Or, Things I Learned From Clots in my Lungs:
After three months of increasing difficulty breathing and one month of doctor visits, on January 24, scans of my chest showed that I had multiple pulmonary emboli (blood clots in the lungs). It was a scary, and surprising turn of events. While the ordeal has set me back significantly in my work schedule, forcing the postponement of a much-anticipated research trip, it has hardly been without intellectual content.
I am More than My Mind
Barbara Kruger, Untitled (Your body is a battleground), 1989. Working in academia, it is hard to remember that my body is not merely an annoying impediment and burden, but in fact, it is me. It's so simple to fall into the easy dualism between mind and body in the day-to-day, especially since academic work does not necessitate much more physical movement than typing, turning pages, and pouring more tea.
In order to, often begrudgingly, take care of my body as well as my mind, I (used to) go on long runs. When my breathing difficulties got in the way of running, the rest of my physical routine fell apart -- diet, stretching, etc. From late October onward I spent an increasing amount of time resenting my body. Turns out, my body was functioning exactly as well as it could, given the adverse circumstances within it.
My takeaway is a reminder that my body IS me. Resenting it only tears myself in two and can hide real problems. I could have gone to the doctor's a lot earlier, but instead of being curious about what was going wrong, I spent my energy resenting my physical limitations. In a sentence: self care is important.
In order to, often begrudgingly, take care of my body as well as my mind, I (used to) go on long runs. When my breathing difficulties got in the way of running, the rest of my physical routine fell apart -- diet, stretching, etc. From late October onward I spent an increasing amount of time resenting my body. Turns out, my body was functioning exactly as well as it could, given the adverse circumstances within it.
My takeaway is a reminder that my body IS me. Resenting it only tears myself in two and can hide real problems. I could have gone to the doctor's a lot earlier, but instead of being curious about what was going wrong, I spent my energy resenting my physical limitations. In a sentence: self care is important.
Self-Care
John Kabat-Zinn, PhD., founder of Mindfulness-Based Stress Reduction As everyone in academia knows, the work never ends. There is always SOMETHING more you can do. Ditto for resistance under the current political regime. Being largely sedentary and unable to attend the marches in the weeks of chaos following the inauguration was frustrating beyond belief.
But this medical mishap made me re-evaluate what I can and cannot handle -- physically, mentally, and emotionally. Burn-out helps no one. Self-care is not optional, but necessary for function.
To fill the hole left by running and my exercise routine until I am fit again, I have started an eight-week online self-administered Mindfulness-Based Stress Reduction course. I'm meditating for a half hour (most) days, absorbing the assigned readings and videos, and spending intentional time taking care of myself. I'm saying no to events and tasks that are optional. I'm trying to go on walks a little bit longer or farther each day.
I'm trying to listen to myself--mind and body.
But this medical mishap made me re-evaluate what I can and cannot handle -- physically, mentally, and emotionally. Burn-out helps no one. Self-care is not optional, but necessary for function.
To fill the hole left by running and my exercise routine until I am fit again, I have started an eight-week online self-administered Mindfulness-Based Stress Reduction course. I'm meditating for a half hour (most) days, absorbing the assigned readings and videos, and spending intentional time taking care of myself. I'm saying no to events and tasks that are optional. I'm trying to go on walks a little bit longer or farther each day.
I'm trying to listen to myself--mind and body.
History Embodied
From page 6 of the Nuva Ring FDA report. I spent my morning in the hospital asserting again and again that no, I've never been a smoker and do not smoke, I have no family history of clotting problems, no recent kidney infections, etc. I was told what this meant in the afternoon: barring the discovery of a latent genetic disorder at my follow-up appointments in March, the only explanation for why a healthy 26 year old woman would have pulmonary emboli was the synthetic estrogen in my birth control.
At that moment, history became real and present. In my body, I realized I was experiencing the cumulative effects of decades, even centuries, of history. The long series of political, social, economic, and scientific choices that made women responsible for birth control rather than men, that made it necessary for women to risk their lives to maintain control of their reproduction, that created systems of knowledge and power where I and hundreds of thousands of other women have no idea that our chances of getting a blood clot on birth control is as high as 1 in 1,000 -- and doctors I have seen say their years of practice makes them suspect it could be even higher. Still, the current FDA labels say the risk for blood clots is 3-12 per 10,000 women years using the Nuva ring. Three in 10,000 is a vast difference from the latest clinical studies -- and the range is so wide as to discount the upper levels of probability as only those who smoke, have family histories, etc.
