all posts, community, eczema, mental health, miscellaneous, mortality, parentings/things about baby and kids, women's health

old plans meet new horizons (aka what I do when the little one sleeps)

woman carrying baby near green trees
Photo by Shari Murphy on Pexels.com

In the past, I may have mentioned how I am obsessed with the fourth trimester and all things postpartum, or how when I was in my physical therapy doctorate program, I was interested in going into a women’s health specialty.

After I left the program, I searched for ways to slowly transition into the women’s health field from a different angle. And so from April through October 2018, I worked as a women’s health information specialist for Dr. Brianne Grogan, a women’s health PT and health and wellness coach and the creator of FemFusion Fitness. It was one of those random connections that seems fortuitous- in fact I had contacted her years ago after reading her book (way before I even had applied to PT schools) because I was interested in learning more about women’s health.

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My job for her entailed handling email inquiries from women trying to understand

  • what was going on with their bodies
  • what content Bri had out, and
  • who they should see (doctors, PTs, etc).

I also worked on various projects like helping make distributable content for bone building exercises, and I collected research for her new topics. On occasion I did some help with audience outreach to get her free content out into the world.

In time though we amicably went our separate ways. She moved on to focus more on holistic health practices and less on women’s health physical therapy and rehabilitation specifically, and so I continued on in my own direction, which at the time mostly included prepping for my baby’s arrival into the world. Working for Bri was an awesome opportunity because not only is she the nicest, but I got to brush the cobwebs out of my brain about women’s health rehabilitation and really delve into the subject (if you haven’t checked it out already, her youtube is full of free videos of explanations and exercises that cover a gambit of topics like prolapse, diastasis recti, pelvic pain, etc. Check it out here).

Afterward having my baby, I had not lost the love for the fascinating field of women’s health, I merely needed time to rethink how I could enter the world as a professional, no longer coming from the physical therapy realm.

I had been contemplating the idea of becoming a postpartum doula for a long time, and I finally realized what I was missing in that thought process. My objective couldn’t be simply to become a traditional postpartum doula because I would always have to explain about my skin condition, that I’m not contagious, what that means for my services, and work around my own flares and down time. But in reality when I was thinking about my own limitations, I should have been thinking about who could relate to having them. This led me to thinking about those expecting, new, or seasoned moms that have to live with eczema or other chronic conditions (shoutout to all the spoonies out there!) while growing/raising a babe or two (or three or more), and what their needs might be.

It’s not uncommon for people with chronic illnesses to have higher rates of depression, and it’s not uncommon for moms to suffer from postpartum depression, so what about those unlucky ladies that get hit with both? How do they find a support system that bridges both gaps, knowing that some of their depression comes from living with an incurable condition, and the other from being steamrolled with new hormones and emotions as a new life blends into theirs? That is a demographic I feel has not been studied or served enough. And so, I have begun to slowly pull my own experiences (both personal and professional) to better understand and then serve this group. I have been working on merging three of my interests to accomplish this:

  1. postpartum education (e.g my postpartum doula course and my position researching and writing postpartum mental health pieces),
  2. community engagement projects (two in the works: one to help educate mamas of color who may face discrimination from the medical/healthcare world or not have access to it at all, and one about how to train churches to better serve new moms in their area), and
  3. volunteering more with the National Eczema Association. This helps me to be in the know about what policies are being created (or challenged), as well as what new treatments or practices are out.

I use these three directions to help understand my own struggles, as well as figure out how I might work to help mothers out there like me (or other parents/caregivers!). It also gives me more reasons to continually I brush up on healthcare policies, systemic support options, familial/community building techniques, measurable outcome scales, all manner of recent research and studies, etc, which I tend to like to peruse anyway.

I have also been exploring the other side of my interests- traditions and cultures around death. Soon I will be taking Alua Arthur’s End of Life training and learn how to best serve individuals and their families around their time of dying. I think it’s such a taboo thing that we really need to talk about more. The amount of people with traumatizing stories and feelings of regret around their loved ones times of dying is astounding, and historically many cultures prevented this by being present and accepting death as nature, not some scary thing never to be spoken about. As Alua says “talking about sex won’t make you pregnant. Talking about death won’t make you dead.”

