Oh, My Aching Body - 2 - Dem Bones, Dem Bones

 ‘Dem Bones, ‘Dem Bones

This month’s “Oh, My Aching Body” submission will address our amazing bones and the problems we cause them on occasion. 

This might seem off topic, but I’m going to start with a look at the honeycombs that bees are so good at constructing. Not a single bee ever attended engineering school, and none of them have ever been taught that the hexagon is one of the strongest strength-to-weight shapes that can be constructed. But there they are, constructing those honeycombs like engineering masterminds.

The reason I bring this up is because our bones have a very similar structure. If our bones were solid, they’d be REALLY heavy, and it would be much harder for us to move. But the honeycomb-like construction allows them to be ounce-for-ounce stronger than concrete, yet light enough for us to move and function the way we do. 

I know I’ve said it before, but I’ll say it again. …. Miraculous.

In addition to giving our bodies form and structure, our skeletons are home to the bone marrow that produces our blood cells. Some of those blood cells carry oxygen to all of our tissues (the red ones), some of them fight infection and give us immunity to ailments (the white ones), and other blood cells cause the blood to clot so we don’t bleed to death with every little cut or bruise (platelets). So while we may look at a classroom skeleton and see an inanimate structure, or a Halloween decoration, the bones inside our bodies are really quite active and full of life.

Bones adapt wonderfully to activity. Several years ago, scientists measured the bone density of a bunch of third graders’ tibias (shin bones) at the beginning of the school year. Half of the third grade classrooms were led by their teachers to stand up next to their desks and stomp their feet 20 times each, 5 times per day. The other half of classrooms didn’t do anything different than usual. At the end of the experiment, those little third grade bones that stomped 100 times per day showed REMARKABLE differences in bone density. It’s not like their non-stomping control group counterparts weren’t also jumping and running and playing as much as they possibly could during the experiment. They’re all third graders, so they’re non-stop motion, jumping off playground equipment, running wildly for no good reason, hopping onto benches to avoid imaginary lava, jumping over rocks to avoid imaginary alligators…. But the experimental group stomped an additional 100 times per day, and their bones adapted noticeably to the added stress.

Ballet dancers who spend a lot of time en pointe have remarkably thicker first metatarsal (instep foot bone) than non-dancers, because that bone becomes a weight-bearing bone, and must adapt to support the entire body weight of a ballerina (like, 85 pounds, right?). But it’s not all good news for bones under stress. Sometimes we ask more of our bones than they can deliver. Those dancers with the super thick first foot bones are at a fairly high risk of experiencing something that’s actually called “Dancer’s Fracture” when the fifth foot bone just snaps while they’re dancing.

 

Last month I wrote an article about muscle strains and joint sprains, and I was able to give a pretty standard recommendation for approaching any and all strains/sprains. For virtually every strain/sprain you’ll ice, rest, and elevate for 48 hours, then add heat and return to play slowly. But when we’re talking about bones we can’t make such sweeping statements. For example, one time I had two football players with broken lower legs. One broke his tibia (shin bone), which is the weight bearing bone of the lower leg. The other broke his fibula, which is the non-weight bearing bone on the outside of the lower leg, and its main function is to serve as an attachment point for the tendons and muscles that operate our toes and ankle. One player was in a cast, on crutches, not allowed to put any weight on his foot for several weeks. The other player was walking around in a walking boot three days after breaking his leg. Both of those are fractured lower-leg bones, but the protocols varied significantly. If you break your wrist, you’ll have a different protocol than if you break your skull. If you break your nose, you’ll have a different protocol than if you break every. single. rib. in your rib cage.

I don’t know which readers need to know this, but after menopause we lose estrogen, and that leads to lack of bone density.

After that sentence I have two things to say. 

First, it’s wise to stomp your feet and stress your bones after menopause, to counteract the effects of a natural decrease in bone density. 

Second, shout out to the guy who discovered the correlation between estrogen levels and bone density! World War II was underway at the time of this discovery, so while one group of scientists was figuring out how to turn atoms into weapons of mass destruction, Fuller Albright was connecting the dots of a mystery that had plagued women for millennia, about three decades before the emergence of “Women’s Health” as a medical discipline. So, hooray for his pioneering work on estrogen replacement therapy! He discovered that women who received estrogen replacement didn’t shrink as much as women who didn’t, and they didn’t experience osteoporosis and bone fractures the way their control group counterparts did. It was really a remarkable finding, it didn’t happen until my mother’s lifetime, and today we take that knowledge for granted.

