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Today's reading: Naaman.

Normally when it comes around in the liturgical year, the Old Testament story of Naaman seems to serve only as a backdrop for the Gospel:  among the ten miraculously cured, the lone foreigner among them is the one who returns to Jesus with thankfulness and so to earn His praise.  It caught my eye on its own today.

Naaman is a valiant and respected man, ill with leprosy.  He travels to Israel to be cured on the counsel of a Jewish child, a serving-girl. 

Bearing riches and a letter of introduction, he seeks his cure first from the king.  The king offers no help, only suspicion.

On the prophet's invitation, Naaman travels next to the prophet, expecting the prophet to cure "the spot" with his own hands by the power of God. 

To his shock the prophet instead sends him to wash in the river and be clean, something so ordinary he cannot believe it will help.  Persuaded by his own servants to try anyway, he does so; and not only is "the spot" taken away, but he is practically reborn from the water in a new skin:  "his flesh became again like the flesh of a little child."

As I listened this morning to the reading -- which begins halfway through the story, just as Naaman plunges in the river -- most of what struck me was the overabundance of the cure.  He hoped for a simple cure, a removal of "the spot;" he didn't really expect anything from this washing; and what he got wasn't a simple excision but a second birth.   

This is a good image to have in mind when you hear the abused words "born again;" you have to be ready for it and not shrink away from the complete rebirth, the complete overhaul of self, because when you go to Christ seeking help with a troublesome spot, He is not satisfied except to scrape the whole thing away and start over.

Going back to the extract later to read the context, I saw again the intrigue of the many characters involved here.   Leading up to the moment when Naaman plunges in the river are the Jewish slave girl; not one king but two; the silent wife, mistress of the servant-girl; the prophet; the commander's servants.  None is there by chance.  Together they make the story of Naaman a surprisingly rich text for meditation.

Sure, the most depressed people got the headline.

That is, "Workers in personal care, restaurant industries have highest rates of depression," as reported in the Strib from the AP.  Nearly 11 percent of personal care workers are depressed.  More than 10 percent of restaurant workers. 

But having been trained as an engineer, and not as a media professional (9 percent are depressed),  I prefer to focus on the good news.

The lowest rate of depression, 4.3 percent, occurred in the job category that covers engineers, architects and surveyors.

"Because it's silly to be depressed," says Mark.   

The next least depressed are scientists, followed by the job category of installation, maintenance, and repair workers.

A great book for little boys.

We borrowed a wonderful book from a friend this week -- her old, hardcover copy of The Real Hole by Beverly Cleary, illustrated by Mary Stevens.  It's out in print now but with a different illustrator -- my guess, mainly to update the 1960 illustrations.  (Personally, I find the fins on the back of Dad's car, the hat that the dad wears to go out, and the mother's apron and skirt charmingly antique, and why can't a story be set in 1960?!? why?)  Maybe you can find the old one if you look around; maybe the new illustrations are good, too.  I don't know.

If you have a little boy at home, and are looking for a good realistic storybook about a little boy, this will fit the bill.  The premise:  Four-year-old Jimmy likes to do real things with real tools, and one day he is given a real (but small) shovel and sets out to dig a real hole in the yard.   By the end of the day it's a bigger hole than his parents thought he could dig, and they have to think of something to do with it. 

I like it because it simply and without preaching tells a story of a still-very-small boy who works hard at something he wants to do and accomplishes something unexpected, something that turns out to be useful and beautiful for the whole family.  I like it because the little boys in my life have also loved real tools.  I like it because of the contrast with Jimmy's twin sister Janet, who likes pretend things (and no, there is no implication in the story that this is necessarily a boy-girl thing, nor that there's anything wrong with liking pretend things, it's just that Jimmy is the protagonist and this is a difference between him and his sister).

And there aren't very many excellent books that are so obviously aimed at little boys.  Well, this is one.  So check it out if you can.

Someone please relieve my mild irritation.

So they're pulling all the infants' cough and cold medications.  It'll be the children's formulations next; the days of liquid cold medicines may soon be over.

The news articles on the subject have all been driving me crazy.  Take a look at this article from the Associated Press, or this one from the New York Times.   (What I heard on NPR this afternoon wasn't any better.)  Patterns of misuse, "the medicines don't help," deaths after taking antihistamines and decongestants...  what's missing from these stories?

