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 March 2011

Finding a name for a boy

SR and I are not the only couple in the history of the world to have had trouble deciding what to name their son. But I wasn't expecting it. Even before I got pregnant with The Lorax, SR and I had the following discussion: "What is your favorite boy name?" "Christian." "Really?! That's mine, too!" End of discussion. I can't remember who said what, but I don't think we fully appreciated the coincidence that two people from different continents would share the same favorite boy name.

But finding a name for our second son has been a huge challenge. I amm trying not to see it as some sort of sign - that when we fell in love, we were in this harmonious state, simply agreeing without much discussion and now, well...

But the truth is, it's even more our parents and families that can't agree. Names that work in Denmark don't work as well in the US and vice versa. Of course we could choose Jakob, Thomas, Daniel, Oliver, Erik or Jesper, but we just can't get ourselves excited about those names. We like somewhat unusual names. We had actually decided on the name Vitus (after Vitus Bering, the Danish explorer who discovered the strait of his namesake). SR's parents loved it. And then we mentioned it to my family and we realized a big problem: though it's pronounced VEE-toose in Denmark, as my sister said, everyone would call him Gingivitis in the US. And that's probably not good.

There are many Danish boy names that simply would never work in the US: Egon, Jerk, Thor, Kim, Toke, Knud, etc. And typical American names tend to sound low-class in Denmark. I did have to laugh, though, when I saw Chastity-Hope was one of the top female names in Germany right now!

My favorite names are simply set-ups for rejection in both countries. They are, after all, very gay: Jean Michel, Sufjan, Orlando, Clair, etc.

The best men's names, in my mind, are unique, musical and fitting of the person, place and time:

Orlando Bloom
Jackson Pollack
Christian Boltanski
Jean-Michel Basquiat
Plaxico Buress
Sufjan Stevens
Gabriel García Márquez
Ambrose Bierce
Brice Feillu

Perhaps our biggest problem is we don't have a "place". If we were staying in Denmark, we'd call him Vitus. If we were permanently in the US, we'd call him Sofus (also a Danish name, but just not as cool here - often used as a name for bunnies, etc.).

But isn't it also fitting that we would finally come to an agreement today on a run together? Somehow The Lorax put up with over two hours in the jogger - maybe because the weather was nice and his parents were in a good mood. Part of it was definitely that we did hill repeats in the woods and SR treated it like a roller coaster. The Lorax screamed and laughed. The name we decided on was actually a name I stumbled upon, not realizing it was a name invented by Astrid Lindgren in the book Ronia the Robber's Daughter. It's not certain we'll use it, but it is nice to be in agreement! Oh yeah, I didn't write the name on purpose, people. The biggest question is whether or not we should ask the opinion of others.

I have to add that SR and I both went on to run almost 4 hours. It was a great day of preparation for the Chippewa 50k, though maybe a bit much considering our marathon next weekend.

Now a music video simply simply because it's beautiful:

Cançó de l'alba - BEDROOM from Compañía Volcánica on Vimeo.

Tuesday 22 March 2011

A cautionary tale and injury prevention for the pregnant runner

When I said I would write my next blog post about injury prevention in pregnant running, I didn't know it would be clouded by such a serious occurrence. No, luckily I have not gotten injured yet, but for those of you who don't read Stefanie Schocke's blog (and I hope she doesn't mind I mention this!), she has just learned that she suffered a stress fracture at the inferior pubic ramus at the end of her pregnancy. She has really been an inspiration to me, with how fast she ran pregnant (made a habit of setting PR's) and how she almost made it to the end before any injury set in. But her injury makes me realize how serious, relevant and poorly understood this topic is among pregnant runners.

I also didn't know when I said I'd write this post that the incidence of pelvic/hip/groin injury was so common in pregnant runners )you are, of course, all smart enough to take a poll on my blog with a grain of salt - but it's hard not to find it a little interesting).

You are more likely than not to have your running curtailed by an injury while pregnant. And the most likely injury (67%) is of the pelvis.

And I consider any groin, hip or pelvic injury to be equivalent. They all occur in the above ring and occur by the same basic mechanism: the uneven loosening of/stress on the pelvis.

What I am about to write is simply an amalgamation of what I have learned in medical school and years of reading about running and pregnancy and is not from any particular research, though I quote one study. The only good reason you have to read it is you probably won't be able to find much else written on this topic (if you do, let me know! I want to read it.).

So, let's get started with my interpretation of the biomechanics that predispose to pelvic injury:

1. The belly grows, of course. This changes the body's position while running. Initially I thought if one ran with a backpack that one would balance out "the problem", but this is the opposite of the truth. (yes, this is my very own illustration)

The truth is, the larger the belly grows, the more a woman leans back to compensate. This puts stress on the sacroiliac joint and the back of the pelvis.

