the plan*

*part 1a.  involves absolutely no cylons

since diagnostic testing (as i mentioned in my last blog) is soooooooo cheap here.  i’m about to have a boat-load of it!  for all you lab geeks out there, this may be interesting.  for everyone else, pardon this boring list!  here’s what all i’m checking out in round one of testing:

the first big question:  am i ovulating??

cycle of ovulation in a healthy ovary

1.  lh–luteinizing hormone is produced in women’s anterior (front) pituitary. but let’s back up… at the beginning of a woman’s cycle, another hormone (fsh, “follicle stimulating hormone”) prompts an egg follicle to form on the surface of the ovary.  when this follicle is ready to pop out its little egg, it secretes progesterone, which blocks estrogen, and when a woman’s estrogen therefore drops mid-cycle, a big burst of luteinizing hormone is released, causing the woman to ovulate (release her egg).  so really, women are just giant hormonal rube goldberg machines–and you WONDER why we’re sometimes nuts!  

if there is no lh surge, then there is no ovulation, so you can gather a lot of information by testing for lh.  if you’ve ever taken at home ovulation tests, this was what those little strips were looking for.  a blue line means lh surge is on and ovulation will occur in the next 12 hours.

i’m finding out how to get the strips here in india.  wish me luck!

2.  serum progesterone–this one is a blood test, not a pee stick, but we have a nurse on staff here, so hopefully my hopeless veins will be found.  so when you ovulate, the little follicle that used to house the egg turns into what’s known as the “corpus luteum” (yellow body) which acts as a temporary endocrine organ and secretes progesterone (pro-“gest”, pregnancy-supporting) until (hopefully) the placenta can take over the job when you become pregnant.

if for whatever reason you have low progesterone, your body may not be able to support a pregnancy (until the issue is corrected). estrogen and progesterone are like opposite ends of a magnet.  when one is high, the other is generally low.  each inhibits the other, and both cycle through once-monthly highs and lows.  if one is too high (dominance) the other can be too low (deficiency), and vice versa.  if one step of the rube goldberg machine is out of place, every step that comes after it will be affected.

to test progesterone, you can either take blood once on day 21 of a 28 day cycle (value should be 20-25), or you can take it 5, 7, and 9 days post ovulation and add the values (should add to 30).  i think i’ll go for the three-day test, just to get the most coverage.

vih-shussssss cycle

if my progesterone is low, it’s probably because my estrogen is high.  fat cells produce estrogen, and if there’s one thing i’ve got, it’s fat cells.  luckily this means that treatment involves weight loss and not horrid hormonal therapy or anything.

3.  pelvic ultrasound–who knows what all they can and can’t see with this one, but it’s only $20 US, so what’s the harm in trying?  ultrasound should help me rule out things like polycystic ovarian syndrome, endometriosis, or the presence of wacky masses.  some sources say ultrasound can help identify any scarring on the fallopian tubes as well, which will let me know if anything is impeding egg travel.

4.  charting–the thing that i like the most about charting is that it’s like opening a little window into your hormonal world.  charting involves waking up each morning and taking your basal body temperature and checking cervical fluid.  you then chart this information onto a graph and use the plotted graph to predict ovulation (look up fertility awareness method if you’re interested in knowing more).  a friend is making me some snazzy charts, so i’m excited to start this.

if these tests don’t give me clarity, we’ll move on to round 1.b which involves more blood tests and imaging.  when working on a differential diagnosis, it’s best to start with the most likely and move on to the least likely.  we call this horses and zebras.  if you hear hoof-beats in the hallway, your mind should go to horses first and THEN zebras 🙂  testing for zebras can come later, but hopefully it doesn’t come at all.

many thanks to steven snyder for pow-wowing with me about my plan 🙂  i’ll let y’all know results in a month or two.

to be continued…

generative fecundity*

*a charmingly redundant phrase coined by my friend paul, wherever the hell he is these days.

