Constipation, Dopamine, and a New Obsessive Research Topic

Despite keeping up with my 400mg of magnesium citrate in the evenings, and my two spoonfuls of flaxseed meal in the mornings, the constipation has returned. I am really bummed about that. But today, what I experienced was way beyond bummed. After three days without a respectable bowel movement (I know, I know, but it’s medically relevant), I woke up this morning feeling blue.

I stayed in bed while my husband got himself breakfast. I felt overwhelmed trying to come up with ideas on what to cook for dinner. By the time I got home from the grocery store, this had progressed to a complete fog of lethargy and hopelessness, with a side of foreboding. I took a nap, and it was difficult to get myself moving when it was time to put dinner together. As I cooked dinner, I felt like crying for no particular reason. And my guts were cramping up. Twice I had to leave the stove to pass an insignificant amount of poo (again, sorry), and as I served up the meal, I fought down a little wave of nausea that for once had nothing to do with food smells.

Somewhere in there, I was able to step outside the black cloud of bad feelings as an observer. I still felt it, and powerfully, but I could tell the feelings were not the result of anything that had happened. They were a singular entity, attaching themselves to any passing thought. This, I thought, is not just a blue mood. This is a crash in dopamine levels. Recognizing the problem didn’t make me feel any better, mind, but knowing it was a physical problem, not a personal problem, was helpful. It meant I could explain what was happening to my husband, and he’d have a better idea how to help/not help as needed, and also that it wasn’t his fault.

Now, recall the digestive situation: 3 days of constipation, dopamine crash on the third day, and at the height of the attack, some gut movement. Now, just an hour later, the black mood seems to have cleared. I know the two phenomena are connected, but I don’t know by what mechanism. I have experienced this, to a slightly lesser degree, before: inert guts, followed by lethargy and seriously depressed mood for no reason, which clears up when the guts start moving again. I have also observed it to an even more severe degree in my father. I accompanied him on a month-long trip in the developing world, and he developed terrible constipation and we had no access to laxatives. After five days of total gut inertia, he was explaining to me how/where he’d like to be buried, and how to get back home without him. He was morbid, hopeless, and overwhelmed with despair. I was scared for him. Finally, he tried the nuclear option: drank a glass of half Pepsi, half vegetable oil. I understand the next day, trapped in his motel room, was pretty miserable… but once his guts were clear, so was his mood (and while it’s a vile thing to drink, a carbonated beverage bubbling up through oil looks really cool).

I know there’s a connection, but I have not, so far, been able to tease it out. Basic physiology says dopamine regulates gut function, but the literature gives no mechanism for the gut affecting dopamine levels. There has to be one, and I want to know what it is, and if there is anything I can do to prevent/treat it effectively in the future. In the meantime, it’ll have to suffice that I can recognize it when it happens, and not simply be swept away by it.

Notes: This abstract suggests the regulation of the gut by dopamine, but not the other way around. However, from the discussion of rats, it looks like it might be possible to read the cause/effect train the other direction as well. Anxious rats develop more gut lesions. But what if the rats are anxious because their guts are dysfunctional?  In another direction, insulin apparently inhibits dopamine secretion, so the more insulin, the less dopamine? It might be something to keep tabs on, but it doesn’t quite fit the sequence of events I’m trying to decode here. This fascinating post points out that certain strains of gut bacteria actually produce dopamine, which is tantalizing. I don’t see how it hooks up directly to the phenomena I experienced, but it definitely gives a mechanism for the gut influencing dopamine levels, instead of the other way around.

Do Chua: The Cure for Acid Reflux (but not for bad breath)

Lately, the reflux has been very bad. It doesn’t matter whether I eat dinner early or late. It has nothing to do with spicy food (WATER gives me reflux for heaven’s sake).  It usually happens at night, but it doesn’t limit itself to the dark hours. I had it this morning too.

