiation ceremony in which the wogs (first-timers) became shellbacks (southern hemisphere veterans). The details are secret, but apparently cross-dressing was involved, and vats of shaving cream, and nail polish. Anyway, I was trying to get comfortable in my sleep and dream-thought, "This is my crossing the line day: I am officially a shellback -- stuck like a turtle if I get turned onto my back." At least nobody sprayed me with shaving cream in welcome.

After my attempt at a sprint I noticed that my symphysis pain was bothering me. Then it wasn't just bothering me, it was intolerable. I said, "Boys, I'm sorry but we're going to have to go home." I limped into the house and hit it with Tylenol and ice, but neither one really made a dent in the pain. I am still shuffling around like an arthritic old lady. The one position that seems to help with walking is if I arch my back and put my hands on my backside, which makes me look like an arthritic former dance contest hopeful who is unfortunately stuck in the limbo position.

My midwife suggested a snug band of fabric or a belt to compress the joint from outside, explaining that it's not unusual for someone with an "expert body" (read: OLD and DECREPIT) to have more symphysis pain. It helps some, but I am still hurting. And feeling clumsy. Sniffle.

T minus 7 weeks (give or take)

Today I am 34 weeks pregnant, which means I will, God willing, be having an actual baby in about 7 weeks. (I know there are some women out there for whom 34 weeks of pregnancy means a baby in 3 or 4 weeks, but I am not one of those women. I appear to have a very comfortable womb, whose occupants are loath to leave it.) I am writing this post to say, Internet, I am giving up sugar. (Again.) I am a sugar junkie but it is bad for my energy level, bad for my disposition, and bad for my plans to wear pants that zip at some point before Easter. I was in the sugar-free groove until bronchitis and Halloween hit me one after the other. Today I am throwing out the rest of the Swedish fish and eating a big salad instead. No sweets until Christmas, when I will be exactly 41 weeks pregnant. (This year I am never uncertain about how many days there are before Christmas.)

One of the things I would like to do with my soon-to-be-burbling font of green leafy energy is to have a FOO -- a Festival of Organization, in which I go through my house room by room and smite clutter and disorganization with the fearsome double-ended blade of willpower and nesting hormones.

Do I need three knitting bags tucked in between the library basket and the end table? Of course not -- away with them.

Will the boys really cry if I implement my proposed plan for Bionicle storage while they are at school, or will they be secretly grateful for the chaos diminishment? Don't answer that. No Bionicles will be harmed in the quest for less chaos, I promise.

Will my husband join in the effort to tidy up the man-cave-ly office which is overrun, at present, with cables and batteries and... and... assorted manly things? I suspect he will encourage me to find more homeless Bionicles instead. We shall see.

I have pretty much decided -- in fact, I am making a firm decision right now as I type -- to delay my attempts to get my early research project published. If you caught the occasional disappearing posts about that project, you might remember that my project director was not as responsive as I might have hoped she would be. Nothing has changed on that front, and it doesn't make a lot of sense to push hard to meet a self-imposed deadline when she isn't answering my emails. Hm, I might need to go back and edit this paragraph later. Upshot: I'm cutting that from my list, thinking I'll shoot for summer when she has fewer administrative responsibilities.

All right! I am going to address some Christmas card envelopes, and buy a couple of Christmas presents, and switch the laundry, and squeeze in a little work before I pick up Pete. Which means I need to move swiftly. See you later.

A few more speedy and fairly random thoughts

This afternoon I sent off version 3.0 of chapter 1 to my advisor, having worked out the thorny organizational issue that had vexed me for weeks. I picked up Petely at preschool and we went to vote. I had brought along a big fat book in anticipation of lines out the door, but we were in and out in no time flat.

We walked down to the hospital so I could pre-register, and I am still enjoying the memory of the sunshine and the sense of relief. This election season has been getting me down, and I'm glad it's over.

When my third son was gestating, he spent the first part of his last month in utero bouncing all around. I was a giant stressball about the whole thing. What if my water broke while he was transverse and his umbilical cord prolapsed? (Never mind that my water has never broken before 9cm.) When baby was breech at my last prenatal visit two weeks ago I said, "Oh, I learned my lesson about this with Joe. She'll turn when she's ready and I can't do much about it."

I was serene for all of five days, and then I was done being serene. I wanted this baby to turn head down now. My doctor is willing to do an external version, but those aren't risk-free. Plus, he'd want to do it at 37 weeks and my prelim is scheduled for 38w4d. I don't want to be one of those women whose baby gets distressed after a version and needs to be delivered immediately, primarily because I don't want to put the baby in distress but secondarily because I'd hate to have to reschedule the prelim. So I am taking matters into my own hands, with a little help from Pete. (I think the stairs are more comfortable than the ironing board.) As of tonight, baby seems to be transverse. That's progress, right?