health

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: thefamilydinnerproject.org)

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.  

Wellness Wednesday: Summer Safety Kit

Here is a convenient comprehensive kit to keep you safe this summer. It recaps some posts from the recent and more distant past, all in one convenient place and on the theme of having a safe and happy summer. 

Reclaim your Summer

This deals with the importance of time off and the concept of summer vacation for adults. 

Weathering the Heat

Contains some amazing facts and figures about heat stroke.

Five Steps to Mosquito Protection

This is especially important to review in this season of the Zika Virus.

Wellness While Gardening

Tells of the little known perils of playing in the dirt. 

Hydration 101

This critical post has concrete information to help you stay out of trouble this summer. 

 

Stay tuned for next week on Wellness Wednesday, when we will talk about the Summer of the Mind.  

Medical MondayL Breaking News from the World of Obstetrics and Gynecology

 

In Zika news, it has become clear that we do not yet know the length of time that Zika stays in the reproductive tract of a man. Thus, we do not now how long he may be able to transmit it sexually. 

In a recent poll, 73% of Americans feel Congress should pass the funding to fight the Zika virus as recommended by the Obama administration. However, reflecting a poor grasp of the situation, only 46% feel they need to pass it immediately. 

In the we already knew this department, ACOG ( American College of Obstetricians and Gynecologists) has issued new evidence based guidelines to help prevent perineal lacerations. These include using episiotomy selectively, and well as using warm compresses before birth. 

SCOTUS ( Supreme Court of the United States) has struck down a restrictive Texas abortion law. This law would have required that abortions be provided at an ambulatory surgical center by a physician with hospital privileges. There is no scientific data saying that either of these elements is necessary for safety of the procedure, which is normally done in an office by a midlevel provider such as a nurse practitioner. Many abortion clinics would have had to close had this law stayed o the books. The Court ruled by a 5-3 vote largely along gender lines that these laws placed an undue burden to women seeking legal forms of health care. 

In other SCOTUS news, the Court has refused to hear a legal challenge to the Washington State rule that pharmacies must deliver all prescribed medications, even emergency contraception. This ends a nine year legal battle in which some pharmacists and a pharmacy refused to stock or fill the morning after pills. The Court voted 5 to 3 not to accept the case. Four Justices must agree to accept a case if it is to be heard. 

In the pendulum swings department, there are two items. First, Obs are giving serious consideration to the optimal time for delivery. In the past, 42 weeks was considered a reasonable time for induction. In my tenure, this has become 41 weeks. Now 39 weeks is under consideration. 

Secondly, women with a statistical risk of ovary cancer of 4% or more who is over 40 may be better off with her ovaries and tubes removed. When I finished residency in 1994, we encouraged women facing a hysterectomy to have the ovaries out as well if they were over 45. In recent years, this has become more of a patient choice. Now, we are refining this judgment to include family history and other risk factors in a statistical model to determine the best course, and it may favor removal of the ovaries earlier than previously recommended. 

Once again the USPTF (US Preventive Services Task Force) has cited the lack of evidence supporting the annual pelvic exam, and how it should be done only when symptoms are present. And yet, when examining their published statements, one sees that they do not highlight the fact that there has been nothing done to prove or disprove the utility of the exam either way. This is because doctors the world over have taken it as common sense to do the exam, thus no study has been done. The public should know that saying that there is no proof that something is not useful is NOT the same as saying that something has been proven TO BE not useful. Personally I find important things every week if not every day I do a pelvic exam, and that includes both speculum and bimanual exams. Furthermore, nobody is traumatized by their exam. Children and those with disabilities who need exams and who might be traumatized are examined with the aid of anesthesia supervision. 

 

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

Wellness Wednesday: Hydration 101 

Summer has finally arrived in the northern hemisphere.

Our part of the planet is pointed much more directly at the sun and you can feel it. Sun protection and hydration become critical. Last Wednesday we covered mosquito protection and this week we will recap hydration. 

A July post from last year has some facts that bear repeating: 

  • 2 Liters = the amount of fluid a non pregnant woman needs per day
  • 3 Liters= the amount of fluid a pregnant woman needs per day
  • Add 1 Liter for temps over 85 degrees
  • Add 1 more Liter for activity like hiking. 