2. At the same time, the ligaments loosen in the pelvis in response to the hormone relaxin. This makes good sense for pushing a baby through. But when things loosen, they unfortunately tend to loosen unevenly.

So what to do to protect the pregnant pelvis while running?

First, buy shoes that promote running on the forefoot. This will give you a posture where you are leaning more forward and less stress with be placed on the pelvis and SI joint this way. If you already run with vibrams or barefoot, you really can't do anything more in this department.

I have now taught myself to run in shoes with very minimal cushion with more of a forward-leaning style. My feet and calves have taken a beating. And it was a while before I could run 3 hours straight in these shoes, but yesterday I did 3 1/2 hours and it went well. I will add that running on dirt as opposed to asphalt makes transition to this running style a lot easier.

Second, you need to have balance in the strength of the muslces that support and surround the pelvis. The balance of strength is perhaps equally important to strength itself when preventing uneven loosening of the pelvis. So what do I recommend? Well, if you run, you legs are strong, but you need to strengthen your abs, back, inner and outer thighs, butt and even upper body to balance things out. Remember this is all theory.

My favorite exercises involve the exercise ball and I attend classes where we focus on the entire body and core. It is easy to overdo the abs and forget the inner and outer thighs for example. Balancing acts (which I have perfected while waiting for trains with my backpack on) are great for strengthening our neglected deep core muscles.

Now, the topic that gets everybody's undies in a bundle: weight gain. It seems intuitive that the less weight one adds to the pelvis, the less chance one has of injuring the pelvis. And I think this is generally true that women who gain less tend to be able to run longer while pregnant. It is very simple mechanics of course, though there are always confounding factors involved.

But, but, but, but. And I admit this actually occurred to me in the last week: women who are pregnant are in essence amenorrheic. They don't have the cyclical estrogen and progesterone spikes that keep female bones strong. Not only this (here comes the one study), but increased prolactin levels cause decreased bone mineral density. Black et al. (J Bone Miner Res 2000; 15:557-63) showed an average decrease in bone mineral density in the spine of 3.5% in 10 women over the course of their pregnancies. First of all, it is thus important to get adequate calcium and vitamin D. But another thing that keeps bones strong is a little extra weight. It is therefore, in theory, important to gain ENOUGH weight so our bones don't weaken too much. (just as an aside, I would love to do a study taking serial dexa scans of women to see if there is a correlation between weight gain while pregnant and the development of osteopenia - or fractures for that matter.).

Sorry, was that just total blabber or what?

Running songs of the day:

Safari Disco Club and Que veux-tu/ by Yelle

Also - Amour du sol by Yelle (can't find a video for it)

Tuesday 15 March 2011

The deformity scan

Yesterday was finally the day of the ”deformity scan”. I'm not calling it that as some kind of pathetic joke. That is what it is called in Denmark. They had the options of "20 week scan", "midpregnancy scan" and ”deformity scan” and went with the latter (I imagine so it would be paid for by taxes). I couldn't help but being affected by the name. Unlike the my scan with The Lorax at the same point in pregnancy, I was really worried.

There has been a lot of negative energy in our life lately. Not because of anything bad in particular, but because SR and I work way too much. And that is all I have to say about that. But am I wrong in believing that when there is negative energy and a feeling of ”unluckiness” that things tend to go badly?

The weeks leading up to the scan seemed to take eons. And the more time that went by, the more nervous I became. But when friends and family talked to me about the scan, they simply wanted to know the following: ”are you one of those people who wants to find out the sex?” and then, since I always answered ”yes, I'm one of those people”, they would ask what my preference was. Well, just because one wants to know certainly doesn't mean one has a preference. I just feel that knowing the sex somehow allows me to imagine the little one better and more specifically direct all of my love. SR and I had discussed it a lot and there were pluses and minuses to both. The biggest plus to having a girl was that we loved the name we had picked out. Plus, people tend to look at families with one of each as balanced and perfect. But since our family will never come close to appearing balanced, with all of the confusing sibling, step-sibling relationships, that really wasn't a consideration. Finally, the day before the scan, I said that having a girl would be nice because it would be different. I was, of course, well aware that the odds were stacked against that. And right after I said it, I regretted it. Because – whatever it is – once you say it, you start to believe it. And before that, I really hadn't had much of a preference.

God, I write a lot of nothing these days.

So on the day of the scan, when they put the probe on my belly and the baby looked healthy, I burst out into tears. I was so happy. I imagine ultrasound techs are used to hormonal pregnant behavior. No matter what I wanted to believe or how I looked at the baby on the screen, it just looked like a boy. But maybe they all do. They went through every single organ, it seemed, before they got to the penis-clitoris matter. Then one of them said something about a ”tap” in Danish and I smiled at our little son. A ”tap” is a rod. Not the first word I use when describing a penis, but it was nonetheless clear that we were not expecting a girl with a rod.

