Breastfeeding I: Colostrum, Antibodies, diarrhea prevention

Human milk provides protection against disease for a baby. There are many ways that it does this, much beyond what I can delineate in my non-studying time allotted. So I will start at the very beginning and then continue later.

A vaginal birth allows the baby's gut to be colonized by healthy bacteria which will deter disease by preventing the growth of unhealthy bacteria. #2 provide essential nutrients such as vitamin K. The proper colonization of the gut is why adults take probiotics, which will be another post.

The first milk secreted by the mother after birth is called colostrum because it is soooo different from 'mature' milk. It actually selectively facilitates the establishment of healthy gut bacteria Lactobacillus bifidus along with aiding the passage of meconium, or baby fecal matter that is still sterile from being in the mother, or not yet full of healthy bacteria.

Colostrum has less kcal than mature milk that will be secreted a few days later but has a higher amount of protein, fat soluble vitamins, and minerals. Further, it has a VERY high level of antibodies against bacteria and viruses that may be present in the birth canal.

These secreted antibodies are called IgA (immunoglobulin A) and are fascinating because the act like little pac-men for the viruses and bacteria. They are secreted by the adult gut and are specific for the topography of bacteria, viruses, etc. The immunoglobuns thus grab onto the bacteria or viruses and hold onto them preventing them from infecting you. In the adult,  IgA is secreted in the nose, the salivary glands, and throughout the gut along with into the breast milk.

In the second trimester of pregnancy, the human breast fills with inflammatory cells and it is thought that it is for this purpose: to identify and greatly increase the amount of secretory IgA made against any bacteria or viruses present in the environment and therefore protect the baby. Not only that but the degree of protection against organisms causing disease is proportional to the amount of HUMAN milk the infant receives, meaning exclusive breast feeding = greater protection vs diseases that cause diarrhea, nausea, etc. It is well established in the medical community that ingested antibodies from human milk provide gastrointestinal immunity against the following digestive tract/enteric pathogens that cause diarrhea: E. Coli, Salmonella typhirium, Shigella, V. Cholerae, Giardia, rotavirus, C. Diff, C jejuni. Therefore the antibodies in human breast milk in combination with the nutrients that help healthy bacteria survive protect the baby against diarrhea, GI ilnesses, etc.

Further the mother secretes immune cells (lymphocytes, T-Cells) that give specific immunity for bacteria present in the environment to the baby whose immune system cannot yet make those bacteria.

A Brief Update

It is discouraging and scary to be coming back from this injury. Strange that I say this as I have come back from two ACL reconstructions. But there the injury was fixed. This time I know I have no miniscus and a meniscal tear. It is not "fixed" and it is up to me to change my training accordingly. Also running cannot be my priority. My schooling is my priority and that takes up a lot of time and effort. There is no clear path forward.

I went for a 14 mile run on tired legs on Thursday and really died at the end; my legs felt like lead. That used to be easy and at an easy pace (~7:30). Now it is difficult to brutal. My physical therapist said on Friday that people have come back from worse and that I will be back out there. And I will try. I know I am not alone when I run, I know I have my mom and my cat (who I put to sleep when her kidneys failed the day after my mom had been hospitalized with her final seizure. She sometimes visits me in dreams. She had been abused by previous owners, so I spent a lot of time sitting with her until I was the first person with whom she connected.) But is is hard to have loved something so much and have it taken away suddenly, whether it be a mother, a cat, or running. But hopefully I can get it all back.

I know I have strength in me. But between school and being in the worst shape since my ACL reconstructions, it is scary. I'm going to keep plugging away at my schoolwork and keep going to physical therapy and hopefully soon I will be back out there racing with my friends and comrades. I won't be at the front of the pack. That isn't how the body works. I will have to take some time to earn my way back up there. Wish me luck; I need it!

It's okay to be a chubby runner!

It was around 3 o'clock on what was a Tuesday or Wednesday afternoon when I got the call. I was fourteen and was doing nothing much after getting home from school. It was my dad's voice on the phone:

"I've got it Courtney"
"What dad, what have you got?"
"I've got the sport that will take you to the Olympics"
[pause... I'd never thought about going to the Olympics .. didn't have any idea why I was getting this call out of the blue]
"And what sport is that dad?"
"Bobsledding"
[another pause... thoughts of being like the guys in Cool Runnings going through my head]

"Why bobsledding?"
"Because you can run fast and weigh a lot"

[pause as I get kind of excited, sounds like fun, but then I realize....]

"Dad, did you just call me fat?"