More recent scientific advances have figured out that in osteoporosis, the cells that build new bones aren’t working as quickly as the cells that cart away decaying bone. Scientists figured out how to slow the function of the cells that cart away old bone. (WHAT?!?! That’s incredible!) People with brittle bone disease and osteoporosis have a new lease on life with medications like Fosamax. But whenever humans get involved in modifying how the body works, we always solve one problem but create others (as you’ll always learn when you listen to the side effects portions of pharmaceutical commercials). Fosamax might increase bone density, but the density isn’t being preserved in a hexagonal/lattice pattern discussed at the outset of this article, so there’s a higher incidence of people’s femurs (thigh bones) just fracturing horribly under normal activity when they take Fosamax. A woman will just be walking down the sidewalk with the dog, and her thigh bone breaks! Her wrists and spine and other bones are fine, but then she experiences what everyone says is the most painful fracture possible. I encountered one woman with a fracture like the one you’re seeing in this x-ray image when I  was working at a physical therapy clinic in Phoenix. She went on a ski vacation and managed to break her femur when she wrapped her thigh around a tree trunk while downhill skiing. It’s not an easy bone to break, usually requiring a car accident or motorcycle accident, and setting it right takes a lot of anesthesia, traction splinting, rods, plates, screws, and pins. To fracture a femur while walking a dog illustrates the necessity and brilliance of that honeycomb design that makes our bones function more like steel, and less like a stick of chalk.

One of the newest interventions for osteoporosis is vibration plate therapy. Instead of stomping on the floor next to an elementary school desk, similar benefits can be gained by standing on a vibrating plate for just a few minutes each day. Vibration plates deliver stomp-like stresses to the bones and muscles, forcing them to adapt by getting more dense. Whole Body Vibration (WBV) on a vibration plate also increases the abundance of those cells that build bone, which is an effect also noted with regular exercise (like pickleball).

In summary, if you think you have a broken bone, you’ll need a doctor to evaluate it. For it to heal - I hate to say it - you’ll have to rest it. Bones that are broken are very busy at the cellular level, and must be allowed to knit together for about six to eight weeks, without the added pressure of holding a pickleball paddle with a broken hand, or getting around without crutches on a broken ankle, or protecting your panting lungs with broken ribs. Just sit down and let the bone heal. If this is relevant to you, ask your doctor about hormone replacement therapy, consume calcium, take some Vitamin D to help absorb the calcium, and stomp or vibration plate your way to some better bone density. The best thing for your bones is weight-bearing activity, so do some planks for stronger arm bones, walk or stomp for stronger leg bones, and keep getting your bones out onto the pickleball court!

Any other topics of interest? Let me know!

Oh My Aching Body - 1 - Introduction

 

Hi, all! This is the first installment of “OH, MY ACHING BODY”. Today’s focus is foundational. We’ll start with some basic definitions, which will apply to virtually every installment from here on. 

The vast majority of what causes our bodies to ache after physical activity can be narrowed down to problems with ligaments, tendons, and muscles. Someday I’ll branch out to address problems with bones, bursae, cartilage, intervertebral discs, and maybe even cataracts, but for now I’m just addressing the majority of sports injuries. 

• Muscles: move the skeleton and give it support. 

• Tendons: attach muscles to bones.

• Ligaments: connect one bone to another bone. 

• Strain: tearing of a muscle or tendon.

• Sprain: tearing of a ligament.

• Acute: an injury that starts suddenly and usually heals within weeks (sprained ankle)

• Chronic: an injury that takes a long time to develop, and takes a long time to heal (tennis elbow)

This article talks about muscle strains, and the best and worst things to do when you get one. But this information can be applied to muscle strains, ligament sprains, and almost every other acute injury you’ll ever have.

Let’s say you’re out on the court paying close attention to Coach Mo, and you’re trying to keep your knees bent and shuffle side-to-side like she does. The next morning you notice that your thighs are sore. Muscle soreness is a natural part of muscle development. When body builders talk about “getting ripped,” they’re referring to a phenomenon where muscles that are being trained actually go through micro-tearing, and in that process the number of muscle fibers multiplies. It’s like when Hercules pulled off the head of the hydra and seven grew back. 