I'll tell you what's missing.  None of these stories mention the words dextromethorphan, pseudoephedrine, phenylephrine, guaifenesin, or diphenhydramine.  These are the common active ingredients (besides acetominophen and ibuprofen) that appear in various combinations in "cough and cold medicines."  None of these stories tell you which active ingredients are implicated in overdoses.  None of these stories tell you whether all of these active ingredients have been found to be ineffective in children, or whether it's just some of them. 

I was reading this story to Mark and his answer was, "If they are claiming that pseudoephedrine doesn't relieve symptoms, they're on crack."   No kidding.  I could believe that of dextromethorphan or guaifenesin or phenylephrine, but not pseudoephedrine.  My second child, Milo, was a "lungy" baby.  Every time he caught a cold, it sounded like pertussis.  Half a dozen times in his first year I sat up with him, keeping him upright so his breathing wasn't strangled-sounding.   What helped?  Children's pseudoephedrine.  Nothing else.  And it helped a lot.  So I was startled to read that several of the withdrawn medications are formulations of pseudoephedrine alone.  Taken with the news articles it seemed to imply that pseudoephedrine is no better than a placebo.  This hasn't squared with our experience.  It is a pretty damn good placebo.

I am not one to confuse "data" with the plural of "anecdote," but neither do I confuse AP or NYT writers with peer reviewers, so I dug briefly around and discovered that indeed, pseudoephedrine has never been shown ineffective in children.  It has been shown effective in adults and has never been studied in children:

The best studied oral agent in adults, both as a single and combination ingredient, is pseudoephedrine. It is most commonly taken to relieve congestion and rhinorrhea associated with upper respiratory infections (URIs). The majority of the evidence from adult studies...do support a modest reduction of signs and symptoms associated with URIs reported both subjectively and objectively, with single doses of the drug. Notably, however, there is limited evidence supporting multiple doses over the course of an illness as well as an absence of supportive pediatric data. ^...

The few pediatric studies that have been conducted have failed to document beneficial effects of any of the compounds studied. Two studies evaluated oral antihistamine-decongestant combinations and found them no better than saline placebo ( Hutton N, et al. J Pediatr.1991 ;118:125 -130[Medline] ; Clemens C, et al. J Pediatr.1997 ;130:463 -466[Medline] ). Two others found no beneficial effects of topical phenylephrine ( Bollag U, et al. Helv Paediat Acta.1984 ;39:341 -345[Medline] ; Turner RB, et al. Pediatr Infect Dis J.1996 ;15:621 -624[Medline] ). Notably, none of these pediatric investigations studied drugs containing pseudoephedrine.

[Emphasis mine.]  In other words, phenylephrine doesn't work -- apparently -- but no one can yet say that of pseudoephedrine.

OK, so if nobody has shown that pseudoephrine doesn't work in children, then why are they pulling it?!?  It's getting lumped in with all the other cough-n-cold stuff.  In the absence of evidence to the contrary, why can't I as a parent make the choice to use what we've seen works really well?

I have two theories.

One theory is that there are a lot of people who would like to see pseudoephedrine disappear completely, because then it would get a lot harder to make meth.  It's already behind the counter for that reason (which is annoying enough).

The other theory is that this is another case of The Government Thinks The American People Can't Handle Complicated Instructions.

I suspect that this is for the same sort of reason that they decided to make the food pyramid nice and friendly by labeling all fats equally bad for you, which any lipid chemist can tell you is an outright falsehood.  It was easier for the government to say "Dietary fat's bad!  Avoid it!" then to lay out the truth:  (a) artificial trans fats are bad and (b) saturated fats appear to raise blood cholesterol and (c) medium-chain fatty acids, saturated or not, have beneficial effects and (d) polyunsaturated fats raise the good cholesterol... so we got the simple, wrong version.

Now all of a sudden, all cough and cold remedies are unhelpful.    That is SOOOO much easier than developing better labeling, or rectifying the overdose-waiting-to-happen situation in which "children's liquid suspensions" are less concentrated than "infant's drops" formulations, or -- heaven forbid! -- actually using long scary words like "dextromethorphan" in a news story.

UPDATE.  I am particularly interested in comparing attitudes about pseudoephedrine to acetaminophen, i.e. "Tylenol," which in my mind is a valuable comparison because it is very frequently given to children and is extremely dangerous in overdose; it'll destroy your liver pretty quickly.

