The final countdown… to my PhD defense

After many years—so many it seemed like they would never end—and an enormous amount of stress, I am almost done.  In one week, I will be defending my dissertation, the final significant hurdle to being granted my PhD.

After working myself to my absolute limit to get the writing done, I now have a brief period to breathe.  My dissertation has been sent around to my committee.  I just need to prepare my slides for the formal talk part, and practice the talk, and remind myself of a couple of little details that I think might come up in questioning.

I waver between serene confidence and absolute terror—so, completely normal for someone at this stage.  In the last few months alone, I have had multiple panicky crises about whether I would ever get the research and the writing finished, but having reached this point, there is no real doubt that I will pass the defense.  My work is solid; my advisor had some extremely complimentary things to say about my last research chapter.  But the question remains: how hard will the committee make it, and how foolish will I feel by the end?

Wish me luck, readers!  I will let you know when it is over.

Survey vent, part 2: do gender better

For the last few years, all the official student surveys coming from my university have offered three options for gender: male, female, and transgender.  I appreciate that they’re trying—it’s better than only listing male and female—but arg, no, that’s not how it works.

By itself, “transgender” isn’t a gender; rather, it’s a descriptor meaning that your gender identity doesn’t match up with the gender you were assumed to have at birth.  Transgender people are male and female and non-binary, not an extra separate gender.

I’ve seen other surveys that attempt to do better by offering four options: male, female, transgender male, and transgender female.  However, that kind of setup implies that trans people aren’t “real” members of their gender.  It would be somewhat less problematic if the first two were specifically listed as “cisgender male” and “cisgender female”—but if you really need to know whether your survey respondents are cis or trans, consider breaking that into another question.  The Human Rights Campaign has a good example of a survey approach that separates “What is your gender?” from “Do you identify as transgender?”

Of course, as alluded to above, gender is not binary, and your survey also needs an option for people who are non-binary / genderfluid / genderqueer / agender / etc.  (Not to imply that these terms are interchangeable, because they are not, just that at bare minimum there needs to be some kind of “outside the gender binary” selection available.)  If your survey design allows it, an additional option with an open text field will help you avoid unintentionally excluding anyone.  And personally, I’d also like to see a “prefer not to say” choice for gender, as is common on some of the other demographic questions.

Survey vent, part 1: married students exist

When designing a survey to be taken by university students, please remember: Some students are married or live with long-term partners—and some students have children.  These things are true for any college-student population, but they are especially relevant when your survey specifically targets graduate and professional students.

This little vent was brought to you by a graduate housing survey from my university’s Residence Life department.  “Lives with family” can mean very different things depending on whether you mean “lives with parents” (which was the implied meaning in this case) or “lives with spouse/partner/children” (for which there wasn’t another, more applicable choice).  And don’t frame your rent, roommate, and bathroom-sharing questions in a way that assumes people are single.

Oh, and while we’re at it, don’t ask me for my “hometown.”  Be more specific about what you’re looking for here.  Where I grew up, where my parents live now, and where I consider “home” are three different things.

Taking medication while pregnant: what to consider

For me, spring means allergy season: constant sneezing, itchy eyes, the works.  Basically, my sinuses go into full freak-out mode and decide that protecting me from some as-yet-unidentified pollen is more important than actually functioning.

Fortunately, medications exist that can calm down my widely overactive immune response.

However, I’m pregnant, and our culture is filled with messages about how the smallest dose of anything is dangerous and scary and really you just shouldn’t risk it.  And most meds aren’t well-studied during pregnancy, so it can be hard to figure out what’s worth worrying about.

So what’s an expectant mother to do?

1.  Talk to your doctor.

Or your nurse practitioner.  Pharmacists can also be helpful, although I’ve found their advice tends to be more generic.

When it comes to anything concerning pregnancy, this is the #1 rule: talk to a medical professional.  Call up your OB/GYN’s office, or bring it up during an appointment, or whatever is applicable for your situation.

My OB/GYN helpfully provides all her prenatal patients with a one-page list of common medications that are considered safe to take as directed during pregnancy.  Happily for me and my allergies, diphenhydramine (Benadryl) and loratadine (regular Claritin) are on her approved list.

Relatedly, you should also talk to a doctor before abruptly stopping medication during pregnancy.  Even if the drug in question is widely considered dangerous to fetal development, you might be risking worse effects by doing a sudden withdrawal instead of a controlled taper.