it’s funny how small the world is and who you’re likely to run into in painfully interesting high-traffic areas like the tuscaloosa farmer’s market.  as i was sitting at my old market partner’s booth one day, trying not to swoon in the june heat as she sold herbal teas and body care goodies to the crunchy-bamas, i was approached by a young woman who told me, upon hearing my plans to go to india, that she had been to kerala. (do i get a sextuple phrase score for that last sentence?)

ma-ma-macita. ma-ma-macita. ma-ma-maciiiiita buy your baby a papaya.

kerala is the state in which i currently live, in the district (county) of ernakulam, in the city of kochi, in the neighborhood of vytilla, on the street of toc-h school.  my eyes lit up…i could talk to someone who had BEEN there!  of everything this young woman said to me, the thing that stuck was that kerala was so lush and so green that if you dropped a piece of metal pipe, a lamppost would grow.

and y’all, that’s the truth.

you think kudzu is tenacious?  every spare lot, every crack in the pavement, every gap in every wall in this city is bursting with bits of jungle.  plants that i only see in the US in miniature form in pots on porches grow to epic proportions here, and trees reach down to snag unsuspecting umbrellas only a week after they’ve been trimmed.  the landscape of kerala exudes the pure, relentless growing power of nature more so than perhaps any other place i’ve ever been.  

banana flower as big as my head!

if humans disappeared tomorrow, the jungle would reclaim her land in mere weeks.  already you can see hints of that fact, as ugly trash piles get pulled underground and bricks get thrown up and over by the roots of ancient trees.

while i’m here, i’m going to suck up some of that power.

i’m burying the trash piles of crap food that i used to eat, throwing off my burden of weight with strong red roots, and finding my fertility here in the jungle.  i’ve written before about the irony of being a student midwife who personally struggles with (source-as-yet-unidentified) infertility. i’m trying to honor this as a gift (since everything, in it’s own way is) because it has taught me more than i could ever have known otherwise about how to counsel and hold space for women who struggle to conceive.    

but this gift has served its purpose.  moving on….

the heck you say…

my plan: (and we’ll see if it works!)

1. whole foods diet, low sugar, healthy fats, 50% raw, fresh juices (all so cheap and easy to get here in kerala, as opposed to processed food, which you have to look harder to find–rice being the exception).  no dunkin donuts here!

2.  water, water, water.  i’m a HORRIBLE water drinker–first to admit.  if i could drink nothing but coffee, my life would be magical.  here though, drinking tons of water is a survival tool, and i get at least 64 ounces a day (and a small 6 ounce coffee!).  so much of reproduction is about fluid movement and supple tissues, so i’m tending to my hydration at last.

3.  movement–another one of my demons.  since i’ve been a student for, oh, 13 years, i do an awful lot of ass-sitting.  and ass-sitting begets ass-sitting when being morbidly obese keeps you from being able to do fun active things.  here in kerala, i walk 2km to and from work about 8 times a week, and i do a lot of other walking out of necessity, since i don’t have a car and i dare not ride a bike in this traffic!

4.  the gym–donna and i paid a fortune (relatively, anyway) to join a gym the other day.  we’re going three times a week (twice we have to get up at 4:30am–eeek!).  they have eliptical machines–my favorite–and my reward is that the membership also comes with free saunas, steams, and massages!  and air conditioning!  woohoo!

5.  CHEAP tests.  so much about my reproductive health is a mystery simply because i don’t have health insurance and can’t afford to go to the doc (and an herbal poultice won’t tell you what your ovaries look like).  here, tests are cheap and anyone can order them.  i am getting a reproductive tract ultrasound scan sometime soon, and it will cost me TWENTY GODDAMN DOLLARS.  that’s all.  not 300.  not 1000.  20.  2-0.  i’ll also be able to do full hormone panel testing for next to nothing, and at the moment, i have a call in to a wise woman i know inquiring which tests i should have.

