connectivity

Medical Monday: The Women's March Where I Live

This year my own small mountain town had an upbeat well attended Women's March. I would like to share some of my photos. I will report on policy and science a little later. For now, it is simply important that you know the government is shut down until there can be an agreement on a budget. 

I am holding the sign saying, "Make America kind again ". I think this by itself would help so much. 

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

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Policy News this week is monumental. President Trump signed an “ executive order” which allows small businesses and individuals to buy cheaper less comprehensive policies which do not met the minimum ACA (Affordable Care Act) requirements. Critics have several issues with this legislation. First, it decreases money in the collective pot used to cover anyone with a catastrophic illness for which a large payout is required. Second, it will drive prices up disproportionately, hurting mostly older Americans. 

Perhaps more impactful is the Administration’s decision to stop making federal subsidy payments to insurers. It is effective immediately. The President has further said that it may continue subsidy payments if a bipartisan agreement is made on health care. This last bit may illuminate the whole issue. When I first heard this announcement about cutting of subsidies, I ascribed it to wholesale lunacy. However now I view it more as blackmail. Without subsidies, the insurers will either bail or fail. Then the economy will follow, according to many analysts. No administration wants this. A bipartisan agreement has been impossible to craft, thus far. However, opposition to this move, and even opposition to the President himself may cause a high degree of motivation to compromise. Leading Republicans have called for continuing payments to insurers. As you read this on Monday, I wager you will be hearing fierce objection from both sides of the aisle. 

Hot off the press is an announcement that the current Administration will allow health insurance sales across State lines. Many of us did not realize that health insurance is sold within a given state. Insurers and their plans must be approved within that State and must answer to that State's Insurance Commissioner. Trump and many other Republicans have endorsed this before. They have asserted that, through increased competition,  premium prices will drop across the board. However, the National Association of Insurance Commissioners has called this a "myth". They have warned that this will start a " race to the bottom" wherein Insurance Companies will choose more lenient State regulators. Such regulators would require less and less coverage to consumers in order to maximize profits. This would result in healthier people getting cheap policies that cover little, and everyone else needing standard coverage getting steep rate hikes to compensate for the insurance company's loss in revenue. 

Unbeknown to most of us, the insurance industry was the Wild West before the ACA came along. Most of us only knew about insurance in their own State. But, it turns out there were different levels of what was covered, different caps on out of pocket, and different limits to premium prices. That all got more standardized with the ACA. That standardization is now being deconstructed bit by bit by changes like this plan of selling across State lines. 

The Department of Health and Human Services has put forth a couple of deeply controversial issuances. They have issued new rules on contraception. Without data or authority they have stated that “ Imposing a coverage mandate on objecting entities whose plans cover many enrollee families who may share objections to contraception, among some populations, affect risky sexual behavior in a negative way.” Importantly, this sentence uses confusing syntax. The subject of the sentence is “ a coverage mandate”. The verb phrase is “would…affect” the object is “risky sexual behaviors”. Thus the gist of the sentence it, a coverage mandate would affect risky sexual behaviors. Perhaps they meant to say the following: contraception WHICH could, among some populations, affect risky sexual behavior in a negative way. I suggest this because they have taken this position before: that contraception promotes sexual activity, particularly teen sex activity. A mass of available up to date and well derived data indicate otherwise.  For example, no-cost contraception is associated with a decrease in the number of partners. Additionally, contraception is NOT associated in a rise in sexually transmitted infections. Available research data clearly show too that rates of abortion and pregnancy fell among teens, when no-cost birth control was provided. ACOG (American College and Obstetricians and Gynecologists) has voiced it’s objections to the weakening of the contraceptive mandate. They have shed light on the patently false claims of the Administration about contraception. Many States have sued the Administration over the weakening of the contraceptive mandate. 

The second controversial issuance by the Department of HHS, Health and Human Services, has been to define life as “beginning at conception”. It has done so through a strategic plan document. This draft reads “HHS accomplishes its mission through programs and initiative that cover a wide spectrum of activities serving and protecting Americans at every stage of life, beginning at conception.”. Defining life at conception is not arguable in scientific terms. That is because it is a belief. In fact, it is a religious belief. As such, one might ask whether including this language in the strategic plan document of the HHS violates the separation of church and state. Clearly this language was advanced by those whose religious beliefs preclude abortion. 

I do not believe there has ever been a time in history when government has been so intimately involved in matters pertaining to Obstetrics and Gynecology. 

Pap smear frequency is again becoming controversial. As usual, the minimalist and government funded USPTF ( US Preventive Services Task Force) has interpreted the available data to mean the need for less frequent screening. They seem to consistently overemphasize the harms of screening (extra false positives, extra office biopsies) and consistently underweight the harms, i.e. more cancer cases. ACOG, various other cancer organizations, and patient advocacy organizations, give less weight to extra false positives and biopsies, with more concern focus on catching cancer early. ACOG still states that paps and HPV testing should go together from 30 to at least 65 years of age, and that for an average risk patient. Smokers, for example, would be screened, even more often. 

In the we-already-knew-this department, a new study shows that epidurals do NOT prolong second stage (the pushing part) of labor. The study, published in Obstetrics and Gynecology, also show no adverse effects of epidural on mother or fetus. 

Also in the we-already-knew-this department, a new study shows that women who have their fibroids embolized may need additional procedures. In particular, they have a fair chance of still needing a hysterectomy later. These women who go from embolization to subsequent hysterectomy were still better off in terms of complications than those getting myomectomies (removal of the fibroids from the uterus) to begin with. 

Finally for a trifecta in we-already-knew-this department, we feature a new study which indicates that “intensive exercise may attenuate excessive gestational weight gain for obese pregnancy women”. Excessive weight gain in pregnancy increases the odds of gestational diabetes, large for gestational age babies, and need for C sections. Research elsewhere also indicates that exercise in pregnancy also produces many other good effects, such as increased likelihood of vaginal delivery. 