I think talking about mortality brings up some important conversations (even just with oneself) about the relative value of our day to day decisions. Interestingly enough, many of my postpartum books now overlap with my study of death. I recently read Overwhelmed: Work, Love, and Play When No One Has the Time by Briget Schulte and it had multiple mentions of how mortality was regarded over the years, and how that was reflected in how we approach our day to day lives, including our aggressive work-above-all work culture today. The logic is, if you think about your mortality to a normal moderate amount, you make choices that are more centered around your mortality. We aren’t talking about the “YOLO” ideology, but rather decisions such as ‘maybe you don’t need to take that extra late business call that’s not really mission critical in lieu of spending time with your loved ones’, and that kind of logic.

Oh that reminds me- I did recently finish a class through Mothering Arts about how to create a community supported postpartum space that I really enjoyed. It offered lots of insight in how to welcome in new mamas as well as community “grannies” and draw-in local professional women to offer their expertise to the moms. My only rub is that I want to create a larger scale space than that demographic (though not necessarily a large number of people at one time). I want to create a space (maybe a physical community shop) that welcomes everyone is to have discussions, seek community, find aid… almost something that mixes time banks, death cafes, postpartum meet-ups, with a part-time bartering system, all wrapped into a welcoming looking shop. I get inspired by places like HausWitch though my target audience is slightly different.

Obviously my long term goals are still being constructed, but I think one day I would like to own this type of shop with my sister (who is paving her career in graphic design/UX and my best friend (who is a social worker), offering classes and discussions, innovative tech, and community services centered around the biggest times of change (birth/postpartum, and death). We also want to raise families together so working together would give us the time and space to figure out how to make it all work. ❤

On the book front, I’m currently reading Witches of America by Alex Mar which I’m finding so inspiring. It’s not that I want to be a witch per se, but I love learning about different routes of beliefs and what draws people to them, and Mar explores this topic so well.

Anyway, as the colder months approach, I’m in the hibernation phase of life again. Lots of reading, snuggles with the little one, obsessions with soups, teas, and decaf lattes. My family and I are moving soon, which is a new adventure on its own because we are finally leaving Massachusetts, but is a lot of mental overload on how to move across multiple states (any advice is welcome). The move might be hugely impactful on my skin too because I think my condition gets worse in the fall due to a mold allergy (and fall here is pretty moldy!). I’m actually friggin’ psyched to be moving- but more on that another day.

 

all posts, community, mortality

let’s talk about death

burial cemetery countryside cross
Photo by Mike on Pexels.com

I seem to be drawn to fields of study that general society deems taboo. From talking about vaginas and all things women’s health, to my desire to talk about death, I really seem to have no boundaries. And so, with that, let’s talk about death.

I recently came across the profession of death doulas, and if I have a calling, I think it’s to become a death doula one day. More on that in a bit.

A doula I believe traditionally is defined as a woman who serves, and is used to denote women who work with other women, specifically in a birth and postpartum context. Both birth and postpartum doulas work as support people for pregnant women/moms, helping them to navigate various systems and life changes. Historically, communities were stronger and so the need for doulas was not so defined (women generally were supported by other women of varying ages, from friends to skilled midwives, and this support could start during the pregnancy and continue through childrearing years). But as we’ve become more individualized and modernized, this communal support has seen rapid decline, and so the doula profession developed to help remedy the lapse of the support.

So then, death doulas? Well, another consequence of the rapid modernization and aggressive individualism has been a shift away from dealing with death. We don’t tend to our deceased personally, we often have family members in homes that we don’t visit, we see more and more people dying in hospitals alone, or dying after enduring unending painful medical attempts to save/prolong their lives. More and more people are starting to feel that the way we treat the dying, and the lack of support around the times of dying are wrong, and it was from this belief that the profession of a death doula was formed.

The first formalized death doula I believe was Henry Fersko-Weiss. Inspired by the birth doula model, and disappointed by his own experience with his father’s and many of his patients’ deaths, Ferkso-Weiss wanted to create a profession that would allow for people to die better.