But I have found an effective treatment: Vietnamese carrot pickles. I made a batch a couple of days ago, and have been eating a forkful with every meal, and before bed. For two nights, I had no reflux. It could have been a coincidence, but I kept eating them because they are delicious and because if there was any chance that was keeping the reflux at bay, I was going to keep at it.

Last night, as usual, ate dinner, stayed up a couple of hours, ate pickles, and went to bed. And there was no reflux. And as usual, I woke up in the dark, sometime before 5am, with a desperate need to pee and a raging thirst. So after relieving my poor overworked bladder, I gulped two glasses of water and went back to bed. And immediately the reflux was back.  So I went back to the kitchen, I ate a forkful of pickles, and went back to bed. And it was like MAGIC. The reflux was totally gone.

My husband rolled over and said: “Gah! What is that awful smell? It’s like a port-a-potty!  Did you just eat pickles?” So I got up, and brushed my teeth, and went back to bed. Sadly, not back to sleep. Once I’ve gotten out of bed three times, it’s a lost cause.

The take-home:

1) Vietnamese carrot pickles are yummy and they kill acid reflux dead. Instantly.

2) They don’t smell so good to people who are neither pregnant, nor pickle fans.

Popcorn, Paunches, and Pickles

The baby is moving! I can feel it! A week or so ago I thought I felt something every once in a while, but it could have been just gas bubbling around my inert intestines, or maybe the huge pulse I have in my abdomen now.  But now I can tell it is definitely the baby moving around– the book says this often feels like having little fish inside or some nonsense like that. I think it feels like I am a popcorn popper. I get little kicks at irregular intervals: pop…..  pop pop…  POP!

I’m starting to show as well. I gained a centimeter back on my butt, so while I’m not back to normal size there yet, maybe I’ll get there someday. Meanwhile, my waist has gained 4 centimeters on my pre-pregnancy size, and my belly button is getting oddly shallow. It is usually kind of a dark mysterious cave in there.

Until now, I had not experienced any out-of-the-ordinary cravings. Aversions, yes: in the early weeks I was averse to pretty much anything that looked like food, and lived on cottage cheese and plain yogurt, because I could choke them down and they’d usually stay down. At six weeks, while visiting my parents, we were desperately looking for yogurt on the way to the airport. At the third grocery store, I was ready to cry. I was bending over with nausea, and there was nothing, nothing I could eat. All the yogurts were the sweetened kind, which would have sent my blood sugars through the roof. Finally, my husband spotted a case of single-serving Haagen Dasz ice creams. We pulled out a vanilla ice cream, checked the label, and found it had TEN GRAMS LESS SUGAR than a yogurt, and the total amount wasn’t going to make my glucometer angry. Who would have thought a vanilla ice cream would be safer than a cup of fruit yogurt?  Next we hit up the drinks aisle, looking for seltzer. All we could find was Perrier. So we headed out the door of the grocery with ice cream and lime-flavored Perrier on our way to the airport (my husband still teases me about this). Still, ice cream and Perrier was not a craving. It was dire straits. I was close to puking pure stomach acid on the roadside, and it was all I could find that would stay down.

Lately, though, I have developed… not just cravings, but some fairly odd tastes. The nausea is gone, so I don’t have to worry about that any more. I crave sour things. I made my own Vietnamese pickles last night, and I’ve had them with every meal since. They are so acid, and so good. I believe they may even have been the reason I didn’t have reflux last night, for the first time in days.  I often make chicken dishes that involve broth– which means I braise/boil a couple of chicken leg/thigh pieces for a few hours on low heat. This makes the cartilage bits and the bone-ends pretty soft. And I eat them. I’ve always liked the tendons, but I’ve never been a huge fan of the cartilage before. And I gnaw the bone ends right off, and eat them. I figure between the healing ribs and the baby, I must need the minerals. I’m not sure where the cartilage plays into that, but… my Granny always ate it, so it’s probably good for me.  For about a month I had a serious poultry/eggs aversion, but that (thank goodness!) has abated, and I can eat eggs and chicken again. I’m seriously relieved to be able to cook again.

