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

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We will start off with novel and beneficial new research. A think tank called “Center for American Progress” has released an analysis of the current state of "sex ed” in America. They found the states to be, as a whole, deficient in teaching about issues of healthy relationships, consent and sexual assault. Only a handful (10) of states programs even mentioned these things at all. 

Backlash continues across states and the nation. Last week, Iowa passed a law which bans abortion once a heartbeat is detected. This contradicts the law on the books at this time, Roe VS. Wade. Iowa is being sued by the ACLU and various abortion providers. 

The Trump administration intends to cut all Title X funding to any clinic which even counsels about or refers for abortion. Eighty-five separate groups have signed a letter to HHS Secretary (Health and Human Services) Alex Azar to restore Reagan era regulations. 

The Trump administration has shown political and financial preference toward family planning clinics who promote only abstinence for birth control, even though it is neither effective nor evidence-based. Since family planning clinics have been organized and staffed by those who endorse evidence-based effective contraception not including abstinence only, this effectively defunds all family planning clinics. The States have a serious interest in this since they realize the health and prosperity of their populace depends on such services. In that light, the States Attorneys General have come together to back family planning clinics nationwide to sue the Department of Health and Human Services over its policy. They argue that the current policy violates the terms of Title X enacted in 1970 with bipartisan support. 

Should Medicaid recipients have a lifetime limit on benefits? Certain states, in cost-cutting bids, have been lobbying for this. However, the Fed, via the Center for Medicaid Services (CMS) has rejected these requests. In doing so, the Fed has broken rank with party conservatives. 

Care for women, pregnant women and postpartum women is not just germane to women. The health of women extends to others in the way that the health of men simply does not. Pre-pregnancy health, we are learning, is more germane to a child’s health than we previously realized. During pregnancy our opportunities to intervene to prevent morbidity and mortality are obvious. Less obvious are the manifold opportunities in the postpartum period. New recommendations from ACOG (American College of Obstetricians and Gynecologists) the Society for Maternal Fetal Medicine, and the Academy of Breastfeeding Medicine reflect a growing understanding that support in the extended postpartum period reaps many benefits. They now recommend that postpartum care should extend to 12 weeks and become a sustained period of support for the new mother and infant. It has come to light that for every 10 weeks pf paid job protected leave, infant mortality decreases about 5 percentage points. 

With the legalization of marijuana all around the country, more and more pregnant and breastfeeding women are using. Until recently, we had only vague warnings for these women. However, now new data indicate that using during pregnancy leads to a 50% increased chance of low birth weight. Use during breastfeeding is associated with decreased motor development in babies. 

The nation is indeed split on the issue of women and children. Part of the country is set on shifting away from collective responsibility toward women and children as they actually live. The current administration is intent on solidifying its base through supporting the explicit ideology of its voters, which gives women certain constraints in society:  abstaining from sex before marriage, using abstinence only for birth control, and rejecting abortion. The administration has combined these emblematic stipulations with their advertisement to cut taxes, and the result is that healthcare budgets for women have been slashed. And as if to add insult to injury, it is not at all clear if the money lost to the health care system will actually end up back in the hands of the taxpayer. 

The other part of the country is looking at the real problems of maternal morbidity and mortality. They are trying to solve problems with the best available science, rather than with ideology. States are beginning to realize that the lack of good routine health care, prenatal care, and postpartum care is expensive. It is expensive in the emergency room and in the workplace. Professional, scientific and legal groups are starting to fight back. 

ABC has just done what amounts to an exposé on the poor quality of pregnant and postpartum care in the US. This column has dealt extensively with the percentage statistics and trends on maternal morbidity and mortality. However, I have rarely included raw numbers. Here they are. In the US seven hundred women die each year in childbirth. Sixty five thousand more almost die. In a response to this program, ACOG has publicized its coordinated initiative to reduce maternal morbidity and mortality state by state. It is called AIM, Alliance for Innovation in Maternal Health. It has already been implemented in 18 states. 

Science marches on. 