Somewhere between politics and medicine we find people and society, and society has a lot to do with health. This week those in the entertainment industry have been reeling from all the revelations of sexual abuse and misogynistic workplace bullying by Harvey Weinstein. It has been sickening and yet illuminating to read the accounts of the women involved. The victims were abused in various ways. Those that escaped unscathed, had career setbacks by failing to acquiesce. They all suffered the shame and anger associated with such encounters, and even now are having to answer for why they did not disclose sooner, why they acquiesced, why they did not have more sense to begin with, etc. etc. 

see: 

http://www.vulture.com/2017/10/the-harvey-weinstein-sexual-harassment-assault-accusations.html

It is widely believed that Harvey Weinstein is not the only such perpetrator in Hollywood. It is also well known that Hollywood is not the only industry where this occurs. Although Weinstein's victims were generally celebrities, most victims are not. Yet even these celebrity women were caught off guard and were made to feel powerless and vulnerable. How much more so must the average woman feel, working a standard paying job on which they depend. 

Harvey Weinstein’s methods were outrageous. The vaster number of abuses in the workplace today are far more subtle. They are microaggressions. They are just enough to make you uncomfortable, but not enough make you realize it is abuse, much less move forward to report it. All of this adds up over time, and it takes a toll professionally and personally, and on stress levels, which eventually impacts health. I had one patient who developed certain medical problems. In taking care of her and getting to know her better, it turned out she had an extremely hostile workplace environment. We encouraged her to speak to people at the local department of labor. After a lot of effort and gumption on her part, the case went to the courts, where she prevailed. She emerged empowered and eventually healthy. But it had been years that she had suffered before she understood what she had actually been dealing with and where it fit on the spectrum of normal social interactions. 

Sometimes we do not realize that what we live with may not be normative. Our standard for what is acceptable behavior may be skewed due to a rough upbringing, or a innate tendency to think that we ourselves are the problem. If you think you may be living or working in some kind of an abusive environment, reach out to a trusted physician, attorney, local social services agency, community health center or mental health professional. Life is too short to let your quality of life or health suffer. 

Stay tuned for more news from the work of Obstetrics and Gynecology her, next week, on Medical Monday. 

Please remember to contact your elected officials to tell them what you think about all of this. 

Medical Monday Delayed due to First Frost

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Gentle readers. We never know exactly when the first frost will hit until it is right upon us. Today we heard it will be Monday night for sure, complete with a Winter storm warning, snow flurries on the Valley floor and larger buildups in the mountains.

Since I will be in clinic in the morning and operating in the afternoon, I had to bring in the frost sensitive vegetables today.  All the tomatoes had to come in, red, green, large and small. All the peppers and zucchinis did too. This all took longer than expected. Then, with this embarrassment of beautiful produce, I had to cook up quite a bit of it, and store the rest. We had stuffed and roasted zucchini with pesto toast, kale salad with tomatoes, peaches, and balsamic vinegar, and crustless peach pie. Everything is safe in the barn, and tomorrow I will be able to write. 

Thanks for your patience. 

 

Medical Monday Postponed

 Gentle  readers,

I must once again ask your forbearance for a small delay in the publication of Medical Monday. I began preparing for a weekend without my family as they departed on white water trip. I have had big plans for all the things that I could get done without them here, including some exhaustive computer maintenance that is been overdue.

 I'm the sort of person who makes somewhat optimistic lists. Nonetheless, I was determined to get my computer maintenance done, as I was covetous of the increased speed it would hopefully confer.  So I did the first thing that one should do when performing computer maintenance. I backed up. Yes, I back up to the cloud; I use iCloud since everything I do is part of the Apple universe. However I thought it prudent to back up the entire hard drive to another physical hard drive as well. 

I have a habit  of filling up rather large hard drives and so I should not have been surprised when my physical back up took all night Friday and half of the day on Saturday. From there I could go on to diagnostics.

Since I gotten a new larger terabyte hard drive I realized I to had re-create what is called an Edrive as a bootable entity on the main hard drive itself.  This is because the computer cannot properly do diagnostics on itself unless it is booted off something else. So after creating the Edrive using my diagnostic software Tech Tool Pro I rebooted to the Edrive and set about doing diagnostics.  I chose the whole suite of tests, thinking it would perhaps take four hours. I began the diagnostics Saturday afternoon and now I see very late on Sunday night that they are still working away. 

 And while right now I am OK with dictating you this quick note on my iPad, I will wait to do Medical Monday since, trust me, I personally have to have three big screens open to do the homework to write Medical Monday, checking sources and whatnot. 

So let this be a lesson to all of you. Keep up on your computer maintenance. It's really not very hard, it really is not. Basically you obtain appropriate software for your operating system and version, and you follow the instructions. If you use the Macintosh operating system I can unreservedly recommend the TechTool pro software which you can buy at microtek.com.  Since I don't use Windows I'm not familiar with the best choices but I know there are several easily obtained pieces of software and many choices out there even some of which are good and free available on the Internet. However, always read their documentation and read the reviews from independent sites before buying or installing. And by all means, back up your machine before doing anything. In fact, back up two different ways,  once physically and once to the cloud. 

Let's hope my diagnostics are done by tomorrow. 

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Food Friday: The Impromptu Dinner Party

Oh yes I did just throw an impromptu dinner party for 15 ! Truth is, this is not uncommon in my house. So, I thought I would share some strategies on how to manage this seemingly impossible feat. 

Who were these people ? These were nine guests from France who we were expecting. We were to house them for perhaps a week. So tonight, in what we thought was the first night of their visit, we thought they could simply settle in. However, it turns out they decided to stay only one night, so this would be our only chance to visit with them. Dinner was served. 

My family totals 6, not counting the baby granddaughter, so we had plenty of hands. This is the first tip.

1. You must train your children (and partner) from an early age to clean up after themselves in the kitchen, so the kitchen is not a fright when you go to use it. You must teach them basic cooking skills so they can effectively sous-chef (assist) you in a pinch. 

