31 March 2010

Healthcare corner #12 - Equity, mental health, and current events

almost done being a faux student.

if these first topics bore you, definitely skip to the end "current events" at least.

first, we had a lecture on equity. so, basically there is equality and then there is equity. equality, at least as used in this context, is literally when everyone has the same amount of something, ie. same amount of resources, same utilization of health care, same access to health care, etc. for our purpose, there is no judgment as to whether this is good or bad, its simply a measure of sameness. for equity, there is a moral or value judgment attached. with health care utilization, for example, we probably want to see older people using the system more since we recognize they tend to have more health problems. if they are using the system the same amount as the healthy 25 year olds, we might be concerned that the older person is not getting the best treatment possible.

there are lots of ways to study this and, of course, its a very hot and controversial field. typically everyone has a favorite population they want to label as being inequitably served. in canada, there have been a number of studies in this area. a few notable findings:
- data from 2000/2001 found that people with low income tended to visit their general practitioners (GPs) less frequently than higher income people. but, those who did visit their GP where then more likely to come back for frequent visits (perhaps showing that they delayed seeing the dr until their condition became more serious...thus requiring more dr visits). this same study also found that people with lower income had less contact with specialists than higher income people.

- studies published between 2004-2006 noted that people of lower socioeconomic status (SES) were more likely to say that they had an "unmet health care need" when surveyed than higher SES people. however, there was no association found with "unmet needs" and immigration status in canada.

- a 1998 study surveyed a sample of cardiac physicians and administrative health care staff about their practices related to preferential access to patients. 80% of doctors and 53% of administrators said that they were aware of preferential access being given to certain patients.
then we had a lecture/discussion on canadian mental health:
1. apparently the world health organization says that at least 5% of a countrys total health care expenditure should be on mental health. in 2003/2004, canada spent this bare minimum (a total of $6.6 billion was spent on mental health with $5.5 billion coming from the public funds).

2. a 2005 paper showed that about 12% of canadians have a self-perceived need for mental health treatment, while almost 20% of canadians are said to have some kind of mental health condition.

3. a 1998 study found that toronto had a total of 1% homelessness in its population. two-thirds of these homeless people had a lifetime mental disorder and two-thirds had a lifetime substance abuse problem. 75% of those people with mental disorders, also had substance abuse problems. the majority suffered from depression.

4. there are some good canadian websites dealing with mental health: one-in-five deals with the mental health of all canadians, and there is another, more local site, focused on teen mental health.
lastly, there have been some current event type articles mentioned by students and my boss in recent days:

1. a news article with updated numbers on canadian wait times.

2. a news article talking about quebecs new provincial budget and the controversial new health care "user fees" they are wanting/needing to impose on people (remember, previously no canadian has had to pay ANYthing when they visit the hospital or their doctor for a necessary health service).

3. there is a neat website about canadian health care with brief "mythbusters." basically short evidence-based summaries are provided to debunk canadian health care system myths. they are well researched and presented in a style to be read by lay-people. they have pertinent topics like "Myth: Canada's system of healthcare financing is unsustainable."

4. shortly after health care reform passed in the u.s., the canadian "globe and mail" did an article about our bill and summarized what was in it. seems like an important piece of reading for people who may still be confused about what is, and what is not, in that legislation...

5. my boss mentioned to the students (since many of them seem to be following the u.s. health care stuff) that she was recently turned on to this blog called "the health care blog," which attempts to keep up on all the u.s. health care goings-on.

30 March 2010

Reali-baby check

got an email that smacked me into reality.

our local pregnant friend couple, emily and craig, are parents! she sent an email to our group that said "it's a boy" and my eyes glazed over for a second trying to understand what that meant. then i tried to ignore it and not click on it. finally i went back to it and opened it...

they welcomed their son rowan 5.5 weeks early on march 27. he was actually a healthy 6.5 pounds. he did have jaundice, so he has to stay in the hospital for about a week. but she is done. done with her pregnancy!

(craig, rowan, and emily. congrats!)

i cant even begin to tell you what the flood gates to my mind were holding back because it all exploded out in one big bang! first i was jealous that she was done being pregnant. then i was shocked, another boy in our group! (she had been waiting until the birth to find out the babys sex. this puts our prenatal group at 8 boys, 4 girls, and 1 monster mystery. give or take [because some people havent come back to the group in a long time so its tricky to count the group size definitively]). and then of course i was excited. another baby in the group! then, the "other stuff" came in...

holy crap, her due date was may 5. may 5! its real that monster will be coming SOON! we're not quite ready. we dont have the crib here yet, i dont have diapers here yet, i havent washed monsters clothes yet, i havent wrapped up the crap on my pre-monster to do list. then daves freak out list surfaced...i have to put the car seat in! and, "i thought monster would have a friend born super close in age to him/her"...basically for the rest of the night we kept looking at each other and going...wow, i cant believe they have their kid. wow. wow.

and as bedtime drew nearer, i realized i was way amped up. i had now graduated on to the more long term worrying. so weird. since france ive been basically dealing with so many acute, in-front-of-my-face issues that i had been able to put most of my typical worry patterns to rest. i thought i had gotten much better with rolling with the punches and adapting on-the-fly. most things that were formerly stressful have recently tended toward "meh, i'll do it tomorrow" or "meh, its clean enough" or "meh, thats just not major enough to waste energy worrying about." it had been fairly liberating. and i was proud of myself. until this. turns out my regular brain was still attached, i had just found a way to compartmentalize out the worrywort. but, as i say, the levee totally malfunctioned tonight. i didnt get any sleep because my mind was racing.

i assume soon i will be able to reset the brain and get some perspective. plus, once the crib arrives, and we have a weekend to finish the important things on my list, then i will be ready and waiting and antsy.

28 March 2010

Silence is golden

tonight was a form of an encore of our friday night from two weeks ago.

we started out at the thai/vietnamese place called star anise. this time i got the yellow curry chicken i had wanted. it was good, but perhaps a bit more salty than i would have liked. dave got the fried tofu and mixed veggies with rice noodle soup. sounds simple, but it was delicious. i would get that next time.

then, after dinner we headed over to st pauls angelican church for the nights entertainment. we were going to see a silent film medley accompanied by a jazz pianist. so, after the acoustic concert a couple weeks ago, i signed up for the jazz east newsletter (jazz east is where the concert was located). the next email that came mentioned a small jazz festival on the last weekend of march. one night would include this silent film event. it sounded interesting.

dave and i had enjoyed many a buster keaton and charlie chaplin silent film while we lived in ann arbor, courtesy of my beloved DVD-R where i recorded all kinds of goodies from the TCM channel. anyway, silent films are actually fabulous if you can get through your first one with the ability to retrain/refocus your eyes, ears, and brain. its where the magic and creativity all started and they add lots of depth to the understanding of film and film history. at some point, we were also lucky enough to find a fabulous buster keaton silent film event at detroits DIA.

but, back to tonights event...we sat in the church pews facing a projector screen. a computer and projector were hooked up on the table in front and the piano was off to the side. the pianist had actually chosen the clips/films himself and written his own music to go with them. i dont know the history of whether every silent film used to come with its own custom music, or if theaters let their organist/pianist create something. of course, custom music means unique interpretation of the movies events. with different music the same scene could become more sinister, less exaggerated, happier, sadder, etc.