New research indicates low levels of free t4 in pregnancy are associated with lower non-verbal IQ in children ages 5-8. Most caregivers are now including thyroid labs in their prenatal panels. Ask your doctor to be checked. 

BRCA genes are not the only genes pertaining to breast cancer. Newer multi-gene testing panels are now available for selected patients. Ask your doctor to speak with a geneticist if you are uncertain. 

Common sexually transmitted diseases are on the rise in California.  New data indicate that chlamydia is most increased in women in their 30s, while men account for the majority of new syphilis and gonorrhea cases. 

Fertility rates in the US have fallen to record lows for the second straight year. The same is true for several other developed countries. What are we to think? We know that at present, 50% of births are unplanned. As women become more educated and have more autonomy, birth rates naturally decline. You hear environmentalists’ concern about overpopulation, and politicians bemoan declining birth rates. The devil is, as always in the details. Certain subgroups in our population are decreasing and others are increasing. All of this will add up to social and economic change. I have one main concern: that growth be sustainable. Since my life’s work is mainly done one woman at a time, I am concerned that my patient's health habits and healthcare are sustainable. I am concerned that she have the means to grow her family or finish her family's growth in a sustainable way. I am concerned that my town and my countryside have sustainable growth. However, for me, growth is not the right word. I’d rather my community mature, or flourish. We shouldn’t always need more people, more buildings or a larger economy. What we need is for the family size to be ideal as determined by the parents. We need our towns to function optimally and to improve the space we have until it is optimized. The same is true for our nation. But our financial institutions are geared toward growth: more consumers, more goods, more profit. But this comes a human, societal, economic and ecologic cost. When we think about family size, birth control, population statistics, and even prosperity in general, we have to think about what we want our future to look like. When women lack access to health care, we cannot craft our futures. 


Stay tuned for more news from the exciting world of Obstetrics and Gynecology, right here next week on Medical Monday. 

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. 


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: Breaking News from the World of Obstetrics and Gynecology

As of Friday, intentions were to hold a vote on the ACA bill in the Senate this next week. This, despite the fact that Senator John McCain (R-AZ) has been diagnosed with brain cancer and will not be back next week for the vote. He would have been a supporter of the bill.

It is clear that there are at least four GOP Senators who have already gone on record saying they will oppose it. Only two opposed are required to kill it. 

For a detailed review of the bill and the consensus on its ramifications, see last week’s blog post which was pretty comprehensive. Really nothing has changed since then. 

Two prominent antiabortion activists who are now on staff with the Trump administration have informed 81 (EIGHTY-ONE !) teen pregnancy centers that their Federal Funding will end in 2018. How can these decisions be made without any due process whatsoever ? 

On to medical news.

 There is not one but two Zika vaccines under development. Zika is the dreaded virus carried by mosquitos in temperate climates which causes central nervous system and eye defects in the unborn. On of the vaccines is in human safety trials, and another is in safety trials for pregnant animals. Vaccine trials may be hampered by reduced funding to the CDC ( Centers for Disease Control) through the Trump administration. 

Another approach to Zika is to introduce genetically modified strains of mosquitoes that die in one to two days. However, some on Texas object to this strategy citing possible unintended consequences. 

Two to three years from now, in 2020, it is predicted that there will be a shortage of nearly 10,000 Obstetricians Gynecologists. This applies not just to rural areas, but to big cities as well. The training is hard, the hours long. The work is risky, from both a medical and a legal point of view.  Costs are high if one is not employed by a large organization. Private practice Ob/Gyn is nearly extinct. Sure it can be rewarding and fascinating. It often is. Lately, though, the lack of regard for women’s health pose new concerns. 

Many rural hospitals are removing maternity services. This should come as no surprise since maternity care is acute care and is potentially intensive or surgical on a reasonably regular basis. Staffing and facility needs for such care is high, and the availability of those who can render it is getting lower all the time. According to recent study, over half of rural counties in the US lack hospital based Obstetrics. In all fairness, this is a big country, unlike Europe for example, and people here sometimes choose to live way out in the boonies. It goes a long way to explaining why the US has the highest maternal mortality rate in the developed world. That, together with the obesity epidemic, its complications of diabetes, hypertension and preeclampsia, and the defunding of women’s health care resources explain it well enough. 