And the pickles… they are wonderful!

Pregnancy Books

I read my first pregnancy book nearly ten years ago, when my sister had a baby. She had a copy of What to Expect When You’re Expecting lying around, and I was bored. That book scared the crap out of me. At that point in life, I did not expect to ever have children– not because I didn’t want them, but because everything I had heard about childbirth from friends and family who’d been through it made me cringe with horror. And these weren’t even bad stories. These were all tales of “normal” births, with their attendant hospitalization, needles, IVs, anesthesia, hosts of total strangers watching and touching in a freakishly intimate way, routine episiotomies…   The actual physiology of childbirth seemed pretty straightforward to me, and the thought of pain was no deterrent– by then I was a veteran migraineur and my periods resembled some people’s late-stage labor. But I got through them, it didn’t kill me, and I was pretty cavalier about mere pain. I still am.

But there are a lot of things more horrifying to me than pain, and among those are hospitals, with their icky smells, their inescapable chill, their lack of privacy, and their migraine-inducing fluorescent lights. I also have a pretty violent aversion to needles and anesthesia. Needles… I can get through shots and blood draws if I have to– I grit my teeth, squeeze my husband, and in a few minutes it’s over and I can go home. The thought of having a cannula or an IV drip installed for hours on end…  that is just too much. I’d probably clock anyone who attempted it, rip the thing out, and leave. I can’t imagine voluntarily submitting to that for any reason other than immediate danger to my life.

I feel roughly the same about anesthesia. I do not like even the idea of being under the complete control and influence of others. There are precious few people in this world I have that much faith in. I had my wisdom teeth taken out under a local, while I was wide awake. It was no big deal. I’m not even comfortable getting drunk around anyone but my husband and my best friend: that’s two people, in the whole world. Why on God’s green earth would I allow myself to be sedated, drugged, or immobilized by someone I may not know at all? Perhaps I’m a wee bit paranoid, but I have a right to be.

Worst of all was the idea of so many strangers and near-strangers touching me. I practically jump out of my skin when random people brush against me on the sidewalk in a completely nonthreatening way, thanks to an overactive startle reflex. I am, oddly enough, not an abuse victim (though I understand many of them have similar responses), but during physical exams, airport security patdowns, and gyn checkups, I rapidly dissociate, and it takes me a while to come back. I hate this experience. There’s nothing particularly egregious about any of those procedures, but my physical/mental shutdown response to them is extremely unpleasant. After a recent bout with airport security, I lost the better part of an hour from all recollection. I flat don’t remember it. It’s like I wasn’t there. I’m glad my husband was there to make sure nothing bad happened, but all the same… not something I’d put myself through if I had any choice about it. The idea of that in a childbirth setting… multiple people I barely know, or don’t know at all, sticking their fingers up my hoo-hoo to check my hourly progress… no, no no! I’d rather not have kids at all, than put myself through that. It sounds like paying good money to be gang-raped by hygienic licensed professionals.

As for episiotomy– doesn’t that make any woman cringe? We all know how much worse it hurts, and how much longer it takes to heal if we cut ourselves shaving, than if we just barked a shin, even with wounds the same size and depth. Whose bright idea was it to cut us to “prevent tearing”? I’d prefer to tear, given the choice, thank you. And that was *before* I’d run across any of the more recent research indicating that an episiotomy actually increases your chances of a truly humongous tear– like the kind where you have to worry about anal incontinence THAT kind of humongous. But of course even the most barbaric medical practices don’t die out until all the people who learned them in med school die or retire, so… yeah, they still DO that. WTF?

Anyway, pregnancy books… everything I read in What to Expect While You’re Expecting confirmed what I’d already heard– and been horrified by– about childbirth. No, I did not want to have kids. Thanks, WTEWYE, for reinforcing all my fears. I would not recommend this book to anyone, ever.

