Photo from Mount Royal, Frisco, Colorado.

"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather

Sunday 27 February 2011

Cannonball: 18 weeks pregnant marathon

The cannonball concept in running is fairly simple: you arrange a marathon on the spur of the moment. This is the kind of marathon we ran today. In all honesty, we had signed up for it nearly a month ago, so it would be a stretch to call it spontaneous. It even has a lovely website.

I have been such an emotional mess lately that I opted not to mention it on the blog. I am subject to changing my mind at the spur of the moment and didn't want to deal with explaining why I didn't run, if I were to wimp out. But this morning I was game, despite my ever-worsening plantar fasciits. If nothing else, I figured I would try to run the same amount of time as SR and then we could go home together.

The race start was a 10 minute run from our apartment and there were about 25 other runners, most of whom we knew. It was just the kind of race I needed. I need support right now. I hate to sound fragile, but I have been letting people get to me. In the last week I have had three female doctors tell me they would never run pregnant because it was too dangerous. When someone says this to me, I get big crazy eyes and ask in slow monotone "how exactly is it crazy?" - still big... crazy... eyes. And then I get stupid answers - "it shakes the baby too much", or "I read that somewhere once, I think". Maybe I give people too much credibility just because of the doctor title (and in honestly, they certainly do know a lot about the field they are in!). But, God, no one wants to hear that what they're doing is a threat to their baby. Sometimes I wish I lived in a bubble where I could just run as much as I wanted and I wouldn't have to deal with having (undeserved) guilt being bestowed upon me from all directions.

The run started ingloriously. Lots of cold, wind and hills. I claim to like these conditions, but then again, I've almost forgotten what it is like to run a flat marathon in nice weather. The latter would have been nice today.

The race was set up in 7 loops of 6 km. I ran the first two with a really nice guy, Claus Fischer, who helped me forget all of the disturbing noise in my head. And everyone there seemed to know I was pregnant - I got comments like "respect!" and "incredible!". It was great. No, I don't want my ego fed, and I'm not running marathons to look like a hero. I run them because I enjoy them and I truly believe it is a healthy thing to do in pregnancy. AND I am an absolutely normal woman who has found herself scrutinized and criticized by many a woman in Denmark, after and article was written about me in the magazine I form (there was not a lot or criticism - but the negativity that was there echos in my head every day).

After Claus went ahead, I focused a lot on my foot and decided to drop. It was killing me. But then Birgitte joined me. She has now run 184 marathons (almost all with her dad, who was there and has run over 420!) and she was like a pain killer and - and her presence simply an inspiration. We had a lot to talk about, including her own pregnancy and how she hated people giving her a hard time. She said she eventually stopped talking about it with anyone and ran in secret. Anyway, she left me after the 4th loop - and by this time I knew I could run the whole thing. My foot felt strangely better. I had run into SR who was doing well and said he'd meet me at the finish with The Lorax. Well, knowing they were going to be there was a big incentive. I was able to pick up the pace and, for the first time, turned on my music. My friend, Jerk was right behind me the rest of the way. My mantra was simply "I must beat Jerk!". I ended up feeling great the last two miles and was able to beat my pregnancy PR (4:19:59), with a time of 4:18:06. Nothing really to write a blog post about, but I was thrilled and, best of all, felt awesome! And I got a solid second place for the females (out of five?). The Lorax and SR were there to give me a hug.

SR had almost certainly beaten the course record, but had not worn a watch, so had no proof (his time was around 3:15). His comment "I don't wear watches on training runs". We thus missed out on winning a bottle of wine, which neither or us would have drunk anyway.

Morten deserves many thanks for a perfectly arranged race. Morten, I just ate a piece of your wonderful cake :).

Running song of they day: Sentimentally Falling by The Rumour Said Fire

Edit: Here is a shot of the marathoners pre-race. No, I did not wear a backpack the entire race. I just ran it to the aid station so my chocolates and non-functional camera would be waiting for me after each loop. I just realized how cool I would be if I had a pair of non-black running tights.

