Heeeeeeey. What’s up? Anything new and exciting? Not much here, you know, normal stuff. Just…. well, we live in California now. And have new jobs. New friends. New life, basically. I don’t even know where to start, exactly, so just picture me kind of jumping up and down excitedly, in a not-quite-unpacked house.

Well, ok, wait. Let’s back up. I missed some things.

Someone turned ONE, which seems… well, it still seems not true. But pictures and the calendar indicate that it is indeed a thing that happened, a month and half ago.

birthday girl
Who, me?

We had a little last minute “party” – just us, our nanny and her mom, and Kevin’s mom. Birthday cake (technically for Hazel AND me) and presents, both of which Hazel enjoyed immensely.

Excuse me, why is there fruit in my cake?
Excuse me, why is there fruit in my cake?

Eliza is really into birthdays lately – she knows the song, she knows there is cake, and presents – so she had a pretty awesome time too. Hazel got a tea set and some baby dolls from the grandparents, both of which are very big hits with both of the ladies.

Hazel FEEDS the babies, I could just die.
Hazel FEEDS the babies, I could just die.
The ladies, having fancy tea.
The ladies, having fancy tea.

Hazel’s birthday was right in the midst of our moving insanity – We had Kevin’s mom coming out to visit for Hazel’s birthday, and a vague sense that we might need a hand, but not sure exactly when. We found out with about four days’ notice when we would be getting packed up. Fortunately, our Washington besties were having a graduation party that week, so we got to see everyone one last time despite the short notice. My last day of work was a Wednesday, and our house got packed up the next day. It was chaotic and insane and thank god for my mother-in-law and our nanny, and also the Cramers for letting us play in their empty house for a few hours. We dropped Sherry off at the airport on Friday morning, spent Friday night in a hotel in Richland, and flew to California way too early on Saturday morning. Especially considering Hazel doesn’t sleep in hotels. At all.

Slept on the plane, though, didn't you Hazel? Mmhmm.
Slept on the plane, though, didn’t you Hazel? Mmhmm.

(I’m going to just gloss over the part where I lost my wallet, and had to take a pop quiz on Susie’s Life History from a TSA agent so I could get on the plane. Fun!)

Once in CA, we did a walk through of our rental house, and then descended on poor Miranda and her lovely family. They were kind enough to let us hang out at their house alllllllll day long, despite our overtired, overstimulated, and slightly ill children. All the next day too. Was amazing. I totally recommend having a best friend available at your new location when you are moving. Among other things, she also lent us air mattresses and blankets for our week in a completely empty house, so we wouldn’t have to “sleep” in a hotel for ten (10!) days until our stuff arrived.

A week in an empty house with two small kids and a husband who is already working a good bit: DO NOT RECOMMEND. (But definitely better than a hotel would have been.) Empty houses with wood floors: super loud. Toddlers: also super loud. Combine them, and you will want to jump out a window. I spent most of the week marching the ladies around town, or letting them eat as much dirt as they wanted in the backyard, because omg please be quiet and calm. It’s been long enough now that I can remember it fondly (….ish), but I hope never to do that again.

The breakfast tableblanket.
The breakfast tableblanket.
Sure, darling, eat all of nature, whatever keeps you quiet.
Sure, darling, eat all of nature, whatever keeps you quiet.
Necessity is the mother of re-purposing one's underpants.
Necessity is the mother of re-purposing one’s underpants.
Oh, just taking 60 lbs of baby for a walk.
Oh, just taking 60 lbs of baby for a walk.

Our stuff eventually showed up, as did the nanny, so the following week was spent unpacking our house. That was a physically punishing experience. It’s mostly done. We moved into a smaller house, so there is still a fair amount of stuff that is boxed and stacked in the garage until we have time to triage it, and hopefully better organize whatever remains. A lot of decor stuff is still in stacks on bookshelves, because we don’t have everything where we want it quite yet. We have to get bookshelves and so forth tethered (earthquakes, small children), and bah. Hey, at least there isn’t an extra couch sitting in the driveway anymore.

It’s funny how my mentality has shifted after four plus years of home ownership – we might only be here for a year! I don’t want to go to great lengths to get the house perfectly set up and decorated, if we are just going to move. But who knows how that will all unfold. We LOVE the town we are living in, and we love our neighbors. It would be awesome if we could stay here longer, but it will be awhile before we know more on that front.

The ladies are adjusting well – Eliza ran around for a week or two, pointing to all our stuff and talking excitedly about how each object came back too!, which was adorable. Our neighbors on both sides also have little girls, very similar in age to Hazel and Eliza (like, a few weeks different. Insane). We even have a gate through our back yard into one neighbor’s yard, and Eliza and Lily knock on the gate and talk to each other. Sometimes we leave the gate open while we are cooking dinner, and the girls run back and forth playing.

We also get to see Miranda et al. a couple times a week – the kids are taking swimming lessons together, and Miranda makes lunch after, and holy crap that girl can cook. We’ve been having them over for dinner once a week, but we’re going to have to step up our menu planning game. Fortunately, I care more about how adorable our kids are, playing together, than I do about my culinary prowess. It’s funny – Eliza has mostly paired off with Hayley, even though Hayley is a few years older and Damien is basically her age. Damien has taken a shine to Hazel, and it’s adorable. He chases her around in slow motion, and helps her when she falls over, and oh. So cute.

They all just... play. It's amazing.
They all just… play. It’s amazing.

So, yeah, things are hopping socially – such a contrast to when we first moved to WA in the middle of winter and didn’t know a soul. I also got to go hang out with Erica and Hillary for an internet baby play date, which was amazing. And we got to see some college friends over July 4th weekend. We haven’t had half a chance to do any sightseeing or exploring beyond our town yet, but we have a list of things we want to do if we ever find ourselves bored.

The bar is low, based on how much Eliza likes even just riding the train.
The bar is low, based on how much Eliza likes even just riding the train.

Work is fantastic so far – it’s a huge change, in terms of the science, the application, the atmosphere, the pace. I’m enjoying it a lot. I like the people, especially my boss. I’m really excited to see how things unfold here for me.

It’s weird, I have this persistent sense that things are just… the way they should be. So many little things have happened perfectly, easily, with this move. We found an ideal house (In law suite! Close to my transit needs! Walking distance to work for Kevin!) available exactly when we needed it, within our budget. It’s turned out to be in an amazing location, surrounded by built in buddies for both kids, and us. And there is a possibility it could work out long term. We both found jobs that we are truly excited about, with coworkers who seem wonderful. The timing on a bunch of little things has worked out perfectly – and things just FIT, in a way that feels so lucky. I don’t know. There have been little not-perfect things here and there (like, oh, my ankle situation flaring up so badly that I couldn’t walk all weekend, or Hazel choosing not to sleep at all during the move), and of course we miss our friends in Washington, but this just feels like it was the unequivocally right decision for us.

