Wellness Wednesday: The Medicine Cabinet

A well stocked medicine cabinet will help your family feel their best. It will also help them get better more quickly from everyday ailments like colds and minor injuries. Here are some dos and dont’s you will want to know when playing doctor. 

First the dont’s. 

• Don’t keep any out of date medications, prescription or otherwise. 
• Don’t disregard handling instructions. Some prescription medications require refrigeration. 
• Don’t store medications of any kind in unlabelled bottles. Throw out anything whose identity is the least bit uncertain. 
• Don’t fail to take your whole prescribed course of medication. You will not get better as quickly. Even worse, in the you may foster the development of antibiotic resistant bacteria. Think about it. If you only take the first 4 days of a seven day course of antibiotics, you will kill all the easily killed bacteria, and leave the more resilient ones to repopulate your body. If you take all your medications correctly, you should not have any “ left over” in the first place. 
• If you had surgery or an injury, and you were prescribed narcotic pain pills, use them only when you need to. If you are better and no longer need them, dispose of them. Don’t keep them just in case. 

How do you dispose of old medications ? It turns out this is not as easy as it sounds. 

Check out this comprehensive guide from the Food and Drug Administration. 

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm

Now the Do’s 

Do have simple non-narcotic pain relievers handy and in their original bottles.

• Acetaminophen, aka tylenol for aches, pain and fever. Can be taken on an empty stomach and during pregnancy. 
• Ibuprofen, aka motrin or advil also for aches pain and fever, but with an anti-inflammatory component as well. Should not be taken on an empty stomach or during pregnancy. 

Do have upper respiratory remedies. 

• Nasal decongestant for daytime (These are non sedating.) 
• Nasal decongestant for nighttime. (These can be the sedating ones)
• Cough suppressant i.e. dextromethorphan 
• Zinc containing cough lozenges which are low on sugar. 
• Lots of herb teas and broth mixes for hydration. 
• Lots of kleenex, and a reliable thermometer. 
• A peroxide containing mouthwash for use after brushing and flossing, but just before bed. (Key to prevent and kick those sore throats ! ) 

All of these measures will actually help you get better more quickly as well as provide comfort. Most upper respiratory infections are viral and self limited and do not require antibiotics. However,  but if one is bad or persistent, call your doctor. There is no reason to hesitate. 

For allergic reactions: 

• Benedryl capsule in case of a minor allergic reaction like rash. They are sedating. 
• EPI pens if anyone has a serious allergy or asthma or lives in a place where there are bees or other stinging species (OK everyone should have an EPI- pen in their house.).  Consult with your doctor about this since they will need to order it. 

Stomach rememedies are trickier.

• Tums or Rolaids are not the best for heartburn, since they are calcium carbonate. These give short term relief of stomach acid, but then go on within the hour to stimulate the production of more gastric acid. Try prilosec OTC. Speak to your doctor if stomach acid symptoms are more than a rare event. 
• For loose stools, do not automatically turn to Lomotil. You can make yourself sicker this way. The cause of lose stools must be determined before a motility lowering agent can be given.
• DO push liquids by mouth and by soaking a tub of water to stay hydrated until you can get care and get better. Liquids which contain a little something ( electrolytes, sodium, sugar) are best. Think broth or soda water with fruit juice. Elelctrolyte replacement drinks are ideal. 

For skin, eyes, hair and teeth : 

(All these should be junk free, and by that I mean free of artificial fragrance, coloring, etc)

• Gentle cleanser 
• Gentle exfoliating scrub 
• Moisturizer for face and some for body; For body I prefer a mix of cocoa butter and coconut oil. 
• Alpha hydroxy acids are evidence based treatments for the younger set.
• Retinoids and vitamin C serums are evidence based treatments for the over 40 crowd.
• Strong water resistant sunscreen in plentiful quantity, as well as sunscreen lip balm. 
• 1% hydrocortisone cream for minor rashes where skin is intact. This will suppress itching but impair healing, so use it sparingly and wash your hands afterwards. 
• Eye moisturizer in little sterile vials for dry eyes or to help with removal of a foreign body, 
• Bandaids, tape, gauze, antibiotic ointment for cuts and scrapes. You do not need alcohol for wounds, or even peroxide. Minor wounds are best cleaned with warm soap and water. Anything more extensive goes to the doctor. 

Did you know oral health is key to avoiding other illnesses ? Do stock the following: 

• Toothpaste with fluoride and some grit 
• Wide waxed dental floss for use every night, maybe even when you are in the shower. 
• Peroxide containing mouthwash

For Hair: 

• Shampoo, used gently and only at the scalp if your hair really needs it ( Dry hair does not ! ) 
• Conditioner, every time, for all hair types. 

This should be a good start to your well stocked medicine cabinet. 

Next week we will have a little more fun and talk more in depth about hair health. 

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

The Zika virus continues to spread. There is increasing evidence that Zika infection causes microcephaly in the unborn as well as post viral paralysis Guillaine Barre syndrome. Every day there is new information about the outbreak, and the CDC ( Centers for Disease Control) is the best place to learn about it.

Unfortunately, there is yet no hint about treatment, and a vaccine is 1-2 years the making at best. The WHO ( World Health Organization )has warned that ZIka is likely to spread to every country in the Americas except Canada and continental Chile. As of this last Friday, January 29th,  the World Health Organization has reported 31 cases in 11 United States states and 1.5 million cases in Brazil alone. The WHO estimates that the virus could affect 4 million people by the end of 2016. About half of those will be women and an unknown percentage of those women will be pregnant.

In other news ACOG, the American College of Obstetricians and Gynecologists, has updated a “ Committee Opinion” which it distributes to all of its physician members. According to lead author, Dr. Allison Stuabe, "the goal is for OB/GYN's to own breast-feeding as a part of reproductive physiology”. The paper advocates that breast-feeding support should begin during prenatal care when breast-feeding can be discussed in clinic. Breast-feeding is still underutilized in this country and the world over. 