Thursday 24 February 2011

Madison, Minnesconsin

About 3 months ago, I found out I would most likely be kicked out of Denmark. I had gotten confused about what I was supposed to do to extend my residency permit, asked the authorities, never got an answer and then applied too late. At the same time, Denmark tightened their rules concerning foreigners and I got message that I was living and working here illegally. Yet I received no concrete message that I should leave.

Three months went by and I wondered if I would actually get a PhD, if I would get prenatal care and maternity leave, if our family would go on living in Denmark. We read in the news about foreigners getting kicked out, Americans included, for applying past their deadlines. It was getting to be time to devise a Plan B.

But last weekend, we received a letter saying I was allowed to stay and was again living and working legally. Not being big on committing international crimes, this was a relief. (The one additional thing we needed to provide was proof that we were living in an apartment that was sufficient for our family. I was surprised to notice that our apartment just barely met the requirements for square meters for a family of four. Needless to say, we're not living extravagantly, but we're not cramped.)

And now we are allowed to go on planning for the future.

For the greater part of my year's maternity leave next year, we are going to be living in Madison, Wisconsin. It is a very logical place for a whole slew of reasons – not the least of which is SR will be close to all four of his kids. Meantime I'll be working 10 hours a week on my PhD, all the while being paid for full time work (thanks, Denmark!).

This change in work hours for me just cannot come too soon. Right now, I work 12 hours days three days a week. And work regular 7-8 hours the two other week days. If SR didn't have a four hour commute each day, this wouldn't be such a big deal. But as it is, The Lorax is in day care 12 hours a day, three days a week. I should admit, I get time off in the middle of the day to run/swim whatever – that is I make time to prevent insanity – but The Lorax is getting the shaft. As is Natty who sits at home alone and is responsible for making her own dinner, etc. This is not fun for a 10 year old, I imagine.

This morning, it really hit me how detrimental this situation could be if it went on long-term. I had time to eat breakfast with The Lorax this morning and made him some toast with Nutella, per his request, only to have him tell me that he would prefer to eat breakfast at day care. He stared blankly, and with the honest numbness only a three year old can have, letting me know day care was becoming his home and he felt strangely abandoned. This is the kind of signal a dad might ignore. And maybe it is meaningless. But I attach a lot of meaning to it.

And thus, I find that in three years, when we do move back to the US, that I don't want to do a medical or surgical or whatever residency where I have to work 80 hours. For SR, me not doing a residency is unthinkable. Yet, I can't help dreaming of living in the US and working part time while doing a masters in say Music Ethnography (one can't accuse me of being overly practical). Or studying more of the history of medicine. Anyway, residency might have to wait until the children are older. Not that I don't want to do a residency – it sure would make finding a job easier. But I also have to be fair to myself here- it's not what I want.

If I did residency in Denmark, the work would be 40 hours a week – and manageable, partly becuase day care here is so darn good. But 80 hours a week in the US, even if just for two years, is to me, not an option. We could have the greatest nanny or au pair in the world and I would be left feeling miserable. And it would never be just two years, because I'd want to do a fellowship afterwards and bla bla bla.

The other thing about moving back to the US that will suck is I fail to understand the political views of most people there. And the way the society functions in general. I had trouble understanding it when I still lived there, and now it has become even more foreign to me. So, since I refuse to be a pessimist, I will just imagine that between now and when we move there, Wisconsin and Minnesota will join forces, becoming of course the country, Minnesconsin, where bike lanes, high speed trains, windmills and socialism rule (Wisconsin needs some help right now, Minn.). But it is pointless to talk politics because no one ever changes anyone elses' mind.

Instead, I will mention my pregnancy. All is well. Lots of kicking (or rather baby movement) and people are actually asking me if I'm with baby now, which preferable to the "you have put on a few" stare. Speaking of which, I still haven't gained a pound in the last five weeks. I'm happy about that because I feel like I look better and I also feel better. Maybe it is simply that I feel I have some semblance of control over the current chaos in my life. Regardless, I don't feel the baby is being harmed in any way. Oh I know people will write angrily at me for this, but you know what, I'm not attempting to not gain weight – I feel it is just my body saying more is not necessary at the moment.

