Too Many Friends?

Maybe this will come in handy.

GMbryo

My final research paper is almost complete! I've been analyzing the public understanding of science in relationship to the disposition of supernumerary cryopreserved embryos after fertility treatment (what people will do with their excess embryos after they conceive: dispose, donate to another couple, donate to science or store indefinitely). What I have found is that most people we've talked to don't understand science well. At all. I found this too in an early study, about eight years ago, when I conducted interviews to see how well people understood genetic modification. This makes the new genetically modified embryo report doubly interesting.

The curiosity lies with the almost visceral reaction I have read in response to the work, whereby individuals automatically jump to "designer baby", "super race" and eugenics arguments rather than looking through their rosy lenses to see what this could mean medically. The reported genetic modification of the embryo by a team of scientists from Cornell University entailed the addition of just one gene, "intended merely to let scientists better study embryo development; the embryo itself was already damaged beyond repair. They weren't going to implant it in a woman; they wouldn't use the technique on an embryo destined for implantation; and they certainly wouldn't start mucking around with any other genes" reports Brandon Keim of Wired. I find it interesting that we tend to dismiss that this is a technology which will potentially be used to correct for genetic abnormalities like hemophilia, cystic fibrosis and even cancer in favor of discussions of very advanced science (fiction-type) scenarios. While acknowledging the risks, oversight seems the key to keeping research from running down the scifi alleyway.

Stay tuned to see where this leads Great Britain's Human Fertilisation and Embryology Bill which is having its second round in Parliament this week. The bill, if passed, will make it legal to create GM embryos in Britain.

Audible Picture Show

From the site: The Audible Picture Show is a growing collection of works by a diverse range of people responding to the challenge of creating short works of audio for 'a dark cinema'.

So much good to say about this, but I'll just let you listen for yourself. My favorite: "The Rooster Moans" by Tom Michael, USA -- Brilliant!

See the Circus

It's that time of year again. If you are reading from anywhere near the Bay Area, come and see the Circus Center's Annual Showcase. The San Francisco Youth Circus will make it totally worth your while. June 19th - 22nd. Here is a taste of last year's show, photographed by Seth Golub.




I am also hearing whispers about the Pratfalls & Rising Stars recital starring students in the Professional Aerial Program and this year's Clown Conservatory graduating class. June 13th - 15th. Buy your tickets for both shows. Do it now.

Dr. Nurse

According to a Wall Street Journal article reprinted here, more than 200 schools of nursing plan to offer a doctoral program that will train advanced practice nurses to hone their medical skills toward those of primary care physicians. This Doctorate of Nursing Practice will require a certification exam "based on the same test physicians take to qualify for a medical license" and could begin as early as fall 2008. "By 2015, the American Association of Colleges of Nursing aims to make the doctoral degree the standard for all new advanced practice nurses." I am curious about what effect this will have on current nursing practice, specifically for newly qualified and practicing advanced practice nurses who do not hold a Ph.D., and how the hierarchy will organize itself around these new educational delineations. Not to mention that we're potentially crossing some seriously established boundaries here. Nurses become nurses because they want to nurse. If we wanted to practice medicine, we'd become doctors. And doctors don't want nurses to be doctors, not to mention "mini-doctors". It will be interesting to see how this one pans out.

Making a Mother

The documentary The Business of Being Born (Rikki Lake & Abby Epstein) has been made available for viewing online. That's nice. What's not so nice is the message. I wanted to like this movie, I really did. But as my partner and I sat down to watch, it was pretty clear within the first two minutes that all of the positive popular press this movie has received has been seriously undeserved, and worse, uncritical. (A crucial exception is this Slate piece.) Not only did I not like this movie for its dubious historical, epidemiological and professional commentary on birth in the United States, I also didn't like that it was horribly elitist, classist and, yes, racist. This in all of the worst ways that information packaged for general consumption can be: coercively.

The underlying message of the film is that the right birth is a normal birth (the film’s term, not mine) and a normal birth is one that happens at home, unmedicated and without any intervention. There was absolutely no call to concern for women with no access to insurance or perinatal care, women with pre-existing conditions, women of advanced age or with high risk pregnancies, teen moms, et al. Basically, anyone that didn’t fit the bill of perfect health and fall into the category of upper-middle class American woman, was bound for the label of “bad mother”. That is shameful.