anyway, on to the things we saw...

the first thing we saw were a bunch of spliced together clips from the lumière brothers. they were among the first people to create moving pictures. most of their "films" were 50 seconds in length or shorter and typically focused on orchestrating scenes from everyday life. the first screenings of their movies were held in 1895. their film technologies and inventions laid the ground work for what the movie world is today.

i couldnt find a youtube clip with the scenes we saw, but this is a good collection of some of their work. the clips start to become more dynamic at around minute 3, so you could skip there if bored...

the second thing we watched was a short film by polish/russian director ladislaw starewicz. he created several extremely imaginative films back in his day. the one we watched was called "the cameramans revenge" and was made in 1912. he loved insects and so, for this, he used actual dead insect bodies to create stop-motion animation (like gumby, or tim burton, or fantastic mr fox). what an amazing use of that technology. the amount of patience he must have had is impressive. the motions are very fluid and the story is still fresh today. the humor seemed ahead of its time...or maybe its a timeless/classic theme?...cheating on your spouse.

i found the whole 13 minute movie on youtube complete with some music. its definitely worth checking out:

the final item we watched was a charlie chaplin film called "the circus" from 1928. the film gave chaplin his first academy award. its very much a physical comedy with his tramp character minding his own business, yet creating hilarious fun in the process.

found a clip of perhaps one of the more genius chaplin scenes from the circus. its about 4.5 minutes long, but at around 1.5 minutes is where my favorite physical comedy scene occurs.

so, we had a nice night doing something unusual and getting some laughs. its always a good time to get to watch films like that with live music and other film lovers. if you see such an event in your area, i encourage you to try it out.

20 March 2010

Spring sprang to summer...for a limited time only

whoa. lemme get this straight, its a saturday AND the sun is out AND the wind is minimal? let me get my shoes on...

dave and i decided on another local drive that we hadnt yet gotten around to today. this time we headed west from halifax and arrived in the little village of hubbards. the "main street" is home to a place called the trellis cafe that is funky and filled with local art and tasty food. it also seems to be the place to hang out for locals and people in-the-know. i loved it. we got a spot inside by the windows with sunlight streaming in. i was inspired to order their homemade lemonade. yum. a hint of summertime to come.

(dave at trellis cafe. above his head...a beer sign)

when we arrived, they must have been in between their breakfast and lunch crowd, so we were able to look around and take in the eclectic mix of wall coverings and marvel at the dessert counter by the register. the waitresses were friendly and soon we had ordered our food. dave got his staple lunch: a club sandwich, hold the tomatoes (which almost ALWAYS get forgotten about and arrive in the sandwich anyway), and i got the soup and half sandwich. soup was chicken veggie, with real slow-cooked chicken pieces, and the sandwich was chicken, apples, brie and curried mayo (yeah i ate brie. all the soft cheese in this country is pasteurized to oblivion) on their thick-cut, soft homemade wheat bread. yum!!!

as we were finishing up our meals the place was really filling up. the front porch was bathed in enough direct sun to entice most of the arrivals to sit outside. its mid-march and outdoor seating is a possibility...im liking this. in order to stick around a bit longer, we ordered some dessert. the dessert menu was loaded with tasty items, so, to choose, we asked the waitress what her favorite was. she loved the plain chocolate cake and ensured we wouldnt be disappointed. i also couldnt leave the mysterious apple dumplings on the dessert counter alone and ordered one of those too. we never get two desserts, and our bellies were bursting, but it was worth it. the chocolate cake was great and the apple dumpling was nice. not too sweet and a different kind of apple treat than normal. yum.

after we paid for our hefty meal we wanted to enjoy the sunshine ourselves. near hubbards you can pick up part of the lighthouse driving route. and as it happened, this was part of the route weve missed because its easily skipped over if youre trying to fit in lunenburg and peggys cove areas in one drive. so, as the afternoon temperatures climbed, we took the road less traveled. we passed a tiny docking area with a few fishing boats and an old shed storing nets and traps and anchors. very picturesque. continuing along we passed more tiny villages with a few fishing boats each and a nice little population of homes clustered together by the water.

(our route for the day: marker A = hubbards, marker B = bayswater beach, marker C = new harbour, and marker D = upper tantallon; one of the fishing villages)

our first real stop was bayswater beach. just another small sandy beach on the coast, but it was welcome all the same. at this point it was somewhere in the 60s and i was flirting with taking my jacket off. crazy! it was great to be out on the beach, listening to the waves, smelling the air...i was tempted to take off my shoes...but i knew id never be able to get them back on without help. dave did end up being unable to resist though...

(dave ready to walk in the surf at bayswater beach. and he did. and it was cold.; me on the dune wearing a shirt from my non-pregnant days. poor little fabric fibers...stretched to their very max...; no, not an easter egg hunt, its monster mountain rising above the dune grass...)

back in the car, we continued west and ended up turning off at the village of new harbour on a "no exit" road near the coast to see where it went. it dead ended at a fish processing plant. tasty. but the road to the plant was a nearly deserted strip of rocky coast that was absolutely beautiful. we found a place to nudge our car off onto the shoulder and explore. we walked out on the rocks and looked up and down the empty coast, spied some tiny offshore islands, and sat down to get warmed by the sun. the rocks were big enough here that waves were breaking on them. such a peaceful place.
(dave and i on the rocks of new harbour. forgot the damn tripod; the pretty rocks and water at new harbour)

the rest of our drive route was nice but definitely getting more and more touristy. the end of this part connected to the road to chester which we have visited and is very close to the popular mahone bay/lunenburg areas. since we had done that part before, we headed back toward halifax. we buzzed through hubbards again and drove the road parallel to the highway, again just to see what we'd been missing. our reward was to find another great spot that we would have totally missed otherwise.

in upper tantallon (apparently pronounced "tan [distinct pause] talon") we stopped at the bike and bean cafe. there are many unused railways in nova scotia, and some communities have decided to rip up their rails and turn them into trails. the main idea is for the usage of bikes, but people also walk and run on them too. the bike and bean cafe is actually housed in a tiny train station along the rail/trail system. the place was teeming with bikes and people. what a great concept! and it was interesting to see the wide population of users: fit middle-aged men in spandex (every bike trail has to have a few), families, teenagers, older couples.

we decided to stop at the cafe and sit on their deck to absorb the last of the afternoon rays (the day eventually hit 70 degrees!!). we split a veggie panini and berry scone. we were pretty proud of all the things we had randomly seen today. and we'd had remarkable weather to boot! cant ask for anything better to lift the spirits. i can withstand a few more grey/rainy/windy days now that ive been recharged. in fact, grey and cooler might not be a bad thing since warmer weather than this would make me want to put the capri pants on, and being unable to bend down and accurately shave the legs would just make me more frustrated than happy.

18 March 2010

Nessie news - 33 weeks

33 weeks. only 7 more to go.

dr appt:
gained 3 lbs (grrr. the recommended is 2 lbs. if i never see a scale again after all this, it will be too soon!). my blood pressure was 106/55. baby heartbeat was okay. the new med student seemed to think monster was head down-ish, though he wasnt very confident. we got the number to make an appointment for the hospitals pre-admission clinic where you can tour the hospital ahead of time and get pre-registered so there is less to do when you come in in labor. and i was told that the next visit i will get the group B strep swab test done. more on that next time...