That’s it, really – I’m being persistently optimistic about everything lately. This is not my standard setting. CALIFORNIA, WHAT HAVE YOU DONE TO ME.

Posted in California Dreaming, little bears, Me me me | Leave a comment

Seven Quick Takes: Moving Right Along

1. Thanks for all the love and support on my last post, for me and for the women who shared their stories in the comments. The UCSB shootings and ensuing discussions really hit me. I think the discussions coming out of this are big and important and I hope they aren’t just a blip. I’ve read a lot of really great posts, old and new, on the subject of misogyny and rape culture in the past few days, if this is a subject you want to read more about. Some of these posts are angry, but so am I, and I think you should be too.

Tara / Our Little Geekling: Advocate
Todd VanDerWerff: Not All Me
Arthur Chu / The Daily Beast: Your Princess is in Another Castle: Misogyny, Entitlement, and Nerds
Kate Harding / Shapely Prose: Schrodinger’s Rapist, or a Guy’s Guide to Approaching Strange Women Without Being Maced
SJ / I, Asshole: Personal Space and Being a Lady
Alice Bradley / Finslippy: On Being an Object, and then Not Being an Object

2. Moving right along to less fraught subjects, Eliza got her first hair cut yesterday. Just a little trim, you can barely tell, but she was starting to look kind of like a hobo when it wasn’t brushed. (She’s 2, so that means most of the time.) Both Kevin and I have been getting our hair cut by the same lovely woman basically since we moved here, so it felt right that she should cut Eliza’s hair too. Her name is Anna, pronounced as in Frozen, and we are pretty sure Eliza thinks she is ACTUALLY Anna. She kept asking where Elsa was, while sitting still quite happily as a stranger played with her hair.

Just a trim.
Just a trim.

3. We are moving to the Bay Area sometime in the next few weeks. We’ve both officially accepted our new jobs, and officially given notice at our current ones. Kevin’s last day is next Friday, and mine is probably the week after. Kevin’s new job starts immediately – he’ll be working remotely – and mine will start July 7th. As for what happens in between, it is still largely a mystery. We will be getting relocated by my new company, but haven’t been contacted by the moving folks yet. We can’t start the house selling process ourselves – have to go through the company. So it’s mostly hurry up and wait – things are going to be totally nuts soon, but not YET.

4. The one thing we CAN do right now is try to find a place to live when we first get to the Bay, and I think we have that wrapped up. Normally, new company puts people up in corporate temp housing for a few months, but our family is too big – there are only a small handful of three bedroom places, which aren’t even available right now, but even if they were- we need four. (Have I mentioned our nanny is coming with us?) So we will rent something ourselves and get reimbursed for a couple of months. Miranda went and checked out a house for us this past weekend and we spoke with the owners last night to finalize things. So with that, we are good for at least a year. We are hoping that will give us time to figure out where we might like to live more permanently, if not the area we land in initially. It’s also possible the owners will make their east coast jaunt permanent, so we’ll see how it all pans out.

5. I am REALLY excited about new house. It sounds like it’s in a great part of the peninsula for young families. It’s walking distance to parks and a downtown area, farmer’s market, restaurants, public transit, all kinds of stuff. It’s a gorgeous house, with an in law suite – perfect for our nanny to live in while we all figure out our new lives, or for family or friends to stay in when our nanny finds more fun people to live with. The school district sounds pretty great, and one of the owners has worked in the school system for a decade, and has tons of useful inside information. The house comes with biweekly cleaners and yard maintenance, oh and also a hot tub. So, things that I would never (or at least, have never) prioritized for us, but would love to test drive. Also, apparently the next door neighbors on BOTH sides have girls the same age as Eliza, and on one side, the same age as Hazel. And more young kids through out the neighborhood. Also, In-N-Out is half a mile away, which is like the perfect “welcome to CA” metaphor for my stomach.

6. If you can’t tell, we are way more excited than we are nervous or apprehensive about this move. Excited about our jobs, our new home and surrounding environs, and also – excited about some of the friends we will be near (though obviously also sad to be leaving our friends here). We actually have a jam packed 4th of July weekend already, and I feel like that is just the beginning. Not being worried about starting a social network from scratch is SUCH a big difference from when we moved to Central WA. It took a good six months for the fog to even begin to lift, here, and for us to feel like we weren’t completely isolated and lonely. I really don’t foresee that happening at all, this time around. (I’d find some wood to knock on, but at least Miranda is so totally stuck with me that I’m not worried.)

7. Rachael introduced me to Duolingo yesterday, and OMG I can take Spanish quizzes on the internet?? This is AWESOME. I love taking tests. I am completely addicted. Let me know if you need me to say anything in Spanish, like “My horse eats a sandwich.” Also, apparently you can be friends on Duolingo and COMPETE so, you know, I’m snoozical. Hit me up.

Posted in California Dreaming, ephemera, Me me me, milestones, Miss Bear, you you you | 4 Comments

Yes, all women.

I don’t remember the first time I had sex. Not because I was drunk, or because it was such a throwaway experience. I don’t remember because my brain won’t let me.

I know the details, though – I know when it was, what I was wearing, all of that. Because four years later, I asked him. I told him I couldn’t remember and needed him to fill in the blanks, jump start my brain. It didn’t help, but I’m glad I asked.

I was 15. I was wearing my favorite green and yellow sundress, and it was in March, unseasonably warm. It was after school, when he was supposed to be tutoring me in chemistry. He was a senior, 18, so smart and for some reason he’d decided he liked me. He was my second boyfriend – I’d dated a guy for two whole weeks in 8th grade, and we’d kissed one time at the baseball fields. But this was different, this felt grown up and real, heady. Maybe also because it was a secret – no one knew, not my best friends, not his. He’d just broken up with his longtime girlfriend and she wasn’t handling it well. My brother was in his grade, and we knew he’d be pissed about it.

He told me he loved me while I was giving my very first blowjob, and I remember that I wanted to feel happy – he loves me! – but just felt kind of dirty. We talked all the time, about everything, up to and including sex – I told him I wasn’t ready, it was too much, too fast, and I was too young. He said that was just fine, that we could wait as long as I wanted, we had all the time in the world. But his words didn’t match up with his body, and he’d push and prod till we were way over the lines I’d set. I’d always say no, try to keep his hands up high, and I’d cry while it happened, but I never screamed. I never left.

It didn’t take long for everyone to find out we were together. I remember that day very clearly – the stares in the hallway at school, people whispering. My brother, angry and not talking to me. His ex-girlfriend’s mom worked for the school system, so even the teachers were paying attention. I eventually heard the gist of what people were saying: that he’d dumped her because she wouldn’t put out, and I would. I remember feeling like it was true – I felt like trash, like a slut. The only person saying something different was him.

I remember sobbing in the shower over spring break that year, because I was afraid I was pregnant. I’d only had my period for a few months before we started dating, and because we weren’t going to have sex ever, he wouldn’t do it again, don’t worry – because of all that, I wasn’t on birth control, and he wasn’t using condoms. I drove a few towns over to buy pregnancy tests. I bought a bunch of them, because I guess I knew on some level that he was full of shit.