I know this is a weird and uncomfortable thing to get around. How on earth does one die better? Dying is miserable! It’s the end of life, etc. It’s hard to wrap one’s head around it, but that doesn’t make it any less important. A consequence of our culture’s death aversion has been increased fear. I distinctly remember my own personal existential crisis around age 7 or so when I confessed to my best friend that I was terrified about dying and becoming nothing. She replied back that this is why many people turn to religion, because it gives us something to believe in (very wise words for a 7-year old). This led me to years of trying to decide whether I believed in something or not (jury’s still out) and if not, how did I make sure I had a meaningful life until my time was over. The culmination of years following show a web of confused choices as I tried (and continue to try) to figure out what is important to me. As a result, I personally come across as erratic and fickle because I seem to change my mind instantaneously when in actuality I am constantly weighing my choices via long term projections, and thus constantly tweaking my day to day behaviors.

Now many people think that thinking and talking about death will get you depressed and worried. I believe the results of the death doula profession are seeing the opposite. Many people find that understanding that we are mortal and working towards accepting that allow them to appreciate life more. And people draw to being death doulas seem to be extreme lovers of life. My personal role model is Alua Arthur. She has an amazing video called I Plan People’s Death For A Living, which so distinctly highlights why she does what she does, and how it’s not as morbid as you think.

To fill the time between now and when I start actively studying to become a death doula (so after the baby (babies?) is (are?) in high school most likely), I have begun the process of reading all there is to read on dying, death, and how we as humans think about it, and how we process and deal with our/our loved ones’ mortality. It’s a fascinating field. And yes, it definitely can provoke the waterworks, but that’s just part of being human.

It’s also interesting because having the skin condition/autoimmune issues I do has made me much more aware of my mortality. If everyone is going on about how your 20s are your magic years, your skin is still great and you are super healthy, yatta yatta, than I already identify as someone who is past her prime. And I don’t feel negatively about this, but I do believe it influences the way I see the world and makes me think about the future in a more concrete fashion than many of my peers. Like when I said I wanted kids before 30, I realized I was 26, that it takes 10 months (ish) to create a baby, and so if I want to be done having kids by 30, it was time to start (and luckily my partner felt the same way).

I’ll end there for now, but this will probably be a running series of posts because it helps me get things out of my head if I write them down.

all posts, eczema, women's health

on biomechanics and katy bowman

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Photo by luizclas on Pexels.com

I’m combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

I haven’t posted in a while because “times [but mostly things in my life] they are a-changing”. What I mean by that is that I have a bunch of exciting things I’m trying to get involved with that are still centered around my various beloved themes, including:

  • community
  • women’s health… and now, a throwback,
  • biomechanics!

Let me catch you up. Once upon a time I was a confused undergraduate trying to narrow down the vast world of supposed choices to figure out my next step post-college. I knew I had splashes of talent in various areas, but that I was also relatively unskilled overall in a whole larger host of things, making me not a great candidate for any job (at least that was the opinion I had of myself). I remember I came to a point where I narrowed the choice down to two respective options:

  1. go to graduate school for biomechanics. Specifically comparative (non-human) biomechanics, but with the desire to see if I could follow in the footsteps of those inspiring people who learn from nature and then connect that learning to something in the human world (e.g. the tensile strength of sharks’ skin as a model for bulletproof vests, or the boxfish’s shape as a model for the most aerodynamically stable (and ugly) car), or
  2. go to physical therapy school. Essentially PTs are the biomechanists of the medical world (so in this analogy an orthopedic surgeon would be more like a biomechanical engineer). This therapy path would allow me a more direct way to give back to the people and help others.

As you may know, I ultimately chose physical therapy, and then ended up leaving it about halfway through the program because the physical contact (manual therapy, measurements, etc) with patients was not conducive with my skin condition. This  ultimately made physical therapy less than an ideal career for me.

So then, the deluge. How am I full circling back to the idea of biomechanics (though not necessarily comparative this time)? Well, first I started working in the field of women’s health a little over two years ago, which has since led me to undertaking the process for a prenatal and postnatal coaching certification (I actually just finished this past week and am officially a certified prenatal and postnatal coach!). I am also tying that field of knowledge to a few other movement-related initiatives, including the current co-creation of a course for single mothers of color (but I’ll go into more on that when it’s further along). I also am in the process of figuring out if I have the time to set up and lead stroller/carrier friendly walks in a local nature reservation.