2. The next tip is similar: Keep the house reasonably tidy on a regular basis. Ensure your house is curated (meaning get rid of what you don’t need), clean and organized every week. Pick a day and keep to it. Then when opportunity strikes, you will be ready. 

3. Keep some basic decorations handy. I use candles and nice napkins. Guests seem reluctant to use our cloth napkins, so I keep some paper ones on hand. My candles are oversized white tea lights available at both Costco and Ikea. I place them in glass candle holders for ambiance. They come in little metal holders which prevent wax mess and get recycled. 

4. Have a set of dishes you can make quickly from things on hand, from the freezer and the pantry. Have ingredients for these recipes on hand most all the time. Have a ready-to-go festive drink as well. Mine is Pellegrino which I keep stocked in the pantry. 

In our case tonight, we made Paleo chili with all the trimmings, green salad and fruit salad. ( Always have those last two side dishes !) 

Here’s the rough recipe for Paleo Chili : 

  • In a large soup pot, saute a tablespoon of green chilis, canned or fresh, in a couple tablespoons olive oil. You may also include minced garlic.  
  • Brown about three pounds lean red meat in this flavored oil. Season with lemon pepper, cumin and chipotle chile powder, coating the surface of the meat lightly with each spice all across the area of the pan. ( This could be done with ground turkey too.) 
  • Saute some Mirepoix (roughly chopped carrots, onion and celery at a 2:1:1 ratio) and add that to the meat. 
  • Add a cup of frozen or fresh corn. 
  • Sitr and get mixture dry, caramelizing, and very hot. 
  • Add 1-2 cans full flavored beer (not paleo) or just water. Keep your face out of the steam. The alcohol cooks right off. 
  • Then add a can each of tomato sauce, stewed tomatoes, and diced tomatoes. 
  • Bean eaters (not Paleo) can add two cans here. I kept ours on the side since you never know the dietary constraints of guests. 
  • Simmer and adjust all seasonings, salt last. 
  • Serve with corn tortilla chips, chopped scallions, (lactose free) sour cream or substitute, salsa, and guacamole. Cheese eaters may add grated cheese. These garnishes are all set out for people to add at their discretion. 

 

Here is my Gluten free but too-sweet-to-be Paleo Quick Berry Cobbler: 

Spread a 2-3 berry-deep layer of red fruits on the bottom of a 13X 9 "ish" baking pan. These could be frozen or fresh raspberries, strawberries, cherries, or even blueberries, or better yet, a random combo of these. Pour off any dilute water from melting fruit. 

Make the topping. Mix the following until crumbly: 

  • 1c gluten free flour 
  • 1c sugar
  • 1egg
  • 1 teaspoon baking powder
  • 1 tea spoon salt

Spread over berries. 

Melt one stick of butter or 1/2 cup coconut oil and pour evenly over crumbs.

Bake at 350 degree until crust is golden brown and berries are not watery. Pro tip: bake on an edged pan lined with parchment. Start watching the cobbler at about 25 minutes. 

Keep conversation going by offering herbal or decaffeinated tea after dinner. 

Let guests help if they arrive too soon and clean up afterward. It is better to be doing things together than to have people idle and awkward.  Don’t think that everything has to be perfect. It is more important that you are warm and inviting.

Now you are all set to throw an impromptu New Year’s Eve party. Happy New Year ! 

 

 

 

 

Food Friday: Food Traditions and People

Winter is here and Christmas is upon us. Our family and friends are assembled. The serious cooking has begun. 

Christmas and Hannukah coincide this year, which is nice for our family. My husband has Lutheran roots, and I am Jewish. We have learned to be inclusive, and both holidays hold real meaning for us. Plus, we get all the good foods ! 

While we partake of many traditional holiday dishes, some treats have taken hold in our tribe. Each dish has a champion and ... a relationship to go with it.  Here is how it is playing out. 

One friend presides over the mass creation of decorated gingerbread houses every year. Another friend is the undisputed pie expert and can always tell what you are doing wrong. My son in law is the grilling king. My sister in law reliably arrives with snickerdoodles. My brother in law is a master of soups and chilis. Two nieces could go pro with cake decorating, and like to do their work here, in my kitchen. Great Grandmother roasts lamb. 

My husband is all about a fancy breakfast. He is one of those Nords who gets up early with a smile on his face. He makes waffles with fruit. Even at dinner we " give him a job he likes" which is making fruit salad. 

The youngest is starting to correspond with me from college about main dish recipes, usually with deer or elk, our red meat of choice. I owe him a custom cookbook, but have been slacking. Last week it was pot roast, and I got pictures. I think our culinary relationship is still forming. 

Our middle child cooks all the time. We have several dishes that bind us, but the most fantastical is our Buche de Noel. We also make fancy non-traditional Latkes. No mere white potatoes for us. We use sweet potatoes, yams, carrots, scallions and the like. I think this year we will fry in coconut oil. 

Our oldest is a skilled self taught chocolatier. This is what she and I do for the holidays. It is epic. We make moulded chocolates filled with ganache. I make the ganache, she makes the molds. Facebook and Instagram light up. So I though I'd share this little slice of our holiday with you. Have a Merry Christmas and a Happy Hannukah. 

Wellness Wednesday: Good Relations with Family

Holidays bring family together and that is good. However, family issues that were never resolved may come to light. To help your family time during the holidays be peaceful and bright, I have collected a few insights and recommendations for your consideration. 

Accept that family relations are complex. Accept that high stress during holidays is real. It relates to the practical demands of decorations, gifts, entertaining, finances and family relations. It also has to do with the inevitable taking stock of the year in conversations in one’s own mind and over the holiday table. People inevitably present their year in holiday card humble-brag style, and it is difficult not to make comparisons between one family and the next. 

Establish a realistic idea about who you are going to see and how they are likely to interact with you. Behavior patterns (also called dynamics) between people are very durable. That is, they are challenging to change. If you have a dysfunctional or uncomfortable dynamic with someone you are likely to see, prepare for it. Consider developing responses in advance should difficult topics come up. Remember to make “ I statements ”, i.e., "I feel", "I think". 