I mostly remember three times, out of however many there were. I remember the two times I cried and cried, so much that afterwards he cried too, and said he felt like he’d raped me. That made me cry harder, and reassure him, no of course not. And I remember one other time, when he came on a ski trip with my family, but that one I don’t like to talk about yet. 14 years isn’t long enough, I guess.

I broke up with him for good when he was studying abroad in France, the summer before my senior year. I didn’t think too hard about any of it – studiously avoided doing so – until another year after that, and that wasn’t pretty. He was the kind of guy parents really like – smart, responsible. They were pretty confused when I followed him up with a long string of boys who didn’t seem to measure up. I mostly dated boys I knew I was smarter than, had more experience than, so I could be the one in control, I think.

I never told anyone, at the time. I thought about telling, but I was so afraid – I knew it would ruin his life, if they believed me. His bright, shiny future. I knew, if nothing else, the age difference was illegal. And I felt like it would have been ME ruining HIS life, plain and simple. I still feel that way, on some deep level – that his actions didn’t deserve the kind of repercussions available. I know that now he is married, he has two young daughters, and he seems happy. I’m glad, truly. I wonder all the time if he gets it, what he did to me, if he understands it was wrong, maybe now that he has daughters of his own to hope for. I don’t think he is a bad person, just that he made bad decisions.

But I do wish that our culture didn’t make 15 year old me feel culpable for his actions, or the effects of my response to them. That I’d be responsible for the outcome of HIS actions, if I chose to speak out. I wish our culture didn’t shame women for being victimized. I know so many women who have expressed relief to me, when I’ve shared this story, that they weren’t the only ones. Relief that a friend had been raped, too, because it made them feel less alone, less damaged. Relief that a friend had been abused, objectified, discriminated against, terrorized, or terrified, or the million other things that happen to ALL women, every day. The best I can do right now is talk about it, loud, without shame, because I know other women aren’t ready to do that, yet. I am.

I am ready for our culture to change.

Posted in Me me me, retrospect | 31 Comments


I had a lovely weekend and birthday in Atlanta. So lovely, and with so much cake (THREE cake situations! I was there for five days.) that I had to ask Kevin to POSTPONE my birthday cake.

The man is wise.

No seriously, I had cheesecake and various baked confections for a baby shower, and then a DINOSAUR CAKE OMG for my totally unexpected surprise birthday lunch (which was at a proper southern mexican joint, with QUESO!), and then my momma got me my traditional Publix birthday cake the next day. I didn’t know about each of the subsequent cakes, so unwittingly had cake for breakfast each morning. SO MUCH CAKE. I also got to revel in my friends and family, and oh, it was just a delicious, perfect weekend.

Is there a more Susie thing in the world than a green dino cake?
According to this cake, I am 16.

For my birthday, I also officially got a new job. And so did Kevin. We are moving to the Bay Area sometime next month. We are just now jumping into the relocation madness and I don’t even know how this will all unfold yet, but I have big eyes. We are really excited – this has been unfolding slowly since February, and now it’s HAPPENING. It was pretty wacky, I spent all of Friday (i.e., the last day of 29) on the phone with Kevin and various colleagues and once and future bosses and HR people and and and. I kept handing off my baby to go talk to people and then finally at like 10:30 pm eastern, it was done. So late! So crazy! That means the new job is baaaasically a birthday present.

New job is in industry, whereas I currently work for the government (sort of…. it’s complicated), and new job is focused on an entirely different genre of compounds than current job, but it’s still my bread and butter: toxicology and pharmacology, pharmacokinetics, dose, response, etc. etc. I am really excited. Like I said, my interview day was just so FUN – I have high hopes that the job will be as well.

We are bummed to be leaving our little town and our current jobs – this move isn’t happening because things are bad, here. This has been the perfect place to start out our grown up lives, and our family. But it’s an odd place – very transient, so many of our friends have moved away over the years, and quite small, so certain leisure pursuits (like frisbee, if I could even still play) are more challenging. It’s hard to get to and from our friends and families, and direct flights will be a game changer. (Though, as my mother pointed out, we will NOT be any closer to Georgia. Sorry!) Our jobs have occasionally felt unstable, here, largely because if something were to happen, there isn’t another option. It’s the only show in town. It’s just a small fish bowl.

So, we are heading to the one of the biggest (and most expensive) fishbowls in the country. This should be quite a lark. Stay tuned.

Posted in Me me me, milestones | 7 Comments

Seven Quick Takes: kids, birthday, vacation, cake.

Today is my Friday, so how about some quick takes, i.e. the only nonsense I can muster.

1. Hazelnut update: Hazel is 11 months old as of yesterday, which is completely bananas. She continues to be very cute, mostly sweet, and to suck at sleeping. (No but seriously, she gets up 2-4 times a night. What the hell. We’ve tried all the things, and I think she is just like that.) She’s still nursing, and I guess we’ll just keep on keeping on with that. She got back into uncontrollable dancing after a bit of a break. She seems to be a bit of a climber, much more adept at scaling furniture than her sister was. (We tried to teach Eliza how to climb up on the couch using a stool. She finally sort of figured it out when she was… 20ish months old?) She busts it into high gear when we catch her doing something she shouldn’t – heading towards the stairs or the cat food or away from the diaper changing station. And she shakes her head no as she crawls off into the sunset, because she KNOWS. It’s hilarious. Still not walking without a hand on the furniture, though she loves this nonsense:

2. That right there is compliments of stomach bug induced cabin fever. Eliza was patient zero a couple weeks back, and then we all fell, even Bertie. Even our nanny’s MOM. Thankfully, it wasn’t nearly as bad as back in September, AND I discovered that domperidone is a pretty effective anti-emetic. (No shit sherlock, they are marketed under the name “vomistop.”)

3. Sadly, a good buddy from our frisbee days came to visit and also got sick. I warned her ahead of time of the possibility, but she decided to risk it, and I love her for it. She didn’t get TOO sick, I think, and we still managed to have a good visit. It was a lot more low key than intended – we mostly watched disney movies and moseyed to the park, instead of camping or hiking or wine tasting. I guess taking the kids camping might actually have been worse than a stomach bug, tough to say. Hopefully she won’t be too scared to come back some day.