Some years later, in a thrift store, I bought a copy of Ina May Gaskin’s Spiritual Midwifery. Something about the 70s artwork and terrifically dated photographs intrigued me. It was a revelation. I was stunned to learn that, all along, there were other options. The way my friends and relatives had given birth wasn’t the only way. Childbirth (imagine!) was a natural process just like pooping or eating or sex, which in the right circumstances– i.e. when the mother is relaxed, unafraid, free to move around at will (i.e. not tethered to a bed and and IV pole), and has faith in her body’s ability to do what it was designed to do– works well without interference by modern technology and the professionals who operate it. Given the right environment, complications are rare and the need for intervention rarer. Nature isn’t stupid, and God didn’t make us broken. For the vast majority of births, we don’t need medical “help” any more than we need a catheter to urinate or an enema to poop every day– that stuff is for extreme circumstances. Sure, sometimes there are emergencies, but they’re a whole lot more rare than popular culture would have us believe.  Ina May blew my mind. And even though I had no idea where to procure services such as hers, Spiritual Midwifery changed me from “I’ll never have kids” to “Maybe I could do that someday”.

NOTE: One fascinating thing I learned from Ina May: having the cord wrapped around the neck happens in something like a quarter of all births, and is not an emergency– it’s easily handled by any half-competent midwife or well-informed husband. We’re just used to thinking of it as an emergency because we hear so many people come home from the hospital after having C-sections or interventions out (or in) the wazoo, and they repeat the line their doctor gave them: “Gee! That was scary, I’m glad brave Dr. Whatsit was there to perform xyz procedure, because OMG the cord was wrapped around her neck THREE TIMES!”  Now, of course, I cringe when I hear this. And I’ve heard it so many times!  A nuchal cord may actually be nature’s way of preventing a cord prolapse (which is truly, actually dangerous), when the baby has a really long umbilical cord. It takes up the slack.

Once I found out I was pregnant, I was ravenous for information. Especially pregnancy information. Ina May has a lot of great things to say about birth, but the preceding nine months are a little sketchy in her books (I’m pretty sure I’ve read them all now– her guide to breastfeeding is fantastic). I went cruising for recommendations and read Pregnancy, Childbirth, and the Newborn, and hated it. While not as scary as What to Expect, it reads like it was written by a committee, exclusively for people with severe ADD. It felt patronizing in the extreme, and the writing was so choppy and dislocated it was difficult to read in anything more than five-second increments. It’s possible the eighth-grade reading level is right for some people, but not for me. I’m a reader. I actually *like* books. I don’t need my data chopped into bite-sized bullet points for me; I’m a big girl. And this was supposed to be THE natural-birth-friendly guide, according to the well-meaning folks who recommended it. Ack!

Anyway, at last I got my copy of Sheila Kitzinger’s Complete Guide to Pregnancy and Childbirth. It’s not perfect, but it’s the book I wanted. It reads well, it has exhaustive information on pregnancy, it doesn’t talk down to the reader, it is truly natural-birth friendly, and at no point have I tried to throw it at the wall. There are a few niggling errors that the fact-checkers and copyeditors should have caught, and because I’m hormonal and obsessive, these drive me a little nuts, but they’re not fatal. Basically, in the week-by-week part of the book, every other week or so it gives a “by now your baby is around x inches (n centimeters) long” spiel. But usually the inches measure and the centimeters measure don’t match up– according to my tape measure they diverge by anywhere from a fourth of an inch to half an inch. Are metric babies bigger than American babies? It also doesn’t tell you *what* is being measured. I had to do my own outside research to figure out that for the first fourteen weeks, the measurement given is from head to tail. Around 16 weeks it seems to switch to head-to-foot without ever saying so. One is left to assume that the baby grew a whopping 6cm in just two weeks. But that and a missing arrow on a chromosome chart are the only gripes I have with Kitzinger’s book, and for all I know they were fixed in some later edition. If you want a good, solid pregnancy book that won’t make you wish you’d had your tubes tied, this is it. Thank you, Sheila.