Yes that is the call that no fourteen year old girl wants to receive.... the fat call. I was chubby and kinda short. One guy who tried to date me in middle school ACTUALLY tried to flirt with me by calling me Courtney FAT-man before giving me his nike wrist band and trying to hold my hand! But I could still out-sprint most everyone in a soccer game. One time I remember hearing the parents from the other team commenting on how long my legs were... and I am 5'4" now, probably was shorter then, and weighed probably ~140lbs. So I knew didn't have long legs, I could just run faster then their daughters. And I remember telling my dad about that and wondering how fast I had to be running to create the illusion of long legs...

I think that training as a chubby athlete all my life has prevented a lot of injury. It takes a lot more muscle to run in a 140lb body than a 110lb body. Then as I dropped weight while living in Montana, I could sustain those speeds.

Now after having been injured I'm back up to ~127, which is 10-15lbs higher than my ideal racing weight. It will come back off if I keep training. But earlier today I did 5 mile repeats at a sub-6 minute pace (between 5:56 and 5:39) while weighing about 15 lbs more than most girls that can run like that.... As great as it would be to be a bobsledder, I can just stick with running for now and see how far this woman who was a happy-go-lucky Chubby girl can get in the running world :)

A woman's best friend

5:00 In the Morning (A true story that I wrote a few years back)

My cat has decided it’s time to eat
She wants a full meal not just a treat
In my back her head she does shove
Reminding me food is payment for love

I curl in a ball and pretend not to know
She cannot wake me back to sleep I go
Meow she screams as she paws my head
Meow, meow: get your ass out of bed

I wipe away her paw and say:
"The sun’s not up, I will not start my day”
Meow she replies “there’s pink in the sky”
Meow: her belly’s rumbling and time is nigh

“An ounce of patience is worth a pound of brains”
Oh kitty, the truth each proverb contains
Meow she responds with a tear in her eye
Meow my belly cannot wait she does sigh

“I love you baby, please don’t cry
But I’m not getting up till the sun’s high in the sky”
Meow, she nudges me “I love you too
But Meow I love food, what do you want me to do?”

Meow: just get up and put more food in my bowl”
Meow, her cry wrenches my very soul
I give up I say and stumble out of bed
But then fall down the stairs and bump my head

Meow she nudges me, you’re still not there
Meow I’m sorry, but my bowl is still bare
I get up and and towards the kitchen I limp
Meow she purrs: I love my wimp

Oh, and Meow: on the chicken you’d better not skimp
But baby, all I own is some brine shrimp
Meow I’ll survive, just give me the shrimp
But baby, not too much, you’ll become a blimp

Meow: my concern is actually becoming too lean
Meow: Now I don’t want to sound very mean
Meow: but bow down and acknowledge what all have seen
Meow: you’re a servant, now worship your queen


I found my cat a starving little tiny kitten, definitely less than a month old, in the backyard soon after moving to Portland. She desperately needed food, so I fed her, and she hung around. Within a couple of weeks she wanted to come inside, but she had fleas. Unfortunately as she was so young this meant she had to get a flea bath. This obviously was painful because while cats don't like baths in the first place, she had scratches all over her little body. She disappeared for three days after that. When she showed back up, she was with me to stay.*

The first problem was that she had a siamese howl and couldn't handle being alone in the house. She would sit in the middle of the floor and howl for the entire time I was out. My upstairs Haitian housemate who was a stay at home pothead computer programmer and said having cats in the house was against his religion seemed to not appreciate her meowing for hours on end very much. So I began bringing her everywhere, the store, to class (she would sit under my chair). After I moved if I tried to leave her at home, she would follow me to class and wait outside. She has gone camping and hiking and driven down the 101 coast with me. The scariest moment was when she jumped out of the car after just after sunset in Yellowstone when we stopped did a quick in the middle of the woods pit stop.... we could hear the wolves howling in the background. She obligingly jumped back in of her own accord, however, when I opened a can of fancy feast. In honor of that occasion her name was officially changed from "Pumpkin Purr-Bucket" to "Pumpkin Wolf-bait Purrbucket."

Being able to live somewhere that I can have my cat has dictated where I could live and whom I met for the last 10 years of my life, arguably changing my life very considerably. Now as I study and isolate myself leading up to the USMLEs, I have my cat right next to me. She meows if I sit still for too long and don't play with her. She meows if I sleep in, as she needs to play by around 5am. Like today, no chance of sleeping past five, it was kitty play time. I have had people ask me if there is such a thing as kitty adderall. But the little girl downstairs loves playing tag with my cat, as do I. I guess I may have made my cat a little ADHD over the years to be quite honest.... But in the end I have a best friend who has stuck with me through the best of times, the worst of times, and many trips all over the United States.

*Note, she does submit to bathing without scratching or complaining now. It seems to be part of the deal we struck when she came back after those three days. She is willing to be bathed as long as I care for her.

About ready to go, my first real speed workout!!!