Set your own boundaries and stay within them. Begin by going to a family gathering focusing on the positive about yourself. Hold to those positive beliefs. Likewise, be tolerant of others and their idiosyncrasies. Focus on the positive in others. 

When you are reconnecting with people, greet them directly and warmly. Ask simple open ended questions but don’t pry. There is often no need to evaluate what they say or respond, just to listen with empathy and understanding. 

Do not go outside of your boundaries. Do not defend yourself if challenged. Just agree to disagree. Do not try to control or persuade others about old or new issues. Do not get drawn into an argument in a family gathering even if you have stake in the issue. It is not the time or the place. 

Remember the reason you celebrate holidays. They should be a time to celebrate the wondrous healing power of hope for the future. Holidays should be about celebrating the value of relationships. If your family relationships have not been well cared for, holiday time is a good time to start your part in this. Medical science has shown that we are happiest and healthiest if our relationships are healthy. Attaining optimal nutrition, fitness, and physical health are not easy. These take considerable learning, patience, and routine. Relationship health is no different. 

 

Belated Food Friday: Paleo Party Shots

This year we joined our sister offices of Family Born Midwifery for our office Holiday Party. We decided to go Paleo, and every one gave it a go. 

It was a fantastic spread of roast turkey, root vegetables, as well as green salads and fruit salads. We had a selection of paleo cookies and a very easy berry cobbler. Unfortunately, the cobbler got eaten before it could be photographed. However, I would like to enclose the recipe for you since it is easy, quick, tasty, paleo, and colorful. 

 

And here are some other shots from our dinner just for fun. 

Wellness Wednesday: Help for the Elves

Are you that truly time strapped gift giver with the finite budget ? Have you been reading all that advice about scaling back this holiday ? Are you tired of the materialistic holidays, the stress, and the excessive spending ? Here is some SMART advice to help you through. SMART means specific, measurable, attainable, relevant and time bound. Instead of saying, I’m going to do better this year, have a SMART plan for getting your tougher gifts done. 

They say the best things in life aren’t things. Here are some: 

Home made paper or gift certificates for activities with YOU ! Examples: 

  • a movie
  • lunch out or lunch in 
  • a hike in the outdoors 
  • spa day 
  • craft day 
  • joint workouts 

Here’s athoughtful gift for that person who has enough “stuff” : A donation to their favorite charity, cause or advocacy group, (usually able to be made online). You can send a card or a decorated email to announce the gift. 

For those who would like to give, but are perhaps late on mailing things to faraway relatives, ebooks and audiobooks come to the rescue. You can send an inexpensive but special ebook instantly even on Christmas eve and be right on time. Amazon.com is my go-to for the instant gifts. Your recipient can read them on any device, not just a Kindle. Kindle apps are available on virtually all platforms including the desktops PCs and Macs, as well as Android and IOS. Your gift can combine an ebook and an experience if you gift the book and buy one for yourself, then propose that you and even a faraway friend can read it “ together”. 

Audible.com is my source for ebooks since I am a member. This service is certainly worth looking into, especially if you ever have long commutes, flights, or road trips. 

For an even more economical gift, you can send music, even just one song, or an app, as a gift. These too are electronic, and thus accomplished at your desk in the wink of an eye. 

It’ s the small things that count. So send valuable information ! Most of us have a recipe or two that is special to others. Write it up with nice paper or digitally with graphics, and send the recipe or a collection of them as a gift. 

Other small things include thumb drives - perhaps one filled with your best photos of activities you and your recipient have shared. Tie it with a ribbon or some twine and you have a very easy, very economical and very special gift. 

Making celebrations and gift giving is fun but can be overwhelming. Get inspired, and stretch a little, but do not stress or worry yourself. That would be missing the forest for the Christmas trees ! 

Enjoy these last few days before Christmas ! 

Food Friday: Holiday Food Preparation

This was going to be a post about Holiday Cookie Exchanges, and how I was going to make mine paleo, but then I realized there was so much more to do than that. There is so much more to do with holiday food on this, the 10th of December ! The time is now to get prepared. I share my list with you ! 

First things first: Make a list of all the food requirements that must shortly be met. 

  • Determine donation at the door for upcoming holiday party- canned goods ? T-1 day 
  • Order turkey from the organic people so I will not have to worry about them selling out. ASAP
  • Order fruit boxes for gifting.( Make fruit box list !) ASAP ! 
  • Raid pantry for homemade jams for neighbors on Christmas eve or Christmas day. Decorate jars. T-10 days 
  • Decide on thank you gifts for office- tea and chocolates in gift bags. By Monday 
  • Decide on thank you gifts for “ helpful people” list: ( First review the helpful people list for this year, i.e. UPS man, insurance lady, dentist, eye doctor, etc. ) Maybe also tea and chocolate depending. By Monday 
  • Try to pull together people who are interested in a Paleo cookie exchange. Tomorrow 
  • Decide what cookies I would like to make for the cookie exchange. Next Wednesday 
  • Decide menu for office holiday party, and see what I can get purchased before the rush. This weekend.
  • Buy decorations for homemade chocolates. ( Amazon !) Tonight ! 
  • Assess the current collection of stocking stuffers for family members and what still needs to be obtained. Be sure to get the correct chocolate percent to each of the kids (Chocolate snobs-all of them ! ) This weekend 
  • Plan the baking and assembling of the “ Buche de Noel” or Yule log, in chocolate and buttercream with piped meringue mushrooms. - Talk to my sous-chef son Forest : ) - Do the Saturday before Christmas. 

It seems like a lot, but I do it because it’s fun and because it brings people together. 

Take at look at your fun list for this holiday season, and have some fun with food. Just make sure to keep up with your workout in the event that there are a few extra calories on the holiday menu. 

Wellness Wednesday: Holiday Parties

It is the party season. Instead of avoiding or stressing about parties, take a new tact: RSVP yes and prepare just a little. Attending parties is a skill like any other and can be learned. Preparation and a dose of common sense is all you need. 