1. heartburn. still doing well with this but bananas have been added to my list of things i want to avoid.

2. hunger. it waxes and wanes but does seem to be creeping back like in the early scary days. i hate it. thinking about food all the time when im now big enough to feel like every bite i take is sticking to me immediately.

3. massive size. i am growing out of my jackets. thankfully, since the weather is getting a bit nicer, i was able to take out the inner liner of my rain/winter jacket and give the jacket circumference a few extra centimeters. we'll see how long that lasts.

4. linea nigra. yeah, that faint brown midline stripe arrived. i thought id seen that people get it way earlier on, oh well. since im not out sunbathing, im sure it will fade away to nothing after. but it does provide a perfect itching target. lately i have been SUPER itchy. not just anywhere on my stomach, only at the midline. i guess thats where the stretching originates? no amount of lotion or time with a cold pack can calm it. SO annoying.

5. and heres a new one. never, ever heard of this before. typically, a few times a day i hear a clicking noise coming from the womb. at first i thought i was crazy, but it would happen while i was silently sitting or resting and all of the sudden, an audible click would emanate. not a bunch in a row or anything, just one click. sounds kinda like the noise you can get from cracking your pinky finger. and its definitely coming from monster. dave has actually heard it now too, so im not insane. and i see on the internet that other pregnant women have mentioned it on chat boards. although, no one seems to really know what it is because when they mention it to their doctor, their doc looks at them like they have 3 eyes. no one seemed to find any reason why it would be something to be concerned about. and i havent been focusing on it in a frightened way anyway, just a weird curiosity.

1. maternity leave. for paperwork purposes i had to choose some specific dates for mat leave, though they are obviously flexible. i picked april 30-august 30. how the canadian system works with mat leave is this: the government pays 65% of your salary while you are off (during the designated "maternity leave" period) and some companies will provide the remaining percentage to get you up to 100%. at dalhousie, each boss gets to choose if they want to do this (since it comes out of their research money). my boss has chosen to "top up" my salary. so i will be getting all my current pay while i am gone. pretty cool.

now, there are lots of other options i dont fully understand, since i am not using them. first, if you have a difficult pregnancy and need to go on bed rest or leave work early, there is some other government paid time period that you can use before the baby comes to cover a percentage of your pay for that time. then, the first 17 weeks after the baby arrives is called maternity leave (what i am taking). then there is an option to take "parental leave" or something like that where you get a different percentage of your pay but you can basically use this leave to end up staying home for one year with your baby. and whats even nicer is that you can split the "parental leave" between you and your husband. again, if you can afford the lower paycheck, you can both split the time home from work (so you could both be home full-time with baby for 6 months. or 3 months for dad, 9 months for mom. etc.). while this isnt as great a system as many european maternity leave options, i thought it was quite generous, especially coming from the u.s.

2. daycare. so, once i put in my maternity leave dates, i starting calling day care places. yeahh.......they are booking infants for summer 2011! you read that right. i know that places like NYC and the like have long wait lists, but never in my wildest dreams did i assume id have to call daycare places BEFORE finding out i was pregnant...in halifax!! get a grip. now im not really sure how september is going to look, but it looks like i'll have to get creative. dave will have to work from home with monster while i go in and take care of my stuff. hopefully i'll be able to stay part-time, or a daycare will magically let us in. or perhaps dave will find a job somewhere else before i have to pull my hair out looking for real solutions.

3. i have recently gotten several "you are all baby" comments in regards to my belly and overall pregnancy body. as these are meant as compliments to my body size/weight gain i try to take them as such, but it makes me feel weird to have people looking at me. although, at this point i stick out like a sore thumb. its still nice that from the back i dont look pregnant, but since my pelvis is sore, i am already tending to waddle, so its not like i can be incognito. i suppose it has mostly been nice to have the weight all appear to be in the front, but ive recently had frightening flashes of looking like katie holmes did at the end. she looked so unnaturally huge just in front that i seriously thought she was faking her pregnancy. plus, now that im in her position, it really sucks to carry a ton of bricks under your skin all in one spot.

(katie holmes, near the end of her pregnancy with suri)

4. we started our free public health prenatal classes. the classes had been suspended due to H1N1, but thankfully started back up recently so that we could take part. our classes are wednesday nights, for 2 hours, for about 6-7 weeks. there are 8-10 couples in our class, and most of them seem like dolts, so im glad i have my self-organized prenatal group of women to chat with.

anyway, our first class was on infant care. the public health nurse leading that was fantastic. she actually presented decent information in a dynamic and confident way that made her seem like a believable source. she discussed reading babys cues and how to make the best transition into parenthood as possible. she was straightforward, presented research-based facts, yet allowed for individual level adoption based on personal preference. dave and i thought that class was worth our time.

the second class was parenting. it was terrible. we had a different instructor and she simply read her notes and wasnt good at answering questions. i felt like i learned nothing, and actually at the halfway break, we wanted to leave. ugh. hopefully we will have better instructors again in the future.

5. babywearing. there has been a lot of safety talk about slings in the news. its interesting. my understanding is that slings were recently put on the list of things that needed to be safety tested, which is why rates of injury and death were looked in to. over the past 20 years there have been like 14 deaths in slings. most of these were premature/underweight babies under the age of 4 months. for me, its great to have this information so i can assess the reports based on my own personal behaviors. i have a sling i plan to use. i know the proper positioning and i intend to be sensible with my expectations for using the sling. for example, if its a sweaty summer day, im likely to choose the stroller anyway so that im not carrying a hot baby in a sack on my chest. anyway, i think its great to bring these things to peoples attention, but hopefully they are reasonable in assessing the real issues/dangers.

celebrity corner:
1. saw some bumps at the oscars (march 7) from celebs who are due around the same time as me:

(amy adams; paula patton. she was in the movie "precious")

2. jim and pam (from "the office") had a baby girl! they named her cecilia marie. while googling, i found that NBC actually created a baby blog for this fictional person/family. creepy? yes.

17 March 2010

Healthcare corner #11 - Chaoulli decision, wait times, and efficiency

a couple different but related topics.

we finished the last of the efficiency lectures with a few more canadian tidbits:

- there is a canadian agency for drugs and technologies in health (CADTH) that has the function of providing information for better effectiveness and efficiency. programs at CADTH:
1. the health technology assessment (HTA) provides information on clinical and cost-effectiveness of drugs, medical technologies, and health systems.
2. the common drug review (CDR) conducts reviews of the clinical and cost-effectiveness of drugs and provides recommendations to the provinces about which drugs are the best investment to cover under their public drug plans.
then we had some discussion on canadian wait times:

- in 2004, the canadian ministers of health developed a ten-year strategy to strengthen health care which included a plan to reduce wait times: benchmarks identified for waiting times in five care types, multi-year targets, strategies to improve access in priority areas, and public reporting of wait times.