4. Eliza update: is starting to act more three than two. Fighting any and all opportunities for sleep, feeling out the depths of her own stubbornness, normal toddler things. But also: becoming increasingly able to articulate her thoughts, which is awesome and hilarious. She hates direct sunlight, so we just bought her like eight pairs of sunglasses and I keep telling her that she’ll have to make it work until she’s 18, and then she can move to Seattle I guess. She’s been hanging out with her buddy Lucy a lot lately, and gives so many spontaneous hugs and it’s just adorable. She talks about hanging out with Lucy all the time – “then it’ll be yater and I go to Yucy’s house!” I’ve been getting a good bit of one on one time with E, because of swim lessons, and it’s starting to reduce the all Daddy all the time thing. She sometimes lets me participate in bedtime! Very exciting. (Also, when Kevin is out of town, as he currently is, Eliza lets me deal with bedtime and everything else without too much fuss, for which I am thankful.) She’s very particular about certain things, and I love the way she asserts herself. “No no no no! I don’t YIKE that!” with her little hand extended in the universal sign for STOP. And then a little head tilt eye squint nod action, “Mommy do THIS, yeah, yittle bit.” Anyway, she is great, and so much harder to sum up than she once was. She’s Eliza.

5. I am waiting for some very important phone calls, and it has basically reduced me to my high school self, pining after a boy, staring at a phone, willing it to ring with all of my being. COME ON PHONE.

6. Hazel and I are going on an adventure tomorrow, so at least that’ll force me to stop staring at my phone. We are going to Atlanta for a quick trip – I’ll be hanging out with my pile of best friends for a couple of days, and then my family for a day. It’s going to be super fast and busy, and I’m bummed I won’t be able to see more of my Atlanta folks, but I’m SO EXCITED about seeing my best buddies. And also spending my 30th birthday with them. I am seriously overcome with emotion when I think about how lucky I am to have these women, and I am bummed that other people don’t have such a lovely support system, and oh. Just the best. ALSO the best: getting to see my family for my birthday! Not the best: ditching Kevin and Eliza.

7. HOWEVER. Kevin just asked me which day I would like my birthday cake, so score one for honest and open communication/passive aggressive blog posts! Just kidding, we discussed it like mature/whiny adults. Who cares though, because CAKE. 30 is gonna be juuuust fine.

Posted in ephemera, little bears, Me me me | 2 Comments

Bury the Lede

I am out of my groove, in so many ways, so let’s try some quick(ish) takes.

1. Hazel update: 10 months and change. We sleep trained her shortly after my last post, and kicked the swaddle to the curb. She had a monster of a sleep regression that was killllliiinng us (me, specifically), and we just hit a wall. We weren’t comfortable letting her rage in her bassinet, because it was a bit too small at that point, and we weren’t comfortable letting her rage swaddled on her floor bed (crib mattress, sans crib), because… I don’t know, I had some wacky notion about her glow worming off halfway and getting stuck and positional asphyxiation, and look. I never said I was logical about things other than toxicology, ok? Anyways, we took her swaddle and plunked her on her floor bed. We were intending to do some nice Ferber training, but it wasn’t working, and we were both SO EXHAUSTED, and well… Weisbluth. It wasn’t pretty, but she was fed and dry and safe and, ok, mad, but it WORKED. The first night was awful, the second night was better, and third night was glorious. AND she naps now! Like real actual PREDICTABLE naps. We can even put her down awake for naps. Magic!

Of course, since then, a lot of work travel etc. has completely hosed everything, so we need to do it again (SHUDDER), but it’s still so much better. She is back to waking up ~3 times a night. Kevin is actually giving her bottles and dealing with most wake ups, so things are on the up and up. For me. Kind of.

2. That leads me to… weaning? Yes/no/maybe? I want to, oh yes I do. I had a bunch of work travel in the past month, and more coming up, and I dragged the stupid pump with me, and excused myself from meetings, and got in a fight with this terrifying old lady running coat check, but lo, my supply still tanked. I got it back up to something resembling useful eventually, with liberal application of domperidone, but … gah. I am trying to decide whether to just wean her completely and be done with it, or see if we can hang where are are. She was happily nursing about 4x a day before my travel and it was nice, but now it’s like 3x a day, plus some slapping because the buffet is subpar, and then also lets wake up a bunch in the night to see if more food arrived yet. LAME FOR EVERYONE. Kevin has been giving her bottles sometimes when I’m just done, and that seems to make things worse in the supply department (DUH). Anyways, we are stepping up what she gets while I’m at work to see if we can cut out the middle of the night snacks.

3. Other Hazel stuff: Not yet walking, but cruising easily, and often standing unsupported so she can play with stuff. Since she isn’t nine months old like her insane sister was, I am perfectly ok with her starting to walk whenever she wants. Ten months is apparently my personal threshold for “reasonable age to start walking,” though I do think we still have some time. She continues to seem very verbally attuned – she signs pretty well (milk, more, all done, bye bye, pointing at stuff, working on some others), and can point to her nose, and do some other little tricks, and attempts to parrot all our talking. Her love of music and uncontrollable dancing seems to have abated, which is a bummer. Her love of food, on the other hand, has only grown – loves to eat. Other likes: reading books, pulling hair, sticking her tongue out, clapping for herself, absconding with crayons to eat. Dislikes: minor injuries, long waits at the buffet, when I leave the room.

4. Eliza update: I’m kicking myself for not writing some lovey dovey blog post about her the past few months, because she was being a DELIGHT, and now those days are past. She just hit 2.5, and oof. The bad: impressive temper tantrums, kicking her door every night when we put her to bed, whining, breaking rules she’s been cool with for ages, taking toys from Hazel, hitting Hazel when she cries, etc. etc. You know, normal two stuff. It’s not a big deal at all, she was just being SO LOVELY for a few months straight, and we got soft. It’s not all bad though, of course. She is talking up a storm, and she has a great imagination, and she’s so busy. She loves to pretend to make food (strawberry pancakes! vegetables!) in the oven (her cabinet), and feed it to her stuffed animals. She packs up her backpack and heads off to work, which is apparently in the foyer. She is obsessed with Frozen, like every toddler in the nation, and we catch her singing the songs to herself sometimes. She just started swimming lessons last week, big girl ones where I just sit on the side and watch, and oh. She’s so BIG and so little, all at once.

5. I tried playing frisbee a little bit a few weeks back, and UGH. My ankle has felt pretty great since I got a cortisone shot, back around Halloween, but I have been taking it easy. I played about three points before it started hurting, at which point I sat my ass down. It hurt for a couple of days afterwards, and I haven’t pushed it since. I’m trying to come to terms with maybe being done. It’s going… not great. I’ve been a huge grump about going to the gym basically since I messed up my ankle – because instead of it being cross training to keep me in good form for sports, it’s just… exercise. BORING. (for me.) I’ve also been a huge jerk about Kevin playing sports, because I don’t get to. So like, last week he went to play soccer one night after work, and I was all pissy about doing the dinner and bedtime gauntlet alooone while he was off running like some kind of uninjured jerk. Real mature, Susie. SO then he texts me and says he got hit in the head, minor concussion, and my immediate reaction was to be wildly irritated about him being even later to get home, like, what, he did it on purpose? Susie. What.

So, obvs I need to work on that whole mess. I have intentions to take up masters swimming, but I’m dragging ass. Also have intentions to seek out additional medical opinions regarding my bum ankle, of course, but blaaah. Also, I am considering taking up bike riding, but I have a long history of head injuries from bicycles, and that was before my vision got hosed, soooo…?