Pseudoephedrine has been involved in at least three infant deaths, according to this 2005 link from the CDC.  One infant got a double dose of pseudoephedrine because he was given two medications that both contained pseudoephedrine as well as, apparently, carbinoxamine, dextromethorphan, and acetominophen.  The other two had been given, respectively, pseudoephedrine and carbinoxamine; and pseudoephedrine, dextromethorphan, and acetominophen.  Hard to say which drug caused each death; the coroners blamed "cough and cold medication."

What about acetominophen?

This annual report from the American Association of Poison Control Centers is chock full of interesting information.  (I love poison control centers.  They are one of the few "healthcare agencies" that actually dispense useful and accurate information to the public.  Wonder why they don't seem to be worried someone will sue them?)  In 2005, analgesics were implicated in more "exposures" of children under 6 than were cough and cold medications.  This does not, of course, mean they were the most toxic.  Analgesics (e.g., acetominophen) are also the most common cause of adult exposures and the category that is most commonly associated with poisoning death in all categories -- 696 cases in 2005, vs. 18 cases that involved cold and cough medications.  They are, I'll bet, the most common stuff in the medicine cabinet, which undoubtedly increases the risk that someone will poison themselves with them.

It is sobering to get to the table in the back -- page 29 in the .pdf, about 831 in the page numbering -- and see the long, long list of acetominophen deaths, including many suicides.  (Yes, it doesn't mean that acetominophen is more dangerous.  It probably only means that it's more common.  Is it hundreds of times more common?)    Scroll down to page 61/863 and look at the list of poisonings from cough and cold medications.  It is a hell of a lot shorter.

I wish the articles would clarify the several different issues -- overdose risks from combining products that have ingredients in common, overdose of single products, deaths from taking recommended doses, and balancing these risks against taking medicines that do show benefits vs. medicines that are shown not to work.

Too many eggs.

I have a standing weekly order with a local dairy farm:  three half-gallon bottles of whole fresh milk, three dozen eggs, and one packet (roughly nine ounces) of cheddar cheese.   My breakfast appetite has been low lately, and the children have been demanding mainly toast; I looked in the fridge and there were something like eight dozen eggs in there. Nice brown farm eggs, but what are you going to do? 

Make quiche and soufflé and egg bake for dinner, that's what.  Now my seven-year-old boy loves soufflé, particularly a tricky and beautiful caramelized-onion-and-sharp-cheddar variety.  Too tricky.  On a busy day I'm more likely to make this egg bake.  Very Betty Crocker.   But it goes together in just a few minutes.

• 10 eggs
• 1/2 cup flour
• 2 cups cottage cheese
• 2 four-ounce cans diced green chiles, undrained
• 1 lb shredded Monterey jack cheese, plus a bit more for the top (I like to use pepper jack; last night I added some farm cheddar)
• 1 teaspoon baking soda
• Pinch of salt

Preheat the oven to 375 deg F.   Combine flour, salt, and baking soda.  Beat the eggs and whisk in the flour mixture till smooth.   Add green chilies with their liquid, cottage cheese and 1 lb shredded cheese; mix well.  Pour into buttered 9x13 glass baking dish and top with extra shredded cheese. Bake for 30-35 minutes until set.

Mark likes it with salsa, my three-year-old with ketchup.  I ate a piece of it for breakfast straight out of the fridge, but then, I'm kind of weird.

The flour is not essential and can be left out entirely or replaced with something gluten-free; I've used soy flour before, and I bet oat flour would work too.  You can cut it in half and put it in a square pan if you want.  I suppose you could add some meat or vegetables to this, but I've never tried, except once when I was out of green chilies and tried to make it with tomatoes and onions.  That was awful; it didn't rise properly.  Probably something to do with baking powder chemistry.  In any case, as-is it's a decent standby for when there are too many eggs.

Evil Caribou coffee! Evil!

I just finished writing a looooong post that got eaten because when I hit "publish" I got redirected to the Caribou thou-shalt-log-in-every-hour-to-use-our-free-wifi screen, which created some kind of stack overflow and killed my post.

There is a reason I usually go to Dunn Brothers.

"Goodnight moon, goodbye sex."

Here's a commentary article by Gail Rosenblum in the Star Tribune discussing how the first baby changes a couple's sex life and how that change can even endanger the marriage. 

I can close my eyes and nearly re-live the intenseness of mothering our first new baby.  Exhaustion, new emotions and drives, the seething conflicting feelings around job vs. home, leftover physical pain from the difficult birth.  (And that was just my husband!  I had all those feelings too.)  And then, going back to work at 8 weeks postpartum threw my fertility signals into an incomprehensible mess.  Let's just say it was a long six months.