6.  charting.  as soon as i can get my hands on a basal body temp thermometer, i’m going to start charting my cycles a-la-fertility awareness method again.  the lovely k.c. vick is doing beautiful handmade charts, and i’ve ordered a year’s worth (with instructions that the package must be waterproofed to make it to me through the monsoon).  on a related note, if you’re interested in personalized cycle charts, find “kick vick” on my fb friends list and message her!

sooooooo yyyyyeaaaaah. that’s about all for now.  we’ll see what else comes my way, but for now, these 6 steps are my attempt at channeling the generative fecundity of kerala.  i can’t wait to be the preggo intern at the birth house in bridgton, and bring my own little piece of the jungle into the icy wilds of maine.

to be continued…

this blog brought to you by wee, nonchalant jungle cat

sick day

*achtung!  this blog talks about the darker sides of travel’s effects on the body.  if you’re weak of stomach or are easily grossed out (then how the hell did you get midwife friends?) then look away.  happier blogs, they are a’comin’

so…traveler’s diarrhea, moctezuma’s revenge, delhi belly—whatever you want to call it—BLOWS.

i was fine for my first week and a half in india, but for about the last 10 days, things have been…amiss.

it started with a few gnarly stomach pains and some cramping after eating, and then it turned into massive abdominal cramping and diarrhea, but only ever after i ate.  all would be well in the in-between, but like clockwork, an hour later i’d be dashing to the toilet.

so picture if you will, me trying to pinpoint the source of the issue.  water here is “meh” on the safety scale, we sometimes stop at a local shop and pick up some prepared food to try–mostly fried stuff that has been sitting there during the day,  our veg is all dirty and then we take it home and wash it in non-drinkable water (also our dishes, clothes, hands), we go to different restaurants.  this could be ANYTHING.  literally anything.

there’s very little i can do in the way of search and destroy for germ sources.

so yeah, this went on for a while (and produced one VERY fast walk home one day) and necessitated that i take tissues with me at all times.  apparently we’re lucky here at the apartment to have a butt sprayer–most places have a bucket and a cup, and i’ve yet to discover how this can be used to rinse one’s hiney.

i finally figured out one day that this was not going away, so i decided to do the pepto thing. on the first day i took two doses to stop the issue, and on the second day, i took two preemptive doses while we were out on a field trip to hill palace (you do NOT want to see what counts for a public loo, if you can find one at all!), and on the fourth and fifth day, i pooped rocks.  great.  i’ve caused a new problem!

so i stopped taking the PB, and the delhi belly stopped, but this morning, things wuz BAD once again.  let’s just say i had several moments when i didn’t know which end of me should be aimed at the toilet seat.  at least there’s a drain in the corner (and thank goddess it wasn’t needed).

so i missed a day of work.  i was supposed to be helping a co-worker design a flyer for breastfeeding week, and i was supposed to be making herbal suppositories for a momma with hemorrhoids,  many thanks to those who picked up my slack.

fresh coconut water. because gatorade is for pussies!

my savior today was the chechi, who brought me soft cooked rice with coconut, plus three macheted coconuts for me drink from.  absolutely wonderful.  gatorade can suck it–this is the way to get electrolytes!

so yeah, gross blog, but true blog.  all’s not roses today, but i’ll hopefully be on the mend soon.  if all else fails, i have cipro with me, but antibiotics cause a whole new trouble of their own.  let’s see if my body can beat this thing’s ass.

to be continued…

blood mysteries

when i was a kid, whenever anyone said “indian,” being, as we were, inhabitants of a semantically challenged country, you had specify “feather or dot?”.  feathers, of course referring to tribal adornments of some native american “indians”, and dots being bindis, the (usually red) forehead markings worn in india.  because columbus thought he’d landed in the indies in 1492, he called the inhabitants of hispaniola “indians” and by god, for better or worse, it stuck.  so here i am, an indian (feather) in india (dot), though not in the commonest sense of the phrase.

but back to the “dots”– bindis, which can be either paint pigment or felt/bejeweled peel-and-stick dealies, are worn by men, women, and children here in india.  they can have religious significance, they can simply be traditional, or they can be worn as a fashion statement/make-up component.  with regard to their significance, i’ve heard as many stories as i’ve seen bindis, but the most popular so far is that the marking is worn as a sort of protection of one’s third eye, the place between the brows that perceives all things mystical and extrasensory.

