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

As the northern hemisphere encounters fall and winter weather, mosquito activity and the risk of Zika infection by mosquito falls but does not go to zero. Of course, sexually and birth related (perinatal) transmission are not affected and can continue unabated. 

Researchers at the University of California, San Diego, have honed in on the mechanism of action of the Zika Virus on human cells. It appears that Zika virus alters our RNA directly. 

We now know that Zika can persist in vaginal secretions for two weeks after onset of infection. During this time, a woman can pass infection on to a partner. Additionally, it has been determined that Zika is detectable in serum ( the liquid portion of blood) for a week. However it is present in whole blood for at least 80 days. These insights have been made possible through the contribution of one particular patient infected with Zika since the beginning of the epidemic. Through frequent and repeated testing on her, we have been able to ascertain these findings. We use a debt of gratitude to this female Zika patient who has allowed herself to be the subject of invasive scientific study since the beginning of the crisis. 

Everyone has heard of menstrual migraines. Some happen right before the period and some happen during the period. Those preceding the period are believed to arise from sharply falling estrogen levels. It turns out that the late-cycle migraines may be related to low ferritin levels from the blood loss of the period. This could lend insight into prevention, which of course might involve ongoing iron supplementation. 

In the things-we-already-knew-but-had-not-yet-been-conclusively-documented department, research published on the Arthritis Care and Research site indicated that systemic lupus wanes during pregnancy and flares in the postpartum period. Nonetheless, the research is quite welcome in that it sheds concrete insight into the baseline mechanisms of lupus and autoimmunity in women. Autoimmune disease as a whole is prevalent and predominantly affects women. Most patients are on current treatment strategies which decades old and are rife with significant side effects. This lupus patient applauds any sound research into autoimmunity in general and lupus in particular. 

Also in this same journalistic department we are now assured that smoking and alcohol are linked to 11 of 15 of the worst cancers. By worst, we mean those cancers most "responsible for premature death and loss of healthy life years”. Any second year med student can assure you conclusively of this. 

Pediatricians are being encouraged to change their counseling of parents about the HPV (Human Papilloma Virus) vaccine. Instead of highlighting the prevention of sexually transmitted HPV infection which can lead to warts, they are being encourage to highlight the cancer prevention aspects of the vaccine. It would be nice if we could simply explain that the HPV virus causes genital warts, precancerous changes on the cervix, which can then develop into cervical, vaginal, penile and even oropharyngeal (mouth and throat) cancer. I am tempted to think that we oversimplify subjects too much for people. People are capable of understanding a great deal if someone takes the time to explain it to them. 

In related news, new data has demonstrated that those children who obtain the HPV vaccine before 15 years of age only need two shots rather than three. Even more incentive to gets your kids done ! 

New research from the Agency for Healthcare Research and Quality have show that the C section rate for low risk patients is about 16%, whereas the C section rate for high risk patients is about 76%. Intellectually, I am a splitter rather than a lumper. Consequently, thinking about C section rates in this way is much more useful that saying, the C section rate in the United States is about 32%. I think information presented in this way will help patients understand their own risk factors, and how to prospectively stack the deck in their favor in the future. 

Here is some sobering but critically important news that I suspect will be woefully underreported. Maternal body mass index (BMI) is inversely correlated with newborns’ telomere length. Whoa, what does that mean ? Basically, the heavier a mother is, the less robust her newborn’s DNA strands will be. DNA is protected at it’s ends by segments known as telomeres, and when they are short, DNA is more apt to be damaged. Shorter telomeres means shorter DNA lifespan, which most likely means shorter lifespan overall. 

We have all heard by now of the micro biome, which means the healthy or not so healthy populations of bacteria and other organisms that populate our body. Women mostly focus on the micro biome of the vagina, knowing that if it becomes disturbed, yeast or bacterial vaginosis can result. However, the vagina is not the only concern. It turns out that the breast has a micro biome. Moreover, it turns out that breasts sampled and found to have benign disease versus those with cancer have very different micro biomes. This could be a clue to something, I’m not sure what. But is is a new and interesting concept. 

In disappointing news, the CDC (Centers for Disease Control) reports that rates of common sexually transmitted diseases have reached all times highs. This include syphilis, gonorrhea, and chlamydia. I’m going to give a shout out to bad parenting and network TV here. Thanks so much, guys. Oddly, syphilis was at an all time low in 2001, and gonorrhea was as recently as 2009. 

In surprising news, 43% of those with no type of health insurance could qualify for either Medicaid or coverage through the Affordable Care Act exchange. The reasons for this are unclear. I will say that some people seem to have quite a bit of trouble filling out the forms online. I have joked to my office staff that the government  should outsource both health care and the elections to reliable companies like Amazon or Google who can design a nice reliable website. 