Have to add a little interesting tidbit. I talked with my mom about pregnancy weight gain and she mentioned that both of my grandmas gained under 15 lbs in their pregnancies. Not only did I get the impression that my weight gain tendencies are indeed genetic, but I also was surprised when she told me that this is what was recommended to them – that they gain less than 15 lbs so that they baby wouldn't get so big that they would need a c-section. Just some interesting history, I guess. Though there was very little uniformity in physicians' recommendations those days.

Running Song of the day: Love is All by The Tallest Man on Earth

Edit: So the drama with my residency permit continues. I just got an email from Foreign Services, right after I wrote this post, stating our rental contract was insufficient and because it depends on my employment at the hospital. I thus need to provide a work contract stating I will be employed until 2013!!! How many people can provide that?! The laws here are unbelievable!

Wednesday 16 February 2011

The Perfect Pregnancy Plan

Excuse the alliteration, but for some reason this post deserves it.

In the future, much as there is discussion about an optimal training plan, women will talk about the optimal pregnancy plan: to lose weight and get into the shape of their lives.

But let's back up. Why isn't it like that now? (and why do you feel that just because I suggest it, I'm perverse??) Well, Heather said it best in her comments: our way of looking at pregnancy is "anitquated". In the 19th century, life was different in the sense that only the upper class had the "luxury" of a pregnancy of rest and lots of weight gain. I imagine that (as is true today) pregnancy outcomes were greatly influenced by socio-economic class and thus these women did at least appear to have healthier pregnancies.

During the 20th century, women gradually looked at physical activity and leanness as desirable. But the rules about pregnancy weight gain and being sedentary remained. Thus women saw their physical condition and weight as something they had to "sacrifice" for the health of the baby. Women now typically get out of shape and overweight due to pregnancy. And most never get back to their pre-pregnancy weight or physical condition. And that's why you find my suggestion "perverse" - because it should be a time of sacrifice. (But while sacrifices for a good reason are noble, sacrificies without reason are simply self-gratifying).

And women don't always make "sacrifices" if they don't find them convenient. Some women go on drinking large amounts of alcohol while pregnant and we have learned from them that babies don't do well when drowned in alcohol. The would have done well making a "sacrifice". Other women went against conventional wisdom and ran multiple marathons, crossed the English Chanel swimming or won biking or running races while pregnant. The reason these women did this is perhaps not difficult for my readers to understand: exercise is healthy when not pregnant - it hardly makes sense that it wouldn't be while pregnant. The body of evidence showing it's health and safety grows and grows: these women have healthy kids.

And not only do they have healthy kids, they have healthier kids. They don't get overweight and they score better on tests of motor and verbal development.

The new "sacrifice" will thus be - I am giving up my unhealthy sendentary lifestyle and my extra pounds during this pregnancy. Pregnancy is wonderful for many, many reasons - among which is a golden opportunity to get into the shape of your life.

Let's consider the example of Stefanie Shocke. She just had a beautiful 7lb 9oz little girl. How much weight would you wager she gained? Answer: 9-10 lbs. (Bet that wasn't your guess unless you have been reading her blog). Even more impressive is the fact that she set a very fast PR in both the marathon (3:31 at 22 weeks) and half marathon (1:35 at 18 weeks) distances midway through her pregnancy! SHE exemplifies the Perfect Pregnancy Plan.

If you are reading this and thinking "everyone already agrees with you, SLG, so just shut it already!", then you have been spending too much time reading my blog. (No, not too much time, just time :)).

Here are the recommendations from the ACOG castle (that's the American College of Obstetrics and Gynecology, of course):

pregnant women should be encouraged to engage in regular, moderate intensity physical activity

(am I the only one who reads this and wonders - if intense is dangerous, then is moderate a little dangerous?)

And here's a quote from Running Times Nov. 2010.

As the research suggests, in most cases, runners are encouraged to run through much of pregnancy, but not to set any big training goals. While more than 30 minutes may be safe, this is not the time to hog mileage. Smart training will ward off stress fractures and sprains, as well as keep the baby healthy. Like a monster hill at mile 25 of a marathon, knowing what to expect can make all the difference.