That’s what the muscle does. Physical effort tears, or “rips” the muscles, and the muscle fibers multiply, which causes the muscle to get bigger. It’s one of many miracles we encounter when we study physiology. Anyway, that muscle soreness is normal after a good workout, and it isn’t injury yet. Body builders and weight lifters will wait two days before stressing that muscle group again, in order to allow those muscles to heal from the exertion. They are always chasing soreness, but never pushing to excess.

But you go out with your sore muscles the next day, instead of waiting two days before another workout, because it’s pickleball and you’re addicted. You lower your hips into an impressive squat at the kitchen line, and suddenly you feel a pain in your right thigh in a specific spot. Now the muscle is strained. You start to feel what everyone always refers to as a “knot” in the muscle. The knot you feel is the (also miraculous) process of muscle guarding. Cavemen didn’t have splints or casts. They had the body’s own internal immobilizing process, which is where the healthy muscle fibers contract in order to keep the injured caveman from running, thus allowing the muscle to get some rest and heal.

 

Back to that kitchen line. Inside your injured quadricep you’ve got a few torn fibers, out of thousands and thousands of muscle fibers. Those little torn fibers are bleeding a little, and that blood is irritating to the surrounding muscle tissue when it leaks out, and that irritation triggers the muscle guarding “knot” response. 

The initial injury - muscle fibers being torn - is what we refer to as the “primary injury.” Think of a break in a water pipe in your house. That water pipe is the primary injury. Everything else that is affected by that burst pipe is “secondary injury”. The damage to the walls, the floor, the ceiling caving in, the valuables that get ruined are all secondary to the burst pipe. If you can fix the leaky pipe quickly, you’ll have less damage to everything else. As an Athletic Trainer we do what we can to prevent the primary injuries from happening. We’ll fit football players in shoulder pads and helmets, and we’ll inspect a soccer field to make sure there’s no holes where a player might twist an ankle. But once an injury happens we are really focused on preventing secondary injury. The primary injury (broken water pipe, strained muscle fibers) might take days to overcome, but the secondary injury (caved-in ceiling, completely bruised thigh) might take weeks to remedy.

Back to your thigh again. You have a tight, irritated muscle that’s bleeding a little, you can feel a knot around the strain, and you’re limping a little. But you keep playing, because it’s pickleball, and you’re addicted. 

Playing warms the muscle. Warming up the muscle makes the blood less viscous, so it leaks out more quickly. It’s like putting syrup in the microwave so that it will flow more quickly. Warming the area also dilates the blood vessels, which also makes the blood leak out a little quicker. It’s like taking the cap off the syrup bottle, because syrup doesn’t want to flow through the tiny hole in the cap. Exercising those muscles keeps your heart pumping, and staying on your feet lets gravity take the blood to your thigh. It’s like squeezing the bottle hard to force the syrup to come out, because when you just hold the bottle upside-down, the syrup isn’t flowing.

After playing on a strained thigh for several hours, you sit down to watch your friends play for a while. When you try to get out of your camp chair, WHOA! That hurts! You think to yourself, “I’d better use a Thera-gun on this,” or “I’d better take a warm bath” or “I’d better get this into the rec center jacuzzi” or “I think I’ll put a heat pack on this” or “I’ll just massage that tight muscle,” or “I’d better stretch this out real good.” All of those ideas are horrible. Every time you add heat before the tear closes, more blood will leak into the area. The secondary injury is just getting worse.

 

Going back to that initial quadriceps strain again, what if your first decision had been to lie down with ice on your thigh right after you felt it the first time? The ice makes the blood more viscous, and if it isn’t as runny it can’t leak out of the blood vessels so quickly. (The syrup is cold.) Ice also constricts the blood vessels, making it difficult for the thicker blood to move through the skinny tubes. (The cap with the tiny hole is on the bottle.) Lying down stops the exercise, and gravity isn’t bringing blood to the muscle as. (No one is squeezing the syrup bottle.) Instead of dealing with a very bruised and knotted quadricep muscle that will take weeks to heal, in this scenario we’re dealing with a few torn muscle fibers. You can add heat and light activity to the area after 48 hours, because that’s when the cap on the syrup bottle will be closed. You might even be well enough for pickleball by next week!