So… the fluid requirement for a pregnant woman hiking on a hot day is 5 Liters !!! 

 

Watermelon juice.jpg

And to recap…

 

Consider a woman weighing 154#=70kg

  • 60% of the body=water =42 kg or 4.2 Liters for our 70 kg woman
  • 1% loss of fluid = 42 ml impairs thermoregulation and causes thirst. 
  • 2% loss of fluid - discomfort and loss of appetite 
  • 3% loss of fluid - dry mouth appear
  • 4% loss of fluid- work capacity decreased 
  • 5% loss of fluid- reduced concentration, headache, and sleeping 
  • 6% loss of fluid-tingling and numbness of extremities 
  • 7% loss of fluid-collapse 

Taken from the World Health Association (WHO) website 

 

Hydration does a number of great things

Firstly, it protects you from harms: 

  • Urinary tract infection
  • Kidney Stones 
  • Preterm labor 
  • Headache 
  • Helps prevent heat stroke 

see Weathering the Heat 

Finally, hydration makes you feel good and look good. 

 

It’s fun to get creative with your healthy drinks.

Break out of the old routine of sodas and beer which do nothing but dehydrate and put fat on the belly. 

Try these instead : 

  • Plain Club Soda with a little splash of 100% fruit juice and twists of citrus 
  • Mocktails like a Virgin Mary or a not so sweet Virgin Daquiri
  • Herbal iced tea or Sun tea, sweetened with a little fruit juice 
  • Healthier frappes made with ice, one pump of chocolate, and your milk of choice 
  • Green smoothies 

Drinking a tall cold glass of something healthy and fun is good for you both physically and mentally. It gives you a little creative outlet, and a chance to sit down and take a micro break. 

Be sure to catch all of our blog posts at 

www.drginanelson.com/drginablogs  

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

Good Monday. This week the news is again dominated by the specter of Zika. I reported earlier that the Puerto Rican chapter of ACOG (American College of Obstetricians and Gynecologists)  is working hard to deliver donated contraceptives to women in this vulnerable population. However, IUDS are not common there due to cost, and as a result, few doctors know how to insert them. Approximately 60,000 IUDS and 80,000 packs of birth control pill packs have been donated by Bayer, Allergen and Medicines 360. The donor companies have also started training physicians to use and presumably teach the use of IUDS. However, their dispensation is held up since the CDC has yet to line up a licensed distributor in Puerto Rico.

This sounds like a problem that can be solved. IUDs are not that hard to put in. I cannot help but think that telemedicine, i.e. videoconferencing, could not help train doctors to put in IUDs. By some accounts there are about 150 Ob/Gyns in Puerto Rico, and about 138,000 women there who are vulnerable to pregnancy.

A little more Googling on my part indicated that the Puerto Rico Obstetrics and Gynecology is holding a “ Sunshine Seminar”  August 4-7 this year at the Wyndham Grande Rio Mar Beach Resort and Spa. Really ? Instead of studying morcellators and bioidentical hormones, maybe conference attendees should put some gloves on and start seeing as many patients as they can. 

I am going to contact the chair of the Department of Obstetrics and Gynecology Dr. Sharee Umpierre at the University of Puerto Rico and see what she has to say about the situation. 

The New England Journal of Medicine reports an increase in abortion medication in Zika affected South American countries. 

In some good news, the FDA has given the go ahead on human clinical trials on a Zika vaccine known as GLS-5700. The safety and immune response will be studied in about 40 subjects. Thank you very much you brave souls. 

In more good news, the NIH ( National Institute of Health) have started a massive study on Zika in affected countries. 

The House has approved $1.1 B to fight Zika. This would come from $750M in savings, $107M unused Ebola funds, $100M in cuts to the Department of Health and Human Services (Medicaid and Medicare) and $534M from Obamacare in the US territories. This does not add up. And, it will not pass the Senate or the President’s Desk. 

Ten cases of Zika were confirmed in Dallas County, Texas as of Friday. So it begins. 

In other breaking research news, there is quite a bit of what we already knew or suspected: Cranberry juice may help prevent UTI (urinary tract infection). Physical inactivity increases risk of ovary cancer and healthy lifestyle reduces cancer risk. Leading oncologists push for greater use of the HPV (Human Papilloma Virus) vaccine. Healthcare is more affordable since Obamacare. Age of puberty for girls is going down. Soy isoflavones reduces menopause symptoms. Women who work long hours face more chronic disease. 