How bad is the obesity epidemic ? Perhaps you have no objections to a full figure. Ok, but do you object to life shortening disease ? Of course. The CDC now reports that over 100 million US citizens have diabetes or pre diabetes. Most with pre diabetes do not even realize they have it. If you are overweight, ask your caregiver to screen you with fasting blood sugar, 2 hour blood sugar after eating, and also screen your cholesterol and triglycerides ! Knowledge is power. 

Fake sweeteners are not helpful. A new meta analysis of 7 studies has shown that people consuming these do not lose weigh compared to those who do not consume them. Moreover, these studies also show that those consuming artificial sweeteners are at increased risk for obesity, diabetes, and cardiovascular issues over time compared to non-users. This probably has more to do with the misbegotten habits of the users rather than something intrinsic to the artificial sweeteners, but we simply do not know. 

We always need some news in the-we-already-knew-this department. This week, we again learned that healthy diet and exercise in pregnancy are associated with lower rates of gestational diabetes and C section. 

Finally, in very interesting and early work, thyroid hormone and metformin (a common diabetic medication) seem to be able to reduce memory and learning problems in rats exposed to alcohol during pregnancy. This groundbreaking work was published in Molecular Cytology and will hopefully spur more research on the subject. 

Stay tuned for more exciting news next week, on Medical Monday. 


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  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. 


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. 

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 ? 




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.

Wellness Wednesday: DNA testing

Your DNA is the code to your programming. It is literally your genetic code. It determines your physical makeup, from appearance, to reproductive potential, to disease states. It may also determine certain hardwired aspects of temperament and cognition. Wouldn’t such information be useful for maintaining health and curing disease ? The answer is of course yes. However, the science of the use of DNA for medical purposes is still in its adolescence if not its childhood. 

DNA (deoxyribonucleic acid) is made like a set of modular children’s toys, K’nex for example. The subunit is a pair of tiny molecules called bases which bind to one another to make a base pair. These are held in a long structure like rungs on a ladder, and this ladder itself bunches and curls depending on the particular molecular sequence of base pairs. A certain series of base pairs codes is a gene for the manufacture of a certain animo acid, and strings of amnio acids are the proteins of which we are made. One famous gene mutation is BRCA, which allows breast and ovary cancers to form much more easily. Another is the gene for ALS ( Amyotrophic Lateral Sclerosis) or Lou Gehrig’s disease, which afflicts Stephen Hawking. 

DNA contains the keys not just to disease, but to health as well. Understanding DNA can help us understand any inborn vulnerabilities to disease in time to take action against them. Understanding which genes go with which diseases may help us come to understand how diseases are caused, and thus, how to cure or mitigate them. The vast majority of human genetic material, also called the human genome, is not understood. However we all have DNA, and we all have a health history, even if all that it says is that we are healthy.  Just think: If we had lots of people record their health history, and the same large number of people sequence their genome, we could use modern computing power to look for patterns between the clinical histories and the DNA. 

DNA tests are now sold direct to consumer (DTC). People are using them to search for their ethnic heritage. This is an imperfect science, and it can only narrow it down to a continent level. Some people use DNA tests to find long lost relatives, but results depend on your long lost relatives having been tested as well. 

I have been thinking about giving my family members the gift of DNA testing. My initial thought was simply to throw our data into the big pool, and add to the collective accumulating accuracy of DNA and disease correlation. It was also my hope that in the process, it would be useful in the future, when hopefully, health enhancing measures could be taken based on a person’s specific DNA profile. 

There is another kind of DNA testing which I should mention for completeness. It is testing for specific genes, and not just testing to view the whole genetic code. Physicians and researchers test for specific genes when a person’s family history is strong for a certain disease process, say colon cancer. If the unaffected relative tests positive for the risky gene, preventive measures may be able to be implement to help them avoid the disease. Genetic tests can also be done on tumor cells themselves to determine what treatment is the absolute most targeted for the specific tumor cell type. This is becoming the norm when treating breast cancer. This helps both improvement in outcomes and decreases side effects of treatments not likely to be helpful. 