While in the midst of these various endeavors, I also ended up finding Katy Bowman, a biomechanist and movement educator known for her Nutritious Movement company, which builds on her nature-based movement ideologies/passions. She believes in modifying our every day human environments (along with many movements we do) to better promote health and wellness, because movement-optimized environments require us to move better by their very nature. An example she gives is not having a couch in your home. This then requires you to do more squats (if you end up sitting on the floor, or chairs of lower heights), and forces you to move your hip, knee, and ankle joints in greater ranges of motion. The no-couch life also facilitates less sitting time by virtue of there not being any comfy furniture to sit upon, thus increasing your NEAT which helps your body even at the cellular level.

As I delved more into her material, I realized I had found someone that encompassed that overlap in my interests that I didn’t know existed; she is not a practitioner of health or medicine therefore not subject to the insurance whims, nor is she just an academic  stuck talking only to other academics/writing scholarly papers while being removed from the direct societal implementation. Bowman also intersects nature with the manmade world, bridging the choice I was stuck between (loving the idea of physical rehabilitation and the like while having a passion for being involved in natural environments, but unsure of how to make either a thing). Even more excitingly, after some light searching I discovered she too has a masters (in health studies, while I’m health sciences, but close enough) so I know it’s possible to straddle the academic world even in a health-esque field while not being a PhD or MD.

This is endlessly inspiring to me because now I’m starting to think it isn’t impossible to focus on prenatal and postpartum women and work with them and their babies/ young children to create lifestyle changes and increase our movement, while doing it all in nature. Though I’m not fully sure of the direction I’m going to end up going to get it started, all in all, things are looking to be very promising in the near future.

I have also used Bowman as an entry into foot health (using her book Whole Body Barefoot), subsequently contemplating the health of my own feet on a more regular basis. Since I left the category of a nulliparous woman (a woman who has never given birth), I’ve been thinking about how my body alignment changed during pregnancy and how now I still often feel joint laxity and generally less in-tune with my body. This has resulted in me walking more duck-footed than I had previously. I am testing out her suggestions to improve my foot (and global postural) health presently, but honestly ,uch of her program is just good practice for regaining balance and better alignment generally (like doing calf stretches and one leg standing balance exercises). I’m already noticing that I am more able to abduct my pinky toes further since starting. My personal goal is to retrain my feet to be able to wear minimalist shoes (or shoes that alter the natural foot mechanics the least). This includes working my way to comfortably wearing shoes with no heel lift (which normal even sneakers and many types of sandals have).

Before that book, I also read Bowman’s book called Diastasis Recti: The Whole Body Solution to Abdominal Weakness and Separation. Though the content is obviously useful for postpartum moms, the condition of diastasis recti (DR) can impact men and nulliparous women too.

In this book Bowman talks about how our modern lifestyles put a lot more pressure (force) on our cavities (diaphragmatic, stomach, and pelvic) and so to combat that we need to make environmental changes in our lifestyle. This includes actions like sitting less in the day and returning to using our bodies to move more (rather than always having appliances and tools to help us).

The point isn’t to remove all modern conveniences entirely if it’s not possible in our lives, but to balance out those convenient factors so our bodies have a chance to regain better mobility and functional strength while we continue to go about our daily lives.

The most crucial exercise Bowman suggests as a takeaway from her book is better rib engagement. This is done by drawing our ribs down and back without just sucking in our stomachs. We need to get our ribcage muscles and joint attachments to be less stiff because it impacts our ability to use our arms in their full range, and can cause issues if we move our pelvises with our ribcages all the time. Anyway, the book is definitely worth checking out to hear Bowman explain all of this (she does a much much better job).

The last thing I read by Bowman was a paper she put out about Movement Ecology. She addresses movement in multiple avenues, highlighting how we as a species gravitate towards decreased movement, which means more than just decreased exercise. She investigates movement as a broader topic, looking at how our daily activities and the environment around us help move and change our bodies in multiple ways, including at the cellular level (e.g. literally deforming our cells as when we lay on an object and our cells flatten). It’s cool stuff!