that’s all fine and dandy, but i recently heard a much more intriguing version.

during her captivity by ravana, sita, wife of rama and mythological ideal of indian wifeliness, was able to stave off her captor’s advances by marking her forehead with menstrual blood, creating a barrier that ravana could not cross, thereby maintaining her purity (though her steadfastness would be questioned later by her people anyway…natch). this reverse “noli me tangere”  is interesting to me because in this story it is the woman, in all her embodied earthiness, rather than an ephemeral resurrected christ, who is drawing sacred boundaries around bodies.

today is the full moon (so they say–i haven’t seen the moon in weeks) and it is also the feast of mary magdalene.  so tonight, in honor of mary and sita, i’m celebrating the reversal of gender roles and wearing my bindi, in honor of women’s bodies and their ability to draw and powerfully maintain their own protective boundaries.

namaskaram y’all

to be continued…

fun bits

every now and then i find that there are things i want to mention, but they may not warrant their own blog.  so here are some other fun tidbits about india life:

–milk comes in bags, not cartons.  they’re small plastic pouches that get their own designated shelf in the fridge.  when you want to use one, you snip the corner and pour (something that i have not mastered as a mess-less task yet) and you sit the pouch snip side up in a small container if it needs to go back in the fridge.

–once or twice a month, there is a hartal, a general strike mandated by the political parties.  during a hartal, which lasts from 6am to 6pm, no one can drive or go to work.  while this might sound horrid, india is a country with a 6-day work week, and i would wager that folks appreciate the day off once in a while.

–india is proof that beauty standards are a grass-is-always-greener deal.  while americans spend a fortune and do all manner of harm getting tanned skin and huge voluminous hair, indian women do the same with skin bleaching and hair straightening.  looks like no one is satisfied!

–arranged marriage is still the norm here, as are exorbitant dowries.  families spend a fortune on a daughter’s wedding, and they give the bride and groom tens or even hundreds of thousands of dollars in gold coins, jewelry, cash, and property.  folks start saving for this the day a daughter is born.

–many women make their livings as chechis, or housekeepers.  ours is the lady who cleans the birth center, but maybe every other day we have someone knocking at the door asking (very persistently) to be our chechi.  i learned a very helpful malayalam phrase for this very reason.  so now the extent of my language is some food items and “we already have a chechi”.

–i spent most of my life thinking that indians spoke hindi.  while many northerners do, there are actually 22 official languages–each state has its own, and both the written and spoken forms differ.

–birth here is ludicrous.  there is an 80% cesarean rate, and women are required to labor alone.  no friends, no family, no husbands.  if they’re lucky, they get a room and a bed.

–on the other hand, there is one part of the postpartum here that’s quite nice.  new mothers have someone come over once a day for the first 30 days or so to massage and bathe them.

–a rupee is worth 0.017 US dollars today.  that means that i’ve had to get used to paying what seems like a ton of money but isn’t actually much at all.  i’ve paid as little as 35 rupees (about 60 cents) or as much as 500 rupees (about $10) for a restaurant meal.  auto rides around town generally cost $1 or so, a ferry ride might set you back 8 cents, and enough fresh market produce to keep me in fresh juices and whole foods vegetarian meals for a week runs about $30, compared to around $100-$150 in the US.  spa treatments that would cost $100+ in the states are $10 bucks here, and i paid around $60 for a new twin mattress.  going to be hard to come home!

–the diversity here is mindblowing and wonderful.  hindus live alongside christians live alongside buddhists live alongside muslims.  and for the most part, everyone gets along.  “what’s your religion?”  is a common conversation starter, and it leads not to bickering and one-upmanship but to a good friendly chat.

i’ll add more and repost this blog again later 🙂

to be continued…

woohoo! friday!

after work today, i treated myself to a spa head massage (i promise i’ll be working my bum off in august–but for now, treats!).  i almost didn’t find the place because my auto driver spoke no english and my malayalam consists of a few spices and food names (must work on that), but there, glimmering through the rain was the neon sign for sheela’s salon–only one giant mudpuddle away from the side of the road.   the sign read, in large red letters,