I can hear you now. “A WHOLE WEEK?!?!”

I know how you feel. I’ve been that athlete. I’ve treated hundreds and hundreds of those athletes. Science tells us that it takes six weeks for soft tissues to heal. So playing next week isn’t the best idea, but you can try it if everything feels good. It would be smarter to sit in the rec center jacuzzi or take a warm bath next week, but if you do play, warm up well, stretch slowly, try not to play like Coach Mo for another week or two, and force yourself to stop after an hour even if you don’t want to. But if you feel that “twinge” in your muscle, it’s time to stop and ice. If everything feels okay during and after playing, you can come back in two days - not the next day - and do an hour with a little more knee bend - but not a lot more knee bend. Don’t hurry the healing. Think about it, if Caitlin Clark can sit there and watch other people play her favorite sport, so can you.

Gradual return to activity is the key to a successful return that won’t cause you to be sidelined constantly for weeks and weeks. This is true if you strain your quadricep, twist your ankle, or feel a pull in your back. Ice and rest for two days, then take it slow.

That’s all for the inaugural article. When it comes to our aching bodies, what do you want to know about? Is there an injury that you’d like to understand and manage better? I’d love to hear from you!

Trip of a Lifetime - Conclusion (Part 2 of 2)

 COMPANIONS

The final section of this blog will introduce you to our trip companions. 

When the trip started in Jerusalem there were seven of us, plus our guide. The seven of us were six Americans and an Australian.

Nazeeh, who goes by Naz, was our guide for our week in Israel. He was born and raised in Jerusalem. He speaks four languages fluently. He shifted easily between Hebrew, Arabic, and English. He also leads tours for Indonesians who come to Israel. Naz used to be a teacher, and he loved the teaching part of teaching, but the rest of teaching wasn't his cup of tea. So he went back to school for a masters degree in tour guiding, and started that ten years ago. He started with G Adventures six years ago, and he is very pleased with them as a company. The tourism industry was hit hard, and he wasn't able to lead any tours for two years. Our tour was his first in two years, and he was greeted very enthusiastically by the familiar people on his regular tour stops. He's very friendly, has a warm smile, speaks in a wonderful baritone voice, and is incredibly knowledgable about the area.

Two of our companions were Ken and Chris. Ken is a general practice physician in Australia, where he has spent most of his life. Chris works in Long Island, New York in finance. Ken and Chris met six years ago on a G Adventures tour, and have been touring the world on tours ever since. It seemed like there isn't a place on earth they haven't seen. Ken has been on 30 G Adventures tours, and Chris has been on 25! When I asked if they had ever been to Antarctica, both said yes, and Ken said twice! Ken would always add extra walking to our extensive walking days, and he's always ready for more exploration. Chris is the one who saved me a lot of aggravation by loaning me her SD card reader for my computer, or else I wouldn't have been able to transfer my photos from my camera every day. 

Tim and Julie are also avid travelers. Both are now retired from careers at the University of Kansas and beyond. Tim spent his career as an accounting professor, and Julie was a Psychologist and instructor at KU until she turned to private practice. Tim has a great, dry sense of humor, and he loves puns. They are living in Los Angeles now, when they aren't traveling the world. Their packing game is on point, traveling with nothing more than they need, and they need very little. They are avid hikers, and they walked up the trails that mom and I chose to ascend on horse carriage, donkey, and golf cart. They made really good time! Most of the hikers in our group clocked 24,000 steps up canyon trails, and it wasn't easy walking. Throughout our trip Julie was on the lookout for a tea pot, because their young grandkids love having tea parties. When mom and I walked into a gift shop Julie was already there, and a salesman was pressing her hard to buy an $1800 antique silver tea pot (a little more than the Fisher Price model that works just fine), and she was trying to escape so she tried getting him to sell to us instead, but mom and I were too quick for that, wanting only to buy postcard stamps they didn'thave, and we left her behind as quickly as possible. Sorry, Julie!