The last 4 months off of running have been tough and it left the question in my mind, will I come back? I never expected to be as fast as I am now. I never expected to run a sub-6 minute mile, much less 5k, or a 6:11 half marathon or a 6:45-paced marathon. But I have with a year and a half of honest training.... Was it all a freak accident?

My knee feels almost better today, tight on the outside (where there is no cartilage) and a little painful on the inside (where there is torn cartilage). In contrast, my head felt like crap this morning. I woke up with a runny nose, swollen eyes, and a scratchy voice. When I feel like this in general, only one thing makes it go away: running really fast. No joke. I feel like I can't get out of bed, so I get that lymph moving and suddenly the runny nose is gone and I can think clearly. As I had a quiz at 7:55 that I needed to study for before class, I had to wait until noon to try to clear my head the way I did throughout winter last year.

While I don't like talking ad nauseum about the pace of my speed workouts or how hard I try, etc, etc, I'm dang proud of my first speed workout back. (For the record I'm not supposed to do speed for a few more weeks....) So I got on the treadmill, put it to a merciful 0.5% incline. Before I did all my treadmill runs at at least a 1.0% incline, usually more, and pulled off:

1.5 mile @ 6:07 pace (9.8mph)

.25 mile recovery

1.5 mile @ 6:00 pace (10.0mph)

.25 mile recovery

1.5 mile @ 5:52 pace (10.2 mph)

.25 mile recovery

.5 mile @ 5:39 pace (10.6 mph?)

.25 mile recovery

.5 mile @ 5:33 pace (10.8mph?)

.25 mile recovery

.5 mile @ 5:27 pace (11.0 mph)

1 mile cool down.

I'm almost back baby and getting ready to go! Hopefully the knee will keep improving and I can get back to my old speed workout paces, but hey, I'll take this as a sign for good things to come! YAYYYYYYYY!

The Runner girl's heretical guide to beginning to swim as an adult

Many people writing about swimming seem to be swimming purists... They think we should just love slogging through the miles. But I don't feel this way. As a kayaker, I have tried to avoid swimming because that means I royally screwed up and came out of my boat. This is about turning around my negative swimming attitude and embracing my inner mermaid.

My #1 tip for beginning to swim as an adult is toys! Toys toys toys! The beauty of swimming is it is about "form" and in order to gain that form people have designed many different toys. People like to play with toys and runners don't like to swim because it feels weird and unnatural. So why not make it an adventure into toyland? The difference between toys and 'gear' is that nothing needs to be top of the line. I like to bring my entire bag of toys and mix it up. I have read several articles about how when you see someone with paddles, etc, you know they are triathletes because they are 'gear-heads.' I say Whatever! The toys are making me a better swimmer AND making it fun.

#2. Get goggles. They help so so so so much. Even though it makes me feel good that I can pass the guy who is swimming laps with his head above the water. Don't let that be you when you are trying to figure out how to enjoy the sport.

#3. Make friends with the lifeguards  Not only will this make swimming more enjoyable, but sometimes they let you play with their swimming-toys. This helps you figure out which toys are your favorite. Over Christmas break the lifeguards let me borrow all kinds of different swimming toys of theirs and would bring them daily for me to use! Also will they tell you "oh, you don't look like a beginner at all" and improve your swimming ego. Until you remember that they are comparing you to the people doing water aerobics and the guy without goggles swimming with his head above water.

#4. When all else fails pretend you are scuba diving and swimming in a school of fish, and there go the turtles! Oh wait, here comes a shark! Sprint, go go go go, zig zag, dive deep and up. Few, made it to safety at the other end of the pool now back to checking out the buried treasure in the sunken ship in peace...

My toys:

I use a waterproof ipod nano and listen to PharmRecall while I swim. The repetitive nature of swimming is perfect for memorization. It would also be a great opportunity for learning a new language. My pharmacology grades have improved since I began swimming!

I use flippers a lot! As a runner, my legs like to go wild. Flippers restrict their movement and make them move 'correctly' so I am kicking effectively. Also they make me go a lot faster. And I like going fast... But can't yet without the flippers, so flippers here I come, vroom vroom!

The forearm fulcrums are one that the lifeguards lent me while I was home over Christmas. They have completely changed my stroke and I can feel the water now. I can actually FEEL when I am stroking effectively, instead of just not knowing why I am going so slowly.

Finally, I use paddles now that make my shoulders stronger (once again supplied to me by the lifeguards that compliment me on my non-beginner stroke). They help a lot with my breast stroke that seemed to just take FOREVER and was brutally slow.

These are all the toys I have so far, though I use the pull buoy and kick board supplied by the Y.

Next student loan check in July I will get a snorkle, which I am excited about. This will absolutely help me fantasize that I am snorkling in somewhere crazy amazing instead of in a chlorinated pool at the Y in Grandpa's AND Junior's urine.