2.  Be skeptical of online information.

This is a universally true rule for life, but it is especially true when it comes to medical information.  Health info on the web has always been questionable, and it seems to have gotten worse in recent years with the proliferation of “healthy living” websites.

Pregnancy-related Google queries are particularly unreliable.  Most of the results you’ll get for something like “is it safe to take Benadryl while pregnant?” are mommy forums where other women have asked the same thing—and gotten a bunch of responses from women who also don’t know the answer.

I understand the desire to scour the internet, hoping that someone somewhere knows something that can give you a definitive yes or no on medication safety.  I’ll be honest, I’ve done some serious Googling on this stuff myself.  But with a lot of drugs, we just don’t have that much data about safety during pregnancy, and you’re far better off going with someone who’s qualified to interpret the data that do exist.

If you must ask the internet, go directly to a reliable source.  I’ve found these resources to be valuable:

  • The medication fact sheets at MotherToBaby, which are put together by experts in teratology (the study of birth defects).
  • The InfantRisk Forums, part of the InfantRisk Center at the Texas Tech University Health Sciences Center.  Forum questions about medication safety are answered by administrators, who are qualified medical professionals.  The InfantRisk Center also has an app, although I haven’t tried it myself.
  • The Massachusetts General Hospital Center for Women’s Mental Health has a ton of info about mental health and psychiatric medications during pregnancy, although you sometimes have to dig around a bit in their archives.

3.  Consider the risks of not taking medication.

The discourse around taking medication while pregnant (or indeed, doing anything while pregnant) revolves around minimizing risk.  There is a general tendency for people to focus on the risk of doing something, as in, “if there’s even the tiniest risk of taking this medication, I won’t do it.”  But what about the risks of not doing?

For example, imagine you’re pregnant and thinking about taking some acetaminophen (Tylenol).  Tylenol is on my OB/GYN’s “OK to take” list, and is broadly considered safe for pregnancy at appropriate doses.  But maybe you saw that study recently about there being a possible association between Tylenol during pregnancy and children’s later behavior problems, and you’re nervous.  You’re worried that you might be taking an unnecessary risk.

What are the risks of not taking that Tylenol?  It depends on your situation.

If you’re just a little sore, maybe you stretched a muscle the wrong way, or you’ve got a bit of a tension headache, there’s probably not much risk to skipping the Tylenol.

But if you’re running a fever, there are documented risks to not taking a fever-reducer like Tylenol: high fevers, particularly during the first trimester, are associated with birth defects.

If you’re in serious pain—let’s say it’s not something directly dangerous, just really uncomfortable—the risks are somewhere in the middle.  Pain stresses your body, making it pump out cortisol and other stress hormones.  Pain might make it hard for you to sleep, or to otherwise care for yourself.  We don’t know that much about how stress affects developing babies.  I wouldn’t want to imply that it has dire effects, because everyone deals with some amount of stress during pregnancy, but lessening the stress on your body is probably a good thing.

(This last one is where allergy medication falls for me: the risk of not taking it is that I will feel like absolute crap.)

With other medications, especially those that haven’t been well-studied, the risk calculation is even more complicated and specific to individual situations.  I am currently taking the antidepressant escitalopram (Lexapro), after a great deal of thought and consultation with a psychiatrist who specializes in pregnant and postpartum women.  I’m aware of what we know and don’t know about the risks of taking Lexapro during pregnancy.  I’m also aware of the risks of untreated depression in pregnant women in general, and the risks of untreated depression in me in particular.

4.  Understand how drugs are classified during pregnancy.

Whenever someone asks a med question on a mommy forum, there’s always that one person who shows up to announce that the drug in question is Category B and therefore obviously dangerous and clearly the rest of you are dolts for even considering otherwise.

That person is a pompous twit, and also wrong.

For a number of years, the U.S. Food and Drug Administration (FDA) sorted medications into five pregnancy categories, A, B, C, D, and X.  Other countries use different systems, often based on similar principles.  As of mid-2015, the FDA officially stopped using the five-category system, but it’s still widely in common use for discussing drug risks, and it’s useful to know what the categories mean.  (It’s also not clear to me that the new labeling rules, which supposedly provide more information, are actually in use yet.)

Here’s what the categories mean:

Category A:  There have been controlled human studies showing no risk to taking this drug in the first trimester, and there is no evidence of risk in other trimesters.

Very few meds are in Category A.  It’s actually pretty hard to find examples.  Folic acid (you know, the stuff in your prenatal vitamin that helps spinal development) is Category A.  Many thyroid replacement hormones are Category A.