- the goal of establishing benchmarks produced these targets in 2005:
1. radiation therapy for cancer = within 4 weeks of the patient being ready to treat
2. surgical repair of hip fracture = within 40 hours
3. cardiac bypass surgery = within 2-26 weeks (depending on urgency)
4. hip and knee replacements = within 26 weeks
5. cataract surgery = within 16 weeks for high risk patients
- in 2006, they were able to report median waiting times for:
1. specialist visit for a new illness/condition = 4 weeks
2. selected non-emergency diagnostic tests (MRI, CT scans, etc) = 3 weeks
3. non-emergency surgery = 4 weeks
lastly, we talked about the supreme courts "chaoulli decision." im confident that my lawyer friends would be better able to interpret, discuss, and summarize this topic, but from our short readings and discussion in class here is my version:

- patient george zeliotis wants hip surgery. there are delays related to the quebec wait listing and also individual factors (he has depression and is often indecisive. he has sought a second opinion for surgery and it was recommended that he wasnt an ideal candidate because he had had a heart attack and bypass surgery earlier in the year). he wants to be able to get his surgery according to his own preferences and seeks private insurance to pay for this surgery. but, because this surgery is covered under the canada health act by the public-pay system, there is no option to purchase insurance to cover this surgery (canadians often have supplemental insurance for things not covered by the private system: dental, eye care, elective procedures, etc. but there is no option to buy private insurance for things that are already covered publicly).

- doctor jacques chaoulli wants to set-up a home-based, 24-hour medical practice and attend to his patients as he sees fit. he has had much resistance from the quebec government as to whether they will reimburse him for care he provides to patients in this way. the provinces public health care has restrictions on what types of services and practices will get reimbursed by public funds. chaoulli doesnt want to be forced out of the public sector and have to practice privately because few patients will be able to/want to pay out-of-pocket for his services.

- chaoulli and zeliotis team up to sue quebec to overturn its laws to prohibit private health insurance for those services that are already provided by the public system.

- the case eventually went all the way to the canadian supreme court where the court was divided. it agreed that the laws violated both the national and provincial charters but, in the end, their decision only ends up affecting quebec. so now, in quebec, there is an option to purchase private insurance for procedures that are normally provided in the public sector. this is still not an option in the other provinces.

14 March 2010

Sunshine and rainbows

seeing the sun meant we had to try and find some way to get out and make use of the day.

we had some errands to run, but we incorporated them with some sightseeing. we first fueled up in dartmouth at our thyme cafe. always a good and cheap place that supports a local social program, and their smoothies and food are actually good too! then it was off to stock up on some used monster clothes (a sack of stuff in great condition for under $25). and now we could use the opportunity of being on this side of the harbour to see some new things. we drove along the harbour (this canadian-british-english is really getting to me) until we reached eastern passage, where we stopped in to fishermans cove.

this is a weird little working fishing village that is also maintained for tourists. there are two rows of little shacks that you can drive down (and theres parking) with restaurants, gift shops, ice cream stands, seafood retail, and other odds n ends. the view of industrial dartmouth isnt gorgeous but you can get a boat over to mcnabs island (which is a large island at the mouth of halifax harbour) and there is also a built-up boardwalk to allow for some viewing of the nicer areas nearby. it looks like a place to come back with visitors perhaps, or at least when the tourist season makes things a bit livelier.

anyway, back in the car we passed intriguing places like emmas eatery and treat shop gourmandises avenue on our nice little coastal drive along hilly, winding roads. we decided to stop and check out rainbow haven beach. the sun was out but its always deceptive near the water. the wind brought some pretty cold gusts off the water, so while it was nice to be on this sandy beach, we also didnt want to stay too long. kind of a bummer, but at least we found another nearby summertime place.

(route for the day: starting in dartmouth [marker A], then to fishermans cove [marker B] and finishing at rainbow haven beach [marker C]; dave and i on rainbow haven beach)

in the end we were able to mix errands with a little exploring. and it was nice to fit this little drive in because we kept cutting it off when we drove the "marine drive" past lawrencetown and martinique beach to get to musquodoboit harbour.

12 March 2010

Musical massage

had a nice out-of-the-ordinary friday around town.

to continue daves birthday, we booked massages at a place downtown. we walked down to body mends at 5p very excited to get our tired muscles dealt with. they had a lady with extra training in pregnancy who did a great job with me. laid on one side with a full body pillow and then switched to the other side and then laid on my back at the end, propping one butt cheek on a pillow, to get my neck, head, and face done. ahhhh. lovely. and dave...he came out looking stoned, or like he'd just come out of deep hibernation. i think its safe to say that those one hour massages did us some good.

on the way home, we were hungry and uninspired to make anything we had in the fridge. we passed "star anise" on barrington, which is a thai/vietnamese place we hadnt gotten around to trying yet. we peeked at the menu and thought we could give it a shot. i ordered the lime leaf coconut chicken and dave got some salad rolls and the rare beef and rice noodle pho. we unpacked it at home and chowed down. the portions were right and the flavors were great. the prices were also pretty standard and the workers and customers at the place were asian. so perhaps we are on to something here. finally.

completing the trifecta for the night was the fact that we had randomly agreed to attend a concert that was occurring near us. we had never heard of the band before but a colleague of daves sent out an email and since the venue was literally on the block behind us, we thought it would be an easy thing to check out and bail on if we were bored.

at 8p we arrived at the little jazz east cafe. its not actually regularly open, only when they have events or member meetings, but its a nice intimate location. they had set up chairs for the live acoustic concert we were seeing. somewhere in the next 15-20 minutes, the concert started.

the pre-opener was actually a member of the headlining band, but he was doing some of his solo stuff. seeing as how he grew up outside of halifax, he had some local things and memories to sing about. he was accompanied by a cellist which was cool, but for the most part, since he was still new to the solo thing, the set was a bit too unpolished for me to really get in to.

the next guy was a great opener. his name is keith mullins. he sang and played the drums while guys from the headlining band jumped in for the occasional piano or guitar need. im not sure what category of music keith is. maybe folk? his voice is very versatile and he had quite a range of songs during his set. the final song was cuban-inspired. his set really seemed to inspire monster, who was grooving around like crazy for his music (which was not the case for the pre-opener guy. monster was napping). anyway, i was impressed to be so entertained by music i had never heard. they also mentioned that he is going to be heading to nashville to do some work with some famous country guy, so perhaps he is an up-and-comer to the larger music scene.

and finally, the headliner band, caledonia, was up. normally five guys (two guitars, a bass, drums, and piano), the drummer was substituted here by keith, which was cool. this was an acoustic show, but i guess normally caledonia is electric and their style is folk/rock. they too had some really nice tunes. the lead singer was also pretty versatile, perhaps not quite as strong as keith, but he had a great falsetto he used for some songs that made him sound like tracy chapman. i also dont think it hurt that he looked like a younger colin firth with a beard and was wearing a cool hobo-type hat. i liked his style.

some of the band guys were also from nova scotia which meant they had many friends in the audience, which was nice for the ambiance. it was very casual and friendly and nice. the music was also easy to listen to if youve never heard it before, and their single from their new album "we are america" was an interesting commentary about how canadians might like to pretend they are different from americans, or would like to say they are better, but many, especially those in the larger cities, really behave the same, buy the same things, etc.

anyway, in the end, we had a lovely evening start to finish and we had done some new things. always nice when that happens. especially when it comes together with minimal planning. a pleasant surprise. :)

11 March 2010

Healthcare corner #10 - Pharmaceuticals and some more efficiency

more class.

got a couple more items on efficiency:

1. these are a few different numbers that can help give a picture of what you get out of a system compared to what you put in it (numbers are from 2001):

Health $ spent as % of GDP

Drs per 1,000 population

Dr visits per patient

MRI scanners per million
















2. also, the world health organization put out the "world health report 2000" which had the focus of wanting to assess the different health systems of the world. in overall attainment (which measured achievement in "good health," "system responsiveness," and "fair financial contribution"), canada ranked 7th in the world. in overall performance (efficiency), canada ranked 35th (italy was 3rd, france was 4th, the u.s. was 37th).

the last part of class was a guest lecture by a pharmacy school professor. of course he was there to inform us about the pharmaceutical side of canadian healthcare.