NO MEN ALLOWED!

for my massage, my hair was parted and oiled, parted and oiled, parted and oiled, and then i got the most amazing head, neck, and shoulder massage.  when i was all gooped up and relaxed, she put me under a steamer thingy that looked like the techo-lovechild of an electric kettle and one of those dryers old women sit under at the beauty parlor.  when i was steamed, i got a wash, a deep condition, and a blow dry (yay! dry hair!!).

all for $10 US–sad i won’t be able to keep this regimen up when i get home…i’d go broke!

leaving sheela’s, i took my VERY FIRST SOLO AUTO home (woohoo!) and then at house, i tucked into a lovely salad of apples, coconut, cabbage, bell pepper, carrot, and mango that donna made.

i’ve saved the mangos for last, so here i go to enjoy my dessert!

to be continued…

the day certainly ended better than it began!

herbalism, old-school style

front room of the ayurvedic shop

today we went to an ayurvedic herb shop to pick up a few things for us and for the center.  the place was a little hole-in-the-wall, but it was stocked floor-to-ceiling with all manner of roots, barks, herbs, powders, oils (plus jewelry and rat poison for some reason).  there were shelves inside plus bags and bags and stacks and stacks outside of all of the goodies needed to make traditional medicines.  

stacks of bagged roots, barks, etc.

in this shop, as in the others we’ve stopped by, the proprietors are practitioners (and sometimes doctors) who will tell you what formula you need and what it will do for you.  priyanka picked up triphala powder to make suppositories for a momma with hemorrhoids (my fun job tomorrow morning!) and fresh wild turmeric root to make a poultice for my nose piercing, which is taking ages to heal (also a good excuse to buy a gold ring!)

right now i’m sitting on my bed with a yellow nose, my turmeric poultice (made with a coffee cup and hairbrush handle because i don’t have my mortar and pestle with me) held on with a piece of an angry birds bandaid.  as adorable as it sounds, i assure you.

unsuspecting alleyway shop

one of the most striking things about our ayurvedic adventure today was that, although i am an herbalist, i am totally lost when it comes to this particular ancient and revered school of medicine.  none of the names are familiar, and the theory behind the system is new to me–i have so much learning to do!  there is another school here, homeopathic (just called “homeo” usually) but it’s less what you think of as western homeopathy (stuff diluted to infinitesimal proportions and then made into sugar pills) and more what we think of as western herbalism.

sticks n stuff

on my agenda is definitely planting some calendula, yarrow, and comfrey at the center, as its getting harder and harder to want to recommend things that you can’t get here. (where’s mountain rose herbs india edition?)

to be continued… 

monsoon season: or, when is a puddle not just a puddle

today it poured an alabama-in-the-summertime-esque pour.  it’s been raining pretty good every day, but nothing like this.  for about an hour it was cats and dogs.  while this creates a lovely respite from mosquitoes (where DO they go when it rains??), it created another issue entirely.

ankle deep

the uber puddle.

our walk to and from the center is about a half mile, winding through walled and gated-off lots in the neighborhood of vytilla.  the road is pock-marked with some pretty impressive pot holes that seem to be long forgotten by anything resembling a blacktopping crew, and while some remain perpetual puddles, others go a gusher whenever it rains.  this means the walk to work is something akin to that game you used to play when you were little, where you pretended the floor was lava.  step, hop, pause, think, hop, step.  all while holding an umbrella, carrying your laundry, clutching your dry computer bag tightly to your chest, and dodging the muddy waves being thrown at you by passing cars and autos, though most drivers are pretty conscientious about that.

today though, there was no stepping or hopping.  we tried our darnedest to hit the high spots, but both donna and i, in sandal feet (because tennis shoes are laughable here) wound up ankle deep in mucky puddle.  we tried to skirt the road into a cow pasture, but that just made it worse, necessitating a big leap into deep water.  squoooooosh.