In doing the research for this post, I have discovered some good advice. First, it is important to think about why you want this information. Do you really want to know about long lost relatives ? Do you really want to know your ethnicity ? What if it is not as you expected ? What if you discover a gene for a bad disease that you do not already have ? 

There are several companies that do DTC DNA testing. I found a good chart which details some of the differences.


Some systems of testing, analyzing and reporting are better for genealogy, and some are better for medical care, and still others are best for research. Some tests go deeper, and research paternal or maternal family lines, but this requires analysis of the X and Y sex chromosomes, rather that just the autosomal chromosomes. 

All of the tests are expensive, ranging from $79 to over three hundred. My research has raised more questions that it has answers. I plan to speak to our genetics counselors at our hospital to see what they think and I will get back to you about what they say. 

Meanwhile, it is Thanksgiving week. It is a good time to think about being grateful for what you are and what you have in the present. You may be coded by genes, but that is not the whole story. Our genes are not a static set of molecules. Instead, they switch on and off like the holiday lights that people are putting up this season. Additionally, a lot of this gene regulation depends on lifestyle choices. This is where we can leverage our health habits to make the most of the genetic cards we have been dealt. 

Happy Thanksgiving 


More reading:

Wellness Wednesday: Post Election Stress Disorder

Ashamed woman.jpg

PESD is not a diagnosis listed in the DSM-5, the widely used manual of psychiatric diagnoses. And yet professionals and ordinary people are seeing it. The morning after the election, I saw and heard about it everywhere, from people on both sides of the aisle. Yes, that’s right, from both sides of the aisle. 

I have heard from hither and yon that people felt that our presidential election was a choice between lesser evils. How sad and disturbing to wake up and have a lesser evil for your President elect. How sad to have members of a family or friends fighting, arguing and estranged. 

While there may not be such a thing as PESD, there certainly is PTSD, and the signs are clear: 

  • sleeplessness
  • undue tearfulness 
  • nightmares
  • intrusive memories of past traumas
  • disinterest in food or inability to eat

Women have been particularly affected. Regardless of politics, no woman has supported Trump’s vulgar and abusive treatments of women. To seat him in the highest office in the land has made many of us feel vulnerable, on an institutional and cultural level. Election is endorsement, and endorsement is usually approval, though in this election, it certainly has the feel of concession. Events of this campaign show that while our society has made great strides toward fairness and decency towards everyone including women, sexism is still alive and well. 

Today’s sexism is not as bold as it once was. Nowadays, it can be workplace bullying, or being passed up at meetings or for raises. It is unwanted subtle advances. It does not have to be “pussy” groping, though now that has officially been recategorized at the highest levels as “locker room talk”. It is being made to feel odd because you were a girl who was also a math and science nerd. 

Lucky for you, I am a math, science and numbers nerd. And I don’t feel the least bit odd. Here is what the numbers had to say, before the election even took place: 

  • 10 % of women suffer from PTSD. 
  • 31% of women suffer form an anxiety disorder
  • 12% of women suffer from depression
  • 25% of women will experience a sexual assault in their lifetime
  • 33% of women report having experienced sexual harassment in the workplace
  • 100% of women report experiencing some type of sexual harassment in their lifetime. 

reference :


Are we women really doing so well ? The number are roughly half this for men for PTSD, anxiety and depression. The election has caused us to collectively and individually revisit much of what has troubled us.

What to do ? 

First of all, this needs to be taken seriously. It needs to be taken seriously on a personal and a societal level. If you know someone who was derailed by the election, make yourself available. Practice empathy and be a good listener. Do not debate politics, or ask about the the innermost workings of their mind or heart. Suggest general stress reduction techniques like regular meals, exercise, yoga, and sleep. Suggest a visit with a counselor or physician if there is genuine disruption in health or regular life activities. Do not force a plan on them. Do not add to their overwhelm. I am guilty of constantly trying to fix people even if what they really need is space. If you try to help too much, it feels like you are trying to take control and this is disempowering, pretty much the last thing they need.  