6. Like the rest of the internet, I fell down the bullet journal rabbit hole a while back, and it’s wonderful. Jonna has said a number of times that she thinks it works well for her ADHD brain, and I think it’s true for my ADD brain, too. (Which, by the way, we were talking about this viral post with some friends recently, and it was so interesting to hear how other people’s brains work! That post was a reasonable description of mine. If your brain is a clean white board, I am JEALOUS.) At any rate, the enormous pile of post it notes in my office is much diminished. My bullet journal is evolving, still – I’ve added in traditional calendars next to my monthly pages, I’m working out a color code. I’ve got a bunch of collections that are jumbled messes, because… my brain is a jumbled mess. But I’ve landed on a bunch of good lists/collections, and I’m significantly less stressed and flakey than I was six months ago. Though, uh, I still have some work to do. I also have a shiny new purple moleskine waiting for me, once I’ve got my system fully worked out, because we all know the magic’s in the moleskine.

7. Ok so, all that work travel? One of my trips was actually a job interview. That went really, really well. I mean, it was FUN, the whole day. I gave a kick ass seminar, and had a great time in almost every single one-on-one interview I had (which, there were… 15), as well as the three hour long dinner AFTER all the interviewing, which I suppose was ALSO part of the interview. The people were engaged, the science was interesting. Yeah, it was just a really good day. I’m not sure what will come of it. We both like our current jobs, and love the people we work with. The potential new job is in the Bay Area, which is so! expensive! and totally, mind blowingly COMPLEX compared to where we currently live. Tough decisions coming down the pipeline next month, but all the options are good, which is an excellent problem to have.

Posted in breastfeeding, ephemera, little bears, Me me me | 3 Comments

Seven Quick Takes

1. This is a great take on science reporting, and the news in general.

“…in a news market overflowing with facts, facts by themselves go unsold; they require a story—and that story … needs some kind of bias on the part of the author, ‘a pair of lenses that slide over reality and aim to bring it more clearly into focus.’ You can see what he means: our capacity to produce data on everything requires packaging; otherwise, it is like finding oneself in a library where all the books have been disassembled into piles of paragraphs, sentences and words. Our consumption of information requires an algorithm of narrative and the perspective of bias in order to produce focus. The problem — the presiding problem of our knowledge economy — is whether we end up focusing on something that’s actually true.”

I really love the author of this post – Trevor Butterworth. He has written a lot of good, interesting stuff for Forbes, and posts good stuff on twitter as @butterworthy (extra points for a hilarious handle/last name).

2. Following that piece indicating that bias is what makes us engage on this stuff in the first place, this article meshes pretty well with my biases. And dang, it would have been useful in that vaccine discussion on Jen’s facebook wall a week or two ago. The study the article describes several fact-based interventions aiming to change parental intent to vaccinate. The study authors sum things up well:

“None of the interventions increased parental intent to vaccinate a future child. Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects.”

Damn, that’s depressing. It only included 1800 ish parents, and I don’t have access to the full text, so I’m hoping the entrenched anti-vaxxers were a small group of people, thereby hindering broad extrapolation. But, well, it jives pretty well with every facebook interaction I have had ever, basically. Ok, that’s enough science for today (I’m saving y’all from a ranty tirade about BPA. BE GLAD.).

3. Hazel finally learned how to roll over! (On Monday, I think it was.) I will miss wee stranded turtle baby. Partially because it was the one surefire thing I could do if I needed to stash her somewhere for a minute. Girlfriend is on the MOVE. Other achievements recently unlocked: shaking her head no, pulling up to standing (and one ill-advised attempt at standing up unassisted, in the middle of the kitchen. NO MA’AM.), crawling over and frequently beaching herself on all manner of roadblocks. Remaining unsavory features: loud screamy yelling at random intervals, refusal to transition to swaddle free lifestyle, preference for late(r than 9:00 pm) bedtime. Made up for by: being the snuggliest monkey baby on the planet.

4. My brother is coming out to the boonies of central Washington for work next week and gets to stay a night with us, and I’m super excited. Hoping I can find somewhere good between here and Portland (where he flies out of) that we can go snowshoeing. I am REAL BAD at figuring this stuff out, as the funky microclimates of the NW are super confusing to me. Suggestions welcome, if you know of anything good. Also, I have to decide if it makes more sense to bring Hazel or my breastpump with me. To go snow shoeing. With my brother. #awkward

5. Speaking of pumps and my baby, I have several work related trips looming in the next two months, and I’m super curious to see how this pans out with Miss Bertie. Kevin has been handling a lot more of Hazel’s wake ups (or, more accurately, refusal to go to sleep in the first place), and I know he’ll be totally fine – and he is a champ at dealing with lack of sleep, if things go poorly. I distinctly remember my first work trip after Eliza was born. She was about five weeks old, and I remember feeling kind of superfluous as I packed up my pump and had no wise words to impart to Kevin about what Eliza might need in my absence, because he was the one who fed her and put her to sleep every night. It is very different this time, but we’ve made a lot of strides in the past month or so that leave me feeling like a) Hazel won’t miss me THAT much and b) Kevin won’t lose his fool mind trying to keep her fed and rested. Also I know Hazel can be, in many ways, a lot easier and more laid back when I’m not around (goes way longer between feedings, takes legit naps, etc.), so I’m wondering if it’ll just be no big deal. So, you know, now that I’m feeling like she’ll probably be just fiiiine, I’ll move on to worrying about my milk supply and if she’ll decide nursing is for the birds*. Can’t just have my brain sitting around, all idle like, now can we?

6. It is my niece’s second birthday today, and as per usual, I have not mailed her present yet. I am the actual worst at gifts, especially of the on time variety. I was talking with a close friend about this – her love language is timely and thoughtful gifts, and mine is NOT. (The love language thing mostly cracks me up – I’m being tongue in cheek when I use it. My love language is playing with my hair, if you’re wondering.) The conversation centered on the possible completion of the second half of her Christmas gift by the end of the month. The gift was: a pair of gloves. Well, half of a pair. A single glove. Anyway, I have talked about this before, so I won’t beat it to death, but let me just say: if I forget your birthday, or a thank you note, or I remember them but send it a month/year late, I AM SORRYYYY. Truly. I am working on this. I will get better, I hope, before my own kids are old enough to realize how terrible I am in this arena. Also, I take back any and all smirking I did at my father for not being able to spit out my or my brother’s birth dates off the top of his head at any given moment we decided to pop quiz him. I am seriously considering engraving my kids’ birthdays on my wedding ring, next to my anniversary, so I have half a shot in hell. (mental note: get a bigger wedding ring.) ANYWAYS. Lucy, a box will come next week! I’m the worst! But I love you!

7. It is 65 degrees out and I can see a little bit of blue sky, and OH, SPRING. I am so excited. I am taking my kids to the damn park. What are you up to this weekend?