Holiday parties come in three varieties: 

Family parties

Social parties 

Office parties 

Each has its special considerations. But they all have one thing in common. Their highest and best purpose is to reaffirm personal connections. Some people go to parties for other reasons, for example to impress, drink, or hook up. But these are not the highest and best purposes of a holiday party. 

Social connections in families, among friends, or coworkers are endlessly complex. Challenges and problems among people are inevitable and natural. There are times and places for working on these issues. A holiday party is not one of them. Parties should be easygoing and enjoyable. 

How is this accomplished ? 

 

Prepare 

 

Be prepared to be sociable, i.e. positive, interactive. Get enough sleep, don’t be rushed, and eat something healthy before you go so you are not “ hangry” or sluggish. Eating something before hand will help you avoid binging on lesser quality party foods. 

Know who you are likely to meet and be prepared to be cordial to them, no matter who they are, i.e. your ex, your hostile co-worker. I would say think up some topics for conversation, but that seems too contrived. Instead ask them about their holiday plans, or something that you know interests them. Here’s the secret: 

The key to feeling comfortable at a party

is making other people feel comfortable. 

Try to be inclusive of those who seem shy. Do not monopolize the host or any high profile guests. In conversation, take a moderate approach, avoiding both awkward silences or talking above everyone. 

Do not introduce controversial topics such as politics. If such a conversation takes place, and you notice some uneasiness, try to smooth it over or change the topic. You may also excuse yourself from the conversation. 

Make the rounds. Try to touch base with most everyone you know. If you are with someone at a party, touch base with them periodically. You are not obliged to be glued at the hip. Do however, look out for their comfort. 

Be liberal with introductions. Be quick with eye contact, a firm handshake and your name. You will put people at ease. Some may be taken aback and you may have to gently ask them their name. 

Come with a gift for the host. Wine is cliché unless you and the host are wine aficionados. Flowers die. Consider a small indoor plant, or better yet some potted culinary herbs.  If your gift is modest and personal, it will be appreciated. A ribbon, some raffia or a brief note will show forethought. 

Love your outfit if you possibly can. Consider black, because…black. Go festive, as this shows an admirable enthusiasm. Do not, however, conduct fashion experiments at an office party. Do not go overboard on risqué or glitzy. You want to maintain your professional reputation. 

A social party is different. There you may show more flair and more skin. However, do not assume you will be as comfortable in your dressing room at home as you will be under the lights at a party. Some people will be taller than you are, and even with heels, they can look right down that cleavage. You will realize this at just the wrong moment and there will be nothing you can do. Remember too, that you may want to dance. Hopefully your sequined sheath and your platforms will permit this. 

Do not under any circumstances drink to excess. In fact, As a physician, I suggest club soda with a wedge of lime. It looks just as sparkly in your hand, and gives an air of restrained elegance. Why ? Because it is restrained, and it is elegant. If you drink, limit yourself to one beer, one glass of wine, or one glass of champagne. Social interactions are complex and challenging. You will want to be within your full faculties at parties. 

Do not overeat. It’s not even fun. Take small portions of just the best things. Hydrate with your elegant soda. 

If you are asked to bring a dish, you must. Do your best and present it well. Consult liberally with the host beforehand to be sure you are getting it right. If it is a DIY kind of casual party, and it seems appropriate, offer to help clean up. 

Do not bring extra people with you unless you have the host’s encouragement beforehand. Do not come early and do not come too late. Do not stay too late. Better that the host should ask you to stay rather than ask you to leave.  

So many rules ! Yes and no. Most of this is just plain old common sense. But, I daresay, common sense is not exactly common these days. 

So, pick a gift, pick an outfit, stand up straight and enjoy the parties of the season.

Food Friday: More on Edible Gifts

There are 23 days until Christmas ! There is still time to assemble some economical, healthful and delicious food gifts ! 

Traditionally, holiday food gifts are sweets and baked goods, and this is great for special occasions. If however, you’d like to focus on more healthful choices, here are some suggestions. Think savory, and think beyond food, per se. 

 

Recipes for all these are easily found on the internet and especially on Pinterest. Please feel free to follow me and check out my boards on Paleo Nutrition and Gifts. 

https://www.pinterest.com/drginanelson/

When you prepare a holiday food gift, make the containers part of the gift. Baskets, jars and decorative boxes are widely available at craft, sewing, or even hardware stores. 

To make your gift really nice, include an artful hand lettered card or tag about how to use the gift. Perhaps include it's recipe if it is prepared. To make the gift really deluxe, include a book. For example, A spice oriented gift could be a selection of jarred and labelled spices in a nice basket, complete with a book on spice mixes. 

Be sure to make a list of all the people you wish to acknowledge, thank, or regale with gifts. Start now if you haven’t already. Have a plan and keep it simple. Doing so will reduce stress during the busy holiday. More importantly, it will give you more joy during the process. 

Wellness Wednesday: There and Back Again

I have a large and closely knit family. But each and every one of us has travelled this last month. Some have travelled for work, some for play and some to reconnect with old friends. But we have all experienced a change in our usual routine, our place, and even our food. This week, we all will have returned home for the season. 

Travel is an exercise in contrasts. It is about how you feel just before you leave home, and how you feel just before you return. In those watershed moments, you learn things. 

You learn that for better or worse, you were in a routine. When you leave, you cannot help but critically appraise that usual routine. And you should critically appraise your usual routine. 

You learn how you feel about being with your spouse, and that is precisely because he is elsewhere. You may make new resolutions about what good things you will do when you get back. But beware, inertia is powerful, and there are reasons why you always did things the way you did. You must figure them out if you want your life and your relationship to move forward. 

You will learn how people change over time. My daughter marveled at the changes she saw in her 18 month old daughter after a ten day adventure. I marveled at the changes I saw in her. 

At reunion I visited with friends of 35 years duration. They are still themselves, but more so. I am glad I chose my close friends wisely so long ago. I still adore my sophomore roommate. Time loops back in a circle and we felt and acted like roomies for the span of one evening, then we went back to our alternate realities. 