The American Heart Assoication has issued a report saying that “heart disease remains undertreated and under diagnosed in women”. It goes on to explain that "The causes and symptoms of heart attacks can differ markedly different between the sexes". Compounding problems is that “ women are under represented in clinical trials for heart disease ", occupying only about 1/5 of the slots. Moreover the report indicates,"even when women are included in trials, researchers do not often parse out the gender specific data that could deepen scientists understanding of how the disease affects women”

Last year the Gynecology community was startled by the revelation that ovarian cancer is now thought to originate in the Fallopian tubes. Accordingly, ACOG made a recommendation that they be removed in the course of surgery for other benign indications. However, a new study through Yale indicates that only slightly more than 5% of eligible surgeries utilize this recommendation. In all fairness, this is relatively new information and the efforts to disseminate it were fairly modest. Additionally taking the tubes out takes extra time at surgery and entails a certain amount of extra surgical risk. I was once told by an old professor of mine that it was not good to be either the first one on the block or the last one on the block to adopt a certain new surgical technique. 

This time the USPSTF (The US Preventive Services Task Force) has done something right. They have come out with a strongly worded recommendation to screen all adults for depression. They have gone on to particularly mention the need to screen all pregnant women and new mothers. They are basing this recommendation on new data indicating that maternal mental illness is more common than previously thought. New research indicates what has been called postpartum depression may actually begin during pregnancy and that left untreated these mood disorders can be "detrimental to the well-being of children". It is interesting that in the past the USPSTF has required proof of benefit to recommend any given intervention. Maybe today's announcement is a sign they will also begin using common sense.

Stay tuned for more breaking news from the world of Obstetrics and Gynecology next week on Medical Monday. 

Food Friday: Easy Weeknight Meals

Most of us work during the week. All of of us are supposed to exercise sometime in the day. Between all this, children and other responsibilities, it is challenging to pull together a good dinner for the family. Here are some suggestions to help you with easy weeknight meals. 

People often suggest “ Make ahead” meals as the solution for busy cooks. However, I am going to assume that you, like me, have trouble thinking ahead and pulling those together. We will tackle those another day. Instead, today's suggestions will apply to “ on the fly” meals you make on the spot. 

• Keep it simple. 
• Keep it healthy.
• Use fresh or frozen. 
• Cut pieces small for fast cooking. 
• Combine protein with produce. 
• Serve three dishes - a protein based main dish, a salad, and an additional fruit or vegetable. 

The protein dish is usually the most challenging for people to devise. Consider meat fish chicken or eggs as a base.  Meat fish or chicken can be fresh or partially defrosted and cut into bite sited pieces and either broiled, sauteed or grilled with olive oil, salt and pepper. Eggs are quick and can be made any way. Serve your main dish with salsa, or another sauce. 

Vegetables can be washed and cut small and either steamed or sauteed in olive oil or stir fry sauce. Make sure and combine different kinds of vegetables after cooking for good color and varied nutrients. Remember to cook the longest cooking vegetables first. Toss with a healthy salad dressing or sauce and serve in large quantity with your main dish. 

Always have prewashed salad at the ready. Always include some color with the greens, such as tomato, carrot or even strawberry. Throw in some nuts, maybe some cheese, and even some hardboiled egg. 

These are simple preparation guidelines for a main dish, a vegetable side dish and a salad. Provided you have the right groceries in the freezer and fridge, you can whip up this kind of dinner in 25 minutes or less. Key points are the small size of the pieces, which cuts your cooking time, and the healthy sauces, salsas and dressings which you can buy or easily make. 

Have fun with this. See how fast you can get. I’d love to see you post some of your variations of this dinner prep format. 

Wellness Wednesday: Winter Skin Care

Most people know to be careful about skin care in the summer. But did you know the winter poses special challenges as well ? Take a look at these facts and recommendations to winterize your skin care. 

Facts: 

• Despite snow, humidity in the winter air is often quite low, drying out the skin. 
• Glare from white snow on an overcast day can produce UV damage comparable to bright sunshine. 
• Indoor heat from any source is drying to the skin. 
• Winter wind is especially drying. 
• Skin can get so dry that is peels and cracks, making it vulnerable to becoming inflamed or even infected. 

Recommendations: 

• Cleanse more gently in the winter. Do not use a lathering wash. Get rid of harsh astringents. Exfoliate less frequently and more gently. Do not use hot water, only warm, and limit the time of baths and showers which can strip skin of natural oils. 
• Apply a more substantial skin protection and moisturizer in the winter. Chose an oil based, rather than a water based moisturizer since they are more protective. According to the American Academy of Dermatology, lotions and creams containing olive, shea and jojoba are helpful. Lanolin and glycerin are also helpful. My favorite is a mix of cocoa butter and coconut oil. 
• Wear sunscreen as a matter of policy. Use actual clothing or fabric to protect the skin in the winter outdoors. 
• Change out of wet socks and shoes promptly as they can be very irritating to skin. 
• Wear a nonirritating layer between skin and wool. 
• Control your indoor environment. Avoid baking yourself by the fire (guilty!). Consider a humidifier (but don’t let moisture build up on your windowsills). 
• Stay hydrated. Ensure your diet has enough healthy fat in it, i.e. olive oil, nuts, avocados, etc. 
• Consider skipping shampoo unless your hair is dirty or oily. Do use conditioner. 
• Chose a lasting lip balm for lips.  
• Don’t forget to get some eye drops for dry eyes.

Happy midwinter. 

references:

https://www.aad.org/public/skin-hair-nails/skin-care/dry-skin

http://greatist.com/health/healthy-winter-skin-hair

Medical Monday: Breaking News from the World of Obstetrics, Gynecology and Women’s Health

Good Monday.

Zika virus takes front and center this week as the CDC (Centers for Disease Control) has issued a travel alert "urging pregnant women not visit Brazil and about a dozen other countries in the region where mosquitoes have spread the Zika virus.” As of Friday the list of countries includes “ Brazil and 13 other countries and territories in Latin America and the Caribbean: Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and Puerto Rico. This is especially unfortunate since Brazil will be the site of the summer Olympics this August.

Zika virus is spread by mosquitos. Women who are infected by it have symptoms such as fever, rash, muscle aches and pink eye. If they are pregnant, their unborn babies are at high risk to be infected and born with microcephaly, a condition where they are born with abnormally small heads, small brains, and often a short lifespan. Women who have been infected by Zika virus cannot spread it to other women since it is spread by mosquitoes. 

Concern has been raised about an association between Zika infection and post viral Guillaine Barre Syndrome. This is a post viral paralysis that is usually self limited. Researchers in Brazil have noticed a significant uptick in the incidence of this syndrome and estimate that the Zika infection raises the odds of getting Guillaine Barre about 20 fold. 