*Well if that isn’t a terrible application of this idiom, I don’t know what is.

Posted in breastfeeding, ephemera, Grumpy Toxicologist, little bears, Me me me, Science!, trawling the interwebs | 3 Comments

A little more ADHD/Tylenol stuff.

I still have a few loose thoughts bouncing around in my head about the acetaminophen/ADHD thing, and about being pregnant and taking medicine. A fair amount of these loose ends came from comments on the original post, and in depth discussion with friends on the subject. I loooove these discussions.

1. I mentioned in the original post that there is research suggesting that NOT treating maternal illness/pain can ALSO lead to ADHD and other “negative” outcomes in offspring. The studies done in this area are smaller and less statistically powerful than the acetaminophen/ADHD study. In fact, some of the most interesting stuff isn’t even done in humans. So why am I willing to weigh these studies against each other to inform my choices? Because: there will never be a large scale epidemiological study that can adequately compare these “exposure” scenarios. It would be basically impossible to design and conduct a study that compares a reference group with no pain or illness of any kind to an exposure group with pain or illness, and to stratify the exposure group by intensity or duration or number of events. And to have these groups be big enough to yield statistical power to look at these subtle, low percentage outcomes. Much harder even than an imperfect, but interesting study on OTC drug use.

2. I want to also make a point about the overall study size, and the actual numbers of kids with the outcomes of interest. The overall study included over 64,000 pregnant women. That’s a ton! But it was broken down into reference group, and exposed groups, each of which were smaller than 64,322. The reference group for looking at ADHD-like behaviors included 18,188 total offspring, 458 of whom had ADHD-like behaviors and 17,730 of whom did not. That’s an incidence rate of 2.52%. In the exposure group for children of mothers who took acetaminophen for more than 20 weeks of their pregnancies, there were 1801 total offspring, 87 of whom had ADHD-like behaviors and 1714 of whom did not. That’s an incidence rate of 4.83%, which gets adjusted down to 3.67% based on the confounding parameters (demographic info and/or disease conditions as I mentioned in my previous post). Adjustments aside, that’s still… 87 kids. For a rate of 2.52%, it would have been 45 kids. 3.67% is 66 kids. That is both a lot of kids, and not that many, depending on your perspective (as usual, if you find yourself on the “wrong” side of a statistic, things suddenly get REAL). The difference in incidence is statistically significant, but I have trouble hanging my behavioral hat on a difference of 20ish kids, especially considering other flaws in the study.

3. I keep focusing on the ADHD-like behaviors, which is sort of a fuzzier endpoint than the ADHD medicines or the KHD diagnosis. Why? It’s because it’s a lot easier for me to talk about the math on this measure – it’s simple incidence. X kids with the outcome out of Y total kids. I don’t have to talk about person-time, which is a really confusing metric.

4. It seems like much of this is maybe a less discussed downside (or just a different side) of our incredible advance in knowledge and diagnostics – instead of “everyone’s different” we have names and syndromes, etc. And of course in isolation, you would rather your child not suffer. but does anyone really not have something? ADHD, asthma, celiac, depression, ASD, bad eyesight, poor coordination, shitty metabolism, mediocre IQ, janky heart, janky lungs, on and on and on. There are so many things to have. And so many degrees of severity for each of them. And I’m not saying we would CHOOSE any or all of these things, or that feeling negatively about them is necessarily bad or wrong or othering or whatever.

It just starts so early. “I want a healthy baby!” when what we really mean is “I want my baby to be healthy.” But that is slightly different. Do you want THIS baby? If he’s not “healthy”? What kind of disorders are acceptable in the abstract? What becomes acceptable when it’s part of your actual child? Where is the line between understanding the etiology of human .. disease is not the word I want. Human variation? The line between understanding what causes us all to be different, in so very many ways, and making value judgments about what is normal and what is not, and then… placing BLAME for (maybe) causing a deviation from that perceived norm?

This is heavy stuff, but I think the distinctions are important, as is considering the implications of these kinds of exposure studies, and the discussions that come out of them. Obviously everyone brings their own values to this subject, and I don’t think we can or should use a universal yardstick, but this has been a fruitful discourse for me, and maybe it will be for you too.

I should say that, especially for the last bit, this is a lot more stream of consciousness than I usually post here. And a lot heavier, and closer to divisive and charged issues. So. Uh. Ok.

Posted in gestating, Grumpy Toxicologist, Science! | 7 Comments

Reads from around the web

1. 23 and Me and Me: A doctor struggles to understand his own genetic testing results. I especially love these bits:

“In arranging for the test to be performed, I broke two of my usual rules as a doctor; don’t try and practice medicine on yourself (I usually outsource my personal medical care to my excellent GP) and don’t request a test where you don’t know what to do with the answer.”

“I have acquired enough genetics knowledge to bluff at a dinner party of non-geneticists.”

2. Gender Judo: An interesting article on being a woman in the workplace. I don’t agree with everything here, but it’s very topical for me as the only chick in my group at work, struggling with being put in the “nice” box, and finding a way to make sure my voice heard.

3. America’s Temple of Pseudoscience:

“The homeopathy section has plenty of Latin words and mathematical terms, but many of its remedies are so diluted that, statistically speaking, they may not contain a single molecule of the substance they purport to deliver.”

“I invited a biologist friend who studies human gut bacteria to come take a look with me. She read the healing claims printed on a handful of bottles and frowned. “This is bullshit,” she said, and went off to buy some vegetables.”

“Whenever we talk about science and society, it helps to keep two rather humbling premises in mind: very few of us are anywhere near rational. And pretty much all of us are hypocrites.”

4. Breastfeeding benefits have been drastically overstated: This is a sort of follow up to this excellent 2009 article on the same subject. Basically, the breast is best movement isn’t as clear and simple as advertised. I had a really interesting discussion with some friends about this article/issue this morning, and it’s far from simple, but I’m happy to see some new Actual Science on this topic, and hope it will help those of us who struggle in this area feel less guilty. (Damn, Gina, what’s with all the guilt?)

5. The Blood Harvest:
Ok this is just kind of cool. Horseshoe crab blood –> science. Also, tangent: my mom once skewered her leg on one of these bad boys. Yeowch, I bet that hurt.

6. A multipart mess on BPA and friends. First up, the good: Maybe That BPA in Your Canned Food Isn’t So Bad After All

“It was only when exposures were millions of times higher than what people typically get that the scientists saw changes like those caused by the body’s own sex hormones.”