My partner referred to it as the NY/LA “boutique” image of the perfect childbirth. Of course, we all want women to have this intervention-free option. But for some of us, there may not be the luxury of an uncomplicated pregnancy and childbirth. And that can make us feel like we've lost control. It became pretty clear by Rikki's third hat change and overly dramatic forward-leaning, finger chapelling attentiveness, that this movie was primarily about women trying to either regain or maintain that control. Not until I was 1 hour and 9 minutes into the movie did I realize that it was not about control of one’s own childbirth experience, as the film lauds, but about control of other women and their experience. Sadly, 'expert' clinicians are also used to meet this end. At one point in the film, Dr. Michel Odent (the OB who also believes men should not be present at childbirth) makes the claim that when a woman gives birth by “caesarean section she does not release [the natural] flow of "love hormones" [oxitocin], so she is a different woman than if she had given birth naturally...and the first contact between mother and baby is different.” Here Odent compares women to monkeys who will reject their babies if delivered by c-section. Upon hearing this, I quite astonished myself and my poor partner, by bursting into tears.

Childbirth is a wonderful, moving, emotional, life-changing event for every woman; the amazing birth footage in this documentary attests to that. What is worrisome, however, is the shocking amount of misinformation the film conveys about childbirth, accompanied by a self-affirming (and often righteous) adamance about the importance of the “right” birth and becoming the “right” kind of mother. This is interspersed with an extreme lack of criticality in regard to the 'big picture' of various practices by those interviewed, including women, social scientists and health care providers. (I should say here that there was a striking absence of L&D nurses in this movie. Not one was interviewed!). Neither was there even a smattering of sympathy for women who have births that don’t go as planned. As a twenty-five year-old first time mom, I had a complicated pregnancy and The Kid was, in the end - thankfully - delivered safely to my arms by cesarean section. But I have known women who have had horrifically complicated pregnancies necessitating close monitoring of both mom and baby; mothers who have had perfectly normal pregnancies and lost their babies in what seemed to begin as an uncomplicated birth; husbands and children who have lost their wives and mothers because of unforeseen problems.

The empowerment of women is not as simple as demedicalizing childbirth. But it is as simple as avoiding shaming women into taking chances for fear of being a “bad mother.” Empowering women doesn't mean demanding we all make the same choices and become the same kinds of mothers; it means allowing us to empower ourselves to become the mothers we choose to be.

Two thank-yous: First, to the nurse midwife Cara Muhlhahn who in the movie describes her own difficult first childbirth, and of whom we get to see footage as she goes into the pain-induced dementia of despising everyone around her. It’s the best footage in the entire movie. And to all of the good docs and nurses out there who have blogged more accurate information about childbirth practices in the United States, inclusive - and even encouraging - of home birth.

Welcome GINA!

Good news: On May 1st the House passed the Genetic Information Nondiscrimination Act (GINA) by a vote of 414 to 1. The act will protect Americans against discrimination based on their genetic information. This will apply to both health insurance and employment. The legislation has been debated in Congress for the past 13 years, so most individuals with genetic diseases and their families -- especially those parents of children with genetic illnesses -- are celebrating. This bill, additionally supported by NIH National Human Genome Research Institute, will also allow for continuation of biomedical research by eliminating the possibility for genetic discrimination. And, yes, this legislation is supported by George Bush who will sign it into law tomorrow.

This issue was brought to my attention by Jen, blogger and super-active alpha1 mom. Alpha1 refers to Alpha 1-antitrypsin (A1AT) deficiency, which is a not-so-rare genetic disease. A1AT is a protein produced by the liver and its function is to protect the lungs from the enzyme neutrophil elastase (NE). When the body is deficient in its production of A1AT, the NE, a protective enzyme that will normally remove old cells or bacteria, can damage healthy lung tissue. People with the deficiency will often develop emphysema. Other common diagnoses include COPD , asthma, chronic bronchitis, bronchiectasis and more rarely cirrhosis of the liver or panniculitis. Alpha1 can be treated with augmentation therapy, drug therapy, or surgeries such as organ transplantation. You can find more clinical information about Alpha-1 here , here and genetic information here.

UCSF MEPN

I've had some inquiries about getting into MEPN, as in, how the heck that works. To be honest, I have no idea. But I can give a simple synopsis of my own history; maybe it will help in some way. Here it is, abridged. I have significant hands-on health care experience, though it is rather ancient (we're talking twelve years past). Because of this, any volunteer or health related jobs I held in the interim, I mentioned in my application. I have a graduate degree in a related field, a few publications under my belt, some first-authored and some in medical journals, and -- this came up again and again on interview day and in conversations with faculty -- I have experience and expertise in a particular area. That is to say, I have access and demonstrated commitment to a particular community. Having worked in reproductive technologies and women's health for about ten years may have been the single deciding factor in my entry to the advanced practice perinatal nursing specialty. As for the initial decision, GPA and GRE scores are kind of like the limbo bar: if you make it under, you go on to the next round. It seems that both the statement of purpose and (strong) letters of recommendation focusing on your proposed area/community are imperative. Beyond that, as far as I can tell, it's a total crap shoot.