El Salvador has been hard hit with this virus, documenting nearly 5400 cases so far in 2015. Pregnant women have been advised to remain fully covered to avoid getting bitten. Imagine the apprehension that is going to develop over this. Salvadoran authorities have also advised women to refrain from getting pregnant for the next two years.

So far pregnancy, travel and clothing restrictions are some of the only measures I have heard of to prevent spread. Additionally, genetically modified mosquitos are being produced to reduce the mosquito population in affected areas. 

Aside from the sheer gravity of the situation and these recommendations, it is interesting to consider the societal consequences of a span of time with NO BIRTHS for 2 years. 

All of the other news pales in comparison to this, and so I am going to leave you with the thought that Big Pharma all over the world is doubtless burning the midnight oil trying to cook up a drug or a vaccine. Let us pray they succeed. 

Food Friday: Spices 101 and the Art of Culinary Armchair Travel

Part of consistency in heathy eating is eating food that tastes good. This generally comes from eating fresh food simply prepared, but it also helps to have some knowledge of spices. Today’s Food Friday is devoted to introducing some spice basics. It is also to introduce the concept of culinary armchair travel. 

I do not get out much due primarily to my work. However, I appreciate many other cultures and many other cuisines of the world, and I like to bring them into my home whenever I can. This can mean something as simple as cooking a traditional dish from another country, or it can mean settling in for a film in Italian while eating a traditional Italian dinner. One time I even gave a French baby shower complete with a French menu, French inspired decorations, French music and pots of live lavender at each place setting. That to me is culinary armchair travel with all the trimmings. 

To prepare, you should think about where you would like to go someday. Then get on the internet and find out about the foods of that place. Check out the every day meals as well as the holiday fare. Find something simply and healthy, then look for recipes. Pinterest, Epicurious.com and food.com are among many great sources of inspiration and recipes. 

Most likely you will already have some basic dishes in mind, such as stir fry for Chinese, tacos for Mexican, chicken curry from India, or spaghetti with meat sauce for Italian. You probably already know the basic recipes. Perhaps all you need is a little help with the spices. For this, I have prepared the following basic guide. 

Spices can be used as individually, but most commonly and deliciously are used as spice mixes.

Some basic spices to always keep around

kosher salt
pepper
lemon pepper
rosemary
thyme
basil
sage
chili
cumin
paprika
garlic, fresh and powdered
ginger, fresh and powdered
cinnamon

Spice mixtures

You can make your spice mix with whole spices and put them in a grinder for frequent use. Freshly ground mixes are far more aromatic than prepared mixes in the store. To do this, you can buy a grinder, but better yet buy a filled pre-made spice mix in a grinder and then just keep the grinder when it becomes empty. Store your spices in an airtight container to keep them fresh. 

Cajun Spice

garlic powder
paprika
 black pepper
onion powder
oregano
cayenne chili powder
thyme

Indian garam masala

coriander
cumin
cinnamon
cloves
cardamom,
pepper
ginger
nutmeg
 

Herbes de Provence

thyme
rosemary
oregano
summer savory
+/- lavender

Thai spice mix

dried ginger
basil
cumin
cardamom
Black pepper
dried lime
dried onion
red pepper

Mexican spice mix

chile powder
cumin
pepper

Italian spice mix

oregano
basil
thyme
rosemary

Chinese spice mix

star anise
cloves
cinnamon
cumin
pepper
+/- fennel,
turmeric,
nutmeg,
ginger
or cardamom

Chophouse

minced dried garlic
chili pepper flakes
dill seed
black peppercorns
coriander seed

It is a shame to reduce spice mixtures to such a simple list, but busy people need to keep things simple. When you mix the spices, start with 1/2 teaspoon of each or one part of each spice. Use quite a bit less of the very hot ones like cayenne. Adjust to your taste from there. Add salt to the dish only at the very end.

Try some culinary armchair travel with these varied flavors from diverse cultures. Use them to make your healthy cuisine more interesting and desirable for the whole family. Bon Appetite ! 

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

Good Monday. We start out with good news, noting findings reported at the World Diabetic Congress that those who breastfeed have a substantially lower risk of developing type two diabetes later in life. 

Northern hemisphere readers will note that the CDC ( Centers for Disease Control) has reported that this year's flu activity, so far, is relatively low. They also note that slow starts aren't unusual and those that haven’t yet gotten a flu shot should get one, especially since this year’s vaccine is good match. 

USPTF (The United States Preventive Services Task Force) has once again released it’s version of guidelines for breast cancer screening. They are, predictably, lax, and recommend individualization for women of average risk before age of 50, and every other year between 50 and 74. They have chosen this age range of screening since they state their data show this is the age range “ of greatest benefit” from mammograms. This is no doubt true since this is when most cancers are diagnosed. However, what they cannot seem to understand is that women want ALL the benefit that mammograms can confer. Think about it. Their recommendations would condemn any woman below 50 of average risk to having her cancer detected only when it became palpable. Of course mammograms detect them far earlier, when they are more curable. 

Women want ALL the benefits mammograms can confer, and yes, they understand all such diagnostic tests must be weighed against their risks. But in this case, the risks are so small. They are the risks of biopsies for concerning findings which come back negative for cancer. They are also, according to the USPTF, the risks of fear and discomfort of the procedure. I have seen two and a half decades of patients and I have never heard one patient cite these risks as even coming close to outweighing the benefit of screening for cancer. Where does the USPTF get the idea that these particular risks are so important or that women even care that much about them ?

The good news is that the controversy has hit the airwaves and the blogosphere. NBC, the Washington Post, the NY Times, and Newsweek, among others, all covered it. ACOG (The American College of Obstetricians and Gynecologists) maintains a recommendation of annual mammograms after 40, and the American Cancer Society recommends annual mammograms from 45 on. ACOG plans to convene a conference to sort out the issue once and for all. 

Group B strep is an important pathogen for moms and newborns. A new vaccine against it is under development. 

Big news: Ovarian cancer actually seems to arise in the tubes. The data for this is sufficiently compelling that ACOG is recommending removal of the tubes with preservation of the ovaries when applicable. 

The CDC reports that the average age of first time mom’s is at an all time high, being 26 years and 4 months. This can be attributed, at least in part, to fewer teen pregnancies. 