I actually have colleagues participating in research in this area, and I wish I were seeing more media reporting on a few studies in particular, as opposed to the usual – such as this:
The Scary New Evidence on BPA-Free Plastics.
Another example of truly terrible science reporting, and also scientists behaving very badly. I won’t argue that there are legitimate issues with the toxicity testing for BPA replacements, and that I personally prefer the known not-particularly-evil that is BPA (seriously, if they have to look THIS HARD for adverse outcomes? It is a waste of time. There are actual toxic things we could be focusing on.), but on the scale of things I’m worried about in my day to day life, it’s somewhere below mopping the kitchen (i.e….. no.) Motherjones has done really bad, imbalanced pieces on BPA before, and they love to a) quote this total crackpot Fred vom Saal, and b) target legitimate science, without c) acknowledging their bias in doing so.
My favorite part is the quote of vom Saal’s that they feature:
“A poison kills you,” says biology professor Frederick vom Saal. “A chemical like BPA reprograms your cells and ends up causing a disease in your grandchild that kills him.”

I mean, that is just terrible, fear mongering horseshit. BPA ain’t gonna kill anybody.

Here is MotherJones attacking a colleague of mine last year, and here is an interesting post on Forbes from 2011 about why this whole thing is absurd (complete with a breakdown of a scientist bitch fight!). These last two links are old but the point stands.

Posted in breastfeeding, ephemera, Grumpy Toxicologist, Science!, times when people annoyed me, trawling the interwebs | 7 Comments

Acetaminophen and ADHD

So I read this article Monday, about a study linking acetaminophen use during pregnancy to ADHD-like behaviors in children. I am mildly irritated by the study itself, and super pissed about a lot the reporting on the study. (Raise your hand if you’re shocked!) Since reading it Monday when Jess brought it to my attention, I’ve seen this article as well as a few others flying around on twitter and facebook, and I’ve heard people express worry, fear, and worst of all, guilt. So I figured it might be valuable to pick it apart, a bit, as well as to broadly discuss the kind of messaging directed at pregnant women, and mothers in general, when studies like this are discussed in the media and elsewhere.

What the study did: The study used several robust and interconnected data sets to look at the correlations of interest. These are actually really cool – in Denmark, there are a few programs that work together to collect a lot of health data on a TON of individuals to facilitate epidemiological studies. (In fact, some of the studies that illustrated pretty definitively that vaccines don’t cause autism came out of these programs!).

  • Danish National Birth Cohort: this program enrolls pregnant women at about 6-12 weeks of gestation (like, when they go to the OB upon becoming pregnant, they are asked if they’d like to participate – and something like 30% of all pregnant women in Denmark do). As part of this study, they complete a telephone interview at 12 and 30 weeks of gestation, and another six months after the birth of the child, as well as a child behavioral questionnaire (Strength and Difficulties Questionnaire, SDQ) at seven years of age. The telephone interviews included questions about use of pain killers, and women were asked to recall specific medications taken on a week-by-week basis for the preceding weeks (i.e., at the 12 week phone call, they were asked to report which medications they took during each of the preceding weeks of their pregnancy). The SDQ was used to identify ADHD-like behaviors.
  • Danish National Hospital Registry and Danish Psychiatric Central Registry: these programs use unique civil identification numbers to track hospital admissions. The researchers tracked diagnoses of Hyperkinetic Disorder (HKD) through these registries.
  • Danish Prescription Registry: this program uses the civil ID numbers to track prescription drug use. The researchers used this to track the use of ADHD drugs (Ritalin*, atomoxetine, and modafinil).

Using these data sets, the researchers stratified and analyzed their data according to various features and/or confounders, such as

  • acetaminophen use profile (how many weeks of use, and during which trimesters/weeks)
  • SDQ scores (<17, or ≥17)
  • HKD diagnosis
  • ADHD medication use
  • Demographic info, like birth year, birth weight, sex, maternal age at birth, parity, gestational age at delivery, socioeconomic status, smoking and alcohol use during pregnancy, maternal BMI, etc.
  • Diseases of conditions that could trigger acetaminophen use, such as muscle and joint disorders, fever, inflammation, or infection (all self-reported).

So, to recap, the exposure of interest is acetaminophen use by week of gestation, and the outcomes of interest are ADHD-like behaviors, HKD diagnosis, and/or ADHD medication use.

What the major findings were:

  • More than 50% of mothers in the study used acetaminophen at least once during their pregnancies. The flip side of this really surprised me – more than 40% of women DIDN’T take even a single solitary Tylenol for nine months? Damn.
  • Compared to the no exposure group, there were increased risks for all outcomes of interest (ADHD-like behavior, KHD diagnosis, and ADHD medication use) in children of mothers who used acetaminophen during pregnancy.
  • For each outcome, the risk was GREATER for children of mothers who used acetaminophen in more than one trimester, or in all three trimesters, or for more than 20 weeks during pregnancy.

Issues I have:

Some of my issues are impossible to solve – you’re never going to get an enormous epidemiological study like this where they can get good, detailed information on the actual DOSE of medication people are taking. You get binary information (did they or didn’t they, over the whole nine months? Did they or didn’t they, on any given week?), rather than something quantitative (how MUCH did they take and when?). That makes it impossible for the researchers to study the critically important dose-response relationship, because they don’t actually have any idea what the dose was for any of these women. These researchers try to get at this relationship by using weeks of use as a kind of surrogate for dose, but it’s kind of messy. They track the number of weeks the mothers used it. They track WHICH weeks the mothers used it. But neither of those is the same as HOW MUCH. And while they make it sound like there is a clear correlation between number of weeks and strength of association, it’s not… THAT clear. The confidence intervals are really wide and overlap a lot with each other, and in many cases, with the non-exposed group. The associations ARE interesting, but they are NOT dramatic.

I’m starting to touch on the language used to discuss risk, here. The study relies on measures of risk called “risk ratios” and “hazard ratios.” What the heck are those? A risk ratio is a measure of RELATIVE risk between two states. So the unexposed group has a risk ratio of 1.0, and serves as a baseline or reference scenario. Then, let’s say an exposed group has a risk ratio of 1.46 with a confidence interval of 1.16 – 1.85 (this is a real example from the paper: the adjusted risk ratio for ADHD-like behaviors for children of mothers who used acetaminophen for more than 20 weeks of their pregnancies). Another way of correctly stating the observed risk for this group would be “the exposed group had a 46% higher rate of ADHD-like behaviors than the unexposed group,” or “the risk of AHDH-like behaviors was increased by 46% relative to the unexposed group.”

Hazard ratios are a little different, and a lot harder to explain, but the interpretation is similar. They are a measure of instantaneous risk over a defined time period. (Now you say: WHAT?) It’s kind of like a risk ratio averaged over time. (WHAT?) Ok, there’s really no easy way for me to explain this, unless you know what person-time is. Maybe you’ve read the insert on your birth control pills before, and it says something about how in a normal year of proper use, 1.7** women in 100 will get pregnant? So, that bit about “in a normal year…” – that’s a person-year. Or, 100 person-years, actually. 100 people, doing the thing of interest, for a year. So it’s the number of outcomes over the total person-years studied, for the exposed group versus the unexposed group. Anyone still here? I swear I just visualized all of my friends backing out of the room slowly.