Some of us like to stay curled up in our Hobbit holes smoking our figurative pipes and drinking our tea. But adventures knock on the door, annoying us at first then compelling us. As the Hobbit's tale teaches us, the journey is the only way to learn who we are and where we are at home. 

Wellness Wedesday: The Wellness of Voting

November 8th is election day in the US. This has been a frustrating season for us. It is tempting to throw up hands and stay home. 

However, there is a healthier way. It is engagement.

I spent a total of 1 hour and fifteen minutes on my voting this evening. I had a voter information pamphlet, mostly for the texts of our local initiatives. And I had the internet. I read the websites of each candidate on the ballot and it still only took that short amount of time. I learned a great deal, and was reassured that there are some well qualified new people running for various local and state offices. I came away with the impression that issues are not really as complicated as I first thought. And, happily, the candidates in our area seemed to portray their beliefs and planned policies clearly for all to see. That made my choices easier, especially when I saw things I did not like. 

At the family Halloween party, we had an interesting debate on the morality and utility of voting. Some argued that voting is a moral imperative. Some argued that it was symbolic only. Everyone acknowledged that voting meant the most if voters are informed. Everyone acknowledged that voting is no substitute for community engagement. For example, we concurred that the real way to influence elections is to help with campaigns and fundraising. This can be by way of real campaign events, or online. 

Voting gets you in touch with the issues. Your vote is just one of many, but you mean something in your community, even if you are having conversations about national or international issues. Ideas spread beyond mountain ranges and across oceans.

Voting is a hard won right, but we must keep to the spirit of the original voters who uniformly knew about their issues. Voting means learning and voting means conversations… conversations that spread. So learn all you can and add your voice to the conversation. 

To be or feel powerless is one of the worst forms of mental and physical stress. This election has made people feel powerless. We are not powerless, especially if we are willing to learn, participate and help.  

Wellness Wednesday: Halloween

This is our last Wellness Wednesday post before Halloween, one of my favorite Holidays. It has been our family tradition to have a grand Halloween party and this year is no exception. In preparation, I would like to share with you how my view of Halloween does indeed bear on wellness, especially for children. Before I share my philosophy on Halloween and how that translates into our gatherings, I would like to go over some basic Halloween safety tips. 

  1. Go out with your children if possible. Cloak yourself and hang back near the street while they practice their confidence and their manners. If they are older and you feel it is safe, let them to go in groups or pairs. Older kids should take their cell phone and turn on tracking. On iPhone that is through an app called “ find friends.” Pushback ? Who pays for that anyway ? 

  2. For kids going without an adult, review a map in advance and agree on a route. 

  3. Set time limits beforehand. 

  4. Feed kids a healthy festive and favorite meal before nightfall, so they are not tempted to feast on Halloween candy as they walk. 

  5. Ask kids to refrain from eating candy until it can be inspected under good light. Discard anything opened or tampered with. 

  6. Discard anything that is not commercially prepared, unless you know the source. 

  7. Ensure that costumes are safe for the weather, and the dark. Use reflective tape if need be. 

  8. Make sure that decorations are safe. Be especially wary of open flames or electrical installations. 

  9. Give kids flashlights and or glow sticks for visibility. 

  10. Forbid children from entering the homes or cars of strangers. 

  11. Remind them to observe traffic laws as there will be lots of cars as well as pedestrians. 

  12. Remind them that some people drink and drive on Halloween. 

  13. Remember sometimes kids get creeped out by creepy costumes. Make it comfortable for kids to come home if they do not like it. 

 

Here is an except from my Halloween post last year which I would like to share again.

My different perspective comes from the historical roots of Halloween which is a witches' brew of an ancient Celtic festival Samhain (pronounced Sow-in), the later Roman holidays of Feralia and Pomona, and finally the Catholic Feast of All Martyrs/All Saints/All Hallows day. The name " All Hallow's"  literally says, " all that is holy”. These are beautiful holidays are full of respect for the harvest, the circle of life, ancestors, saints, and the turn of the seasons. They all included feasts, and outdoors activities late in the night complete with festive fires. Accordingly, " Halloween" is of course a contraction of the words " Hallowed" and " Evening".

I have a soft spot in my heart for All Hallow's Eve as I like to call it, since our youngest child was born on that day. As a result, it has always been a big family celebration for us, and so we have always had a party. Accordingly I have never gone in for the typical commercial Halloween decoration and imagery. True, I like a very dark and mysterious Halloween. Particularly after I had children, though, I haver saw fit to incorporate images of violence into the holiday. For example, I am totally not into the blood gore and mutilation thing. Instead, Halloween is to me about the beauty and magic of the night and the natural world. For example, I have incorporated themes of stars, the moon, planets and comets. People consider these magical motifs but to me they evoke magical math and science which can describe their movements. I also incorporate anything botanical. At this time of the year the leaves are getting crinkled and brown, and the branches are bare. Some are dried all but the berries, but there is beauty even in this. You can make them even more evocative with paint, glitter, or interesting low lighting.

I incorporate the creatures of the night in my All Hallows' decorating. From mice, rats, bats, spiders, beetles, wolves, and owls to moths chasing a flame, these are all interesting and beautiful creatures who are worthy of our attention. Instead of vilifying them or presenting them in caricature, I try to present them as they are, almost like museum specimens. If I could have live ravens with their glossy black feathers, I would. For children I might do a faux insect display, with a little parchment note about the creature, and how they fit into the ecosystem. 

And fire, of course fire, since fire harkens to the primordial processes in the heart of our sun which make life on this earth possible. Did you ever think about the fact that when you watch the flame you are watching matter being turned into energy? To bring fire to the home and patio in first must be safe. I like metal tea lights since they turned safely sat inside a beautiful container. These are easy to clean up as well. I use lots of candles and keep the regular lights down low. For fire outside, make a traditional bonfire. Check your local fire regulations and use common sense of this, especially with children.