Gestational… Hypoglycemia?

The women in my family are all diabetic, except for me. My mother, my sister, my aunt, my grandmother: all type two diabetics. I watched my favorite great-aunts deteriorate and die from the complications. I know what diabetes is, I know what it looks like, and I am very, very paranoid about it. I would like to avoid getting it. I have a glucometer, and I monitor my blood sugar. Anything that sends my numbers over 150 gets axed from my diet. I never eat a whole banana, but so far I can handle just half of one. I’m careful about things like rice, and sugar is The Enemy.

Or at least, that was the picture until I got pregnant. Very shortly after I confirmed I was pregnant, a weird thing happened to my blood sugars: my fasting numbers dropped from a consistent 83-84 down to 70-74. I assumed this had something to do with the horrific nausea disrupting my eating patterns. I lived for a month on cottage cheese and plain yogurt, unable to keep anything else down. But then, we left the country. Up in the mountains I got even more sick, and my fasting numbers got even more weird, dipping into the upper 60s. I was really, really hoping it was something to do with the altitude, and things would normalize once we were out of the mountains. This was not the case.

In the meantime, the nausea abated some, but we lacked the facilities to cook properly, so we ate at least one meal a day in restaurants, and made up the rest with avocados and yogurt. When we returned to normal altitude, the problem actually seemed to get worse. At the hostal, we didn’t even have the dishes to manage avocado and yogurt, so all meals were in restaurants. My morning blood sugar readings were regularly in the 60s– the lowest I recorded was 61, just at the edge of real, scary hypoglycemia. I started keeping little juice boxes in our room, so I could get back up to normal first thing in the morning– we usually wake up at 6am, but none of the restaurants open for breakfast until 9am. That’s a long time to wait with low blood sugar. I was waking up groggy, confused, and lethargic. And ravenously hungry. 84 is my normal zone, where I feel good. At 65 I am a barely-functioning zombie.

Once we got our apartment, we stopped eating in restaurants. the content of our diet didn’t change all that much: meat, vegetables, rice, etc. But over the course of a week, my blood sugars went back to their pre-mountains level: still low, but back in the 70-74 range so I don’t feel dead when I wake up, but I can still feel out of sorts and a little slow-thinking until after breakfast.

Then one Sunday some friends from church took us out for lunch. The next morning my glucometer read 68. I think it’s something about the restaurants that is really doing me in. An expat friend informs us that “everything here has MSG in it”, so that’s a natural first suspect. I certainly don’t cook with the stuff at home. Whatever it is, there seems to be a pretty strong correlation between me eating in restaurants, and my blood sugar doing a nosedive over the next 24 hours.

But that still doesn’t solve the riddle of why it dropped to begin with, and why it is still consistently lower than my normal pre-pregnancy readings. That part mystifies me. There is a ton of literature on gestational diabetes, and how it’s normal for your body to get a bit insulin-resistant during pregnancy to make sure the baby is getting enough nourishment blah blah blah. But I can’t find any information on why my blood sugars might drop while I’m pregnant. There’s a tiny hint that this might not be unusual, in that the recommendations for morning sickness sometimes include a little blurb about eating as soon as you wake, because low blood sugar may be what’s making you nauseous. But that’s it. Nobody elaborates. Has this actually been studied? Are we talking about ordinary first-thing-in-the-morning fasting blood sugar as though it’s “low” or are we talking about lower-than-normal blood sugar? The literature is extremely unhelpful here.

I know I’m not the only person to have experienced this: I’m not half-Martian, and no single human physiology is THAT unique. But I’m guessing there aren’t that many weirdos out there paranoid enough to be monitoring their blood sugars without being diabetic (yet). Maybe there are a ton of women attributing that new I-feel-like-hell-in-the-morning feeling to the pregnancy alone, and never investigating it further. But I can’t help worrying that the low glucose levels may be having a negative effect on the baby. I wish I could find a good answer for it.