Stay tuned next week for more news from the amazing world of Obstetrics and Gynecology.  

Food Friday: My Strategic Foods

I am a 54 year old woman with Systemic Lupus. Sounds dismal, huh ? Actually, I am healthy, working, and recreating full time. I hate to say it, but my lupus may have caused me to take better care of my health than I would have otherwise.

I am one of those people who pursues optimal health. I feel I have to, since I am obliged to set a good example for my patients, and because I have a family who relies on me. 

I can’t afford to do anything but eat optimally. I can’t afford to do anything but workout regularly. At my age, with my condition, going backwards is really hard to make up. Going forwards is extra slow, since I also cannot overdo it, so I have to make gains really gradually. 

I love good food and cooking, and I love working out and how it makes me feel and look. So these things are not hard sells for me. I try very hard to convey to my patients and readers the joys of these things, but you may certainly relate when I tell you that most people are not where they would like to be on their fitness and nutrition. So instead of me just sharing how I feel, I would like to tell you a few simple things that I do that help me keep my nutrition in line easily. This is Food Friday, and we are going to talk about my strategic foods. 

With my lifestyle, workout, goals and medical condition, I need more protein that the average 54 year old woman. To help me get that conveniently, I start every morning with about 16 ounces of skim organic lactose free milk mixed with about 2 scoops of whey protein powder. That gets me nearly 30 grams of protein, a reasonable start to the 80 grams per day that I shoot for.

At about 10 am, I make some oat bran cereal, one of my strategic carbohydrates. I include this for the fiber it provides. I take a page from the Giada DiLaurentis' playbook and dress it with about a Tablespoon of olive oil and some kosher salt. It is reminiscent of buttered popcorn. I usually have a bowl of decaf green tea matcha which is full of antioxidants. 

At lunch I usually have fish, chicken or red meat with veggies, which are usually leftovers brought from home. I try to eat lunch with water, either cold or hot. I may also have fruit. I favor blueberries and strawberries, which is good because they are nutrient dense, and low on the FODMAP scale. ( More information on FODMAPS HERE)  I bring them in a little tupperware. These generally leave home frozen and thus by lunch they are just right. 

Mid afternoon I try for some more protein with some kefir ( cultured probiotic milk) or a meat stick. Additionally, in the afternoon, I have taken to drinking a Kombucha which is a fizzy  probiotic drink. 

When I get home from work I need a little something before dinner, and it is usually a little fruit and drink. This sets me up to work out, which I do before dinner. Sometimes I or someone else starts dinner, and I work out while it is cooking. I drink sips of water all though my workout. 

Dinner is, not surprisingly, meat, fish, chicken or eggs, with vegetables and fruit. And here I use another strategic carbohydrate, brown rice. Between the fiber in that and the oatmeal, things “ go well”. Again, I drink water with the meal to aid digestion and keep me hydrated. When I am cleaning up dinner, I fix my lunch and two snacks to take to work, since I am not a morning person. I also fix my protein drink in a “ shaky” bottle so it is ready to grab in the morning. 

And though it is so trendy it is outdated, I am still crushing on kale. I eat it dried, and I eat it chopped and sautéed either in olive oil or coconut oil. I like to toss in tomatoes for color and a bright flavor. I have learned to salt and season after it is finished since it shrinks down so much. You have to start with a heaping pan full to get a couple servings. I use lemon pepper very liberally, as well as Mirin, rice wine, or rice vinegar. Balsamic vinegar also works nicely on kale. 

At bedtime I usually get a little dark chocolate. My recent favorite is a raw Mexican chocolate from Taza. It is spendy, but you only need a little bit. I also get something more to drink. 

Yes, it’s a lot of time spent, and a fair amount of preparation, but it makes me feel good and I like it. Try these strategic foods or develop your own favorites. Remember, small healthy habits, done over long periods of time, make health. 

Medical Monday: For the Autoimmune Among Us

Chances are, you know someone with an autoimmune condition. This might be Lupus, Rheumatoid Arthritis, inflammatory bowel disease, Multiple Sclerosis, or many others. I decided to post about this on my site since autoimmune disease affects so many women. 

I received a diagnosis of autoimmune disease (Lupus) in 1995, but probably had it long before that. And yet, I am fit and healthy. I believe my health habits have helped with this.

If you have received a diagnosis of autoimmune disease, be encouraged. How you do will depend on your unique disease process, but will also depend tremendously on how well you take care of yourself. Those with autoimmune disease and those that care about them can learn more HERE