I'm happy to answer any additional questions that future applicants might have. Ask away. As for the program itself, I still know nothing, so I'll refer you to friends and links over at MEPN Nation who are finishing up the first year, looking for jobs, and prepping hard for the NCLEX.

The Confidence Factor

I'm in a bit of a funk right now over circus. I've been active with the center for going on two years; I am not -- and have no interest in becoming -- a professional. (After all, I'm a mom, an ____ologist, researcher, and I'm about to become a nurse!). Granted, I am not the most self-confident person on the planet. And while I like to think of this as humility, I am fundamentally aware that it oftentimes manifests as self- consciousness and self-doubt. So, there's that. But the thing that's getting to me is what any good teacher knows well: the best way to help a student to learn is to be encouraging and to help to build confidence. I am not always getting this feedback at my place of practice. I should say here that I am not shabby, in general, at the art of circus. (Though, I don't hold a candle to The Kid.)

I trained for a couple of hours this morning on my own, just strength-building exercises, but I had the constant sense of judgment from a particular instructor, (and students who felt either obliged or merited to participate in the evil eying) which just kills confidence. Without confidence, exacting a skill is going to be impossible. Feeling watched and judged makes even hanging from the trapeze like threading yarn through the eye of a needle. Impossible! As a "recreational user" (a term I love because of the apparent lack of awareness of its contemporary, urban connotation) there is always a degree of displacement, but one would think that circus folk, for love of their art, community (and livelihood) would be inclined to encourage outsiders' interest in their trade. Well, on that front, at least the clowns are always very welcoming.

My take-home message on this one is that we need to believe in others; if we don't, we'll never be able to believe in ourselves. That, or we just need to surround ourselves with clowns.

Tomorrow, partner and I have a wieny roast at The Kid's school to attend to, but Sunday, I'll be back at the circus center, back on the trapeze, heart tucked tidily inside sleeve.

Nurses Wanted?

Over at NursingZen I was a bit disheartened to read that the Dean of the School of Nursing at UCSF has made the somewhat dire statement to outgoing nursing students that San Francisco is "the only place in the country that has no nursing shortage". Economists do seem to be projecting a lull in the immediate need for new nurses. Some other analysts are telling us it's not so.

This is a hard one to second-guess, as it seems doubtful that delayed retirement, or current nurses moving from part to full-time work, would so easily dissolve this long-standing deficiency. Still, nursing students take heed: any job is a good job until there is an economic upturn, which, judging by all local predictors, could be a while.

Tethered

Photos from flickr, respectfully: lorella101, MT Grizzly, Capa_r2, amaoricangirl, K. Willis, J. Handcock, K. Hanson, and Zach

Mother's Day

Exclusive
- Sharon Olds

I lie on the beach, watching you
as you lie on the beach, memorizing you
against the time when you will not be with me;
your empurpled lips, swollen in the sun
and smooth as the inner lips of a shell;
your biscuit-gold skin, glazed and
faintly pitted, like the surface of a biscuit;
the serious knotted twine of your hair.
I have loved you instead of anyone else,
loved you as a way of loving no one else,
every separate grain of your body
building the god, as I built you within me,
a sealed world. What if from your lips,
from your starred, gummed lashes the love of
other lashes, from your shut, quivering
eyes the love of other eyes,
from your body the bodies,
from your life the lives?
Today I see it is there to be learned from you:
to love what I do not own.

Eccentric Contraction

I had a cardio conditioning class at the circus center two nights ago, and now I am hurting all over. A class taught by circus folk is very different than the traditional aerobic experience: think Jane Fonda at Burning Man + steroids and a heavy-duty stimulant (she was drug free, of course, she just had way more strength, energy and spirit than your average Betty). Needless to say, I almost expired.

I was recently discussing my very sore muscles with one of my acro training partners, who also happens to be a physician's assistant. Contrary to what I've always been told and believed, she reports that the sore muscle factor has nothing to do with lactic acid. Apparently, delayed onset muscle soreness (DOMS) is caused by small tears in the muscle fibers caused by eccentric contraction (elongation of the muscle under tension due to an opposing force greater than the force of the muscle).