In sobering news, a new virus called Zika is causing birth defects in the Caribbean and South America. It is spread through mosquitos. The CDC may warn pregnant women not to travel in that region. I’m sure we’ll hear more about efforts to deal with this in the near future. 

The effort to develop personalized vaccines to treat ovarian cancer is in the early stages. This work is on the desk of the FDA as we speak. 

Wow, so much happening ! Stay tuned for more breaking news from the world of Obstetrics and Gynecology next week on medical Monday. 

Food Friday: Staples of the Fridge and Freezer

As promised, this week we are going to see how the healthy fridge and freezer look. The lists below are my idea of what you will need to put together healthy meals and snacks all week long for you and your family.

Take a critical look at your fridge and freezer. How healthy are the contents ? Can you tell what the contents are, or how old they are ? Let’s hope so, otherwise send it to the compost. Take a gratifying step further and clean out the whole refrigerator. Here are some tips to having what you need, being sure of it’s safety, and making it easy to prepare healthy meals and snacks. 

• Shop twice a week
• Buy only healthy items such as those listed here. 
• Make a deliberate point to use what you buy. Do not plan a meal without looking in the fridge first. Factor in the what needs to be used as well as the balance of the meal. Do not, however,  be tempted to save a couple bucks and use questionable items. 
• Make sure to have a set of good clean containers to use for subdividing bulk purchases and for storing leftovers. Containers which hide their contents tend to go unused and spoil. 
• Have a couple sizes of ziplock bags also for subdividing bulk purchases and for storing leftovers. Sometimes it’s easier to store things this way instead of in a giant clear box. 
• Label and date all your unlabelled containers. 
• Search for recipes or even techniques which use your healthy ingredients, and keep them simple. 
• Use your freezer to enhance your nutrition. Buy good food on sale, in bulk and in season, divide it strategically and freeze it. 

Here are some healthy contents which should be in your fridge and freezer. 

The freezer

nuts: i.e. cashews, pecans, almonds, walnuts

pestos in ziplock bags

frozen concentrated juices i.e. orange juice concentrate for sauces

chili paste, clearly labelled

coffee or cacao (raw chocolate) bean

bags of frozen fruits, home made or store bought, for pie, cobbler, tarts, smoothies

frozen vegetables such as corn and peas

fish, meats, poultry, in bulk or divided by you into single servings

bulk items like ziplock bags of garlic cloves

ziplocks of good leftovers which you can’t use quickly enough

dried fruits which are moist and apt to spoil

cheeses : block parmesan, shredded cheddar, shredded parmesan

ice creams and sorbets

The refrigerator

Dairy:  

milk, half and half, cream, butter,

certain oils like toasted sesame  

soft cheese: cottage cheese, cream cheese, ricotta, mozzarella

hard cheese: cheddar, pre-sliced and shredded, shredded real parmesan

eggs- at least two dozen

Meats, poultry and fish which are thawing, marinating, preserved, or leftover. 

Cultures for home made yogurt, yeast to make bread

Vegetables:  

salad greens like romaine, spinach, arugula, cooking greens like kale and chard,

Hard vegetables like carrots, beets, cabbage, broccoli, asparagus, zucchini, cucumbers,

red and other various colored peppers

vegetables ad infinitum  

Fruits:

Strawberries, blackberries, blueberries, other soft fruits like pitted fruits, i.e. peaches, apricots, etc (Tomatoes, bananas, apple and oranges are stored at room temperature ) 

Condiments:

pickles, sweet and dill, olives, ketchup, mustards, mayonnaise, salad dressings, opened jams, jellys, chutneys, salsas, Worchestershire sauce, soy sauce, Siracha or other hot sauce, lime and lemon juice, fresh ginger, garlic

It takes some time to adjust your meal planning, cooking and eating habits to include all the good things all of the time and very few of the bad things very seldom. But having fridge, freezer, and pantry filled properly will help. It is also necessary to realize that healthy eating takes a little extra time at first. But healthy cooking, once learned is minimalistic simple cooking, and can be made to be very time efficient. 

I hope these lists will help healthy eating become easy and enjoyable. 

Medical Monday: Breaking News from the World of Ob/Gyn

2016 brings in some good news for women’s health. Physicians are starting to weigh in on the new over the counter contraceptives available in Oregon and California, and they are overwhelmingly applauding it. 

A recent article in the Los Angeles Times also indicates physicians are also weighing in on the controversy on mammogram frequency recommendations, and many support annual screening from the age of 40. This view is supported by the American College of Obstetricians and Gynecologists, the American College of Radiology and the National Comprehensive Cancer Care Network. 

The National Public Radio Health Blog Shots has indication that 2015 was the year “ menstruation came out of the closet. They cite the care of Kiran Gandhi who finished the New York Marathon on her period,without pads, drawing publicity to the idea that #PeriodsAreNotAnInsult. They cite other instances where menstruation entered polite public conversation, thereby beginning to erode long held taboos. 

The FDA now classifies mesh for prolapse as a "high risk device". Given the complication rates, I think this is a good thing. Also good is that the FDA excluded mesh for incontinence which is a different device entirely and works rather well, without the same high complication rate. 

You may hear of a retrospective observational study has picked up an association between the use of oral fluconazole (Diflucan) in the first 6 months of pregnancy with a 50% increased risk of miscarriage. From this data, it is not at all possible to say whether the diflucan is causing these miscarriages. Think about it…. maybe it is the yeast itself, or a diet high in sugar. More study is needed to figure this out. 

A new blood test may help physicians sort out those at risk for preeclampsia. This is most welcome since it is sometimes difficult to discern preeclampsia from chronic hypertension. 

Finally, in some really fantastic news, the Journal of the American Medical Association (JAMA) has published research indicating that even “ older women” i.e. 69 or older, who get regular mammograms have a lower likelihood of dying from breast cancer during the ages of 75-84 compared to their counterparts who did not get regular mammograms. Currently we are permitted to stop screening around 70 and the US Preventive Services Task Force says mammograms should not be done after 75. This has to do with supposedly having an expectation of living less that another ten years. You know, something tells me this whole line of thinking is going to evolve as women live longer and more vital lives. I wonder what Betty White, Angela Lansbury, Sandra O’Connor, Ruth Bader Ginsburg or Dame Maggie Smith would have to say about all this. 