I learned a new phrase when researching this post. It is, HOLD SPACE. This means to create a safe space for someone, a space where they will not be judged, and where no one will try to change them. It is space where they can be heard. It is unconditional support. I will be researching this gem of a concept further. 


Have a better week. The holidays are coming. Take some time to plan to make them low stress and lovely. 


Additional reading:

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.  

Wellness Wednesday: Being Proactive

I found myself a little out of my comfort zone this week. I was working on a little app for the App Store, and I am new to developing. I had done my due diligence, reading, and going through the tutorials. And yet, things were just not working out how they were supposed to. I got a little down about it. I got a little mad about it. Tech support sent me a lame email back not really addressing the questions I had clearly asked. I put the project aside for a couple days. I thought, maybe this is just not my thing. Then Monday morning rolled around, and thought, I am going to wend my way through the phone networks of Apple Computer and find someone who can help me. Three layers deep, I did. The person I reached was amazing. She agreed that I had done all that I should have; She took on my cause and bumped it up the chain of command. Ultimately the advice she gave me worked. I looked back on the incident and realized how silly I was to have gotten discouraged. Only when I got proactive and reached out, did things get better. 

Proactive is the opposite of reactive. To be proactive is to be psychologically healthy. It means being the one who takes the steps to make your life what it is. It means to be responsible for one’s self, one’s thoughts, actions and circumstances. It means to be self-determined. 

To be reactive, on the other hand, is to be a victim of life. You life is determined by other people and other factors. What you do is a reaction to other factors which have happened “to” you. You may feel out of control or like a victim. 

Wouldn’t anyone want to be proactive ? You may want to become a proactive person. And yet, until you adopt the mindset and behaviors of being proactive, it would be very difficult. 

How do you become a proactive person ?



The first step is to realize that you are responsible your own well being and success.  Life hands people circumstances which range from good, to bad to ugly, and yet, mindset is the main determinant of how people feel and how they do in life. Remind yourself you are empowered in your life. Pin a pin, put up a poster, or do what you need to do to train yourself to remember this. 



Also central to the process of being proactive is to understand your starting point. This requires honesty with one’s self about one’s present state. It is like talking a good hard look at the balance sheet of your life. What are the assets, and what are the liabilities ? Only then can you realistically plan for going forward. Train yourself to honesty. 



To be responsible is to be accountable for yourself. In literal terms, you are the accountant of your life. You have the ability to set a budget, or a goal, and work backward to meet it. You are more than dreams and talk. You have real steps to realize your plans. You may even use the so-called SMART goals. (Click HERE to learn more.)You are reliable to others and to yourself. Train yourself to take regular inventory or your life. Train yourself to use SMART goals. 



When you use SMART goals, you will get used to the idea that big goals are achieved with small steps. Furthermore, you will get used to taking small steps. Many people who haven’t realized their goals are simply not used to taking steps outside their normal routine. Being proactive means training yourself to get used to taking new and different steps as part of a larger, realistic plan. It also means training yourself to get used to the fact that meeting goals proactively takes time.  



When you become proactive in your life and start to take steps toward realizing your life goals, you usually encounter obstacles. These may derail or discourage you temporarily. This is natural. However, the proactive person must have resilience. This is the trait which embodies the best response to adversity. With resilience, the problem is acknowledged, analyzed and the steps of the plan are reworked. They are iterated, and reiterated.  With resilience, one has to train oneself to keep a flexible positive attitude, along with the idea that continual reiteration is part of the process. 



In everyday life, being proactive is easier said than done. Everyone feels pressured, angry or frustrated at times. These are small everyday examples of being reactive. Sometimes even bigger situations like peoples' jobs or relationships are the result of being reactive rather than proactive.  Learning the emotional and communication skills associated with being proactive is no easy task. 

During challenging encounters, the natural reaction is fight or flight. Proactive communication requires acknowledgement of these reactive feelings, but not acting on them. Simply pausing, and breathing is an essential first start. In that moment, the feelings of anger, frustration or sadness are acknowledged and set on the back burner. Then a constructive response can be proactively made in accordance with the speakers highest and best ideas.