Exercises that involve many eccentric contractions will cause the most DOMS and thus the most pain. The pain is believed to be caused not by the damage to the cell but the muscle's response to the contraction, reinforcing itself beyond its strength by increasing the size of the muscle fibers. So the reason my calves feel swollen today is because they are. The jury is still out on whether or not to train during DOMS, and while it is always a good idea to stretch and warm-up before exercise, (and this should be of note to cirq-types) stretching on muscle soreness is not a good idea as over-stretching itself can cause DOMS. The only proven treatment so far is contrast showers, to increase circulation.

I think I'll just wait it out, thank you.

For The Kid

Children believe that everything bad that happens is somehow their fault... but they also believe in happy endings, despite all the evidence to the contrary. -Margaret Atwood The Blind Assassin

Whooping Cough

There is a pertussis outbreak in neighboring Contra Costa county.
Here is some information from the CDC and Contra Costa Health Services. My partner has been suggesting for some time that this is the cause of The Kid's on-going cough. Could be.
Another indication of the importance of vaccinations.

Va-va-varoom!

I have a pretty great partner. Monday, he got me this hard to find Palace record. Tuesday he rented another classic film noir which was the most far-out movie experience I've had in a while. Today, aware of my interest in chronicling feminism, he sent me this piece by Rebecca Walker, estranged daughter of Alice, with the accompanying message: Hi Sweets, here is the article about Alice Walker's daughter that I was mentioning to you....It is sad article overall, but there are some interesting asides about the ideological struggle to keep feminism pure despite real world issues like motherhood, etc. Am I lucky or what? What better than a man who understands the contradictions of feminism?

~ Postscript: On her blog, Walker had link to this piece, which once again demonstrates the contradictions.

No, You Are Not Fat

Can we just get this straight? There is a cultural obsession with body image and I am convinced it goes hand-in-hand with the feminism problem. And I don't mean that feminism can solve it, I mean that modern expectations of/for women exacerbate it. Women around me lately seem totally obsessed. I, too, am guilty of said preoccupation from time to time.

Granted, circus girls look a lot like this, which is to say circus bodies are not traditionally feminine nor particularly skinny. And that's a big change for some. But other women around me seem even more singularly-minded. Today alone (it's noon) I've heard one woman, weighing maybe 90 pounds soaking wet, say she was having a "juice" for lunch "because I have to watch my calories" (?) while another of similar proportion told me, "All I do is eat. Look at me." I wanted to say, "I can hardly see you."

Unless you are suffering from morbid obesity, which is an entirely different physiological problem, don't even ask me, because no, I don't think you are fat and, no, I don't want to argue with you all of your dissatisfactions with your body.

To be frank, that kind of discussion is incredibly punishing to all of the other women around you.

~ Postscript: the picture above is of Laverie Vallee née Cooper, bka Charmion (1875-1949), an American vaudeville trapeze artist and strongwoman, best known for her act during which she disrobed on the static trapeze (down to her leotard). You can see the act here, in a short film made by Thomas Edison (1901).

Nursewear

I got my letter. Classes and clinicals begin June 23rd!
Here's what I need:




(I really just wanted to show off this outrageous "nurse watch" and great old stethoscope poster.)

Muscle Memory

My tissu teacher (who is great, by the way) has been trying to get me to keep a notebook so that I will remember the different wraps and drops. My take on this is that for chronicling what we've done week to week, this is a fine exercise, but for learning, it is an exercise in futility. As a former dancer I have pretty decent body awareness. I am aware that my body learns through repetition. The trouble is that at the circus center, other than during class, there is no way to practice because the silks are not hanging. I maintain that without this repetition, I will make slow gains and will, likely, need to be reminded of where my feet, hands, butt should go. But this argument was putting me at odds with my instructor, so I conceded and whipped out the handy dandy moleskine, with a mental note to check up on this one. I recalled a piece I had seen in the NYT last year about a professional dancer who had a very detailed explanation of learning by watching and repeating movement, something which is quite natural for me - and imperative - in physical activity, even though I am much more of an auditory learner, generally.

After class I looked into muscle memory, aka neuromuscular facilitation, a very real phenomenon. The way it works is that through repetition, training movement of the body will stimulate neurological adaptation processes. The outcome will eventually induce physiological changes resulting in increased levels of accuracy in movement. Both fine and gross motor skills are involved in muscle memory. As we reinforce specific movements through repetition, the neural system learns those fine and gross motor skills so that we no longer have to think through the action. We merely react and perform. As you can imagine, anyone learning a new activity has a significant amount of brain activity occurring. Since muscles grow accustomed to certain types of repetitive movement, (walking, brushing your teeth, driving a vehicle) the best way to insure correct and adequate unconscious performance is repetition. Practice. Ask any musician or athlete.