Category B:  There have not been controlled human studies, but the existing evidence (including animal studies) indicates there are no serious risks.

Pretty much everything that’s basically fine is in Category B.  The meds on my OB/GYN’s “OK to take” list are Category B.  Tylenol is Category B, as are some antibiotics, some allergy medications, and a variety of other things.

There is, I think, a tendency for laypeople to assume that drugs end up in Category B because they’re inherently not as safe as drugs in Category A, and that isn’t true.  A lot of meds end up stuck in Category B because it’s really, really difficult—not to mention frequently ethically problematic—to run controlled trials, the kind where you assign people to treatment and non-treatment (control) groups in advance, in pregnant women.  You can ask women about their med usage and compare outcomes, as they did in the Tylenol study mentioned above, but a lot more confounding factors can creep in that way.

(Somewhat weirdly, Category B does include drugs that have had controlled human studies with good outcomes—if there are also animal studies that show possible risk.  As always, talk to your doctor for details on your particular drug.)

Category C:  There are limited data in humans, and maybe some animal data showing risk.

There are a bunch of different combinations of data (or lack thereof) that can put something in Category C.  There’s “we don’t have formal studies on this, but women have been taking it for a while and it doesn’t seem to cause anything dramatically bad.”  There’s “we can poison animals with really high doses of this, but we don’t have human data.”  There’s “we’ve seen this cause withdrawal symptoms in newborns but it doesn’t seem to have any long-term effects on their development.”  In short, Category C meds are not known to be safe, but they are also not known to be unsafe.

General pregnancy references often lump Category C meds in the “don’t take this” group, but what they mean is “don’t take this without consulting your doctor about your own personal situation.”  Any source that tries to tell you Category C drugs are absolutely unsafe should be treated with great suspicion.

Examples of Category C medications include my Lexapro and several other antidepressants, some types of antibiotics, and the antiviral Tamiflu.

Category D:  Human data show that this drug can have negative effects on developing babies, but the benefits might still outweigh the risks in certain situations.

If you’re dealing with a serious health situation—epilepsy, cancer, etc.—and less risky drugs are not available or appropriate, a doctor may consider giving you something from Category D.

Interesting fact: the common painkiller ibuprofen (Advil) is in Category D in the third trimester.

Category X:  Human data show that this drug is dangerous and should not be taken during pregnancy.

Category X includes things like thalidomide (infamously prescribed for morning sickness in the late 1950s), methotrexate (used, among other things, to treat ectopic pregnancies), and isotretinoin (the prescription acne medication Accutane).

5.  Don’t panic.

And carry a towel.  (Because if I can’t make Hitchhiker’s Guide to the Galaxy jokes on my own blog, where can I?)

Do I worry, sometimes, that taking Lexapro and allergy medications and the occasional Tylenol will hurt my growing baby?  Yes.  But I’ve talked about my worries with my doctors, and I trust them, and I trust myself.

Be thoughtful and be cautious—but take care of yourself.

Should I answer the phone? A flow chart

My cell phone is ringing. Should I answer it? (A flow chart.)As a parent, I’ve become much more vigilant about carrying my phone around with me, even into meetings and places where I can’t easily step out to take a call.  Thank goodness for caller ID, is all I can say.

In practice, my “should I answer it?” thought process has a few more qualifications than the above chart, although not many.  Which of my contacts is calling is relevant.  For instance, if I got a call from my brother, I would drop whatever I was doing to answer it, because my brother has literally not called me since the year 2010 and I can’t imagine what would prompt him to do it now.  (We communicate by text.)  And yes, I do have Little Boy’s daycare in my contacts, but only their main line; the teachers usually call from the classroom phones and I don’t have those all saved.

Also, when I say local number, I mean local as in “where I live,” not local as in “same area code as me.”  Like many folks my age, I’ve moved since I was first assigned this number, and no one who’s not already in my contact list is going to be calling me from my original area code.  I still get mystery calls from that region, though.  They never leave a message, so they’re either genuine wrong numbers or scammers trying to spoof a number they think I’ll pick up.

On rare occasions, I still get calls for the guy who had this number before me, even though I’ve had it for more than a decade.  Usually, it’s just automated spam with his name inserted, but once it was a real person.  A collection agency, I think.  I assured the lady on the other end that I had no idea where the guy was or how to contact him, and she never called back.

How do you decide whether or not to answer the phone?