A proactive person also knows she has the right to defer. She can take time to think about things, calm down, or gather more information. She knows how to say these things the right way. She uses responsible closed loop communication. Responsible communication uses "I statements”, i.e.“ I think”, ,”I feel”, or “I need” or “ I want”.  In this way, you speak for yourself. You may not be listened to, but at least you have spoken up for your self, and your statement has the weight of authenticity which may well continue to sink in after the conversation. 

Closed loop communication has to do with listening well. When you speak, you are obliged to listen. Listen with full attention until the speaker is finished. Then use another “ I statement” , which is “ I heard….” then repeat back a nutshell version of what you thought you heard the speaker say. This is especially useful for challenging or complex conversations. It honors both the speaker and the listener and greatly reduces the chances of misunderstanding. 

Train yourself to breathe, pause, use "I statements", and closed loop communication. 

So you see that being proactive is a training process. Nobody has a charmed life. But everyone can use the methods of responsibility, honesty, accountability, action, resilience and communication to be more proactive and move toward the life they want. 

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:

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: Travel Insights

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

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

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




Wellness Wednesday: Stanford Medx 

I just knocked something off my bucket list. 

Stanford Medx is a multi-day conference on innovation in health care. The conference is akin to it’s older and more popular cousins TEDx and TED, programs which are available online to everyone and which deal with topics in technology, entertainment and design, really all the big issues. 

Medx brings together people interested in moving medicine to a new and better place. It’s themes are people, technology and design. I would like to share with you some of the material that I encountered and the people that I met, together with a few images. 

On Wednesday my first day, I travelled. It is always an entertaining shock to change biomes so quickly, going from the alpine to the sonoran in little more than a couple hours. From cool pine I went to warm eucalyptus. After getting settled, I attended presentations and a workshop at the D school - The Design School on the Stanford Campus. There I met designers, architects and medical people all coming together to make buildings, objects, and even procedures which would make getting medical care more effective and pleasant for patients and caregivers. I met a women who is involved in renovating the Women’s and Children’s hospital at Stanford, just as I am at my hospital. I also met the grandson of Charles and Ray Eames who reviewed principles of design though a survey of his grandparents’ work. I also met the mother of an unexpectedly premature baby who had struggled with expressing colostrum. She had, as a result, developed a clever and inexpensive device to modify existing pumps to make them more effective. We expect its use to become widespread. 

Day two was a workshop on shared decision making. This was meant to be decision making between anyone and anyone else: doctor-patient, doctor-nurse, and family member to family member. Shared decision making was a key theme which dovetailed into one of the main themes of the conference, EVERYONE INCLUDED.

Decisions from the top down can be problematic, and partake of hierarchy. Hierarchy for its own sake is to be banished from medicine. Effective communication, and therefore better results, satisfaction and even safety grow out of shared decision making. This was amply explained an demonstrated across all the varied content of the conference.

Communication needs more than clarity. To be optimal, it is two way, and involves empathy. EMPATHY was another key theme echoed over and over again. As physicians, engineers and designers, we must employ empathy in all our thinking. We need to ask the patients and the users for input at all stages of development. Such a process creates more user satisfaction and better results. 

On day two, we partnered up. Our group was composed of the professionals I mentioned, but also of special “ e-patient scholars”. These were medically sophisticated patients with serious chronic medical conditions who could speak to us about their long experience in the medical system. They were there to help us see through their eyes. I was paired with an older woman in a wheelchair with end stage MS and lupus. Since I have lupus we exchanged notes about that. But it was her MS that was making the critical problems. She spoke about her end of life plan. Even so, she was as pleasant and sparkling as a person could be.

On days three four and five we had presentations from morning until evening, often rapid fire. That is when the conference really took on a life of its own. The conference designers were smart. They had substantial breaks every hour or two, and provided food, and tables, and encouraged everyone to live tweet the conference. The session to break ratio was optimally dialed for stimulation and interaction. All the speakers made themselves accessible, so not only did you hear these phenomenal stories, you met the phenomenal people. Bread was broken and contact information was exchanged. 