Why are studies done on matters that already seem established ? One reason is that prior studies may have been done to get a rough indication of a cause or pattern. Later, better designed studies can establish something closer to proof. However, some of these things are just common sense. If we took full advantage of the knowledge we already have and actually put it into clinical use with our patients, there would be so much more health and so much less disease. Case in point: HPV vaccines usage. 

 

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

 

Food Friday: Kitchen Gadget Heaven

I have a kitchen gadget fetish. But I am not ashamed. Food…including the taste, the process, and the nutrition, is very important to me. It is worth my time and money. I have my priorities. Over time, I have learned what I really need in the way of kitchen gadgets. I would like to share my thoughts with you, so you don’t end up spending your money on stuff you don’t use. 

Good kitchen equipment is nice, but not essential to delicious healthy food. Many memorable meals were made in tiny European kitchens or over an open fire by a river with very little in the way of gadgetry.

Some basics as needed, and most can be obtained at your local goodwill store. Moreover, parents and family are usually willing to part with older serviceable items like blenders, thus making it possible for them to get the latest greatest model. Use your ingenuity, save up some money for nice things, and place food and food preparation high on your list of priorities. Food is a critical part of your health and cuisine a delightful part of your social life. 

 

Must have

  • dishes
  • flatware, i.e. knives, forks, etc.
  • all purpose glasses, for hot and cold, the ideal being for both, i.e. Picardie glasses (repurposed jam jars for cups, anyone ? )
  • saucepan
  • frypan, nonstick
  • ladle
  • spatulas
  • knife set
  • usable cloth napkins
  • pitcher
  • roasting pan
  • covered casserole pan, stove to oven
  • potholders
  • dishtowels
  • cutting board
  • cookbooks or internet access
  • set of preparation bowls
  • measuring sets: quarts, cups, teaspoons and tablespoons.

 

Nice to have

  • serving dishes and utensils
  • table wear such as table cloths
  • toaster
  • blender
  • hand blender
  • slow cooker
  • sushi roller
  • yogurt maker
  • ice cream maker
  • air popcorn popper  
  • dedicated freezer
  • panini press
  • waffle iron

 

Objects of Desire

  • barbeque or grill
  • Cuisinart food processor
  • Kitchenaid Mixer
  • Vita Mix Blender
  • wood burning pizza oven
  • pressure cooker

My new favorite gadget is my Instant Pot Pressure Cooker. It is the opposite of a slow cooker. It is a fast cooker, but the result is the same: tender flavorful meat from inexpensive cuts, and rich well developed sauces. For a long time I had the great idea to set food cooking in the slow cooker before I went to work, and when I returned 8-9 hours later, it would be all nicely done. Well, that did not materialize for a variety of reasons. I failed to prep the night before. I worried about burning the house down when I was gone. I didn’t want to leave it overnight, or I thought I might not come home as planned.

When Michelle Tam of Nomnompaleo.com turned me onto the Instant Pot, I knew it was a match made in heaven. I could come home from work anytime and have a thoroughly cooked hearty meal ready in thirty minutes or less. Last night I spent 15 minutes of prep time on a brand new recipe,  threw raw chicken thighs in the instant pot with sauce and onions, and 15 minutes later I had steaming fragrant lemongrass coconut chicken that seemed like it had simmered all day. Everyone was intrigued and there were no leftovers. 

Cooking is one of the best hobbies, along with fitness. I have prepared a little collection for you to illustrate just how I feel about the the tools of the cooking trade. Enjoy ! 

 

Wellness Wednesday: Five Steps to Mosquito Protection

Mosquito season is here. This has taken on a critical importance in many states in the south and eastern parts of the United States and in all of Central and South America. This is because mosquitos can carry, among other things, the Zika virus, which has been shown to produce serious brain damage in the unborn, and potentially serious disease in adults. Mosquitos also carry other serious diseases, including some which affect dogs and horses. Examples include West Nile virus, Heartworm, Dengue fever, Malaria, and even Ebola.  It is high time to discuss mosquito bite prevention. 