Oh hi, it’s me again

Whenever I go for a while without blogging, I get into a negative feedback loop about it.

It’s been a while, so my next post needs to be something Big and Important.

I don’t have the time/energy to write any Big and Important posts right now.

[days pass]

[cycle repeats]

So this post is a deliberately short note to break the cycle.

I’m almost halfway through this pregnancy.  The baby is healthy, so far as I can tell; he or she is a strong kicker.  I’m healthy by the numbers, but ridiculously fatigued, which is pretty much the story of my adult life in one sentence.

Little Boy’s two-year-old cuteness deserves its own post.  The Terrible Twos get a bad rap, I think.  He can be plenty obnoxious sometimes (and has an inexhaustible supply of bouncy energy), but he’s also smart and thoughtful and independent and deeply engaged with his world.

How are you?

I love that Moana ties her hair up

The animated Disney film Moana came out on DVD/Blu-Ray last week; we hadn’t had the chance to see it in theaters, so we bought a copy and watched it at home.  It is a gorgeous, wonderful movie, with a strong heroine, great music, and the most amazing animation of water that you’ve ever seen.  Disney put a lot of thought into its portrayal of Polynesian culture and people, and while I have read thoughtful criticisms of some of their choices, the overall response seems to have been quite positive.

Blu-Ray case for the Disney movie Moana.

The quality of the animation is much higher than the quality of this photo.

On top of all that, there is a smaller aspect of Moana that was a joy to watch: Moana’s hair.  She has long, dark, wavy hair—and it behaves like real hair.  When she gets washed up on a beach, her hair is sandy and salt-poofed.  When she jumps or turns, her hair sometimes gets in her face.  And so when she’s getting ready to do some tricky sailing, she ties her hair up in a bun.

It was absolutely delightful to see a female character whose hair did not magically stay in place in all contexts.

I have straight, blonde-ish hair, so I’ve never suffered from a lack of “people who look like me” in movies, nor have I ever had to face the conscious and unconscious racism that can creep into people’s assessments of what constitutes “professional-looking” hair.  It’s still frustrating, though, that the cultural expectation for long-haired women of my age is that we wear it down, without clips or headbands or obvious hairspray to keep it in place.  And this is definitely a thing in popular entertainment—seriously, don’t even get me started on Supergirl’s hair.

My hair simply does not stay in place.  It gets in my eyes when I walk outside, when I play with my kid, even when I’m just sitting at my desk typing.  If I were superhero-ing or navigating a ship across the Pacific, you can bet my hair would be tied up.

It was so nice to see this in a movie!

Happy second birthday, blog!

It’s now been two years since I wrote my first post—happy birthday, little blog!  *Blows noisemakers and distributes virtual birthday cake.*  My posting frequency has been more erratic this year, but I’ve noticed something: my views-per-day never drop to zero anymore, even when it’s been weeks between new posts.  It feels like crazy grad mama has found its little niche on the internet, and that’s nice.  (Or maybe it’s just that the spambots know where to find me.  I prefer to look on the bright side.)

My biggest post this year was the one about why I hate attachment parenting.  It got shared by someone—I don’t know for sure, but I think it was the Skeptical OB—when it was posted in April, and continues to get new views nearly every day.   I like to imagine that new moms are finding it through search terms about their own frustrations with the expectations and pseudoscience of parenthood.

And speaking of traffic, a big shout-out to nicoleandmaggie, whose Saturday Link Loves have been my biggest driver of views after social media and search engines.  I was reading their blog long before I started my own, and it continues to be consistently excellent.

It’s been a big year outside of blogging, too.  I got another research paper published, and we put out a little press release that got picked up and repeated by the standard science content-reporters (IFLS, Gizmodo, etc.).  So now more people have read about my research than have read my blog, although I’m still quite sure that more people have read my blog than have read my actual research papers.

This coming year is going to be… well, it’s going to be full, and that’s about all I can predict with any accuracy.  Expect posts about pregnancy and new babies, about gender and identities and finding one’s place, and about the stress of finally finishing a PhD.  Oh gosh, what am I going to do about the blog’s name when I graduate?  Maybe it’s time to invest in a fancy header.

Thanks for being here for the ride.