Still, I can't imagine ever thinking that our marriage was at risk because of it.  We always knew we'd make it through.  I think that marriages are strained in this situation because (a) few couples have experience choosing abstinence, even for brief periods, for the good of their family; (b) few young adults have spent as much time around babies as they ought to have, and so a baby's needs come as a kind of a shock; (c) far too few women and men really view their sex life together as a gift they give to one another.

About that last bit.  There's a temptation to write that women, and especially men, tend instead to view their sex life together as something they get from each other.  But I don't think that's it at all, or at least, that would be far too simplistic.  Rather, I think that a lot of fairly-newly-wed couples -- especially those who get along well, love each other, and have a satisfying sex life -- view their sex life together as a really fun hobby that they have in common and that binds them together mainly because they like doing it together, they like having each other as partners in it, so much.  Like rock climbing or tennis or mountain biking.

This creates a problem when suddenly one of the parties doesn't really like it all that much for an extended period.  Which happens to a lot of nursing mothers.  Libido just disappears, overnight, and it can be gone for months.  It's not necessarily what we would choose, but on the other hand, you can see its utility for baby-spacing.

So if your sex life is a really fun hobby that brings you closer together because you like it so much, and all of a sudden one of you has just up and lost interest, doesn't like it anymore -- well, not only does the other person not get to play or practice, but -- he's lost his partner!  It's like, I do not even know this person anymore.  One of the reasons I fell in love with her is that she likes this as much as I do, and she likes doing it with ME.  They seem to have lost something they had in common.  It can't bind them anymore because they don't both like it anymore.  At least -- it can feel that way, even if intellectually they know better.  And wouldn't you be worried that the change was permanent? 

Meanwhile, from the other side of the bed, the sex-life-as-mutual-hobby model could lead to a simple equation of:  We do this together because we both like it and feel like doing it; I don't feel like doing it right now; and both of us are too damn busy to waste time on hobbies anyway.  It's not like I have time to go mountain biking, either.   Requests for sex might even seem borderline crazy, like you're being asked to play tennis when he knows damn well you have a pulled hamstring.   And the point is to enjoy it together, right?  So if you're not enjoying it, then you're not really together, right?   Bad sex = bad marriage, ergo, avoid bad sex?

The model of sex-life-as-mutual-gift is a lot less superficially exciting, I admit, but it has traveled really well over the rough spots we've encountered.  In practical terms, for us, it means we follow two rules of thumb:  Don't say "no thanks" unless you really, really, really feel you can't go through with sex right now (e.g., due to migraine; influenza; serious need to avoid pregnancy; utter exhaustion); and trust each other to reserve "no thanks" for those situations.  Today we are young and healthy and in pretty good spirits, so today it means rarely refuse, never pressure.  We will not always be young and healthy.  Maybe someday one of us will have to say "no thanks" more than rarely.  That's where the trust will really have to come in.

I guess a corollary is that somewhere between "no thanks" and "YES WHAT A GREAT IDEA" is a  vast middle ground, fairly common when there's a new baby in the house, along the lines of "Okay, if you don't mind me falling asleep halfway through." A sense of humor helps immensely there, but doesn't it always?

Powerful stuff.

I don't like reading stories about miscarriages, but this one is important on several levels.

I don't feel much pity for that "disturbed" doctor. 

h/t Sphere of Influence

Chesterton on specializing in generalities.

After I wrote the last post about my love for general knowlege, I seemed to remember that G. K. Chesterton had written something that touched on the topic.  Amusingly enough, I had to google the half-remembered phrase "woman drudges in the home" to find it.  It is called The Emancipation of Domesticity.  He believed more strongly than I do that the split between specialists and generalists necessarily ran along lines of gender, but the part of the essay that is a defense of being a "generalist" (and a mother) resonates:

Woman must be a cook, but not a competitive cook; a school mistress, but not a competitive schoolmistress; a house-decorator but not a competitive house-decorator; a dressmaker, but not a competitive dressmaker. She should have not one trade but twenty hobbies; she, unlike the man, may develop all her second bests. This is what has been really aimed at from the first in what is called the seclusion, or even the oppression, of women. Women were not kept at home in order to keep them narrow; on the contrary, they were kept at home in order to keep them broad. The world outside the home was one mass of narrowness, a maze of cramped paths, a madhouse of monomaniacs. It was only by partly limiting and protecting the woman that she was enabled to play at five or six professions and so come almost as near to God as the child when he plays at a hundred trades....