I remember clearly reading this the first time and thinking "what the hell does that mean?" - basically the whole paragraph is a confusing mess. But "not the time to hog mileage" - why does there always have to be a guilt trip - and for no reason??? Sometimes all of this bullshit makes me throw up in my mouth. This whole "take it easy, don't do too much" comes from no scientific evidence and is simply ANTIQUATED. I applaud people who set new training goals, run farther and faster than ever. Heck, I ran way more miles a day during my very own first pregnancy than I had ever run before - why is it exactly that the working hypothesis is this is dangerous?

Because all of our working hypotheses stem from (another Heather quote I love) "you must rest during pregnancy, you poor delicate reproductive blob"

And here in Denmark, it is no different: - no high intensity exercise, - no long-distance running, - nothing more intense than you did before you became pregnant. Says the Danish Ministry of Health.

Not only is the above not supported by research, but it is confusing. Again what is "high intensity" - running up a hill? running a 100 miler?

I have imagined many possible scenarios in which a study could be done which would clear up this confusion. But these studies are really hard to do - I get tired just thinking of all of the confounders. The truth is more and more women will find they become more physically active than they were before pregnancy and more will participate in sports at an intense level. And this is how or views of exercise in pregnancy will change. You may not agree with me - but your kids will!

And since I'm prophesying - the weight gain recommendations will also continue to come down or widen. They were just lowered in 2009 after the recommendation of the Institutes of Medicine and now women who are normal weight should gain between 25-35 lbs. Some women can "get away" with gaining this much - and it certainly must be genetic. But many, many women who eat healthy, listen to their bodies and exercise find they gain significantly less than is currently recommended. And they are more likely to return quickly to their pre-pregnancy weight.

As I have discussed before, the current recommendations are based on one study, where women who gained less in the second trimester had babies that did worse. But the study is flawed from the outset because babies who have an illness or condition to begin with often don't grow correctly and thus these mothers ALSO gain less - making it appear as though the mother's weight gain was the problem when the baby had the problem from the beginning. Anyway, I am certain the weight gain guidelines will also widen to include much lower weight gains as being healthy. One day.

Now I am tired of writing.

I will simply mention that I had a beautiful 3 hour run in the hilly woods around Næstved - and have to admit this was the running song of the day (since I may have listened to it 8 times): Go Do by Jónsi. (Thanks for the rec again Steve Q. I have decided you are allowed to make a running music library for me to save me some time :).)

Edit: Okay, I rarely add something to my posts as an afterthought, but I really need to make one thing clear (thought it would just be assumed, but it's actually not that obvious) - there is no "perfect plan" for every pregnant woman, just like there is no "perfect plan" for everyone who wants to run fast. There are only perfect plans for every individual. Stefanie's pregnancy was simply one example of a plan. And if you're more for the high mileage preganncy, then I guess you'd be following more of my sort of plan. The LAST thing I wanted to do was make people scared or guilty because they feel they're not doing enough.

Monday 14 February 2011

3/10 Narrative

I guess I could apologize for my absence - but you probably didn't even notice you missed me! To clear up any confusion, I am not the type of person who doesn't post because things are going badly. I tend to post more than ever in tough times. I think I have simply reached that horrendously busy period of doing a PhD that everyone talks about. I thought if I planned right that it would never come, but here it is.

And I keep getting involved in extra things - like starting a prospective study on what body fat range is healthy for women based on development of morbidity and mortality (yep, this blog does give me some ideas).

Now what is this about 3/10?

It sounds like a terribly difficult time signature for a song. In fact, I can't find an example of a single song that was written in 3/10.

Everyone talks about John 3:16. But what about John 3:10?

"This is how we know who the children of God are and who the children of the devil are: Anyone who does not do what is right is not God’s child, nor is anyone who does not love their brother and sister."

Ever get the feeling that The Bible is a bit harsh and anachronistic? I mean who can do "what is right" all the time?

The Lorax and Natty turned 3 and 10 respectively this last week. When I think about the line from the Bible verse about loving your brother and sister, then I am as convinced as ever that these two are God's children. There must be something about being seven years apart and step siblings that unites them. I personally grew up with constant sibling rivalry, but it is almost completely absent with Natty and The Lorax. I get tears in my eyes thinking about Natty moving back to the US this summer. What will they do without each other?

Here is a picture from The Lorax's celebration.