Mary Anne, from Dallas, TX, was a solo traveler, as she often is. Like the others in our group, she has also traveled the world, and she is also retired. She spent her career in early childhood education, and she spent seventeen years of that career as the educational director for Barney And Friends! One of her stories about traveling abroad as a main contributor to the Barney show was hilarious. Through her work with the Barney program she had many travel opportunities to help set up Barney in foreign markets. At one stop she was introduced as the creator of Barney, but she was in a foreign country, being introduced in a foreign language she didn't understand, so she had no way of knowing the mistake, after being celebtated by high level dignitaries. Later it came to light, but it was too late to undo the expectations and misunderstanding. Mary Anne is the one who introduced mom and I to the tiny toilet paper roll, a tip I'll travel with for the rest of my life.

The final two travelers in week one were these two:

The woman on the left is Ethel, from Morton Grove, Illinois. She spent her career in Human Resources at a company in Skokie, Illinois. She's a woman of simple needs, a generous spirit, and an outgoing and friendly personality. She can strike up a conversation with ANYONE, learn all about them in a few minutes, and sometimes even gets their address so she can follow up with a greeting card. And boy is she a good sport! She braved 11 hours in an airport in Munich due to a missed connecting flight, she walked for miles and miles on a hip that's causing her quite a lot of aggravation, she washed her clothes several times in several hotel bathroom sinks, she rode to the top of a mountain on a donkey, she endured an email scam that hacked her account and sent a request for money to all of her contacts, she couldn't get money out of the ATMs because she accidentally forgot her debit card, and she almost never complained. She does, however, apologize several dozen times every day, for inconveniences she is in no way responsible for. She's the easiest travel companion I can imagine, and I've been looking forward to this trip with her for over 30 years. Absolutely everything about this trip with her was perfect.

The woman on the right is me! After reading these blog posts you don't need me to elaborate any further on that.

For our second week we crossed the border between Israel and Jordan, meeting up with a new guide, Monteser, and six new tour companions. These six companions were four Brits and two Canucks. We heard that sometimes when a well-established group of tourists meets up with a brand new group of disconnected tourists, it's very hard for the new group to blend with the established group. This wasn't the case at all with the 13 of us. We all blended really well, and I was so pleased with everyone we met in our two groups.

Week two was less about religious sights, and more about adventure and ancient ruins.

Monteser, who offered to let us call him Monty to make things easier, is a life-long Jordanian. He was very kind and knowledgeable, and you can tell he really loves Jordan. When he talked about the special places we visited his face would light up, like a parent's face lights up when they're talking proudly about their child.  He was especially enamored with Wadi Rum, and he says Petra is always fantastic, even though he's been there hundreds and hundreds of times.

The first two travel companions I'll introduce you to are Ron and Joyce, two trauma nurses from Toronto. Ron has spent the past five years putting away 20% of his income, so that he could take off an entire year to travel. This is a program managed by the hospital where they work, and he's going to really do it up. He came to our Jordan tour from his week at the World's Fair in Dubai. Regrettably, Ron's boyfriend couldn't take a year off to travel with him, so Kevin travels the world with Ron as a laminated photo. In the first photo you see happy Ron and Kevin, when they're experiencing wonderful things together. In the second  you see grumpy Ron and Kevin, for times when they miss a flight, encounter rude tourists, or have bad service at a restaurant. 

Traveling with Ron, and often mistaken for his wife, is B. Joyce Palmer. I don't know why we always say her full name, but it's a thing. Joyce is also a trauma nurse, and a Canadian, so she is twice nice. (Ron is a nurse and Canadian, too, but he's more snarky, and far less likely to apologize for things that aren't his fault the way my mom and Joyce do.) See the beer she's holding? She stole it! Okay, actually she went to pay for it and the woman behind the counter said the bill had already been paid, but none of us ever paid for her beer, so she got her beer for free. I'm not sure Joyce will ever sleep again, knowing that she got away with free beer. Joyce looks super sweet, and she is, but she's also hilarious. They spent quite a lot of free time in search of karaoke establishments so Joyce could belt out some tunes to unsuspecting Jordanians. They also spent some time re-enacting a scene from Lawrence of Arabia in the desert where it was filmed. Like the original movie scene, Joyce's scene was epic.