My Pants are Falling off, But at Least I Have a Midwife

According to my pregnancy guidebook, I’ve probably gained a couple of pounds by now. I can’t tell. I don’t have a scale, and the one in the midwife’s office is in kilos. I meant to run the number through a metric converter the last time I was at the internet cafe, but now I have completely forgotten what the number was. Anyway, in theory, I should have gained weight. But my jeans are falling off me. So I got out my tape measure this morning and measured around my hips/butt, and found I am 3cm smaller than I was before I got pregnant. How did that happen? I did not pack a belt, because I didn’t need one before and figured it’d be useless in a few months. Today I got desperate and threaded a spare bandana through two belt loops, cinched it up, and tied it in a knot. I’d look lumpy, but I wear my rain jacket everywhere anyway, so I’m hoping it just looks like I’ve got a wad of something that is not cash in my pocket.

Ok, I was sick for like two months straight, with the horrible nausea, and then the bronchitis. And I did suspect that at least in the early part of that, I probably lost a little weight. But I thought for sure I’d have gained it back by now. And my belly is sticking out just a little bit– not in an obviously pregnant way, but even my husband notices it. That stubborn little paunchy bit I’ve always had is still there, but I can no longer hide it by standing up straight and tightening my abs. It’s being pushed out from the inside. Is my belly stealing from my butt?

In other news: flaxseed meal. I can’t say much for the taste, but it’s easy to mix in with a little hot cereal in the morning, and it was brought down by angels straight from the hand of God. I thought nothing would ever bring my intestines back into working order. I can have a cup of coffee in the morning, and then eat prunes all day and all night (seriously, I tried), and NOTHING HAPPENS. But for the last 3-4 days, I’ve added two spoonfuls of flaxseed meal to my morning maca-and-oats, and suddenly my colon works again. Nobody should really be this happy about regular bowel movements, but… this is brilliant!

And I found a midwife! I had read that the private clinics here run a c-section rate of anywhere from 50% to 90% (yikes!) and was not looking forward to trying to find a natural-birth friendly obstetriz who speaks English. We searched the archives and came up with a promising website for a sort of activist midwifery practice. That was a couple of weeks ago. We had other things to worry about, like finding an apartment, so we made a couple of halfhearted attempts to call them, but when we called the number it didn’t even ring– the call would just cut off immediately. I worried that it might have gone out of business, and the website was all that was left! Finally I emailed them, they emailed me back, in English, to assure me they were still around, and I figured out that we were dialing the number wrong, so called and made an appointment. Yesterday, we went to talk to the doctora/midwife, I was totally thrilled with both her and the clinic, which are totally natural-birth-friendly, totally affordable, and are probably my best chance of not getting sliced open– here or back in the states. She answered my whole boatload of questions, and cheerfully spent two hours with us. I got to tour their facility, and a second midwife took my blood pressure, weighed me, and felt around my belly to measure my uterus. I still wonder how an English-speaking doctor from Germany ends up in South America advocating for natural childbirth. But I’m glad she did.

Nausea, Bronchitis, Rib Fractures, F#$%g Prenatals, and Other Irritations

Pregnancy was pretty textbook for me, until the bronchitis. 13 days after I ovulated, I found out via urine test that I was pregnant. For another week and a half I felt pretty good except for the constipation. Whee, this is easy, I can handle being pregnant. Then, of course, I was unbearably nauseous for the next 3+ weeks, unable to eat anything that wasn’t plain yogurt or cottage cheese, unable to cook, unable to even look at or talk about food.

And then, we moved to a foreign country, to a city high, high, high in the mountains, where I spent three or four days with altitude sickness on top of the nausea. I thought I might like to die. It would be easier. Instead, I slept a lot, and when I wasn’t sleeping I was puking– even when I hadn’t eaten anything. I’m pretty sure I actually lost a few pounds in that stretch.

For a week, we stayed in a cute little apartment. By the end of the week, we were begging my husband’s school for a transfer. The stove leaked propane, and road construction left the air constantly full of fine clay dust. At the end of the week, I got bronchitis.