Key themes were as follows: 

  • open medical data, especially genetic data
  • open research data 
  • the quantified self 
  • gamification of healthy lifestyle goals
  • getting patients, doctors and researchers together, often through the internet
  • patient education, often self education, through apps and the internet
  • collaborative and integrative medicine
  • collaborative end of life planning

A lot of this came together under the topic of PRECISION MEDICINE. This means care tailored to one's precise condition, down to the genes if possible. It also means giving exactly the right amount of medical care, not too much, and not too little. It also means care tailored precisely to the patient’s wishes. Finally it means oversight so that care dollars are used optimally. 

By far the most stunning presentation was that of Dr. Lucy Kalanithi, the widow of Dr. Paul Kalanithi, Stanford neurosurgeon who wrote “ When Breath Becomes Air”. Her presentation detailed the reality of love and connection despite suffering and death in a way that I have never imagined. Her presentation had more power than any I have ever heard. I recommend the book. 

Besides being stunned, I was also charmed. I got to meet so many delightful people who were also talented beyond measure. The same people were uniformly willing to share their insight and experience. Noteworthy among these was Dr. Wendy Sue Swanson, Seattle Mama Doc. She is a Pediatrician, mom, and writer extraordinaire. Check out her website, blog, and book " Mama Doc Medicine".

It was also great to meet Dr. Kyra Bobinet, who shares my interest in helping patients realize their goals in fitness, nutrition and health in general. She told me that everything she knows is in her book, " Well Designed Life". I didn't believe her but I can't wait to read it. 

Medicine is moving forward folks, and you will want to come with it. Medicine needs your input to be what it needs to be. Monitor yourself. Get your health data. Try to connect with your caregivers. Tell your story. Listen and see an alternative point of view. Have a discussion.  This is the basis of the future of medicine, medicine 2.0. 

Not nearly everything from the conference is uploaded, but a Stanford MEdx youtube channel exists. Check out the link below and I know you will be inspired.



Wellness Wednesday: Unpacking the Seven Principles 

Last week in the post entitled “ Couple’s Wellness “ I referenced the work of Julie and Stuart Gotten of the esteemed Gotten Institute and the Seattle Love Lab. I introduce their book entitled “ The Seven Principles for Making Marriage Work”. However we didn’t really go into what those principals really are. This week I will give you a thumbnail sketch of each in the hopes that you will be interested enough to pursue more study. They are as follows: 

  1. Enhance Your Love Maps
  2. Nurture Your Fondness and Admiration
  3. Turn Toward Each Other Instead of Away
  4. Let Your Partner Influence You
  5. Solve Your Solvable Problems
  6. Overcome Gridlock
  7. Create Shared Meaning 

Enhance Your Love Maps

The love map is a term for the area of the brain which holds all the information about your partner. The Gottmans propose that having a detailed love map of your partner enables you to love better, and weather challenges more easily. This is done by concerning yourself with all the things that are important to your partner and keeping up to date with what is going on in their life. 

Nurture Your Fondness and Admiration

Fondness and admiration usually exist at the beginning of any relationship. However, as time passes and life’s difficulties are encountered, they may diminish. Expending effort to deliberately keep these past memories and present feelings of fondness and admiration alive will prevent bad feelings from developing in their place. In particular, the Gottmans state that fondness and admiration are the antidote to contempt. 

Turn Toward Each Other Instead of Away

A couple’s connection is built of many small connections throughout the course of everyday life. When one partner reaches out even slightly in speech or gesture, the Gottmans call this a bid. If the other partner turns away from (disregards) the bid, the bidder is slighted and some degree of detachment or irritation takes place. However, if the partner turns toward the bid responsively, their connection is strengthened. The Gottmans teach that a tendency to turn toward your partner’s bids build trust, goodwill and emotional connection. 