To put the matter shortly, woman is generally shut up in a house with a human being at the time when he asks all the questions that there are, and some that there aren't. It would be odd if she retained any of the narrowness of a specialist....I can understand how this might exhaust the mind, but I cannot imagine how it could narrow it. How can it be a large career to tell other people's children about the Rule of Three, and a small career to tell one's own children about the universe? How can it be broad to be the same thing to everyone, and narrow to be everything to someone? No; a woman's function is laborious, but because it is gigantic, not because it is minute. I will pity Mrs. Jones for the hugeness of her task; I will never pity her for its smallness.

So it's not an original thought, but it still has felt like a discovery to me.

Specializing in generalities.

When I was a very little child someone bought for me a book.  It lived at my grandparents' house; I browsed through it whenever I visited.  I remember it was a fat, large-size paperback, with cheap pages.  I do not remember its name, but I think of it as the Big Book About Everything.  That may as well have been its title.  I would pay a lot of money, I think, to get a copy of that book for my children today.  It was divided into sections -- one was about animals, one about the human body, and there were several others.  Each page had a question at the top, and the text below was an answer, illustrated with cartoons.  Who invented the toothbrush?  What is the fastest animal?  What is a tsunami?  Why do tennis players say "love" instead of zero?  I read that book voraciously, and learned a few interesting facts about a great many things.  (To the annoyance of my teachers, I'm sure, because I couldn't help showing off, either.)

I loved, even then, knowing something about everything.

In high school I specialized a bit and among my classes I loved geometry, physics and chemistry, which anyway are just another way of knowing something about everything, because what subject is there that isn't informed by geometry, physics, and chemistry?  (I also loved my foreign language classes, which at least gave me another way to talk about everything).   I went on to study engineering in college, and there discovered that I also loved the rest of mathematics.  Another way to talk about everything.  I loved becoming fluent in that system.

So then I went on to graduate school, where one tries to learn everything about something.  And I kind of fell flat there.  Oh, I finished all right, with a lot of prodding and help and a last-minute patch created by having someone else actually go about solving the halfway-decent, reasonably mathematically elegant, possibly useful, theoretical problem I'd posed.  But by the end of it, I hated the something I was learning everything about.  Just couldn't stand to think about it anymore. 

I was about three years into graduate school -- I had just passed my oral examination -- when I recognized that I did not like knowing everything about something, and that I preferred to know something about everything.   I repressed this, because it seemed like a shameful perversion of the intellect.   I thought that the thing to be, if you wanted to do something worthwhile, was an expert.  The field doesn't matter; it could be polymer science or it could be finish carpentry; but one had to be capable of learning everything about something.  Loving to learn something about everything instead -- well, that made a person shallow.  And so I slogged unhappily along in the narrow, high-walled channel I'd sluiced myself into.

And then... I dropped out (well, that's how I think of it; actually I graduated and didn't look for a job) and the vista opened back out into a wide delta.  I had a four-year-old child.  All of a sudden, my old love for knowing something about everything has blossomed into something wonderfully useful.   Some children like to know everything about something, and some children like to know something about everything, and many children like both; but the business of early learning is, of course, to gather information about the whole world, a vocabulary and grammar of experience, and tales of things that happen in far-off lands that they cannot experience immediately.  So taking their hands and showing them something about everything has suddenly become my job.  And there is of course the possibility that they can know something that's totally new to me -- for someone as "shallow" as I am, heh, this is great fun.  I get to dip into something brand-new, as deep as I want to go, learning together with a seven-year-old, a four-year-old; and then move on to something else. 

I no longer think there is anything shameful about being a "generalist."  Something ab0ut everything is indeed a worthy goal, especially if you remember that you can always dog-ear the page and come back to dip in further if you need to.   I even know a little bit about what it's like to know everything about something, so perhaps those years in the channel weren't entirely ill-spent.

Today:  Understood Betsy, a lovely children's book I'm reading for the first time; mineralogy, a subject I took a college class in once; planning a weekend picnic to see igneous rocks; practice typing; Latin and Spanish, languages that are new to me; the sound /j/ spelled with the letter j; the concept of geometrical symmetry, explored with pattern blocks; subtracting nine from the integers between nine and twenty, inclusive; the Gospel of Matthew; how to make egg salad; and Jan Vermeer's painting Woman Holding a Balance.

I'm astonished to find that I'm finally in my element -- or rather, in my elements.  And it feels natural and good, and also -- fun.