1. as you might recall, drugs are not covered under the Canada Health Act. so, the provinces are not required to cover them. however, every province does cover a portion of drugs for a portion of its population (for example, nova scotia has a seniors drug program that includes a select list of meds). also to keep in mind, if you are in the hospital for treatment of some kind (surgery or some other intervention) any medication you are given while undergoing that treatment is covered for free in the Canada Health Act.

2. since drugs are a major cost and a major part of healthcare, in 2004, the government signed the "national pharmaceutical strategy" health accord. it was a comprehensive approach to addressing problems related to affordability and safety of drugs. the plan had 9 specific action items...basically though, despite coming back to reassess every so often, almost none of the action items have been adequately addressed. however, it did serve as a good tool for individual provinces who wanted to make their own headway on those issues.

3. some stats about canadians and drug use:
- in 2007, half of all canadian adults were taking at least one prescription drug, while about 15% said they take 4 or more.

- the number of prescriptions filled each year has almost doubled in a 10-year period. in 1996, about 234 million prescriptions were filled compared to more than 422 million filled in 2006.

- in 2007, 6% of canadian adults said their families spent more than $1000 out-of-pocket in the past year on drugs.

- in 2006, total drug expenditures for the country were $25.3 billion with about 40% of that covered by the various provincial governments.

- a 2008 study from a busy vancouver hospital found that 12% of ER visits by adults were related to problems with medications.
4. there is a website called "MedEffect" available to canadians that offers drug safety information and the ability to report adverse reactions and side effects.

as a side note, not sure if people saw the news item that sarah palin has admitted to using the canada healthcare system. apparently in her childhood, her family chose to go over the alaska border into the yukon to receive care. hmmm.

10 March 2010

Sometimes your words just hypnotize me

haha. a summary of my three hypnotherapy sessions.

so i mentioned that i got a referral for hypno from my regular doctor. one of the girls in my prenatal group went to him and thought it was worthwhile, and since it is free for me with my referral, i thought it could only help. basically i am looking for any way to help me relax and stay calm during labor.

so this dr brown is like the only hypnotherapist in town. he is 60+ (maybe 70+?) years old and is a sweet guy. he had an interesting background of actually starting as a regular family physician. he was trained to deliver babies in his practice and one day (back in the 1960s or 1970s, i dont remember) a pregnant patient of his asked for some information about hypnobirthing because she wanted a non-traumatic hospital birthing experience. he had never heard of the technique, but asked some colleagues about it and gave her some information. she taught herself and he then attended her totally calm and natural birth. he was so intrigued by the experience that he looked into it a little more and eventually it took him on many interesting fact-finding missions (he did some work in birthing hospitals in australia and he did a fellowship at UNC). it all led him to drop the family practice career and become a hypnotherapist. he now treats addicts, psychological disorders, and the occasional pregnant lady.

at my first session, he mostly asked me about my personality and lifestyle and what my goals were for coming to him. he then explained what hypnosis is (a self-controlled state of alert relaxation. a brain-wave EEG looks the same as someone who is fully awake, contrary to the perception that the "hypnotized" person is asleep) and is not (you cannot be forced to quack like a duck or take your clothes off while "hypnotized). his major goal as a therapist was to give people the tools to be able to relax and visualize things for themselves at home. he is the guide, you are the do-er.

so actually, i had encountered this kind of relaxation stuff before. i swam competitively during many winters of my childhood. toward the end of one season, those of us going to one of the major regional meets of the year were gathered in a room to listen to a tape (sounds creepy right? get your mind out of the gutter). visualization in sports was not something new to me, often athletes come across this type of "training" at some point if they stick with a sport long enough. anyway, the lights were turned down and we listened to this 45-60 minute tape that was nothing more than a guide to helping us breathe deeply and focus on each muscle group, individually, and get it to relax. once relaxed we had some visualization described to us about the kind of race we wanted to swim. blah blah blah. not sure if the other kids took it seriously, but the experience stuck with me. i paid attention and actually tried to breathe like the tape said and to relax the muscle groups they mentioned. by the end, i really felt like my energy was a little altered. i really was relaxed and focused. maybe, as a normally impatient, go-go-go person i am not able to do this for myself and it works best if someone or something else helps me do it.

at any rate, to end our first hypno session, dr brown guided me with two short relaxation techniques. a couple deep breaths with eyes closed and suggestions to relax certain muscles in a sequence. it was nice. and it was simple.

the second time i went back to him i brought my laptop. he recorded a 45 minute guided relaxation for me. it was just general in its purpose. for my third, and final, session he did another 45 minute relaxation for my laptop that was more specific for labor and delivery.

interestingly, he said that the idea is to listen to these recordings, get familiar with them, be able to hear them in your own head, without the recording, and learn what it feels like to be that relaxed, and what parts of the relaxation are most helpful for getting you there. then you can tap into those resources during labor. the idea is not to "hypnotize" yourself during labor and lay there in the hospital bed still and silent in your own little distant land. you can be up, walking, present, and alert but still benefiting from the ability to calm yourself down and focus when things get hard. i like that about his approach at least. and actually, i learned that lamaze is considered a form of hypnosis, in the sense that it is a breathing technique with the goal to help you relax and focus your mind on something else (the rhythm and/or the breathing itself) during the pain of labor.

all very interesting stuff. hopefully i can find some time to re-listen to the recordings and help myself get relaxed. we shall see.

Sweet jane helps dave turn 30

in honor of dave entering the second third of his life (im optimistic) we went to dinner.

dave choose to eat the first meal of his 30s at "janes on the common." he had actually eaten here back in february 2008 when he came to visit halifax to see if he wanted to be a post-doc at dalhousie. he hadnt had a chance to get back there with me since then. as the name implies, janes is located across the street from the halifax common (an open park north of the "downtown"). its a very popular place (even mentioned in a very touristy blurb in the nytimes) with a packed brunch scene. the dinner menu looked intriguing so we thought it was a good time to visit.