(just goes to show you can't determine sex by the severity of nausea!)

When I got home, I finally got in touch with SR at work and he started crying like a baby, apparently right there in the middle of the hospital ward. ”I just get so happy imagining another Lorax” he said, choking on his words. I was afraid that this baby would somehow be ”just the fourth kid” to him; I cried too, mostly because I had underestimated my husband.

Meet Finnbjørn (again). And remember - that's just his name in utero :).

First from the outside

And from the inside

Running songs of the day: 1. Eager for your Love by Tristan 2. Civilian by Wye Oak

Take note of the poll to the right. My next post will talk about why it is pregnant women get injured while running - and what they (maybe) can do to avoid it

Wednesday 9 March 2011

Humor on a Wednesday in March

I considered calling this post "Wednesday Humor" but that would somehow put pressure on me to be funny on more than one Wednesday. That is just too much to ask of a woman who has developed a syndrome - the "I am a mom in my 30's and I am NO LONGER FUNNY".

You're probably thinking "SLG, but you were never actually funny." And you may be right, but some would disagree. You see, in both junior high and high school I was voted "funniest girl" (I was actually just runner up in high school, if you really want the truth). Seeing as I wasn't winning any beauty or popularity contests, I took this very seriously.

But something has happened. And rather than pontificating about whether or not this is an evolutionary phenomenon in women (getting less funny during motherhood) or just a phase in my life, I will simply say that I am grateful to be surrounded by humorous things. And, more specifically, I am glad that I haven't yet resorted to pictures of small animals in precarious situations as my main source of humor.

For example, today I received an email from a woman named Lone Bitsch-Olsen. She was kindly asking hospital employees to move their fucking cars, which were parked illegally.

(No, I didn't make up that name. I also really like using "fucking" without *'s or #'s or even %'s because that is just how unrefined and untalented I have become).

Then, later this evening, I spent 435 kroner ($81) to fill 10 gallons in our almost 11 gallon Hyundai Getz with gasoline. For those who are less mathematically inclined, that is $8.10 per gallon. This is the lowest gas prices have been in the last week and I went to the cheapest station in town at the cheapest time of the day. Okay, okay, it's not funny, but it did make me laugh out loud.

Then The Lorax.

This is actually not The Lorax, but a boy who bears a strange resemblance to the Lorax (minus the brown eyes) with the haircut I would like The Lorax to get on Friday. Christian (Lorax's real name) saw this picture and said pointedly "That is not Christian. That is a tomato." Needless to say, I think he likes the haircut.

Finally, step daughter showed me this video. I admit it is kind of annoying to post of video instead of actually writing something funny (but if you've been paying attention, I'm not funny anyway) - but this is such a classic example of good Scandinavian humor, that I would be amiss not showing it (there are subtitles).

I think the best part of the above video was going over it moment by moment afterwards with SR, both of us laughing so hard, remembering in some way how we fell in love in the first place. I didn't mean it was a smelly ass that made us fall in love, but come to think of it...

Now, please, brighten my spirits - who are some of your favorite female comedians?

Sunday 6 March 2011

Giving Birth in The Gambia

So, I haven't actually been to The Gambia. I just enjoy saying it because it is one of the few countries that gets a The. Not even La France gets a The, even though they call themselves "The France".

Anyway, I finally went to my first appointment with my "earth mother" (jordmor) here in Denmark. This is the woman who is assigned to deliver our baby; the American/British equivalent is a midwife. Nobody here is assigned a doctor for delivery - unless for some reason you are pegged as having a high risk pregnancy. My first appointment was supposed to be around week 13, but because things are so backed up here, I had to wait until just before week 19.

I don't know what I was expecting - but I was expecting something. But she (actually there were two of them there) just talked to me. "Wow - that's great you run so much! You saved me time convincing you to exercise. You should take more iron. Here are some brochures about breastfeeding. Here's the number to call when you go in labor." They didn't weigh me, take my blood pressure, measure me. And then they were like - "well, since you're just two weeks away from the next appointment with us, we'll just skip that one and you can come back in week 29. See ya in the third trimester! Good luck! Keep running!"

I admit, I did get to listen to the fetal heart sound for the first time. Sure that was nice, but I knew it would have a heart beat since I feel it kick nearly hourly.

So I started thinking... is it actually dangerous to give birth in Denmark? I mean how they heck do the ever get the impression something is wrong?

And that's when I started thinking about giving birth in places like The Gambia. I did a bit of research and found their infant mortality rate is around the 31st highest in the world. Angola actually has the highest at almost 20%! So is Denmark even close to this? Of course not. Denmark's infant mortality rate is .46%, the 12th lowest in the world and is, not surprisingly, lower than that in the US (.63%). But this number isn't really that interesting when talking about giving birth. Infant mortality rate includes all deaths in the first year of life. Most infant deaths that occur in the third world are sometime later in that first year due to infection.