The next couple you'll meet are Barb and Dave, who live in London. Dave spent his career in Human Resources, which made my mother crack up when she found out, but they didn't compare careers after the realization. Dave is a very sweet guy, who made his wife quite proud when he drank two beers very quickly before we headed from the bar to dinner. (He had been nursing them for quite a long time, so it looked like they were going to go to waste, but he made sure that didn't happen. Barb saw his accomplishment and cheered, "Oh, well done, dear!") Barb spent her career in the schools as a guidance counselor and classroom assistant for kids with special needs. She's incredibly kind, and SO friendly. She has survived three different types of cancer, which makes her a medical curiosity without much precedent, and she is determined to live an incredible life. She certainly did that on this trip!

That's Dave and his second happy hour beer. "Well done, Dave!"

Barb experiencing a donkey ride. She didn't love it, but she looked quite natural and quite happy up there!

The final couple are Tim and Jackie, also retired and living in London. Jackie is a retired archaeologist, and Tim will be retired at the end of this month, but I can't remember what he's been doing with his career. I DO know that he's a fanatic for Sheffield Football (soccer, for my American readers), despite what sounds like a long history of disappointment. Mom had mentioned that the Chicago Cubs owners, the Rickets, were poised to buy the Chelsea team. He doesn't know much about the Chicago Cubs, and I didn't bother him with the "Oh, you think YOUR team has a long history of loss!?" conversation. As an interesting aside, while looking up which English soccer team the Rickets were going to buy just now, I saw in the news today it was revealed that the Rickets will not continue their bid to buy the Chelsea Football Club. As it turns out, Joe Rickets (father of the would-be owner) made anti-Muslim comments two years ago, and the Chelsea fans are not okay with that. They've staged protests, so the Rickets family withdrew their bid. Good for you, Chelsea fans! Anyway, that's irrelevant to the conversation because Sheffield isn't Chelsea. So back to Tim and Jackie, who couldn't have been lovelier people or a better couple, and they were celebrating their 25th anniversary during this trip (but I'm not supposed to tell anyone).

Here they are, looking like bedouins.

Here they are looking like a proper British couple.

And this concludes the final post in this "Trip of a Lifetime" series. Thanks for joining us for this incomparable adventure! I hope all of you have an opportunity to have a vacation as incredible as the one we just experienced.

Trip of a Lifetime - Conclusion (Part 1 of 2)

Conclusion: Curiosities, Companies, Causes, and Companions

The trip is over, and it's time to tie up some loose ends. I didn't intend to make this full of alliteration, but I'm a fan of a good literary device, so now that the title just worked out that way I'll milk it for all its worth.

CURIOSITIES

Bathroom curiosities will start this section. It's curious that the more you spend on a hotel, the less of a shower enclosure you get. 

Here's the Landmark Hotel in Amman. That stationary glass panel only extends about two feet from the shower wall, and the shower head extends out a foot. 

The bath mat would be soaked. The floor would be soaked. 

I didn't take a photo of the one in our Jerusalem hotel. It was similar to this. The mirror was on the opposite wall. It's an incredible motivator for dieting.

Here's the shower in our simple kibbutz. Full closure! They even provide a squeegee on a pole so we could squeegee the floor if it got a bit wet, which it didn't, because it has shower doors.

Here's the shower in a TENT in a bedouin camp. Full closure! Dry floors!

When I just googled "no hotel shower door" to find a photo of the one in our Jerusalem hotel, I discovered that Condé Nast Traveler even wrote an article about The Slow Disappearance Of The Hotel Shower Door. So it's a thing at the fancy hotels. You wouldn't catch that kind of nonsense at a Motel 6 or Best Western. Only at a 5-star hotel will you get the experience of sloshing on a completely drenched bath mat at the edge of a soaking wet floor right outside the shower. And no squeegee or floor drain. Just dry yourself off and throw your own bath towel onto the floor to sop up the floor pond to avoid a nasty slip-and-fall.

Another bathroom curiosity is the kitchen sink dish sprayer mounted to the wall next to the toilet. We couldn't find toilet paper in every bathroom, but we could always find these sprayers. The first time I saw one I got an "ew" face. I've seen bidets in restrooms, and they gained popularity in US households with "the toilet paper shortage of 2020," but bidets usually have the sprayer in the bowl. The wall-mounted kitchen sink sprayer seemed a little more unwieldy and likely to cause a mess on the seat.

One of our travel companions had warned us about the possibility that we might not find toilet paper anywhere. She had packed a small pack of toilet paper designed for travel and camping. (Not my photo. I grabbed this photo from the internet.) See how small this roll is? This roll would fit into the core of a standard roll of toilet paper. It fits very easily in a purse or jacket pocket. 