the puddle in question…

buuuuuut here comes the best part.  the roads here are flanked on both sides by what appear to be sidewalks but are actually just concrete slab gutter-covers.  the gutters are open in some places, revealing an oozy and sometimes-oddly-pearlescent-whitish water.  is it run off?  is it sewage?  both?  who knows.

so, when we jumped into the lake-puddle on the side of the road, THE FACT that it was on the side of the road meant we were jumping into a rainwater + flooded gutter mess.

sometimes, there just isn’t enough lysol.

we squooshed our wet-shoed selves home and angled for the bathroom buttsprayer to clean our feet.  i then emptied around half a bottle of hand sanitizer on my tootsies and washed my shoes with beaucoup de vinegar.

it’s really one of those things that you just can’t think about too hard.  best to just keep swimming, just keep swimming!

to be continued (unless i’ve contracted the plague)…

gimme that love touch

people be funny, ya know?  what we consider to be acceptable and what we consider to be taboo—these things are all a reflection of where we are culturally, at any given moment, on the neverending pendulum ride between expression and suppression.  back and forth, back and forth.  this is most striking to me, as a foreigner in these parts, when i consider public expressions of affection in india.  (and the coolest bit is that what i see here tells me as much about the states as it does about india).

consider:  in india, or i should say in the state of kerala, because that’s the only point of reference for me, men and women DO NOT have physical contact in public—even if they’re married.  even if they’re coming to the birth center together.  in a prenatal visit, it was striking to me to note that the husband and wife seemed to be sitting as far away from one another as humanly possible.  no hand holding, no touching, not much interaction at all really.  but it wasn’t in a cold and indifferent way—it was more of a this isn’t-an-ok-time-for-that way. 

i haven’t seen men and women hug, kiss, hold hands—anything—since i’ve been here, and that’s just because here that’s not how it’s done in public.  but before you start to think this too odd, consider one other bit:  here there is LOTS of touch between men.  and i don’t mean back slaps and shoulder punches—i mean hand holding, arms around waists, and the most tender caresses you’ve ever seen.  male friends standing in close proximity often touch one another in the way that men and women in the US might do (no kissing so far!)

so whereas in india, men and women stifle public displays of affection, the need for human touch and contact bursts out the seams of male friendship.  conversely, in the US we have no problem with PDA between men and women (other than annoyance at it, mostly when our own lives are currently lacking—get a room!!), but we don’t at all sanction healthy touch between men.  those back pats and shoulder punches have to be SO hard just so your friend, who you want to express affection for through touch, doesn’t think you’re after a little somthin’somthin’.

so really both cultures are in a rather unhealthy place with physical expression of emotion.  in the US, men can’t express non-sexual affection for other men (although the “bromance” hints that the pendulum may be swinging), and in india, oddities around interactions between genders (no doubt made more difficult because of arranged marriage) mean that men can only seek touch publicly from other men (and who knows where women get it).

we are all of us strange, strange creatures!

to be continued…

you and me could have a rad bromance

stop whatchu doin!

oh that moment—when you’re clacking away at your keyboard, writing birth center mission statements and project profiles, and you hear the WEEEEEeoooooooooooo sound of a whole building losing power.  rolling blackouts are a way of life in most of india, although i haven’t experienced one in kerala until now.  because there is too much draw on the power grid to meet everyone’s needs, cities cut power for minutes or even hours at a time in different regions.  being from tornadabama, i’m pretty familiar with the drill—don’t open the fridge and let out the last bit of cold, find a place to swoon and fan yourself madly. 

currently fanning myself madly here at a table in the upstairs of the birth center.  when the power went, my eyes darted immediately to the ceiling fan (the single most important appliance in india, second maybe only to a water filter) as it wound down and lost steam.  i must have looked like someone stranded on a desert island, draining the last drops of water from an old canteen.  it’s amazing how fast the stagnant air can get to you in a building here.  fans go off and things become heavy and dense, as if there were no longer enough oxygen to go around.  then you start to get slick forearms and beads of sweat on your lip. 

and just when you think you can’t go on, booooooOOOOOOOP the power comes back on and everything winds back up.  thank the goddess for short-lived blackouts!

to be continued…