So while doubting its efficacy, I will write down the drops and wraps until there is a tissu up on which to practice, at which point I guarantee marked improvement (and decrease in trainer frustration over having to shout out, "no, behind! no, left leg up! no, turn to the right!"). Which brings us to the confidence factor, another documented phenomenon in which a person's sense of being unable to perform affects muscle memory. But that's a different problem for another day.

Advice, Nurse?

The Kid has been sick for a pretty long time, off and on, with a number of ailments. Typical of an elementary school-aged child. Most recently, it's been a persistent cough which the pediatrician decided to try treating with qvar and albuterol. I reserved the latter since he has no signs of asthma. He did use the qvar inhaler. Vomited. The cough persists.

Why is this worthy of a blog post? Because I am about to begin study to be a nurse. When he vomited after having used the qvar, I called the advice nurse, just to be safe. He's had a recent history of respiratory problems as well as a nasty case of gastro; I disclosed related health information, including chest x-rays, previous treatments, basically his medical history for the past few months. While thorough, I think I was concise. ("Should he stop using the inhaler?" was my exact inquiry.) Apparently she was a little unsure of how to proceed and had googled the same web-advice I had. I found this mildly amusing and enlightening, if frustrating, as she proceeded to read to me every single symptom of every possible childhood ailment on the planet.

Note to self: process what patient/parents tell you about symptoms and behaviors. Don't read out of the manual or off of the screen. Mentally eliminate. As in, "Yes, he can put his chin to his chest and does not have meningitis. He has no other symptoms of meningitis, say, like an elevated temp." "No, he is not coughing up blood; I would tell you that." "No, there was no blood in his vomit; I would tell you that as well." "Yes, he is conscious or I would be hysterical and on my way to the ER, not talking on the telephone".

He seems fine now, as all of you other nurses out there probably could have predicted.

Why is the Room Spinning?

This single point trapeze has got me thinking about balance. After the first round, which was a solo lesson lasting about an hour, I felt pretty good. My instructor, mightily prepared with water, ginger, smelling salts and a bucket (just kidding about the last two), was very conscientious about checking up on my dizziness every few minutes: “How are you doing? Do you need some ginger? Drink some water.” And I was really fine. Until… I finished the class and made it all the way to work when I realized I felt exceedingly tired, had trouble focusing, was walking very slowly, methodically placing one foot in front of the other. I imagine I looked drunk, which is not the best way to appear at work. When I made it to my office, I sat at my desk, both feet placed firmly on the floor. With hands flat on my desk I stared straight ahead for about an hour. Then, quite suddenly, it passed.

So, what is this experience? The theories in the single point class abound. I’ve heard everything from fluid in the inner ear moving too rapidly, to low blood sugar. The remedies are even more diverse: eat protein before class; after you’ve been on the trapeze place the palm of your hand an inch from you face and study your life line; jump up and down; or my personal solution, which is to invariably, inadvertently close one eye.

According to more knowledgeable sources, our balance is maintained by a complex interaction of many different parts of the nervous system including the eyes, inner ears, joints, spine, muscles, sensory receptors, the brain and spinal cord. The symptoms of dizziness occur when the central nervous system (brain and spine) receives conflicting messages from the other systems. Each of these systems works in a particular way. The inner ears, or labyrinth, help us to know the direction of motion of our body, such as turning in different directions. The eyes monitor where the body is in space and also the direction of the motion in our environment (think about sitting at a stop light in your car and the car next to you begins to move slowly forward and you slam your foot on the break, having the sensation of movement). The joints and spine are skin pressure receptors which communicate which part of the body is touching the ground. Muscles and joint receptors tell us which part of the body is moving while the brain and spinal cord processes all of the information from the other systems. So, when the systems are sending contradicting signals, such as a spinning on a trapeze, hanging upside down from one knee, while simultaneously trying to focus either on nothing or an unmoving body part, this will inevitably cause the CNS some confusion. Rightfully so.

Now, how to combat the dizziness. This guy calls dizziness his idea of “absolute hell”. I wouldn’t go that far, obviously, or I wouldn’t be on the trapeze. But dizziness can be a real drag. So his remedies seem quite useful. Recommendations include: move slowly and find a focal point, stay hydrated, practice deliberate movement (walk a straight line), build focal strength (do exercises like following moving objects with your eyes). His final solution? Avoid dizziness-inducing activities. Heck no!