So use branches, bugs, bats in mobiles, candles, and faux spiderwebs is done carefully, with dark elegant colors, or moonlit white. But whatever you do, make your party beautiful enough to transport your guests to different holiday "Hallowed" frame of mind.

Reference: 

http://drginanelson.com/drginablogs/2015/10/15/food-friday-food-for-halloween-party?rq=halloween

Halloween can involve a healthy dose of fantasy. People of all ages love costumes and stories. There are so many fantastical costumes to try, there's no need to resort to the grotesque or sinister. Here's my Pinterest album of costumes and cosplay for your inspiration.

https://www.pinterest.com/drginanelson/costume-and-cosplay/ 

You might also like my collection of steam punk fashion which celebrates the popularization of science and engineering in Victorian age.

https://www.pinterest.com/drginanelson/steampunk-fashion/

Halloween should not be about fear and horror. Quite the contrary. It should inspire. Its historical roots lay in the efforts common people trying to encounter the wondrous. It recalls village life and the collective joy of the good harvest. It celebrates the interplay of chaos and order, day and night, summer and winter. This is the wellness of the holiday: that we gather together to express respect for the harvest, community, ancestors, Saints, the cycles of life, science, nature and hints of the divine.

 

Food Friday: Grocery Store Reverie

I am back in Palo Alto, California for reunion and I hardly have time to think about food. But, in the course of my travels, I have come across some of the most beautiful grocery stores ever. 

I have never been to Italy. But I have been to France. In these places, people care deeply about food in a way most Americans don't seem to. However, here in Palo Alto, these are my people. I watched in the stores how twenty something men would converse over the quality of fruit. Or how professorial types moved about with one meal's carefully chosen foods in a basket. I saw others asking questions about cheese, and the butcher explaining a fine point or two to some prospective buyers. I saw bakers, hatted in white,  displaying desserts for the evening's customers. Even the checkers would comment on the items in my basket, like a Sommelier complementing my choice of wines. 

I enjoyed this throng of like minded people. The beautiful displays of foods engendered conversations all around the store. Many people had phones to their ears, checking with companions elsewhere about what to purchase. These were not just grocery lists. They were menus that were being executed. Several were doing what I had been doing earlier in the day, holding a phone out in front sending a live video to another who would look over the wares and voice their preferences. 

There were thoughtful conversations here and there, but at the same time, the group had a bit of hustle and bustle as if they all had somewhere to get to. People were expecting them. Within the hour, so many well considered tables would be set. 

This would be my wish for every one on this evening of travel. The food you buy and the place you buy it should mean something. Moreover your dinners should be special in some way.  Finally, do what you can to have special dinners with special people, in a special place.  

Food Friday: Disaster Relief Food

If you do not know about Hurricane Matthew and what it is doing, then stop reading this blog post right now and check out this link on the weather channel: 

https://weather.com

This is one of the most devastating storms our nation has ever faced. Hurricane Matthew is a Category 4 of 5 hurricane. This ratings are done by the wind speeds observed in the storm and these are currently at 130 miles per hour, enough to tear the roof off a house. It is not terribly uncommon for a hurricane to achieve this category. What makes the potential for damage so great in this case is the path that this hurricane is likely to take. It will travel straight up the populated Florida coast, passing over Cape Canaveral and onto the southern part of the Eastern Seaboard. These are low lying populated areas.

We are told the main hazards are wind, as wind, but also as a fringe of tornados at the edge of the hurricane. Other hazards are the sheer volume of rain and flooding, powerful waves at the coast battering the shoreline, but even more so the so called storm surge, which is like a monstrous high tide coming far higher and more inland than it should, amidst everything else, complicating the task of dealing with buildings compromised by wind and falling debris. 

Power will be lost, and food likely spoiled. Tap water may not necessarily be safe. Food will be a challenge. In the aftermath, people may eat the spoiled food and get sick. Water born illness may spread, as may common maladies like pneumonia, since people will either be without shelter, or in crowded shelter where illness is easily acquired.

The Red Cross is the preeminent organization for disaster relief in this country. For this reason I have devoted food Friday to a link to direct you to their donation page. I was going to talk about Kombucha, a delicious probiotic drink, but I cannot get my mind off the hurricane and its victims. 

When I was a little girl, ages 6-12, I lived in St. Petersburg, Florida. I lived through hurricanes Agnes and Camille. Camille was class 5, though it merely sidelined us. I have many vivid memories of being in a hurricane. Oddly, all of them are pleasant. 

For kids, a hurricane was all excitement. There was no school. It was 1967, and everyone gathered around the TV to watch Meteorologist Roy Leep track the storm. He was kindly but authoritative, with the air of a scientist. Where the colorful and dynamic realtime satellite images are now, there was a large very much analog wall map full of symbols, isobars and moveable pieces. Almost all children had a hurricane preparedness booklet. I  even had a felt map of Florida, and had cut out the official symbols for tropical depressions and hurricanes so I could move them along the map.  I was familiar with the tracking terminology. I tried to predict time and place of landfall. 

Once during a hurricane my mother made me sit on the couch in the middle of the house with her and would not permit me to get near the windows as I wished.  In that same incident, large lightning strikes caused sparks to come out of the wall outlets. Eventually the power went out and we lit candles, which I though was wonderful. We got to eat snack foods, which were normally not allowed. 

Once, when I lived on a small residential island on a bayou, we had a tremendous hurricane related storm surge. I slept through it, and the next morning it was bright sunshine. I, together with all the other children in the neighborhood took to the streets... in boats. There were also pool toys like floating seats. Everyone got out and had a grand day, and were all the happier when we learned that the one bridge had washed out. We all swam like fishes in the first place, living there. We all had pools, and seawalls, and boats. But now, our boats banged awkwardly against their pylons whose lines had been slacked, and our pools had all become contiguous with the ocean waters which had come over the seawall and across the lawn. 

Somehow I think the adults did not have the same experience. As I got older, more toward two digits, I didn't either. I learned in retrospect, that during Camille, two states away, many had lost life. Our Florida houses were made of concrete and screened porches, but in the old south, they were made of wood. Homes and lives had been lost, and would be again and again. 