So what about actual birth outcomes? Everyone reading this knows that mothers and babies alike are much less likely to die at birth in the developed world than in the third world. But why is this? And what if I told you that in the 1940's the perinatal and maternal mortality in the US were similar to what they are in the 3rd world now (between 3 and 4%)? What is it then that has made the difference and what should all mothers worldwide have available when giving birth?

Unfortunately the answer is not at all simple. So much changed between the 40's and the 60's. Well, actually, the improvement is not that complicated when it comes to maternal death; that rate fell drastically after the introduction of penicillin in the 50's. But what about perinatal mortality? In developing countries, most perinatal mortality occurs due to the baby in some way getting stuck, the umbilical cord getting compressed and the baby asphyxiating before it can come out. A myriad of things came together at once in the 50's and 60's ensuring that this basically never happens in the developed world anymore: fetal heart rate monitors and people who know how to read them, quick access to a person skilled with forceps or a cesarean section with anesthesiologists and obstetricians. APGAR scores give an idea of how the baby is doing seconds after birth and neonatal intensivists are on hand to take over if the baby was not doing well. And prenatal ultrasounds give warning when there may be a problem in utero. This, along with many, many other little interventions, is the modern "obstetrical package". And it consists of so many elements that have never been analyzed separately, so it is tough to say what really made the difference. Today almost all perinatal mortality occurs due to premature birth, and with access to a neonatal intensive care unit, it is only the very, very premature that don't survive. And, in all honesty, when born before 25 weeks, most will lead a life fraught with disabilities and health problems (there are exceptions).

So, thankfully, I have access to all of these modern interventins here and that is why Denmark does just as well as The US (I should also mention that there are two sets of ultrasounds here - my second is next week) and for much less money.

But, when my earth mothers asked if I wanted to give birth at home, I said no, no, no. And why, if my water breaks before 33 weeks, I'm going to have SR drive me to Copenhagen - or I'll drive myself. I have to be near a good NICU.

Normally I am not one for much medical intervention. But I have worked in the 3rd world delivering babies - and have seen how frequently things can go wrong. I was involved in a case where the umbilical cord came out before the baby- the family doc there gave me a warm saline bottle to hold the cord in, so the cord wouldn't spasm in cold air and cut off the blood supply. I sat there for almost an hour in the middle of the night, with my hands between this woman's legs. She only spoke Tz'utujil , and well, a little Spanish, so we were able to very little small talk. The Fam Med doc, who normally would have had my help, set up for a c- section. Finally another family doc arrived to set up the anesthesia. We performed a c-section, the baby was delivered, and the mother could not stop hugging me. But an hour later, the baby started not breathing properly and not reacting right. I apologized to her, but I will never know if she understood. They were driven to Guatemala City and the baby died on the way.

This is not a reality people reading this blog deal with and if they ever did, they would sue. When the blood supply of a baby is compromised time is brain cells and very, very unfortunately nothing happened quickly that night.

It's probably good for me to put things in perspective - and admit that most of the things I talk about on this blog (exercise, weight gain, etc) are not factors that make a big difference in birth outcome.

The modern "obstetrical package" is one of the few examples in medicine of an group of interventions that has saved a huge amount of lives. But, the other side of this coin is that deliveries in the US (and Europe) have become over-medicalized. Women's labors are started if they go slightly past their due date. If labor is too slow or there is even a blip of heart-rate deceleration on the heart rate monitor, women are rushed to the OR for a c-section. Not based on evidence, but simply on the idea that one must "do everything" and "not take chances". I'm not criticizing; it is tough to make decisions when it's no longer ethical to due a study about not using one of the interventions.

To end this post on a running note, this is perhaps one of the biggest benefits of running while pregnant: much lower chance of emergency c-section. Babies heart rates don't decelerate - they are strong due to all of that blood flow variation they have gotten through their exercising mom. So doctors worry less. Also, babies of running moms are much less likely to be large for gestational age and, to some extent, they are less likely to go beyond their due date. Run for your own health - and run to avoid the risks of the overmedicalization of labor and delivery! But the real risk of problems at birth is dependent on where you live - not what you do.

I have to thank The WHO, The CIA, James Clapp and Atul Gawande for their writings and reports, which I used in this blog post.

And finally, since SR is in Portugal this weekend, I have turned to dreaming about singing a pop duet with Enrique Iglesias. My two running songs of the day were "Escape" and "Heartbeat" by Enrique Iglesias. The only downside is his lyrics are uninteresting. But they worked well on my long run- on the first warm day of the year in Denmark!