The fun thing about Bowman’s work (and I’m just talking about the books/papers I referenced in this post, so foot health techniques, diastasis recti prevention, and movement ecology practices), you can already come up with a fairly comprehensive program for prenatal and postpartum mothers to help them stave off lifestyle-related aches and pains, and regain more function respectively, while building foundational blocks of strength and mobility. And that’s what I’ll be playing around with next with my own routines.

On a tangent, I wonder how much of the severity of my topical steroid withdrawal would be alleviated  if I moved more?

all posts, community, nature/the environment, parentings/things about baby and kids

on parenting, environmentalism, and community

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Photo by Craig Adderley on Pexels.com

I’m combining all my other blogs’ content to this site. Please bear with me as I post older content. 🙂

I read the book Achtung Baby by Sara Zaske, which was a great read all about the differences in parenting mentalities and practices of Germany (specifically Berlin) versus the U.S. It covered categories ranging from policies about children walking to and from school alone, to history courses offered at their respective schools and the differing practices when it comes to forming children’s senses of cultural and civic responsibility, to how to allow the children to establish confidence in themselves.

Zaske also addresses the importance of unstructured play on future development of children, and how to try to change/influences policies where you live.

I read this books, not to replace my own instincts in parenting my baby, but to understand how much of my parenting style is built from within a specific culture, and is not just “intuition”. The more I read, the more I see what culture I am blended within, and the more I can truly pick and choose what works best for me.

Of the “parenting” books, I have also read The Happiest Kids in the World by Rina Mae Acosta and Michele Hutchinson. It depicts two expats’ views on parenting, this time in the Netherlands. The expats were one British woman and one American woman talking about their insights into raising children (from infancy to eleven years of age) based on the fact that parenting in the Netherlands focuses on creating happy children. The whole society gets involved to make it a priority.

It’s a good read, and I recommend it for any parents who are worried that they are trying to push their children into checking off too many accomplishment boxes, without taking into account their children’s wants and preferences. Or it’s a fun read if you are just curious to understand how parenting is done in other places.

Previously, I also read Bringing Up Bébé by Pamela Druckerman, and French Twist by Catherine Crawford. So my distribution in countries has extended to Germany, France, and the Netherlands but I am working to expand that presently.

These books aren’t here to specifically instruct or convince readers on a certain way of how to parent per se. In fact, most of the authors are expats raising their kids in a new culture and then trying to blend that with their their own in attempt to find balance. However, they all do reflect on commonalities they see in whatever society they are part of at the time, the one that shapes their raising of children. They also do end up implanting little nuggets in the malleable pockets of my gray matter that make me question the status quo of my own culture. In particular, why does my culture (and many others) prioritize working above all?

How does removing playtime for young children and filling it with structured activities with parental supervision impact both the future generations of children as well as the parents currently doing the implementation? What can individuals do to try to mitigate the cascade of symptoms that lead to a cemented cultural practice enforced by litigation (the culture of suing everyone and everything for accidents)?

My mind is teeming with perceived implications for my own little one, and I’m wrought with fervor to carve out a way to achieve the most balanced route for her to grow as her own person. Now I wouldn’t say I worry about her future yet in the anxious melodramatic ways that bubbles into most of my thoughts, but I would say I’m genuinely curious about what happens next. How do I find like minded, community-based people who want to preserve the innocence of youth, but also encourage the growth of young independence in a society that looks to constant busyness as a sign of success? Is it possible within our societal framework? Also, what is happiness and how do we create a space for our children to discover it, and have it be lasting? More to come on this subject in later posts!

One last tie-in I have for today. I read a book called There’s No Such Thing As Bad Weather by Linda Åkeson McGurk, and it compared different aspects of parenting in Scandinavian countries versus the United States (and other English-speaking countries). Much of it compares how the way we raise our children in regards to their relationships with nature. According to McGurk, in Scandinavia they have more focus on outdoor education for young children so that when those children grow up, they continue to appreciate nature and are naturally (ha, pun) more inclined towards environmental protection.

But another large takeaway from the book was that your society has to support these kinds of initiatives. In some Scandinavian countries, people can cross over (or children can play on) other people’s private land/property (think huge backyards and fields) legally, so long as they don’t cause any damage.