Is my child a south paw? (do you see the useful animation tricks one learns as a PhD student? - time not wasted!)

Speaking of loving your siblings, my very own sister was just accepted to the PhD program in Cognitive Sciences at The University of Minnesota. Feel free to congratulate her here :).

I guess it has been a long time since I have talked about the pregnancy or running.

Almost exactly a week ago, I started feeling the baby kick. That is more than 4 weeks earlier than I started feeling The Lorax. People say it's because you remember what it feels like, but I am convinced the nerves around the uterus become more sensitive after the first birth - I mean I don't think I could have been confused about what this feeling was the first time around.

Since I am oh so scientific, I believe one can tell the gender of the baby by how they kick. I was convinced The Lorax kicked like a boy before the scan and now I think this one kicks like a girl. Of course, if it is a boy and he goes on to become a soccer player, he'll be so mad about this post :).

In other news, I am slightly worried about my blood sugar. I haven't checked it, but I am peeing way more than I should and in large quantities! Besides that, eating sugar makes me feel absolutely lousy (multiple birthday parties with cake = multiple panic attacks following sugar bolus). I have now almost completely given up on sugary foods and I feel much, much better. I am going to do a fasting blood sugar on myself one of these days, though I know pregnant women are supposed to do the oral glucose challenge for gestational diabetes, I'll certainly get an idea if something is wrong if my fasting is up. (BTW, you don't get tested for gestational diabetes here unless you meet certain criteria, which apparently I didn't meet and would have refused anyway - but alas).

My weight gain is a little less than 6 lbs so far and is exactly where I was with The Lorax at 16-17 weeks, and this is with really not making a conscious effort to be a specific weight; it is all seeming so genetic (though certainly exercising has kept the weight gain to a healthy amount). I gained the first 5 lbs in the first 12 weeks and then 1lb the last 4-5 weeks (exactly like I did with The Lorax). So FINALLY this week I am below the IOM guidelines for weight gain and thus know I am on track to a nice pregnancy like the last. (I simply can't stand the thought of gaining much more than last time - everything went so well, and it took a few months to get back to my prepregnancy weight anyway. So I'm saying 16 lbs is the limit again!).

My big running news was that I ran a 31 km (19.2 mile) hilly trail run last weekend in 2:58! This would even be acceptable for me on a non-pregnant day! I ran with a group of guys from Næstved and it certainly was the group that inspired me to pull it off.

And I have finally found the shoes that will save my pregnant hips from injury!!!

Minimalist, fast shoes with killer tread for trail running! Watch out Chippewa 50k participants - prepare to get preggo-chicked!

Finally - SR is travelling with Natty and The Lorax to the US for two weeks at the end of June (when I am 33-35 weeks pregnant) and I am really on the fence about whether or not I should go. According to the airline, it is acceptable. But I am feeling wussy. It will just be really weird because I will already be on maternity leave - add no work to being completely alone and I might just go nuts (or love it). The worst part is this is my chance to say good-bye to Natty before her move back to the US. Any advice?

Running song coming (once I get home and check the music library!).

Thursday 3 February 2011

Daring to discuss teratogens in the culture of blame and guilt

I know I am in over my head. Once again the disclaimer: I'm not an obstetrician. And now I'm adding this one: I'm not an expert on teratogens.

But, that being said, I feel it is my role to bring a little balance back into the universe. I get very angry when I see discussion forums where women discuss what it was that caused their miscarriage, their baby's neural tube defect, etc. There are just endless comments such as this: "I had a fever when I was 3 weeks pregnant and a miscarriage at 6 weeks. People try to tell me that is not what caused it, but I know better...". Come on now. Fevers are common. Miscarriages are common. A woman having a fever and then a miscarriage proves nothing. And bear in mind, women who have a fever and don't develop any problems never write anything. This is how myths develop. The women who write these comments think that they are helping solve the mysteries of the human body. But they are actually doing a huge disservice to other women who become fearful after they develop a fever.

Now for a little personal background: I am a professional sauna sitter.

That is not me in the picture. If it were, I'd be naked like all the other Danes.