Food Friday: Staple Pantry Goods

As promised, here are my lists of staples for the pantry. You will notice that not everything here is a superfood. That is because there are special occasions like birthdays which require treats. Not only are these events important for family and social life, but it is important to learn how to use restraint and have a small single portion of an indulgent treat made after a healthy meal. Bon appetite ! 

Grains

• Cornmeal for Polenta
• Quinoa
• Oats for baking and hot cereal

Rices

• short or long grain brown ( preferably basmati)
• wild rice
• black forbidden rice
• sushi rice

Pasta

• whole grain and gluten free pasta, i.e. spaghetti or penne
• Oils and fats
• Canola, for higher heat cooking
• olive, extra virgin, for medium heat cooking
• olive, extra virgin, cold pressed, for dipping.
• sesame oil for flavor
• flavored oils
• coconut oil

Some basic spices and herbs

• kosher salt
• pepper, preferably whole peppercorns
• lemon pepper
• rosemary
• thyme
• basil
• sage
• chili
• cumin
• paprika
• garlic, fresh and powdered
• ginger, fresh and powdered
• cinnamon
• cloves

 Canned and jarred goods
 

• tomato sauce
• diced or stewed tomatoes
• tomato paste
• canned olives
• canned pineapple for pizza or stir fry
• various beans, like black, pinto, garbanzo
• pickles
• sauces like soy
• chilis, diced
• canned salmon
• coconut milk
• all the jams, jellies, chutneys, and pickles that you have canned : ) 
• vinegars like apple cider vinegar, balsamic, rice

Dried things

• raisins
• dried cranberries
• sun dried tomatoes in oil

Baking Ingredients

• whole wheat flour, I prefer fine grind for the most protein and the heaviest bread
• whole wheat pastry for pie crust
• unbleached flour if you must have it
• gluten free flour for those who require it
• baking powder
• baking soda
• cream of tartar
• cornstartch or tapioca powder for thickening pies
• sugar, white, brown cubed and powdered
• chocolate chips
• bakers chocolate 2 forms, blocks and powder
• expresso powder
• sweetened coconut
• molasses, agave, honey
• Nuts (see the freezer section in future posts) 

Beverages:

• a complete selection of chai and coffees, including decaffeinated versions of each
• teas: black, green, and herbal
• Soda water, or Perrier or Pellegrino to splurge

Stay tuned for the fridge and freezer sections next week on Food Friday ! 

Wellness Wednesday: Time and Goals

We each have goals. What would it be like to accomplish them ? What would it be like to accomplish a lot of them ? Some people do. These are people with good time management. 

It occurred to me that before I discuss exercise on this Wellness Wednesday blog, I should discuss the one thing my patients say they need before they can exercise: more time. We all have one lifetime of time. What matters is how we use it. Everyone knows this, so what is the problem ? 

Most people are not fully aware of how they spend their own time.

They are not as factually familiar with how they spend each hour as the think they are. I have found that everyone thinks they’re busy, and everyone thinks they're active. People are less sure if they are efficient in their day. This is the territory I suggest we explore at this point in the New Year. 

We are talking about time management. Have you ever had a class in this ? Few people have. It seems like it would be a good idea right at the beginning of high school. Or how about right now, in the blog post ? 

Here is your mini class on time management, complete with some handouts and homework. 

• Obtain a notebook to document this process. 
• Record your present schedule, down to the hour, for one week. Include everything from housework to Facebook. Wear a watch all week so you will have realistic estimates of time. 
• Make a list of goals, for the week, month, quarter, year and five years. 
• Order the goals by priority.
• Assess your week long log and see where you are misdirecting or wasting your time. 
• Realign your schedule with your priorities. Include a spot for 30 minutes of exercise 6 days per week. 
• Record what happens the next week and repeat. 

Now this is a VERY simplified version of a time management class. It is, however, the essence of the process. It only works however, if you are absolutely truthful with yourself about how you spend you day’s time and absolutely truthful about what you really want. 

I hear so much about not “ having enough time” to exercise, or to shop for healthy food, or to prepare healthy meals, that I decided to address it head on. 

For those interested in more, there are really so many great resources on the web, from Lifehack.org, to books by Harvard Business Review. 

Here is a one page handout on the subject. Click on the title below to download. 

"Time Management" from the Stanford Center for Teaching and Learning

For extra credit, here is an awesome self assessment and time management tool from University of Kentucky. Click on the title to download. 

"The Successful Person's Guide to Time Management"

This should be be printed, filled out and used. 

Class is dismissed. Homework is due next week! I’d love to hear how you do. 

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

Good Monday and Happy New Year. ACOG (The American College of Obstetricians and Gynecologists) has once again reiterated the newer recommendations regarding cervical cancer screening. They have stated that “ Women ages 30 to 65 at "average risk" for cervical cancer should receive co-testing with cytology and HPV testing every five years or screening with cytology every three years”. ( Cytology just means sending cells with a pap and co-testing means DNA testing for HPV, Human Papilloma Virus via the same sample.) I would like to emphasize a couple of aspects of this statement: the phrase “ average risk”, and the idea that they are talking about sending specimens to the lab. 

Average risk is not precisely defined, and this is ok, since it gives clinicians room for applying clinical judgement to individual patient cases. Average risk does not certainly include those patients, who are by virtue of disease or medication, immunocompromised. It does not include those who have recently had precancerous cells in the cervix, vagina or vulva. In my opinion it does not include those who have a significant smoking habit, since smoking is tightly associated with accelerating the progress of HPV disease. I do not believe average risk includes those with alcohol or drug problems since these patients can have poor immune function and struggle with satisfying recommended follow up protocols. In my opinion, average risk also should not include those with high risk sexual habits, such as having unprotected sex or large numbers of partners. But does the media ever highlight any of these things ? I have not seen it. 

These ACOG recommendations are about the recommended sampling frequency for cells on the cervix. They are not a statement about the frequency of annual exams or even pelvic exams. Those proceed on their own schedules for their own separate indications. The media has not done a good job at highlighting this important distinction. After all, a woman is more than just her cervix. 

The Journal of the American Medical Association (JAMA) has received a request from a group of researchers to retract their own study from the Journal on the grounds that they have discovered that the lead researcher has falsified data about the usefulness of nitroglycerin for improving bone density.  Kudos to those whistleblower researchers. 