I got to where I could readily discern that strange green light in the sky which precedes the hurricane and occupies the eye. I could literally feel the lightness of the fall in barometric pressure. Once here in Montana my daughter and I were taking our groceries to the car during a bad windstorm.  Though it had been over 40 years, I remembered that green light in the sky, so beautiful. I told her if I didn't know better, I could feel the lift of the whole atmosphere. I told her about the funnel clouds I'd seen over the Gulf of Mexico, and how they started as a dark grey V shaped little buds off a big cloud. We looked around and thought maybe we saw one. As we got home, ten minutes away, we passed by what had been a stand of massive old cottonwood trees. Now there was just a giant pile of sawdust and twisted roots. The three homes in proximity including ours were untouched, though people in the neighborhood said the wind had been a deafening roar. We later learned that two small tornadoes had been believed to touch down. I was heartbroken for the magnificent trees, but then ashamed of my sentiment compared to what victims of violent storms must feel. 

By morning, the Red Cross will be badly stretched for resources of all kinds. We all need to do what we can to help. Here is their link. 

 

Wellness Wednesday: Wellness in Dying

I generally shy away from this topic. But a few things have happened recently causing me to realize that there are some issues that can make the process better. 

I did say process. I have observed a range of situations, from a young person with a couple of years to plan, to a middle aged person who died suddenly and unexpectedly, to an elderly person whose passing was entirely anticipated. In all cases it was a process. They were all hard, and they were all different. As an inexperienced observer, I did notice that several things had a big impact on how the whole process went, for the patient and the friends and family. 

Wellness in dying comes from wellness in living. It comes from the most basic of things.

  • Get along with those around you. Resolve your issues and express all your affection. 
  • Stay out of debt.
  • Obtain life insurance to cover any debt that you have and to provide for spouse and children through college.
  • Clear out your household clutter so your family and friends will not have to do it.
  • Have a clear paperwork system.
  • Have computer backup and passwords entrusted to someone.  
  • Establish a will if you have assets and or children. This can prevent bad feelings after you are gone.
  • Establish a living will (advance medical directives)  including instructions for any organ donation with your primary caregiver. 
  • Arrange your life and work so you are not always postposing special experiences. 
  • Arrange your everyday life and work so you have good experiences routinely. 

These are the Days of Return and Repentance in the Jewish Calendar, a time of self examination. It is the week between Rosh Hashanah and Yom Kippur, the High Holy Days. The liturgy refers to the Book of Life. It refers to those whose names will be inscribed for the coming year and those that will not. The traditional blessing reflects this imagery. The whole service is very much a contemplation of mortality and the need to be mindfully present in the time we have. 

May you be inscribed in the Book of Life for the coming year. May you have a good year and a sweet year. 

Wellness Wednesday: Travel Insights

 I am in black and with me is Kyra Bobinet, MD, MPH of drkyrabobinet.com

I am in black and with me is Kyra Bobinet, MD, MPH of drkyrabobinet.com

Although travel is often arduous, it has the capability to be really invigorating. Travel is meant to refresh both the body and the spirit. 

I travel seldom. Often, when I do, it is for a specific reason such as a conference. Nonetheless, it gives me perspective on the destination and on home. I also learn things about myself. Here is a sampling of my insights from a recent trip to Stanford Medx. 

  • I worry before a trip and invariably come to find that my worries were largely unfounded.
  • Every time I travel, especially the day I’m supposed to depart, I'm reluctant to leave home and have strong feelings of missing home. However, by the time I change planes, I am very glad I went and I get excited for the destination. Toward the end of the trip, I'm anxious to depart, and love arriving at home.
  • I romanticize my destinations yet ultimately find that they, like all places, have advantages and disadvantages.
  • I sleep more when I am not at home since I do not engage in the endless list of things to do at home.
  • I feel better when I sleep more as many people have told me I would.
  • I am becoming increasingly selective about what I eat.  I am therefore becoming more careful about bringing food, especially snack foods, with me.
  • I am more determined than before about finding new ways to keep up on my workout while I travel.
  • I drink more and hydrate better when I am away and I feel better because of it.
  • I am still reserved at the beginning of a big interactive conference. I then realize partway through the conference that there is no reason not to approach anybody, including the main speaker, that I find interesting. When I do approach people with reasonable points or questions, they are uniformly receptive and share generously.
  • I never bring enough business cards. And in a related vein, my business cards are boring. I need some new ones.
  • I sometimes get the “ I am not worthy“ feeing when I meet people of towering brilliance and accomplishment. It does not take me too long to realize that this is a waste of energy. However, it still happens. Thankfully, this feeling does not paralyze me, and it makes me want to do more. These negative feelings are eclipsed by my gratefulness at getting to meet such people.
  • I am afraid of “ losing” the cool people I meet on my trips, so I have become more thorough about getting their complete contact information, often including pictures. The funny thing is, everyone else seems to be doing the same thing.
  • I used to disdain Twitter, but now I get it. I don’t know if this was one of the original intended uses, but I quickly learned to do as others were doing and tweet out key points from the lectures, including helpful hashtags and relevant twitter handles. The twitter stream from the sometimes concurrent presentations in one conference could thus be shared by all who were interested, regardless of what presentation they attended or, regardless of whether they were present at the conference at all. I was enthralled by the idea that we were creating a crowdsourced collective impression of the conference available live in the twitter sphere.
  • When I travel to places where I have lived before, I feel a pleasant sense of continuity from past to the present. I also get a sense of longevity, as though life is reasonably long, and that you are free to do many different things over the decades.


Traveling inspires me to do more and be more. It makes me appreciate both home and the destination better. If I go back in time by going back to a place I’ve lived before, I gain understanding and compassion for my younger self.

Traveling can be expensive and challenging to arrange. However, I believe that it is worth it.

 

Here are some older posts I wrote about travel: 

Travel Wellness

Travel Food

The Structure of Travel