Actually, I am not a professional. I just sit in a sauna about 3 times a week. When I got pregnant, I didn't think twice about continuing, granted I can't sit in there nearly as long. I even told my swimming friends about my pregnancy in the sauna. Tons of pregnant women sauna sit in Denmark; it is simply part of the culture here. One day, a woman was telling me a personal story in the sauna and I suddenly got the emergent need to GET OUT. When I got out, I felt terrible in like the primordial terrible kind of way. I almost threw up, but didn't. This was the first time I thought "maybe that wasn't so healthy". But I reassured myself that pregnant women get fevers all the time (with certainly higher core temperatures for longer periods of time) and end up with perfectly healthy babies. If we've evolved through fevers, we must be able to tolerate saunas.

But what does research show?

In 2002 a study was done in Denmark in 24,000 pregnant women demonstrating no relationship between fever and miscarriage or still birth, regardless of how high the fever was or how long it lasted. So one must conclude that if there is an association, it is a very small one because this was an exceptionally large study. (The Lancet, Volume 360, Issue 9345, Pages 1552 - 1556, 16 November 2002 )

What about neural tube defects? Well I will point out first an observational study from Finland where they found that 98.5% of expectant mothers visited the sauna regularly and that Finland has close to if not the lowest percentage of neural tube defects in the world. Now, that is not to say saunas are beneficial, just to say that they are likely not very harmful (Saxén, Sauna and congenital defects, Teratology Volume 25, Issue 3, pages 309–313, June 1982).

So where did all the fear come from? First animal studies. And then a study in the Journal of the American Medical Association in 1992. In a study of nearly 24,000 pregnant women, there was no significant association between any single heat exposure (hot tub, sauna, electric blanket or hot tub) and neural tube defect when they were examined together randomly. BUT there was an association between hot tube use and neural tube defect that was significant. This was NOT true for fevers, electric blankets or saunas. From this, somehow it was deduced that any heat exposure (including that from exercise!) was potentially dangerous to the developing fetus. THIS (and animal studies) is where the "don't overheat during exercise while pregnant" comes from. Read the study for yourself and decide what you think (Mulinsky et al JAMA. 1992 Aug 19;268(7):882-5.). My personal interpretation of this is it tends to be women of a lower socioeconomic class that frequent hot tubs in the US while pregnant and that this group also tends to have poorer nutrition and higher percentages of substance and alcohol abuse. This was not controlled for, likely because they thought the study would not get published if they did not show any significant associations (studies with positive associations are about 9 times more likely to be published).

Bottom line - don't worry about an increase in body temperature from exercise in pregnancy inducing a neural tube defect (neither fevers nor saunas have an association, so why should exercise, which almost always rises the core body temp less?)But watch out for yourself like usual! Heat stroke is always dangerous (but is, by the way, much less likely while pregnant due to improved heat dissipation). I am still uncertain what the significance of the hot tub - neural tube defect is.

But now you can see why I didn't go into Ob-Gyn in the US. Can you imagine the lawsuits?! But on this blog, I feel free to give you all my honest opinion. Heck, when it comes to pregnancy, I am a scardy-cat. But no one needs to worry about things that aren't actually dangerous.

Remember, we are all nomads from Africa genetically - it simply doesn't make sense that an increase in body temperature from exercise would be dangerous.


There has been a little banter going on between Piccola Pinecone and myself about whether or not a female's core body temperature rising slows down sperm transport, thus decreasing fertility. PPC said that she had read this in a Clapp book (does he have more than one?). Anyhow, I have not been able to find this study or any related study for that matter, but I simply want to point out why this theory doesn't make sense to me.

Sperm like to live in relatively cool temperatures. That's why they live outside the body (in the testicles). It is well documented that a rise in temperature in "the balls" causes DNA damage to the sperm and can affect fertility. But certainly once sperm enter the female body (or go into their active state), they have to be "ready" for the increased temperature inside the female body. Otherwise none of us would be here. And if an increase in a woman's body temperature (from for example exercise) negatively impacts the sperm, why is it evolutionarily speaking that we get so warm (as in exercise) during the actual act of baby making?

Okay, that last part was more "something to chew on" :) rather than proof of anything.

Running songs of the day:

Something old - Jesus He Knows Me by Genesis
Something new - Freedom Hangs like Heaven by Iron & Wine