South Carolina Department of Health and Environmental Control (DHEC) will revise its regulations concerning the practices of licensed midwives, what we call lay midwives, meaning those who are not Certified Nurse Midwives. The DHEC was picketed by about 50 midwives. ACOG has said that while women deserve the right to chose where they deliver, they should be informed of the risks and benefits of the choices, including the two to threefold risk of neonatal death while delivering outside the hospital. (This data came from a study reported in the New England Journal of Medicine (NEJM) and involved a study of 80,000 pregnancies in Oregon.)

Let’s think a little more about that statistic on neonatal death. Neonatal death is defined as the baby dying in labor or in the first month after birth. Why would such a terrible thing happen in the hospital ? High risk pregnant patients come to the hospital. High risk mothers may have very early labor, ruptured membranes, or severe preeclampsia, all resulting in deliveries so early that babies are far more apt to die or have serious morbidities. This is the source of neonatal death in the hospital, not the average pregnant women who comes in for labor or induction.  On the other hand, most licensed lay midwives restrict their practice to low risk patients, with none of these aforementioned problems. And yet many more of their patients end up with dead babies, despite the fact that hospital caregivers are dealing with these sometimes insurmountable obstacles. Problems which are solved by a simple medication in the IV, or the use of forceps, or even a C Section in the hospital, result in death when the same problems occur outside the hospital.

Speaking of neonatal death being two to three times more prevalent among those who birth at home, did you ever consider that this is a group average ? What happens when you unpack that group ? It turns out that first timers delivering at home have a 14 fold increase risk of first apgar score of ZERO, which is tantamount to neonatal death. And while the multiparous patients (women with multiple prior births) may do better with labor, they are much more prone to hemorrhages and other maternal complications, which are not even addressed in this statistic. 

So beware of the medical reporting in the popular media. Don’t take those statistics at face value. Remember the actual human realities behind them. 

Stay tuned for more breaking news from the world of Obstetrics and Gynecology next week on Medical Monday. 

Food Friday:A New Year's Pantry

It’s time for a fresh start on your nutrition. Here’s an easy way to go beyond intentions and take a SMART (Specific Measurable Attainable Relevant and Time bound) step to better nutrition: 

Clean out your pantry. 

This is a way of taking stock of your eating habits as they really are. I suggest the following plan for success in this endeavor: 

• Put your family on notice so they can prepare.
• Have a simple plan for your healthy meal while you get all this done
• Take everything out of the pantry and sort it into
  • Keep 
  • Donate 
  • Compost 
  • Trash 
• Be ruthless and keep only what fits into the plan of healthy eating. If you are unsure, then review our section on Nutrition. 
• Clean the whole pantry. 
• Replace the good stuff which made the cut.
• Now that you have a detailed overview of what you have and what you lack, make an excellent list of your healthy pantry staples. Keep the list on your phone and make a couple laminated copies for the pantry itself and for your wallet. 

You will feel such a great sense of satisfaction, and you will be on your way to dietary honesty. Stay tuned next week for my preferred list of staple pantry goods. 

Wellness Wednesday: New Year’s Resolutions

I have always been skeptical of the idea of  New Year’s resolutions. Did you know that only 8% of them succeed ? I am more in favor of a New Year’s PLAN. Plans can change things. 

I am all for establishing intentions and all for making lists. A resolution however, is more like wishing for something and expecting that the strength of your wish will make it come true. Research shows the desire or willpower alone is insufficient. If you are ready and willing to make changes, bring out the power tools. They are called SMART goals. 

SMART is an acronym for Specific, Measurable, Attainable, Relevant, and Time bound.

See more at:

Structure Sunday: Three Ways to Get Ready for the Week

So make a New Year’s list of the goals you would like to achieve, but apply this metric to each one. 

Here is more on exactly how this works : 

The Importance of Inspiration

For example, if you want to exercise daily, you must know what exercise you will do, and where. You should make a record of what you do. It should be something that is realistic at the present moment. You should know exactly when in the day and week it will take place and give yourself a date to reassess your progress. If you do not do these things for your exercise plan, then you are not serious about this goal. If you actually set yourself up this way, you will almost certainly be successful. It’s like Dorothy and the ruby slippers. You had the power all along. 

Meanwhile here is some additional fun and illuminating reading on New Year’s Resolutions : 

LIfehack: 50 New Year's Resolutions and How to Achieve Each of Them

Happy New Year ! 

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

Medical Headlines took a bit of holiday break just like us, so today’s report will be brief. 

The Journal of Pediatrics recently presented research that has shown that many new parents use car seats incorrectly. The most common mistakes are straps too lose and chest clips placed too low. Anyone with doubts can just stop by any labor and delivery or pediatric clinic for an on the spot demonstration of the correct technique. 

In the good idea department, the American Journal of Public Health reports that young pregnant women  might get significant benefits with group prenatal care. The study groups ranged in age between 14-21 and received either traditional prenatal care or group prenatal care. Those receiving care in the group setting were 33 % less likely to have a small for gestational age baby. Personally I think it would be fun to instruct young women in a group setting. 

In the frustrating and dangerous section, Reuters has reported on Canadian study retrospectively comparing 11,000 low risk women who had home birth with 11,000 low risk women with hospital birth. Their endpoints were still birth or death. For these endpoints, there was no significant difference in outcomes, with the incidence at home being 1.5/1000 versus 0.94/1000 in the hospital. There are two glaring problems with drawing a conclusion from this: 

1. The incidence of stillbirth and neonatal death is small in both cases, so comparisons of even large numbers cases are relatively unrevealing.

2. We care about many more outcomes than still birth or neonatal death. For example, we care about near death of the baby or the mother, brain damage, post partum hemorrhage, retained placenta, postpartum infection, and so many more grave life altering things. The truth of the matter is that neonatal and perinatal medicine is so good now that no matter how badly a case is managed, modern medicine can almost always salvage it enough so that it does not qualify as a stillbirth or a neonatal death. Badly managed cases requiring intensive perinatal and or neonatal care that do not result in stillbirth or death are definitely things I should think everyone would want to avoid, but nonetheless are NOT on the radar of this study. For that matter badly managed cases that require intensive perinatal and or neonatal care that do not result in stillbirth or death but that DO result in bad outcomes like brain damage are not also reflected in this study’s conclusions. How helpful is that ? And yet, what is the Reuter’s headline ? “ Home Births May Be Safe For Low Risk Pregnancies “ Really ?