(the birthday boy at janes)

the place was pleasantly populated for a tuesday night and we got a nice little corner seat along the window to enjoy the atmosphere in security. first up, drinks. dave got a propeller bitter beer and i tried the "rhubarb cordial." for $2.50, it came spritzed up with soda and lemon and would be a must for rhubarb fans (there were real chunks on the bottom). shortly after drinks arrived, the bread and butter came. one warm, flaky biscuit each, with butter. unfortunately the butter wasnt salted, so it tasted simply like flavorless lard being spread on carbs. plus, the biscuit itself was made with tons of this same butter...so again, it felt worthless to be eating the calories even though the texture and freshness of the biscuit was appealing.

for appetizers, dave had the warm spinach salad with candied walnuts, caramelized shallots, ran-cher goat cheese and lemon poppy seed dressing. while he ended up eating it all, he thought there was an overwhelming presence of shallots that masked all the other flavors. :( and i ordered the cup of moroccan lentil soup. lentils suck me in every time. sadly, they didnt win me over this time. the soup was totally pureed, which could be fine if the spices are right, but for being called "moroccan" i barely caught a hint of anything resembling the region. in fact, it was so bland that it was barely distinguishable from baby food.

so, we were off to a rocky start. we hoped dinner had more in store for us. dave ordered the smoked pork chop stuffed with spinach, sage and aged white cheddar topped with an apple cider and pommery mustard glaze. it looked really nice and ended up being quite tasty. i got a few bites before he finished off his plate and i liked that the pork was cooked well and didnt taste of "farm." for me, i ordered the black bean and sweet potato stew served with roasted red pepper and smoked cheddar polenta. the portion size and ratio of items in the dish were just right. the smokey cheddar polenta was a bit crispy and went well with the black beans. i would have enjoyed sweet potatoes that were a little softer, but it didnt stop me from finishing off the dish.

(daves pork chops; my polenta and stew)

with our solid main courses settling in our bellies, we drooled over the options on the board for dessert. ultimately, dave chose the chocolate peppermint pot de crème for his birthday treat. not too rich (or sweet), it was smooth and creamy. and while i can always stand to have minty things be stronger in the mint flavor department, he definitely had a DElish sweet ending. for me, i chose the lemon pudding cake. uh, yes, it was as good as it sounds. possibly better. a moist yet fluffy/airy/spongy cake supporting a half-inch thick layer of zesty yet light and smooth lemony pudding. not too sweet. with blueberry sauce drizzle. yeah youre jealous. and you should be.

(daves peppermint chocolate pot; my lemon pudding cake)

finally fat and happy we waited for the bill. to my surprise it arrived along with a little plate featuring two warm slices of plain shortbread cookies. love that they were warm. love even more that they were buttery (yet the salt was there this time in correct proportion to enhance the buttery-ness) and slightly gritty as any good shortbread should be. when you are made with something like 3 ingredients, youve got to somehow set yourself apart. i like a little texture to my cookies and these were great.

so, while the meal started out a little questionable, it ended with a memorable oompf! pretty successful for a birthday meal i would say. love you nib. hope you enjoy your thirties. :)

Jane's on the Common on Urbanspoon

08 March 2010

U.N.C-een uglier oscar dresses

on a lighter note, the oscars!

dave was visiting a friend of his who recently accepted a faculty position at UNC. while he was "working" on a collaboration this weekend down in the sunny/warm south, i was here. thus, i was very much looking forward to the oscars to interrupt the boredom.

i was able to find live red carpet coverage on the internet and settled in to watch. unfortunately, my take home feeling was that this was the worst year for dresses since fashion became a focal point of the event (back in the 1990s). before that time, i cant really fault people for some of their wacky dress choices. this year, i found there were too many ruffles or pleats, too much avant-garde design, and/or the dress colors were too washed out (pale pinks, peachs, golds, and blues).

this was made worse, in my opinion, by the fact that all the live commentating i was finding was nothing but positive. since when does that happen? ugly dresses were called "edgy" or "unique" or they would simply skim over the dress and say that "her jewelry choice was perfect." get out of here. biased media has even crossed over to entertainment "reporting." stop trying to get in sarah jessica parker, j.lo, and vera farmigas pants!! ack. pull the claws out please, i mean, usually being catty is unnecessary, but some of those dresses were asking for it. in the end, i knew it was bad that i actually thought demi moore and miley cyrus were looking good. ugh, what a night. and to top it off, i couldnt find a live feed to watch the actual oscars. i have resisted youtubing the parts of the night that were most talked about because i want to find the thing posted somewhere in full length. anyone got any suggestions?

(sjp in her gold chanel sack. ugly neckline. ugly hair that was too huge, and the back of the dress looked even worse; vera in her magenta fan ruffled disaster. the hair and lipstick didnt add anything helpful; j.lo in her shiny folded quilt. that extra bunch of quilt material on her left side looked like a side pony tail. ridiculous; charlize theron, i think you were just egging people on to say something mean about your hypnotic boob spirals. i mean come on!; zoe saldana you are newish to this so i can cut you come slack, but the ruffles and dress dye job are a no-go)

(demi had both ruffles and a washed out dress color but somehow it still came out making her look decent. and i guess since she has made some ugly fashion choices in the past, i was approving of this look; miley, i hate you, but i ended up liking the dress and hair. good for your age and body type and event appropriate)

(a gorgeous couple of presenters, jake and rachel looked hot. they should make babies; lifelong fav molly ringwald was there for a special john hughes tribute. the lady looks fabulous as a mom of three over 40 who gave birth to twins 8 months ago!)

05 March 2010

Healthcare corner #9 - Research on pregnant women

went to an interesting talk at the dalhousie law school today.

again, i'll try to be brief. this was a talk by researcher françoise baylis called "pregnant women and the H1N1 vaccine." her general interest is in arguing for pregnant women to be included in clinical trials for drugs/interventions that could be needed or of use to women during their pregnancy. she chose the recent H1N1 vaccination situation as an example.

so, in this past flu season there were a number of strategies employed in different countries for getting the vaccine out. since it is known that the flu in general, and this H1N1 strain in particular, put pregnant women at increased risk of serious complications and death, it was important for them to be recommended for vaccination. unfortunately, there was a muddled message presented to the public due to the lack of "gold standard" information involving pregnancy and vaccines.

she mentioned that in the u.s. the vaccine strategy was to purchase enough vaccine for high risk groups only (which included pregnant women) and to buy the inactivated, unadjuvanted virus vaccine only. in the u.k. the vaccine strategy was again to purchase enough vaccine for high risk groups only (which included pregnant women) but they recommended the adjuvanted vaccine to pregnant women. in canada, the strategy was to purchase enough vaccine for everyone who wanted it to be injected (however, they would roll it out in waves to get the high risks groups taken care of first). originally, they only bought the adjuvanted type of vaccine and then later bought the unadjuvanted and told pregnant women that that was the one recommended for them because the adjuvanted type lacked safety information for pregnancy. the result was confusion and fear due to the governments own confusion and mixed messages (also seen in other countries this past flu season).

the major issue is that vaccines (in general, not just this past flu season) have not been tested on pregnant women in the traditional sense. normally before something is approved for use in a population, it is tested on a sample of people and the FDA approves it for specific uses (to paraphrase). pregnant women have always been a scary, taboo population to want to test anything on for obvious fear of harming the fetus. but this presents an interesting issue: are we actually doing more harm by not specifically testing on pregnant women in initial clinical trials?