The countries also work to instill independence and responsibility in their children by letting them take more age-appropriate risks (like 8 year olds walking to and from parks alone, or playing outside for hours after they’ve gradually learned the areas with their families). I also recently rewatched Lord of the Rings with my husband, and it always instills in me how important nature is to humans, and how much of humanity just sees it as something to conquer rather than a large part of our health and happiness. We forget that we need the good bacteria from the soil and plants, that the fresh air helps decrease infection and disease risks, that our food either comes from or is fed from nature, that we derive a sense of peace from greenery, and that we can find comfort with change by appreciating seasonal life cycles.

It feels like letting our children learn from and develop stronger appreciations from nature sets them up with a good baseline to be happier and healthier than we are. I’m excited to hear and see about all the different initiatives small communities in America enact to figure out the balance that works for each child and family.

all posts

the 4th trimester, books, and blogs

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Photo by Pixabay on Pexels.com

I’m combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

The “4th trimester” is a term that has growing in popularity recently (and with it better policies!). It refers to the first 3 months after a baby is born, when there is still substantial growing happening (the baby develops the ability to sweat, to produce tears, to hold his/her head up, etc).

The exciting part is just how much more this period of time is being acknowledged by the women’s health community, including by healthcare providers. People are realizing that this is a period that can be quite difficult for women to adjust to, as well as babies. More discussions about postpartum depression, as well as physiological changes that can happen to the women are being had  (like how many women find that their stomach muscles do not “bounce back” after birth whether its due to diastasis recti aka abdominal muscle separation, or from having issues with pelvic organ prolapse).

The American College of Obstetricians and Gynecologists came out with a statement called “Optimizing Postpartum Care” this past May that talks about changes they believe should be included in the healthcare protocols/coverage, including an initial contact with the Ob/Gyn within 3 weeks of the baby being born, and then a comprehensive examination by 12 weeks to include “a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance”.

There are also doctors out there like Eva Zasloff (the founder of Tova Health), who are trying to reform postpartum care even more by offering comprehensive combined mom and baby postpartum care via home visits. So instead of having to rush out to the doctors’ offices for all these check-ups, she (or someone from her team) comes to you to allow you and your baby to get checked from the comfort of your own home, which can also reduce the likelihood of getting infections/sicknesses from others coming in to see the doctor. Honest Mamas, a group of three moms who are also psychotherapists who make podcasts recently did an interview with Dr. Zasloff that can be found here.

My obsession about learning more about the 4th trimester (in tandem with my love of understanding how pregnancy, motherhood, and parenting are done in other countries) led me to this article called “How the World Nourishes Mothers” the other day on goop.com. They did a Q&A with Heng Ou, a mother and the creator of MotherBees, a company that does meal deliveries to new moms. The meals are based on zuo yuezi, a Chinese ideology of nourishing a new mom with specific warming foods to welcome her and help her transition into motherhood. Ou also wrote a book called The First Forty Days, which I plan to read (and use!) and will write up about afterwards in my books of the season post.

It’s interesting to think about how different cultures respond to new moms. For women that are blessed with communities and support systems, a wide array of behaviors can be seen, from how much rest time moms are expected to have, to what foods people bring them.

And lastly, since I first wrote this when I was getting quite close to my own due date, I’ve been looking to hear more about the 4th trimesters experience of new moms’. One morning, amidst a bout of insomnia, I came across this post by Jen Eddins on her blog Peanut Butter Runner. She talks about her life as a mom of a now 3-week old, her emotions, how her body is doing, etc.

all posts, community, miscellaneous

a community is like a spider web

spider web formed on green leaves
Photo by Johannes Plenio on Pexels.com

Jake and I had been talking when he said something that made my brain go “OH!” and basically re-wired years of misguided searching. What he said to me was, “I think you are confusing community with suburbia. You grew up in a suburb, but you had a community… most of the time suburbia is not synonymous with community.”

Now that may seem obvious to you readers, but for me it was an eye opening moment. For years I have waxed poetic about how and where I grew up, equating the two in my mind and constantly yearning to find that again as an adult, in a new place. We actually currently live in a suburb (though a weird one because it acts like a seceded city from a larger nearby one. It also gets terrible amounts of run-off traffic that only a coastal town abutted by a huge city can get).