From the “ clues on the trail” department, we have the following two tantalizing tidbits. One, it turns out that there is some sort of association between gum disease and breast cancer. Those with gum disease have a 14% increased risk of the disease. Add smoking and it jumps to 20-30 % and that means smoking ANYTIME in the last 20 years. Yikes ! information like this could ultimately help us understand how breast cancer arises or persists. 

Two, Metformin, a common medication to help with ovulatory dysfunction, polycystic ovary syndrome, carbohydrate intolerance, and diabetes, “can block the release of toxins from the placenta when preeclampsia is present." Wow cool. Now someone smart needs to figure out why.

Ending with heartwarming news, the journal Pediatrics has presented research showing that “ kangaroo care” benefits premature and underweight babies in several measurable ways. Kangaroo care is prolonged skin to skin contact, and it is associated with half the risk of serious infection, 78% lower risk of low core temperature, and 88% lower risk of dangerously low blood sugar. 

So go hug your kid and have a happy new year. 

Wellness Wednesday: Holiday Wellness Collection

Here is a little collection of holiday wellness quick reads from my past blog posts. I hope they help the next week or two be merry and bright. 

Holidays, the Happy Disruption

Holiday Wellness

Gratitude is at the Center of Wellness

Look forward to more post collections during the holiday week while I take a little time off from writing and just highlight the “ need to know “ stuff. 

Merry Christmas and Happy New Year. 

May the light of the season be within you. 

Wellness Wednesday: Body image

Hello Angels. Did everybody watch the Victoria’s Secret Fashion show last week ? I did. It is a provocative female fest of the first order and boy does it provoke a lot of conversation. So thank you VS for stimulating conversation around the world. 

I am a doctor and am first and foremost interested in health: physical health and mental health. So that is my filter. And through that filter, this is what I see, and it isn’t all pretty. 

I see that many women of all types and sizes have poor body image. I have seen umpteen conversations in the blogosphere running along the following lines: “ The VS show made me feel bad about myself.” I wonder if these women feel the same way after watching the Olympics or the Cirque du Soleil ? I wonder if they are aware that these models train like professional athletes, boosting their calorie and protein intake way up to build muscle and compensate for the long hard workouts that they must do. Many women are 5’10 or more and have pretty faces, but few can achieve this level of discipline and training.

I am not so unsophisticated that I do not realize that the VS show is essentially marketing and that it sends mixed messages to and about women. Yet, it would be nice if we could all watch Olympics, gymnastics, or even the VS show and be inspired to be our best selves. 

I am certain this chronic problem with poor body image is something we inherit from our culture, and that we are retaught every generation. Historically, we women have been property, and most generally utilized for our physical attributes. Is it any wonder this is still how we define ourselves ? Although the problem of our self worth came from without, the problem is now within us. Likewise,the solution can only come from within each of us. It is for each of us take a hard look at ourselves and count our own strengths. We need to learn to define ourselves in our own terms, and value ourselves as whole people. We all know none of us is perfect, mentally or physically. However, we must learn to celebrate what we are and to learn to enjoy the process of making ourselves better all the time.

Through my filter, I see that women of all descriptions hurt one another with fat shaming and thin shaming. Women already have to deal with objectification, abuse, unequal pay, glass ceilings, and sexism. The last thing they need to be doing is undermining each other.

I see people outside the health profession mistake all sorts of things: slim for anorexic, obese for “ big boned”, obese for "womanly" and muscular for unfeminine. I even hear some of these things from people in the health sciences. None of these analyses are helpful to the cause of the physical or mental health of women.  None of these critiques allows for the fact that there are many body types. None of them asks the right questions about fat percent, muscle mass, bone density, strength, nutritional status, menstrual health and other truly relevant parameters. 

I am very concerned about eating disorders in young women. However, I see them very rarely. But, numbers wise, prevalence wise, I am profoundly more concerned about the obesity epidemic. This will end up causing no end of disease related suffering as women of this generation come into middle age and older. We as women have to come to terms with the need for good nutrition and regular fitness. We need to get back in touch with strong female physicality.  If we cannot get in touch with our physicality, we become oblivious to our bodies and avoid them outright and they get less and less healthy with each passing year. 

Strong healthy physicality in women, and I mean mature adult women as well as young women, lends confidence to the mind as well as the body. What does physicality mean ? To me it means, being in touch with your body. This means being able to honestly assess your bodies strengths and weaknesses with the help of your doctor and maybe even a trainer. It means standing in front of a mirror without clothes. It means getting on a scale and doing a waistline measurement. It means accepting where you are at the present moment and knowing you have the power to better yourself.

Physicality means having the courage to try new things with your body, new exercises, new sports. Sports ! Yes… I believe all women need sports and competition in their life. It builds confidence in all things, because sports teaches you how to try and try again. Sports teaches you how to practice, even how to train, however modestly. 

Your physicality extends to other people. It asks you to acknowledge your own sexuality, and to ask whether it is in a reasonable state. 

Physicality bears on how you present yourself to the world. You may not wish to become a materialistic fashion slave. But….. do you neglect your own appearance and present yourself poorly to the world ? Do you neglect your hygiene ? Do you dress down or to be invisible ? Is your posture poor ? Think about these things and take responsibility for yourself. Love what is, shower it, brush it, put some cream on it, then dress it up to show your best self. 

Physicality extends to the natural world. It asks that you get out in it and feel it with all your senses. When learn to use your body in the natural world, the natural world will, in return, sculpt you into a better adapted creature. 

It is good to embrace health and beauty in all forms. True beauty is health. You have the power to make some of your own. 

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

There is some sobering news in this week's collection. 

Findings from Sweden published in the Lancet indicate that babies from women who gained a large amount of weight in pregnancy are at increased risk of stillbirth and infant death compared to others. This work is an impetus to study the issue in more depth, since there is no clear indication of why this is it the case. 

A study presented at the World Diabetic Congress has shown that about 10 % of teens with type 2 diabetes in the study got pregnant over at 6.5 year period. Any women with diabetes in pregnancy are at high risk for complications. Pregnant teens with diabetes are at especially high risk. It was noted that these pregnancies frequently have poor outcomes. 