At that moment, history became real and present. In my body, I realized I was experiencing the cumulative effects of decades, even centuries, of history. The long series of political, social, economic, and scientific choices that made women responsible for birth control rather than men, that made it necessary for women to risk their lives to maintain control of their reproduction, that created systems of knowledge and power where I and hundreds of thousands of other women have no idea that our chances of getting a blood clot on birth control is as high as 1 in 1,000 -- and doctors I have seen say their years of practice makes them suspect it could be even higher. Still, the current FDA labels say the risk for blood clots is 3-12 per 10,000 women years using the Nuva ring. Three in 10,000 is a vast difference from the latest clinical studies -- and the range is so wide as to discount the upper levels of probability as only those who smoke, have family histories, etc.
I fell down the rabbit-hole of research, trying to understand (and by understanding, regain control?) of what happened to me. Studies clearly show that estrogen in contraceptives is linked to venous thromboemboli, the scientific term for blood-clot events. My specific clotting event was in my lungs and pulmonary system; according to a Surgeon General's report from 2008, "community-based epidemiological studies suggest that roughly one in five individuals die almost immediately from PE (pulmonary emboli), while 40 percent die within 3 months."
Despite estrogen-based birth control first hitting the market in 1960, a twenty-first century peer-reviewed article that included hormonal birth control as one of their variables notes:
Despite estrogen-based birth control first hitting the market in 1960, a twenty-first century peer-reviewed article that included hormonal birth control as one of their variables notes:
"There is good quality evidence on the magnitude of VTD (Venous Thromboembolic Disease) risk associated with specific clinical factors in women. No studies on the utility of preventive measures have been performed for most of these circumstances. There is no evidence about the risk associated with the combination of several risk factors."
Ultimately, I decided to opt for NuvaRing -- at the time, thought to be lower-risk than oral hormonal contraceptives. I thought back to 2011 -- I was smart, savvy. I did my research, read all the fine print of the packaging, asked doctors and read articles when I selected birth control using estrogen. I was assured as long as I wasn't a smoker and didn't have a family history, I shouldn't worry about any risks. I was privileged to have years of top-notch education, access to academic studies otherwise hidden behind paywalls, money and time to spend on a consultation doctor appointment, insurance that would help with the financial burden, and the time to weigh my options. How many women are that lucky?
The FDA pursues investigation after investigation, Merck pharmaceuticals has been sued, and mainstream outlets like NPR have occasionally followed the story over the past few years: see "Birth Control and Blood Clots: Women Still Weighing the Risks". But I was never one of the women weighing the risks -- I didn't know them.
This situation didn't arise overnight, and it won't disappear overnight either. As Nancy Langston notes in her book Toxic Bodies: Hormone Disruptors and the Legacy of DES,
The FDA pursues investigation after investigation, Merck pharmaceuticals has been sued, and mainstream outlets like NPR have occasionally followed the story over the past few years: see "Birth Control and Blood Clots: Women Still Weighing the Risks". But I was never one of the women weighing the risks -- I didn't know them.
This situation didn't arise overnight, and it won't disappear overnight either. As Nancy Langston notes in her book Toxic Bodies: Hormone Disruptors and the Legacy of DES,
"Political, cultural, and scientific pressures all shaped these repeated retreats from precaution, and the echoes of those decisions still haunt us today. [...] Any given exposure was probably harmless. Nevertheless, we have somehow created a world in which mushrooming chemical exposures go hand in hand with reproductive chaos, partly because no one can prove that an individual chemical caused a particular health problem, and so regulators have largely failed to act."
The analogy between Langston's endocrine disruptors and birth controls isn't perfect. DES, in addition to being prescribed to mitigate morning sickness in pregnant women, was also fed to livestock within our industrial food system, for starters. Still, one particular line from Toxic Bodies has always stuck in my mind; this line sent me back to the text to process my own experiences:
"Failures of regulation are expressed not just in hearings and in court cases, but also inside our own bodies."
Through this ordeal, I have been abruptly reminded that I am not merely a mind, but also a body. This body is physically affected by historical forces, just as social and cultural forces shape my thinking. Going forward, I'll be looking to inhabit my body more mindfully.
ADDENDUM:
Bumped from the middle to the top of my to-read list is Gabriela Soto Laveaga's Jungle Laboratories : Mexican Peasants, National Projects, and The Making of the Pill.
Does anyone have further recommendations for histories of hormonal birth control? Comment, email, or tweet!
"Failures of regulation are expressed not just in hearings and in court cases, but also inside our own bodies."
Through this ordeal, I have been abruptly reminded that I am not merely a mind, but also a body. This body is physically affected by historical forces, just as social and cultural forces shape my thinking. Going forward, I'll be looking to inhabit my body more mindfully.
ADDENDUM:
Bumped from the middle to the top of my to-read list is Gabriela Soto Laveaga's Jungle Laboratories : Mexican Peasants, National Projects, and The Making of the Pill.
Does anyone have further recommendations for histories of hormonal birth control? Comment, email, or tweet!
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