ANYWAYS. You can talk about hazard ratios in basically the same way as risk ratios. So, for example, the study found an adjusted hazard ratio of 1.53 (1.21 – 1.94) for use of ADHD meds for children of mothers who used acetaminophen (can we abbreviate that shit? Damn. COMWUA? Ack.) for more than 20 weeks of their pregnancies. So we can say “the exposed group had a 53% higher rate of using ADHD meds than the reference group.”

All right, so raise your hand if you’re like, “OMG, FIFTY THREE PERCENT AHHHH” and between this and that This American Life episode, you’re chucking out the only damn drug you were comfortable taking when you were pregnant, because WHOA that’s a lot?

That means it’s time to bring up ABSOLUTE risk. Absolute risk is a measure of the actual incidence of the outcome of interest in a population. So, in this study population, the absolute risk of a child having ADHD-like behaviors despite their moms never taking Tylenol ever was 2.6% (458 hyper kids / 17730 unmedicated moms = 0.0258). The absolute risk for the poor suckers whose moms popped acetaminophen for more than 20 weeks of their pregnancies was…. 3.8%.

When you start layering percentages like this, things get muddy real fast. “46% higher” sounds a heck of a lot scarier than the absolute risk numbers do, to me. And this is where I start to get bent out of shape (1400 words in! We made it!). I think it is appalling, based on this study, for researchers, clinicians, and reporters to make statements like:

“If these results reflect causal associations, acetaminophen should no longer be considered a safe drug for use in pregnancy.” – study authors

“(Pregnant women) shouldn’t worry at this point,” says study author Dr. Beate Ritz, professor and chair of the epidemiology department at the University of California, Los Angeles Fielding School of Public Health. “But if I were a woman who was pregnant … I would try to avoid taking painkillers as much as I can until we know more about this.” – CNN article

“If there is a pregnant woman out there willing to take Tylenol after reading this research — or just the associated headlines — I’d be surprised.” – Motherlode blog, NYTimes

“There are nonpharmacological ways to deal with pain,” says Dr. Jeffrey Chapa, head of maternal-fetal medicine at Cleveland Clinic Children’s Hospital. Massages, baths and acupuncture are some alternatives he suggests to help relieve pain. “I think we have to focus a little bit more on that as opposed to just medications.” – CNN article

I would say the majority of my issues here are with science reporting, as opposed to the research itself. I do think the authors over-interpreted their results a bit – I don’t think that the researchers should be making, or even suggesting making a broad value judgment about whether acetaminophen should or shouldn’t be acceptable for use in pregnancy. I understand why they did – as scientists, we aren’t taught how to write in a fair and balanced way – we are taught to describe our findings and their importance, and then our continuing employment depends on politicians grading that importance. So you end up with inflated statements and sweeping judgments. I get that. I wish it weren’t the case. But at least it isn’t free standing.

My bigger beef, though, is with science reporting – some of it is link bait bull shit – “you’ll never guess what common medication will ruin your kid’s life!” – but even leaving the really egregious examples aside, the tone is just awful. One liners stripped apart from the caveats and quantitative information provided in the original research. And usually science reporting focuses on a single study at a time, rather than the body of literature on that topic, thereby further isolating these often grandiose “findings” from their proper context.

So it ends up as another one liner in the broader conversation about pregnancy, and pregnant women, and what they can and cannot do.

Like, as a pregnant woman, it your JOB to have a neurotypical, model-perfect child, and any deviation from that ideal is a) problematic and b) your fault. That is a seriously dangerous message! And it is everywhere. And for this particular example, well… Some of us actually have these “ailments,” or kids with them. And I know *I* don’t feel like damaged goods over here. Nor do I appreciate the implication that I should.

As this post discusses, there is a catch-22 about use of even common medicines in pregnancy – they aren’t studied in pregnant women because of possible risk to the fetus, so we never have enough information to know if they might be harmful to the fetus, and on and on. So all the meds, and pharmacists, and doctors say: take it if the risks are worth it to you. Which is terrifying language! What are the risks, both of taking the medicine, or of choosing not to? (They never actually TELL me the risks, when I have asked, that is for sure.) How do we weigh those risks in a useful way? There is really very little useful information or discussion to help women navigate these questions. (Sidebar: one of the MOST useful tools for this that I have found – for lay people! – is Motherisk. Or Jen and her handy book.)

The prevailing attitude seems to have evolved to the point that a pregnant woman is viewed as a host, or a vessel, and her mental health and happiness are totally secondary for the duration of pregnancy. I was talking to some friends about this, and one raised a really interesting point – because society has moved towards having fewer children per capita, this attitude has become more and more prevalent. When it was (and in communities where it still is) really common for a woman to have a lot of pregnancies, no one expects a woman to suspend her normal life just because she is pregnant. If you expect to be pregnant or nursing for the better part of a decade (or longer!), it would be preposterous to suggest that you not eat a normal diet, exercise, or engage in normal activities, TREAT PAIN! for that long. I mean, truly absurd.

There is also the point that this particular study treated acetaminophen exposure in kind of a binary way – the null group was totally unexposed. Considering acetaminophen is one of the only drugs that is touted as truly safe for pregnancy, I find it actually kind of hard to believe a woman who didn’t take even one measly tylenol for nine months should be the definition of “baseline.” While they controlled/adjusted their estimates of risk based on things like maternal fever, inflammation, infection, or chronic pain, I would still argue that there is likely a connection between a woman who takes not even a single dose of acetaminophen and someone who might be less willing to seek a pharmaceutical solution for their child’s ADHD-like behaviors.

Additionally, and more importantly, there is evidence suggesting that NOT treating maternal  pain, inflammation, infection – the issues that generally cause people to take acetaminophen – ALSO seem to elevate risk for ADHD-like behaviors, in addition to a host of other (perhaps more legitimately negative?) health outcomes (1, 2, 3).  This is also true for other maternal health issues – like depression or anxiety or even STRESS – not treating them also leads to bad health outcomes for our children.

The only thing that is obvious from these kinds of studies, the only thing that is truly clear: you can hope for a completely uneventful pregnancy, and completely pristine maternal and fetal health throughout, and if you are lucky enough to have that happen? You and your kid (both of whom may or may not have “ideal” health outcomes anyways!) get to be in the reference group! That’s…. it. Hope for that. But don’t count on it.

And if you aren’t that lucky – as nearly all of us are not – please, try not to stress over correlations between health outcomes with low incidences and legitimate medical interventions. Sure, don’t take medicine for no particular reason, of course not. But if you’re asking me if I were pregnant, would I take acetaminophen for a fever, a headache? Absolutely. Without a second thought.

* Amusingly, the authors of the original study state that a prescription for Ritalin “…is a highly specific indicator for an ADHD diagnosis and it has only one additional rare indication  – narcolepsy.” Guess what face I’m making. GUESS.

** I totally made this number up, but it’s close to the real one.

Posted in Grumpy Toxicologist, Science!, soapbox, times when people annoyed me, trawling the interwebs | 11 Comments