We moved to a new apartment, in another part of town. The apartment had no gas leak and no dust problem, and the landlady was very nice to us. But it was too late: the bronchitis had settled in for the long haul. On the plus side, I seemed to have traded out my nausea for a severe cough, so I didn’t have to deal with both at the same time. After this, the only time I puked was after taking my $%#@&^* prenatal vitamin. I KNEW I should have just got a folic acid supplement– it would have taken up so much less space in my suitcase, and been cheaper to boot. You can’t freaking find a prenatal vitamin without iron in it, and what freaking good is a prenatal vitamin, if you invariably barf it up within ten minutes of swallowing it? So I stopped taking the damn thing and now I am free of the nausea. Yay! I mean, I would love to have the awesome trace minerals and stuff, but… I wasn’t getting those even when I was taking it, so… tough luck. I’m being extra super concientious about eating lots of meat and fresh veggies, and that will have to do.

Anyway, the bronchitis. I had it. The new apartment didn’t make it better. We brought emergency antibiotics with us, but we were unable to determine if they were safe to take while pregnant. There was only one decent study on the subject (at least for azithromycin, which is what we have), it was done back in 2006, there were only 138 participants, and while it didn’t find any increase in birth defects with the use of the drug… that’s not exactly a lot of info to go on. I decided not to risk it, and just tough out the bronchitis. I’ve had it lots of times before, it wouldn’t harm the baby, and it wouldn’t kill me.

For three weeks I hacked and coughed convulsively. And then I fractured two ribs– this also has happened to me before, during my worst-ever bout of bronchitis in high school. I seem to have re-fractured them in almost exactly the same places, too. Maybe it left a weak spot. After that, the bronchitis started to let up, and now, a little over two weeks later, it’s just a little irritating throat congestion… and two fractured ribs. Those take 3-6 weeks to heal and there is not anything you can do for them except avoid stressing them further. This means trying not to cough, sneeze, lift heavy things, be hugged, sleep on the wrong side, wear a bra, or breathe too enthusiastically.

Fractured ribs are also incompatible with certain aspects of hand-washing laundry, which is how our clothes are getting clean these days. Most items don’t give me trouble, but dumping out the wash-water is tricky, and getting a heavy, wet pair of my husband’s pants wrung out is just not possible. I hang them up dripping and hope for the best. So far, we’ve had four pairs of jeans out on the line for two days. They’re still soggy.

Not being able to wear a bra (the elastic band goes right over the fractured ribs) has not really been a problem. The city we live in is constantly cloudy and chilly this time of year, so I just wear my rain jacket everywhere, and nobody can tell. It’s no great loss. Most of the bras I packed no longer fit anyway. I’m not looking forward to that aspect of my ribs healing: the part where I’ll be obliged to find new bras that fit, in a totally unfamiliar sizing system. It was hard enough in American sizes. My husband, of course, really likes my new boobs. I’m just wondering if they’ll ever go back to my “normal” size. Looking at the older women in my family who’ve already had kids: I am SOL. Not only are they never going back down, but if I have any more kids, I’ll have a nice big shelf in front where I can set my glasses down, and I’ll be able to tuck my wallet and cell phone and keys in there without making any appreciable changes to my shape. My pre-pregnancy size was bad enough. At 32D, it was already impossible to find a cute blouse that actually fit: anything that fits across the chest is two or three sizes too large in the waist and makes me look chubby, and blouses that fit in the waist are either popping buttons loose in the chest, or gaping open indecently. I was stuck with crew neck t-shirts for every occasion. Now… who knows? Maybe after the baby is born, I’ll have the protruding gut to match my bra size, and everything will fit at last. I can’t say I’m looking forward to that, either.

Maybe I’ll try the prenatal vits again when my ribs are better and I can risk the puking– right now that kind of spasm would probably kill whatever bone-mending progress I’ve made.