Let Your Partner Influence You

The Gottmans have found that partners who share power are more likely to have happy and long lasting marriages. Part of sharing power is allowing influence to flow back and forth. In these marriages conflict prompts a search for common ground. 

Solve Your Solvable Problems

This sounds hard at first but the Gottmans break it down as follows: 

  1. Soften your start-up. 
  2. Learn to make and receive repair attempts.
  3. Soothe yourself and each other.
  4. Compromise.
  5. Prices any grievances so they don’t linger. 

These are the features that an effective problem solving session needs to have. They liken good problem solving to that done between respectful professionals or esteemed guests. 

Overcome Gridlock

The Gottmans assert that gridlocked issues in a marriage touch on deeply held beliefs or wishes, or each partner’s dreams for their life. If partners sit down with each other and try to discern the real basis of the tightly held position, then perhaps a common ground can be found. 

Create Shared Meaning 

The Gottmans assert that a real marriage is more than the sum of its parts. By parts I mean living or loving each other, raising kids competently, and having sex. Instead, they argue, the couple must create a their own unique culture, which incorporates both partners' closely held beliefs and dreams. The Gottmans have identified four aspects of creating shared meaning:

  1. Rituals of connection, such as a family sit down dinner 
  2. Support for each other’s roles
  3. Shared goals 
  4. Shared values and symbols.

This will give us all a lot to think about until next week on Wellness Wednesday. 



Food Friday: Family Dinner

It’s summer and the kids are home. Why not take advantage of their company and get serious about some awesome family dinners ? Sounds like fun, right ? But it’s much more. According to a considerable body of research on the subject, family dinners are important to well being. (Reference:

Family dinners are associates with the following findings: 

  • Better academic performance 
  • Higher self esteem
  • Greater sense of resilience 
  • Lower risk of substance abuse 
  • Lower risk of teen pregnancy 
  • Lower Risk of depression 
  • Lower likelihood of developing an eating disorder 
  • Lower rates of obesity 

Let’s think about why. 


The family dinner is a testing ground for the performance of a family group as a team. And yet, pulling it together to make a family dinner is not all that hard. It is within most every person's or every family's reach. Engineering the family dinner is an exercise destined for success. Most people are grateful when someone makes them something to eat, no matter how simple. It is a primal act of caring, usually free of strings, that one person does for others. Thus a dinner is easy to produce and easy to accept. 

Children and teens can and should help prepare the dinner, even if is just setting the table. They learn preparation and cooking skills, and they learn to pitch in. They also learn that if they don’t pitch in, they will stand out. 

The family dinner is a time when most families put aside conflict, since conflict at the dinner table just doesn’t work. The ritual and the food cause us to make a deliberate change in our behavior for the better. We cease to be isolated individuals and come together to make something more, a family or a even a social group. Thus, it is very hard for someone to be lonely at the table. At the table, it is graphically obvious that you come from somewhere, and that you have a place. 

Our family table has extended into the adulthoods of our children and to the younger cousins and their friends. We are very lucky in that regard. Most of them have gone off to college and have come back, bringing spouses, girlfriends, friends and grandchildren in tow. They have each developed family table specialty skills. Echo bakes and is an award winning amateur chocolatier. Forest is lately enamored of our Instant Pot, a cool pressure cooker, which enables you to make impressive meals with little planning or tending. Geri does veggies and my son in law does smoked meats and salads. Vale is smoothie man. Hanna my niece is a cake decorating expert. They are all serious students and professionals, but they have all come to be serious foodies too.

Stepping back, I see that no matter what their fancy, the whole thing is one big shared hobby, and when we do food, everyone is pretty happy. A happy hobby. Moreover, while it was simple and easy when they were little, they have, on their own, leveled up, as the gamers say. They relish the acquisition of skills needed for their culinary hobbies, and that gives them social confidence. Finally, they relish the presentation of their dishes to others. The “ breaking of bread” has always been a bonding experience and in a family this is nothing but good. 

Think about all this this summer, when your kids are around more, and hopefully you have a little more time. All you have to do is start something fun in the kitchen. Put your heart into and it and invite others to join in the process of creation. It will take on a life of it’s own.