After her warning I grabbed the extra roll of TP in the hotel bathroom at the Grand Court Hotel. But traditional rolls don't really fit well in a purse or pocket. So my standard toilet paper roll ended up in my suitcase, which got packed away in the back of the bus (and now that roll is here in Longmont, Colorado). I tried to always keep some tissues in my pocket just in case. One time we stopped at a convenience store and our guide stood at the bus door holding out a tissue box for us to grab some tissues on our way in. He said, "The chance that there is no toilet paper in there is 100%." Between the tourist places that had toilet paper, and the times we were prepared with our own, there was only one time that I wasn't prepared. I knew there wouldn't be toilet paper, but in my denial I still looked everywhere. There wasn't a single roll anywhere. No wrapped rolls sitting on the toilet tank, no empty dispensers on the walls where toilet paper would usually be, and not even any trash receptacles for tissues or even feminine products. Just a sprayer on the wall.

It was ... effective! (I might even say... exhilarating?)

Cuisine is the second curiosity. On our first day in Israel we were in our Jerusalem hotel at the buffet, and I picked up a 1/2" thick rectangle of something near the dinner rolls. When I got it back to the table mom asked what it was. "I don't know. I'm just trying a little of everything." I took a bite off the corner. It was firm and not easy to cut through with the side of a fork, kind of like a really dense brownie in consistency. It tasted sweet, and felt a little ... gritty? I told my mom I thought I had just bitten into a slice of brown sugar? But it wasn't sweet enough for that. During our walk through the Jerusalem Shuk the next day we learned that it was halva. 

Having grown up north of Chicago, with Armenian neighbors next door, Greek and Italian and Indian and German and Pakistani and Chinese and Sushi restaurants everywhere, the third-largest Jewish population in the world with their kosher delis and restaurants, mom inviting all the foreign engineers to our house when she'd introduce them to her company as head of human resources, and our travel to many countries, I've been exposed to a lot of foods from around the world in my life. So it was a surprise to see something I had never heard of that we found literally EVERYWHERE in Israel and Jordan. The halva we  tasted was at a place called "The Halva Kingdom." The perfect name for what we experienced, and there were four or five Halva Kingdom locations in the shuk. It was made of tahini (ground, toasted sesame seeds). Each "cake" of tahini in the case you see above was a different flavor. Pistachio, Chocolate, Vanilla, Pomegranate, Date, Walnut, and combinations of two or three ingredients. Our chef guided us from shop to shop during our tour, and the employees at each shop happily handed us samples of all sorts. Across the way we visited another branch of Halva Kingdom and saw how tahini is made in the ancient way. Toasted sesame seeds entered a large stone mill from a hopper above the mill. They were crushed between rolling stone disks, and the oil drained through a pipe at the bottom of the mill. 

This store sold bottles of this tahini in every flavor you can think of. Buffalo chicken, spicy chili pepper, chocolate, honey, dates, walnuts, coriander, parsley, mocha, and more. Gift boxes of multiple bottles were a big seller. We got little spoons and sampled many of the varieties. It's shocking how much can be done with sesame seeds. 

Currency is the third curiosity. We could pay in dollars in Israel and Jordan. We could also use Jordanian Dinars in Israel, and the New Israeli Shekel in some places in Jordan. We could swipe our debit and credit cards just about everywhere except the little make-shift markets on the street that had no electricity, and therefore no credit card processing machinery. Otherwise, even in the smallest of shops in Jerusalem's Old City market we could use our cards and currency.

COMPANIES

National Geographic is the company Amy decided to use for this trip for mom and I. She has seen this trip on the horizon for a long time, and she wanted to go with a very reputable company that would put safety and traveler experience at the top of their priorities. 

G Adventures is a travel partner that National Geographic uses. They have multiple styles of travel. The most economical level is Classic. We went that route, but the tour that went for 15 days through Israel and Jordan was "Upgraded." 

The National Geographic Expeditions page has the same exact tour listed in Journeys. The higher level of travel, with fancier hotels, expert lecturers, and more cultural excursions, is National Geographic Journeys. Their Israel/Jordan tour is exactly the same as the G Adventures Upgraded. Same tour for the same price on the same dates. Their most expensive tour is called "Wildlife of the World by Private Jet." That one lasts 24 days, it offers the ultimate service level, and it costs about $100,000.