An anxious introvert calls her Congresspeople

Before November, I had never called an elected official.  Way back in high school, I wrote a letter to my town council, about something tiny—the safety of a local intersection, I think it was.  It was for a class assignment and not something I felt super-strongly about.  My councilperson delivered a written response in person to my house, which was both awesome and terrifying.   A few years later, I emailed my representatives at all levels, local through federal, asking for pins to trade at an international event.  (Is this still a thing one can do?  I don’t know.)  All were quite responsive; I got several bags of nice pins.

But calling?  I hate making phone calls.  The social anxiety I have about talking to people in person is an order of magnitude worse on the phone, where I have no visual cues and it’s hard to hear what people are saying half the time.  This phone-hate is not uncommon, I gather, among anxious folk and among introverts more broadly.

People in the know, however, say that calling is the most effective way to get your point across to an elected official, short of showing up at an in-person event when they’re in town.  So now, I call.

It’s still a lot of work for me.  I have to write out what I’m going to say (or find a script I can use), with adjustments for leaving a voicemail versus talking to a live person.  I have to spend a solid ten minutes just sitting in silent isolation with my phone and my script, mentally preparing.  And then I have to decompress afterward, for however long that takes.

At the same time, I have to combat the thoughts that tell me I’m not doing enough.  There are so many things I could be doing, so many calls I could be making.  There are activism messages saying I ought to be making longer, more confrontational phone calls.  The amount of input that I have to sort through to figure out what I should do and say is overwhelming.

To combat all the different directions of anxiety, I try to remember a few things:

1.  Doing something is better than doing nothing.  The perfect is the enemy of the good, and all that.  Right now, my choice isn’t between “make a long, involved call” and “make a short, here’s-my-message call.”  It’s between “make a short, here’s-my-message call” and “don’t call.”  So I do the thing that I can do, which is less than some people can do, but still a thing done.  Similarly, when I put in a solid effort to call about something and get only busy signals and full voicemails, I’ve given myself permission to not feel bad about emailing instead.  A message in a less-noticed medium is better than no message at all.

2.  Focus is good.  Basically another take on point #1.  I can’t make calls every day—I would be a constant nervous wreck.  And I don’t have the mental space to keep track of every single issue.  So I don’t: instead, I pick the issues I’m going to follow in-depth.  (For the curious, these are health care / women’s health / reproductive rights, and LGBTQ+ equality.  These may not be your personal top-priority issues, and that’s OK.  Point 2 in this piece has a good explanation of why.)  Regardless of issue, I also call my Congresspeople on the rare occasions when they do something I approve of, because positive feedback is good, too.

3.  Those people answering the phone?  That’s their job.  They are specifically supposed to be listening to me and passing on my message in some appropriate fashion.  I am not imposing on their lives.

4.  I’m not the weirdest person who’s ever called.  Even when I’m nervous, even if I trip over my words, I figure the person answering the phone has heard worse.  I’m polite, and I’m calling about something that’s reasonably connected to reality.  (Note that by “polite,” I don’t mean “agreeable,” I mean “recognizes that the staffer on the phone is another human being.”)

5.  I’m not alone.  This is relevant for both external impact (my call doesn’t mean much on its own, but as part of a hundred calls, it matters) and internal turmoil (loads of people have varying degrees of phone anxiety).  When I’m freaking out, I review the helpful “How to call your reps when you have social anxiety“—it reminds me of my strategy, and reassures me that others are dealing with this too.

I tell myself these things, and I keep going.

I’m sick and I need to complain about it

I’ve been down with the flu all week, and it sucks.  Sinus congestion, headaches, body aches, low-grade fever, and, of course, fatigue.  Just walking around drains my energy.

I’m getting awfully darn tired of being sick.  I got hit with some other flu-ish thing, slightly milder but still exhausting, in mid-December, and haven’t been properly well since.  Unlike everything we caught last winter, neither of these illnesses seem to have originated in daycare; Little Boy was also sick this week, but with pink eye and an ear infection, both of which are bacterial.  (Lucky kid—he gets antibiotics.)

Fortunately, your basic flu isn’t a threat to a developing embryo.  Unfortunately, my pregnancy nausea is now in full swing, and seems to especially flare up whenever I lie down.  So that’s fun.

My mental state is understandably not great, a combination of general misery, hormone-induced anxiety, and frustration at not being able to get anything done.  I’ve been continually grazing on whatever food sounds good, and it’s triggering my body image issues hard.  I feel fat and gross and ugly, and too sick to do anything about it.

Here’s hoping the next week is better—well, OK, let me rephrase that: here’s hoping that whatever crap the next week brings, I’m at least physically well enough to start trying to deal with it.