to be more clear: for example, in the u.s. from 1941-1971 it was common for pregnant women to be given DES because it was a drug that was supposed to prevent miscarriages. it was originally approved for use in other populations of people (menopausal symptoms, vaginitis) but doctors found there was this added benefit of being able to prevent miscarriage so they started prescribing it in this new population (called "off label" use). some 5-10 million people were exposed (both in-utero and the pregnant women themselves) to DES which ended up causing major reproductive/fertility problems and an increased risk of cancer. these women were basically socially experimented on and it took 30 years to discover the link between the drug and these abnormalities and to stop its usage.

another example is the drug thalidomide. it was used in nations worldwide (including canada and the u.s.) from about 1957-1961, its effects were so severe that they were noticed much more quickly. the drug was given as a sedative and morning sickness aide to pregnant women (although, again, it was originally approved for use in other populations). the effects on the fetus were severe with more than a few dozen possible negative implications (cancers, digestive tract development problems, blood vessel problems, eye problems), not the least of which were malformed limbs.

anyway, this speaker then briefly mentioned the history that all our medication/intervention knowledge from experiments used to come from study populations involving only healthy, white males. in the 1980s, researchers and other advocates finally got children into experiments so that again the safety could be tested on them in a controlled environment and real, tested results could inform drug recommendations for kids. and in the 1990s, women were finally included in clinical trials. this may seem crazy, but thats the history. and this is why the speaker advocated for responsible, controlled testing of the drugs/vaccines/interventions that pregnant women are likely to need to use during pregnancy.

for example, a pregnant woman who is diabetic/epileptic/depressed, etc. is going to still need to take her medication while she is pregnant. the effects of diabetes or seizures would likely be more harmful to her and the fetus without the drugs. but, these drugs need to be tested in this population. currently they have not been. all the information we have on medications and vaccines for pregnant women is accumulated through historical information, which can definitely be used to define something as "safe" or not...the problem is that it takes years/decades to build up this information.

in the case of vaccines, they have been around long enough, and used on millions of pregnant women, so compiling that data and analyzing it does show that vaccines are safe and effective for use in pregnant women. but, it took this H1N1 situation to show us that there is still a widespread misunderstanding of the issues surrounding the information we have available and what kind of standards governments should require before they can be confident to recommend use in vulnerable populations. in the u.s., they were actually spurred on to begin a national study including pregnant women in trials of vaccines. it looks like they will be the front runners to getting this population much needed information in the more traditional "gold standard" type way. kudos.

and to end with something related, but not from the talk, i was really fascinated to have recently seen the news that the infamous 1998 study that suggested the link between vaccines and autism has been retracted. printed in one of the most famous and respected medical journals in the world, every single author involved in the "research" has denied the findings. apparently the lead author was paid by groups of concerned parents with autistic children to find a link between the two, and "find a link" he did. he freaked out millions of parents and changed the landscape of childrens health for who knows how many years into the future. numerous studies have come out since 1998 saying they could not find a link to autism, and now this retraction is added to the pile. however, it saddens me that it has probably irrevocably damaged vaccines in peoples minds. when it comes to medical things, nothing is 100% safe, so im not suggesting vaccines are perfect, but they have certainly been massively important for saving millions of lives over the decades with minimal negative effects.

Diaper me baby

went to a cloth diaper workshop at the nurtured store tonight.

dave and i showed up at 6:30p to join three other couples in learning about the many different cloth diaper options available. so, first point: cloth diapers of today do NOT use pins like previous generations. they are also pretty technologically advanced with detailing added for adjustability, absorbency, durability, etc.

there are a few big name brands that have the biggest market share, but there are people cropping up everyday who are designing and sewing their own version of cloth diapers. again, i only first started having modern cloth diapers enter my knowledge base back when my public health friend was stocking up for her daughter (now three years old). back in ann arbor the emerging diaper place is the little seedling, and here in halifax, it seems like nurtured has more cloth diapers than i can hope to try.

for the workshop, the owner broke the diapers into a few categories: pre-folds, fitted diapers, pocket diapers, and "others" (which include some newer emerging trends that i wont bore you with).

a brief rundown:

pre-folds are basically the closest looking diapers to what your mothers or grandmothers may be familiar with. they now have more layers sewn together and are made with more absorbent, durable fabrics. often you can get organic cottons/fibers as well. you can fold them in a variety of ways as your child grows and to provide better absorbing coverage for a girl v boy. to secure them on baby, they come with a little snappi thing that is the alternative to pins. since this is an all-cloth situation, you need to buy outer diaper covers in order to prevent pee from getting on babys clothes. as for pricing, pre-folds are like $2-4 each and covers are maybe $13-15 each.

(an unbleached stack of cotton pre-fold diapers; the snappis to secure them)

(a diaper cover; a baby getting suited up with a pre-fold and diaper cover)

fitted diapers are the next step up from pre-folds. these are still all fabric so you need to buy the outer diaper cover, but they look more like a disposable diaper. there is no folding necessary and no additional snappi thing, you just put it on and snap the attached snaps together and its on. these come in lots of different fabrics again, including hemp which is a natural fiber and SUPER absorbent, ideal if you have a heavy wetting baby. fitted diapers are about $15-19, not including the covers.

(a hemp fitted diaper; the inside of a fitted diaper)

pocket diapers are the third major kind. the two major/popular brands are bumgenius and fuzzibunz. basically there are absorbent liners that you place inside the diaper pocket (one for regular situations, or possibly two liners for nighttime sleeping or if your baby is generally a heavy wetter) and then you just put the diaper on as a whole, like a disposable. most companies with pocket diapers now make the diapers adjustable so they can grow with your baby from birth to potty training. pocket diapers are like $23-26 each.

(the bumgenius 3.0 model adjusts to these three different sizes)

diaper care is really not that bad. if you are breastfeeding (and before solid foods) there isnt anything more you have to do besides throw the dirty diapers in a dry diaper pail (some people are tempted to want to soak them in a wet bucket, but this just encourages bacterial growth). it is recommended to not let dirty diapers go for more than about 2-3 days before washing. the women using them at the store said theyve never had a problem if things came up and they couldnt wash them for a few days more, or if they accidentally left them steaming in a hot car (gross). when your baby starts having more solid poop, you can still just leave it and wash it as is, or you can remove the poo by one of many methods/techniques.

while it may seem like lots of overwhelming information, i can just about guarantee that any diaper/baby store worth its salt would be more than willing to go over things with you. ultimately, you want to get lots of information up front so you can make the right (and most convenient) decision for you. the pluses to using cloth diapers are many, and not all of them involve hippy "saving the planet" motivations.

first, babies in cloth diapers typically have little or no diaper rash (unless going through a growth spurt). it is thought that disposables cause rash in one of two ways: the absorbent chemicals in the diaper react with babys skin and/or the fact that disposables arent made of breathable material so the area under the diaper can be 4° celsius (~7° F) higher than the rest of the body, making it a great environment to grow microbes. for a reality check, my 3-4 friends who had their babies in cloth diapers said they truly never saw rashes.