When Jake said that to me it hit me that that was what is missing from here versus where I grew up. I lived in the same place from ages 11-23ish and got to re-invent my life in my community over and over again. I had friends in the area sure, but even after many of them came and went I had their parents, my neighbors, new co-workers with whom often shared people in common who we knew, random encounters with townsfolk, etc. The life felt interwoven and connected despite me spreading my wings in multiple literal towns.

So while I was taking a bath today I was thinking about my community and what it takes to have one and why I don’t have one here. Some of it is definitely a product of time. I have only lived in this town for 10 months now, most of which I was pregnant for or had just given birth, and for all of it I was sleep deprived and battling topical steroid withdrawal. So yes, I haven’t been spreading my roots as aggressively as I could have. I started out strong: when I moved here, I baked cookies and delivered them to neighbors’ houses with hand-sketched phoenixes as a weird get-to-know-you thing; and then I also made it a point to meet all the librarians during multiple library visits, and also explored the farmers market on occasion. But then between my physical condition and my pre-to-post baby phase, I grew tired.

That and was hard to establish a deep connection when one is in different stages of life. Our neighbors are mostly all parents with kids who are between 9-19 years old, and the parents themselves are probably all in their 40s (I’m guessing). Many of the parents include one of the couple who is a state native, and if not born-and-bred in this town, they were probably born in one within a 15 mile radius, and thus lots of them have family around. Many of them are working, or randomly gone a lot of the time so it’s always a chance encounter when I do see them.

It’s also just a different type of town than what I grew up in. This is car community. I’ve tried to make it walkable to the extent that I love, but the sidewalks end randomly and the roads are hilly and windy, and people tend to speed aggressively. It was fine when it was just me on foot, but with Fiona in her stroller I just don’t feel as comfortable.

But how does this relate to a spider web? And why am I thinking about spiders when I have such a phobia of them? Well, I’ve been reading a lot of southern-set books lately (first ‘Midnight in the Garden of Good and Evil’ by John Berendt and most recently ‘The Prince of Tides’ by Pat Convoy), and the one thing they have in common is a deep-seeded love for their environment. They talk about the flora and the fauna and the smells and the colors as an important part of the experience around the stories they weave.

In The Prince of Tides (which is fiction), there is a background story within the story that talks about how black widow spiders helped save the family from a murderous intruder (because the children released the spiders all over said intruder) and how afterwards the family never killed another spider again, and it made me think about spiders and my own fear of them. Then when Jake and I were discussing community, I thought to myself, “hey, a community is kind of like a web” and that led to this post.

A community is like a web. And by this I mean that the ideas behind a web almost fully apply (if taken with creative liberties).

A web is built slowly over time,
One thin gossamer strand at a time
With the determination of knowing what it should look like
But innately, without blueprint,
With knowledge of its fragility
And understanding of the need for constant adjustment
As bugs and debris and miscellaneous items rend it broken.
It is made over an existing space
Be it flora, or the existing corners of a barn
Or something in-between
The web does not exist without some sort of baseline structure
But it can be recreated over and over again in new places
As need demands, thread by thread
Again and again as it suits the needs of its creators

Anyway, that’s where my mind was roaming today. I think it’s also why I yearn to move back to my parents’ area. I found a community I liked and now I just want to return to it so Fiona can experience it too. Maybe that’s lazy, but I make no excuses for it.

all posts, eczema

“how doctors think” about eczema

assorted doctors tools
Photo by rawpixel.com on Pexels.com

A few weeks ago I finished a book called How Doctors Think by Jerome Groopman and oh boy do I have thoughts. First off I have to say that the book had its fair share of  downer moments because it had a lot of cases of patients with cancer who struggled with doctors to find plans of care that extend their life just a bit more.

But other than that it was full of all kinds of information about different schools of thought that doctors employ to help their patients. Two specific ones it mentioned included the evidence-based and algorithm-based approaches.