And when some swimming purist comments on all your toys just tell him/her... yeah, I have a lot of toys, but at least I'm not a stuck-up jerk. Just say it in Urdu and all other of the twelve languages you have managed to learn fluently while practicing swimming back and forth and back and forth and back...

A reaction to the shooting: Why I first wanted to be a doctor

When I first heard about world war II and the Nazis was when I first decided that I wanted to help people on an emotional level. What happened horrified me, because everyone involved was human, these were people hurting people. I was five and wanted to be a psychologist. I wanted to help people that no one else could help and I believed I could. I believed I had special powers to see beauty, pain, and good in people that no one else could see. I believed that all people are inherently good and have the capability for incredible evil. So I could stop evil if I could just reach the good in each person.

Since getting into medical school and becoming an elite runner, I feel as though many people look at me differently and think I was always successful, one of those people that fit in. People don't see or know that for many years I was the family screw up. A big part of that is that I am ADHD and make people angry no matter what. Another big part is that my parents were both horribly horribly abused. While they did their best, when my mom lost her temper she would get incredibly violent and mean. And I would make her lose her temper. My dad would get distant/withdraw/go to work/ and occasionally get angry, but usually just disappear.

Yes, social services were called. Yes, we had neighbors threaten to call social services on top of that. Yes, I moved out of my house and slept in a park and friends' houses because my mom got so angry that she came close to killing me. And yes, that is all water under the bridge because I LOVE my family and I am one of the most fortunate people you will ever meet for having such smart, kind, hardworking, generous, and honest people as my family even if we all have our issues.

However,Yes, I was incredibly depressed and different and hid it all away and no one knew that I was broken inside. I didn't let anyone know how broken or suicidal I was. How much I hated myself for who I was and what I created in the people around me, most importantly my mother. The truth is years later, after I moved across the country to Oregon to find and define myself as something positive, to work through all that crap, my mom apologized. I forgave her. That is what made it imperative that I spend her last months with her when she was diagnosed with terminal cancer, so she knew that no matter what had happened, she was deeply loved. That she was still my hero for how hard she struggled to be the best person she could be. That I knew she was just an abused and hurt herself, but still very lovable. I knew that she tried her best all her life to be an amazing mother. That she gave me the gifts of learning and education and opportunities, even if she had the limitations of a fiery temper and impossible standards. I needed her to know that I forgave her for the years of abuse because that whole time she loved me and was being the best mother she could be. That makes her my hero. My tragic hero. That her struggle and many gifts define her as a person and mother, not her mistakes, not her anger.

This experience, these experiences, have made me privileged, have helped me develop a gift for seeing a different side of people, a beautiful side, that they may not feel as though anyone else can see. For example, over the years I have connected with several schizophrenics despite the idea that schizophrenics lose the ability to connect with people during their meltdowns. One time when visiting old housemates I met someone who had moved into one of the rooms and chatted with him for about 20 minutes. ~1/3-1/2 year later he had a schizophrenic meltdown that lasted about a week and was arrested by cops after having broken into some random person's car and was just sitting in the backseat. From jail he wrote my previous housemates a letter and about half of it was addressed to me. Another guy I met on campus and chatted with him during dinner. That night he broke one of my neighbors' windows trying to get someone to let him in to talk to me. My neighbor delivered the present... a bag of chocolates with his cell phone because he was being tracked by the cops, and needed to get rid of it, a strange present... I must make the disclaimer that this was not sexual, he was not hitting on me, he had mentioned a girlfriend in our earlier brief conversation, and it did not strike me as sexual. I have many other strange stories as well.

As a kid I used to have nightmares about my elementary school. One repeated nightmare is that there were aliens invading the school. One by one they were pinching those around me, my teachers, my classmates, my friends and family, making them into automatons as well. That one by one everyone else was losing their humanity, losing their ability to feel and love. All I could do to not get pinched, my only defense against becoming an alien like everyone around me, was to pretend that I, too, was an alien with no emotions. I always woke up barely having escaped being pinched and made into an alien like everyone else around me, but always retained my humanity.

My  secret struggles have defined who I am. They have defined my ability to look into people's eyes and see their humanity. To understand what it is like to go to school with a smile on my face and try to make everything okay then return home to either a warm happy family or to running away and hiding and crying because my life may have depended on it. My mom always called me her sensitive little girl or her tender little girl. The shootings remind me of this and my vow to return as someone with the power and gift to help others who feel that isolation and alienation and searing pain and shame that I have felt most of my life for being different. Of my promise that I would help others, less fortunate than I, by seeing them, and helping them find a way to succeed despite their differences and disabilities and inability to fit in with society. That I would use my greatest gift, my ability to retain my humanity when it is too easy to feel completely broken and alone.