What impressed me about G Adventures was their commitment to animal welfare, child welfare, environmental welfare, respect of local culture, and redistribution of wealth through directed channeling of tourism dollars. They partner with Planeterra, which is a non-profit organization that supports communities in need. 

CAUSES

One community in need that we visited was the Noor Women's Empowerment Group in the Aida Palestinian refugee camp. This is a group of 13 women with disabled children, who have banded together to create opportunities for their children by building a rehabilitation and education center for them. They earn money through offering cooking classes, selling hand-stitched embroidery items, renting out space to visitors to the camp, and taking donations. If you'd like to support what they do, you can learn about them and donate through their website. This page provides a video of what they do, and how much good can be done with different levels of contribution. 

Another community we visited was in Jerash, Jordan. Beit Khayrat Souf teaches cooking classes to tourist groups, which brings them income, thus empowering women toward equality in society. They opened their doors in 2016, and began receiving support from both Planeterra and Unicef in 2019 -- just before the pandemic shut them down. 

Jameel, a founding member of the association, says “Every woman should have this confidence to go out and start working, and to share the workplace equally with men.”

Equality in the workplace is a big ask in Jordan. In 2016, when Beit Souf opened its doors, the comparative percentages of economically active men to women was 58.7% to 13.2%  

Here's a sign we saw in a women's restroom at a gas station in Jordan. 

The first thing that jumps out in this photo is probably the hole in the floor. It's a squat toilet. I didn't attempt it. The other stall had a toilet (and this time I had the tissues that our guide handed out in the bus). Anyway, do you see the sign that's INSIDE the women's bathroom? It says "Sorry Bathroom Women." This is an apology to the men who have to walk five paces further to use the men's room. I wish I knew what this says in Arabic, which might reveal more about the message than the sign creator's English efforts. Maybe it says, "Hey bro, you clearly weren't looking at the sign of the woman OUTSIDE this room, but this restroom is for WOMEN, so please get out and walk five more steps to your own bathroom. Thanks, Management." However, I suspect the Arabic also apologizes to the men that this is the women's room. I include this photo simply to say that a center that strives for women's equality in Jordan is doing some pretty tough work. 

For more examples of gender obstacles women face in Jordan, walking on the sidewalks of Jordan turns out to be a daunting thing for women. I know that mom and I clearly look like tourists, which might have had some impact in what we experienced, but my mom and I also a women tourists. The men were not about to step aside for us on the sidewalk, even if they were walking side by side, we were against a building walking single file, and there was nowhere for us to go. On several occasions we had to step off the sidewalk into the street to let them pass. Last month I saw a woman's Facebook post that's going viral in America. It said, "I decided not to step aside for a man on the sidewalk if we were walking toward each other. In two weeks I've collided with 38 men." Well, in Jordan it would be far more than 38. One female in our group said, "I tried to order something at a restaurant last night, and the waiter wouldn't look at or acknowledge me. He kept asking the men questions about what they'd like to order, but when I'd ask for something he'd look away and not acknowledge me. It's been years since I've experienced anything like that." 

So bravo to the women of the Beit Khayrat Souf, in your most admirable goal of equality!

Another place we visited was the Al Numeira Environmental Association. This link takes you to the description of their work from Planeterra, and this link takes you to their own website, which describes their multiple efforts to increase sustainability and improve the environment in their region of Jordan.

Mission Statement: Al Numeira Environmental Association’s mission is to promote innovative water conservation methods and environmental education to build a more sustainable future and improve human well-being in the Jordan Valley.

This association feeds tourists from the foods they grow, they receive broken bicycles and repair them, then rent them to tourists who want to roam the area on bikes, and they repurposed used and discarded materials to make all the furniture we sat on, and all the planters we saw were made from used tires. 

The women in the front and center of this photo made our lunch. Not to sound like a broken record, but it was delicious. (Do people say "broken record" anymore? Does it indicate that I'm an AARP gal, since cassettes and CDs have already come and gone since the last time I heard a vinyl record skip?)

This conclusion has too many parts and words, so I'll cover the final segment, Companions, in a separate post.