With the evidence-based approach, the doctor relies on existing research, especially those that have a large amount of studies behind them. The issue with this approach is that doctors often default to using said heavily-backed solutions without inquiring or considering less numerously-backed ideas. This could become a problem, say if a new drug has tens of studies done on it, all sponsored and paid for by the company that produces the drug, while an alternative medicine or treatment may have great results but only a handful of studies supporting it, In that scenario, it’s almost more of a research field monopoly,  rather that robust results that gives the drug the good reputation, causing the doctors to favorite it more. In relation to eczema, where these ideas can be applied is in understanding how to approach doctors in a way that doesn’t cause them to default to automatically prescribe topical steroids (the long standing, most heavily-researched atopic dermatitis prescription option) as the first line of action.

With the algorithm-style approach, the doctor can follow a flowchart style of logic that’s been proven relatively effective over time. Its basically like having a graph that has arrows from each option to a few subsequent options, like:

“Does the patient have X cluster of symptoms?

  • Yes = Prescribe drug A.
  • No = Run test 1.

Is test 1 positive?

  • Yes = Give drug B.
  • No = Run test 2.”

And so on, and so forth. The flaw with this approach is that it doesn’t allow the doctor to think outside the box, which Groopman argues can result in said doctor trying to fit a patient nicely into an existing “flowchart” result, even if there are some signs or symptoms that don’t quite match up with that diagnosis. This may be the case when someone has other co-morbidities too or when someone has common symptoms of two very different diseases (like this example of a woman who was using topical steroids and found out she had lymphoma). For this problem it can be useful to ask the doctor what are the best and worst case scenarios of diseases that fit the presentation of symptoms. Asking this can help a doctor think beyond their initial conclusion and more thoroughly work to rule-out other options.

Another significant point the author makes is that for doctors to really become better, they must remember their mistakes and use that vulnerability to inform their care. He gives examples of renowned doctors who literally have binderfuls of their mistakes that they reference to maintain humbleness and act as a forcing function to always push themselves to improve. This might be a more difficult conversation to have with your doctor as I imagine no doctor enjoys being asked, “so let’s talk about all the times you royally effed up with patients”.

One last subject the book addresses that I’ll bring up is the pressure doctors implicitly face when they accept any form of samples or gifts from big pharma companies. It’s not that all pharma-marketed medicines are bad, but that you want your doctors’ reasons for choosing a specific product to come from no other influence than that they believe it works and have seen that said products have good efficacy. This is why it can be hard to decide whether or not to use samples a doctor gives you as you don’t know that they really think it works or if they just happen to have them around from a sales pitch. A question to ask in this case might be “have you seen a lot of positive outcomes from use of X product?” Another way to foray into this territory with a doctor is to ask about long-term results, as well as what are any known side effects (this could apply to eczema-related products like topical steroids to non-steroidal creams or biologics or brand-name moisturizers). If something sounds too good to be true, it’s probably fairly new to the market and so the longevity of effects haven’t been tested. A further question to ask is if there are any cheaper off-brand equivalents because those usually only come out after something has been on the market for a while.

These are just a few of the points that the book made, that I’ve tried to connect back to how to talk with your dermatologist about eczema. There are more factors involved that could make the process more convoluted or impossible in some instances, but I do think these provide a light foundation to attempt to build a stronger relationship with the right doctor.

Speaking of the right doctor, I have an older post that goes more into making sure you feel comfortable and that you have a good rapport with your doctor, which was another huge point Groopman made in the book. He explained that a patient who is difficult to treat, simply by having complex issues that don’t respond to more common treatments, often ends up being resented by the doctors, and as a result gets worser care. The suggestions in the book for overcoming these kinds of doctor-patient relationship issues is to say something like, “I know my condition is difficult” or “I feel like we got off to the wrong start” to help try to make the doctor aware of their negative emotional bias.

On the flip side, a patient that the doctor likes too much may also get worse care if the doctor makes overly sympathetic emotion-based decisions like skipping tests to not inconvenience the patient or by avoiding procedures that may cause the patient pain, etc. To overcome this issue, it can be as simple as saying “please treat me like you would a patient you knew nothing about”, and hopefully that should provoke the doctor into making sure they’re as analytical and diagnostic as possible again.

I’d love to hear about any particular experiences you’ve had with your dermatologists in the comments, and whether or not you agree with my suggestions, and also from any doctors out there reading this.