A study published in the Journal of Clinical Electrophysiology has indicated that women who were overweight at age 18 have a greater risk of sudden cardiac death. This persists irrespective of later weight loss. Those with a body mass index (BMI) in the high 20s have a 33% greater risk.. Those with  BMI over 35 quadruple their risk. 

New research indicated that 62% of all Ob/Gyns are now women ! That even counts the old ones : )  

Speaking of doctors, new research published in JAMA, the Journal of the American Medical Association indicates that about 29 % of all medical residents have depressive symptoms or depression during their training. The general population comes innate about 6.7 %. Of course this is all about long stressful work, sleep deprivation but also about hierarchical structures and bullying. In my opinion, a lot would have to change for this to be different. 

Omigosh this post is so dismal it is sounding like a parody but I kid you not, researchers from Oxford, namely statisticians and medical epidemiologists, have now asserted that happiness has no direct effect on mortality. They say the idea that unhappiness causes illness is a really a case of illness causing unhappiness. 

Data crunching at the CDC has concluded for 2010 and from 1976 until 2010 pregnancy and abortion rates have fallen to record lows. 

Dame Sally Davies (Yes, ladies she is a Knight of the British Empire ), the Chief Medical Officer in England, has declared obesity the greatest threat to women’s health and to that of future generations. She has declared it a national priority. 

Finally, in a bit of progress, the FDA has updated the required pregnancy and breastfeeding labelling for prescription medications. 

Maybe the world's researchers wanted to get all the bad news out of the way before the holidays. I can't wait for next week. Stay tuned. You can't make this stuff up. 

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

Until recently, the only treatment for preeclampsia is delivery. However, a new study is underway to test Recombinant Human Antithrombin to manage early onset ( 23-30 weeks) preeclampsia. As the same suggests, this medication acts by inhibiting abnormal blood clotting and inflammation, two components of preeclampsia. If this helps, this will be the first medication to directly address this common and serious disease. 

In the unbelievable department, The Government Accountability Department (GAO) has discovered something concerning at the National Institute of Health (NIH) . They have discovered that the NIH does not, in their research, always keep data on sex, thereby making it impossible to determine whether or not an intervention or exposure affects men and women differently. Those of us from the world of Ob/Gyn can tell you that rather often, the same factor will affect men quite differently than it will affect women. 

Here’s your reference http://www.gao.gov/products/GAO-16-13

The Radiologic Society of North America heard research results indicating that the recent Medicaid Expansion has boosted rates of breast cancer screening in low income women. Assuming these and other women do not pay too much attention to the USPSTF ( US Preventive Services Task Force) recommendations of later and less frequent mammograms, we may soon see increased rates of early detection and eventually, longer survival. 

ACOG (The American College of Obstetricians and Gynecologists) has made its strongest statement yet on pregnancy, stating not only that it is safe, but that it is recommended on a daily basis and should be the norm. 

OB/GYNS all over the world are nodding on this one. The Journal of the American Medical association has indicated the WHO's (World Health Organization) optimal rate of C section at 10% is too low. As C section rates rise to 15%, the study shows maternal and infant deaths decrease. In fact, maternal and infant deaths continue to decline through about 19%. This is the sweet spot, meaning where maternal and infant well being are at their highest. In the US about 33% of births happen by C section. This probably has to do with many things, including our culture, patient preference, doctor’s risk tolerance, the medico-legal climate, and the obesity epidemic. We can improve. 

Sobering : False positive mammograms may be linked to a higher risk of breast cancer later in life. The group in question is those whose mammograms indicate the need for a biopsy but then whose biopsies are negative. These women, despite negative biopsies, have a 39 % higher risk of breast cancer in their future that women who didn’t require a biopsy. I wonder how this finding will factor in to the recommended frequency of mammograms. So many authorities are weighing in on how frequently they should be done. ACOG still says every 1-2 years after 40. 

It turns out that giving flu vaccine to pregnant women in the second and third trimester benefits not only the mom but at least have of the unborn babies as well. Bonus ! 

Stay tuned next week for more breaking news from the world of Ob/Gyn ! 

Food Friday: Food Gifts

Tis the season to start firming up your holiday gift plans. To do this, remember that gift giving is supposed to be fun. It shouldn’t stress you out, or be unduly expensive. It should be personal. Finally, we all know the best gifts are home made. 

Here’s a list of ideas that should get you cooking on some fun food projects that will make great gifts. For more ideas, think of what you are really good at preparing. And, if you are still at a loss, then just consider what you might like to get ! 

Holiday food gifts divide themselves nicely into several categories: 

1. Baked goods, from cookies and cakes to fancy breads. You can even leave your cookie dough uncooked in a roll of waxed paper, and package them nicely for refrigeration. This is the so called “ refrigerator cookie “ which you can slice off as needed and “ bake” in the toaster oven. 

2. “Kits" for baked goods, cleverly packaged in, for example, a mason jar. Decorative recipe cards are included. 

3. Homemade candy, since it is a project to make. Brittles and toffees are classic, but truffles are highly prized. 

4. Candied or spiced nuts, since they are festive and because they are handy for entertaining. 

5. Other mason jar “ kits”, for soup, spiced hot drinks like chocolate, coffee, or chai. 

6. Spice mixes in nice containers. 

7. Preserved goods such as jam, jelly, and pickles. Of course if you live in the northern hemisphere it is not summer at Christmastime. Thus you will not have fresh fruit and vegetables to preserve. But you can still make preserves from other things, like wine ! You can make jelly from wine and even from balsamic vinegar. Plus, it only takes a few hot peppers to make some colorful hot pepper jelly. 

8. You can make infused oils and vinegars and use pretty bottles. 

9. Food kits can become more elaborate if you include equipment and table dressings. Consider a sushi themed basket with rice, seaweed, sushi rollers, pickled ginger, horseradish, chopsticks and dipping bowls. 

10. If you are super short on time, you can present someone a “ coupon “ for a dinner catered by you, or even just a batch of brownies. 

Food gifts are really fun to receive. This is especially true is you package them artfully and with care. Craft, fabric and even grocery stores have great materials for wrapping. I am partial  to unbleached parchment paper and plain brown cooking twine. You can add natural embellishments like pine cones, or evergreen twigs. You could even tie in a small wooden spoon. 

Whatever kind of gift you chose to give, just make sure that there is a little of you in it.