second, cloth diapers are cheaper than disposables. you buy the diapers up front, so yes, it is a higher one-time fee, but then you arent running out to the store each week to buy more. typically you buy enough to have a set of 24 diapers (newborns wet the most, at about 10-12 diapers per day). for one child, a set will cost somewhere between $400 - $1200 (depending on the style you buy) which is compared to a two year supply of disposables costing about $2000 (this then assumes your child is potty trained at age 2). plus, depending on how you cared for the diapers, how long you used them, and which style you bought, many people find the diapers are usable for their second child (obviously, this saves even more money!).

third, ive seen research suggesting that disposables put kids at an increased risk for asthma. this can be likened to the plastic shower curtain situation. youve seen the reports about how its bad to breathe in that plasticy smell you get when you put up a new, plastic shower curtain right? same idea with disposables. the chemicals being exposed and breathed in continuously have the potential to irritate babys lungs and possibly then go on to encourage asthma.

lastly, its been suggested that cloth diapers lead to children being potty trained at an earlier age. the idea is that, while cloth diapers are very absorbent and do pull moisture away from the skin, they do still provide the child with the sensation that their diaper is wet. they then make the connection earlier between the wetness and the need to go to the bathroom to prevent that from happening. the women at the store felt that this wasnt something contributing to a major difference of like one year earlier training for cloth diaper kids, but they certainly felt that cloth diaper kids train about 3 months earlier than disposable kids (again, then you are saving money compared to disposables).

anyway, i think i mentioned before, we are going with a diaper service. im not going up and down the stairs to use a public washing machine with a newborn. nope. there is a local diaper service that really isnt expensive that we are going to use. so, we dont have to choose between a hundred diaper styles. the diaper service does have both pre-fold and fitted diapers as options though, so we have some flexibility. plus, the service is roughly the same, or possibly a little cheaper than disposables, so we are still not breaking the bank. it will be my one luxury.

so, the workshop was packed full of useful information, even though we are using a service. it was educational too to see the other people there who were interested in cloth diapers. some people were super hyper about it, some people seemed like a deer in the headlights, and two of the dads seemed like total dimbulbs. even though dave is at novice status, he was very attentive and motivated to learn. i think he will be amply prepared, which will be good because i think he will be the diaper king to my boob queen role.

04 March 2010

Nessie news - 31 weeks

31 weeks. we are now in the single digits for the number of weeks until the due date! crazy.

dr appt:
gained only 1.5 pounds again! so now i am at a total gain of 30 pounds. awesome. my blood pressure: 120/58. baby heartbeat: 152 bpm. urine fine. the med student rotating through the docs office felt and said that monster was head down (this was also the case at the last visit when she felt for monster). and while it still seems like monster is regularly flipping around, at least there seem to be moments when the head down position is being tested...good job little one, remember to go to that place when the real time comes. also, my sensitive skin has caught up with me. i apparently have some dermatitis on my elbows and hands, but with regular dousings of lotion, ive been able to keep it under control.

1. well, i feel like i got bigger overnight. shortly after my last doctor appointment i woke up and really felt like i was carrying a bowling ball around...ALL day. its taken until about now to adjust to this new form of normalcy and not feel so rundown and achy by mid-day.

2. of course, the feeling bigger is also made less fun by the fact that monster is now enjoying wedging into some tight spots that make me feel a lot of pressure. body parts jammed between hips and ribs are exciting, and curling up and using my hips/pelvis area as a turtle shell is highly enjoyable. perhaps most disturbing though are the regular jabs below my underwear line. i mean, i dont really feel like there should be access that low. its like, while im showering, i expect at any minute for a tiny hand to reach out and hand me the bar of soap. get out of there! float up and play somewhere else, near my belly button perhaps.

(two monster videos. better than last time, in my opinion. pretty sure these will be the last time i post kicking videos, so dont worry. we couldnt decide which was better of the two so both are here. dave said this is acceptable because the future grandmas might be interested.)

3. pregnancy brain! this hasnt been consistent, but recently i had two episodes in two days where i felt like i was losing my mind. while heading out to prenatal group last week, i couldnt find my keys. since i always put them in the same spot i was freaked out. did i leave them in the door? they arent there. did someone steal them? are we now vulnerable to a stranger entering at night while we are sleeping? who should i call? where the hell are my keys? yeah...they turned out to be in my purse.

second incident involved the doula. the appointment was on the calendar. i knew it was coming. in the morning, i reminded dave about it. we talked about it. i was ready. then i ate lunch and never thought about it again. dave called me from the coffee shop on the doulas phone and was like "...uh, where are you?" i was so embarrassed that i totally forgot. i told him to go ahead and chat with her since i trusted his opinion and that i might get over there in time, which i ended up doing and totally feeling like an idiot. pregnancy brain sucks. thankfully i havent had any more recent episodes, and hopefully my list-making and organizational tactics will keep more embarrassment at bay.

4. latest baby dream: during a storm we were in a community center. i knew i was in labor so we calmly gathered our stuff to go to the hospital. got to the hospital and they said that i was in labor. they said i could try and give birth by myself without c-section but they wanted to give me an ultrasound. during the ultrasound monster was waving hello. i felt contractions but they were manageable. the nurse brought me the customary seafood chowder with 5 special (mussels, clams, oysters?) in a richer creamier sauce than the chowder. dave had some too. my contractions slowed.

5. heartburn. this is only slightly creeping back. ive noticed it most after mustard, wasabi, milk, and fatty foods. so now i stay away from that stuff (except dairy). if i happen to get a flair up, my handy remedy has been papaya juice. i dont need more than a few sips and a couple minutes later i start to notice a real change. our grocery store actually only has a papaya/pear juice blend, but it is still potent enough apparently to take care of it. plus, it is possibly also helpful that i tend to drink 1-2 mugs of peppermint tea each day. its caffeine-free and a natural digestive aid, so maybe that helps sustain a low heartburn probability.

1. found an interesting article saying that they are about to change the gestational diabetes guidelines in such a way that will lower the accepted values for the glucose test. this will mean that two to three times more women are going to be considered gestational diabetics. where there are currently about 5-8%, these guidelines could call more than 16% of the pregnant women population "diabetic." this seems just crazy to me. i mean, there are real consequences for being called a gestational diabetic. you likely have to receive insulin and you are often considered "high risk." will this lead to more c-sections and interventions and negative effects on mother and baby? i mean, i know they are trying to curb the negative effects caused by the diabetes, but calling 16% of a population "sick" doesnt seem realistic. yikes.

2. monsters stroller was featured as a prize for a people.com celebrity baby blog giveaway. these are the newer ones being made in china. ha ha. but cool that it was in the spotlight. :)

3. new item: i am now a full-time worker. in the wonderfully wacky world of academic funding, my boss found some extra money and a project that needs working on. she asked if i wanted to be full-time for march and april. i said...sure. seemed weird to decline. i still have a flexible schedule. as long as i am getting my items done for the week, it doesnt matter where or when i work. so, while it doesnt put many more physical demands on me, it is a little bit stressful to know that every time i choose to take it easy or turn my brain off mid-day, i will have to find time later on to get that work done. so bizarre to have stepped things up just when i am slowing down. although, my boss is reasonable, so if things started to swallow me up, i think she would be understanding and let me adjust back down a level or two.