First one must note that mosquitos need standing water to reproduce, and even a tiny amount will do. Natural bodies of water such as ponds, puddles, and sloughs can breed mosquitos. Manmade water collections such as buckets, tarps which have collected rainwater, birdbaths and the like will provide very suitable breeding ground as well. 

Step One:

Eliminate standing water around your home. Get rid of any debris in your yard or patio (e.g. toys, wheelbarrows, pots etc.) which could harbor mosquito larvae. Change the water in your birdbaths at least once per week. Fill in any low spots in the yard. 

For larger bodies of water such as a pond or fountain, purchase “ Mosquito Bits “ or “Mosquito Dunks”. These are pellets or pucks of biological agents which interfere with mosquito reproduction. Once example is Bacillus Thuringiensis, which does not harm the environment. 

Step two: 

Install replace or repair your screens. You will want to enjoy the summer breeze without worrying about the mosquitos. 

Step three: 

Invest in some lightweight cool summer clothes. White gauze shirts with long skirts or lightweight palazzo pants are a pretty option. Most outdoor clothing companies such as North Face or Patagonia offer mosquito resistant shirt which are also usually sun protective as well. 

Step four: 

Buy some DEET based mosquito repellant. This is the only mosquito repellant which has been proven to work. Moreover, it has been shown to be safe in pregnancy. Use your insect repellent correctly. 

  • Read the instructions and precautions of your product. 
  • Only use on exposed skin and clothing. 
  • Do not use near eyes and mouth.
  • Apply to face by spraying hands or cloth, the wiping on. 
  • Never use on injured skin. 
  • Do not breathe it. 
  • Do not use near food. 
  • Do not use it on animals. 
  • Keep out of reach of children. 
  • Do not apply to children’s hands. 
  • When returning indoors, wash treated skin and clothes with soap and water. 

Step five: 

Stay indoors during the twilight hours when mosquitos are most active. 

 

Stay tuned next week for more summer health tips on Wellness Wednesday. 

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

The CDC( Centers for Disease Control has revealed that there are 6 cases of Zika related birth defects in the mainland US. These  are those that have delivered so far. Overall, there are 234 cases of confirmed Zika in pregnancy women in the US. All of these Zika infections were acquired elsewhere and brought here. Accordingly, New York has the most cases of Zikaa in the US, being a port of entry. So far there have been no cases of Zika infections transmitted by mosquitos in the US, though Aedes mosquitos are due to being bitting in the Southern states this week. 

Another preliminary study has come out suggesting that contracting Zika later in pregnancy confers less risk of perinatal malformations. This study was done in Columbia where there are over 12000 pregnant women who have the virus. It is interesting to note that about 80% of Zika infections are asymptomatic. These asymptomatic cases cause microcephaly all the same. 

The WHO (World Health Organization) has come out stating that there is little risk that the Olympics will case Zika to spread around the world. I personally question this, but hope they are correct. 

In other news, California Governor Jerry Brown has signed a bill potentially allowing illegal immigrants to buy insurance coverage on the state’s exchange. This seemingly radical idea is interesting to consider, since these people do come in for care. Without this coverage this care goes unreimbursed but still costs the taxpayer money. With the coverage, these people would presumably come in for preventive care or at least for earlier treatment which would mean a savings in both money and human suffering. 

A study released this last week predicts that if the next president repeals the ACA (Affordable Care Act) the  24 million Americans will lose health insurance coverage. Most doctors feel this would cost us more than the insurance in the long run. Speaking of the ACA, premiums may rise as much as 10% next year. 

CMS(Center for Medicaid Services) has adopted a policy encouraging the use of LARCs (Long Acting Reversible Contraceptives). They have concluding that this is good way to reduce the incidence and cost of unintended pregnancy. An article this week in the Atlantic has highlighted how many communities in the south the so-called “ Bible Belt” discourage discussion of contraceptives, especially IUDs, preferring instead “ abstinence curriculums” .

New research published in Obstetrics and Gynecology has indicated that most websites and apps for fertility are inaccurate in predicting fertility window. Really ? This is not rocket science. 

In the good news department, there may finally be some help to prevent vertical ( mother to child) transmission of Hepatitis B. When Tenofevir is used before birth, infant’s viral load and 7 month infections rates are lower than those who did not get the treatment. 

Stay tuned next week for more news from the world of Obstetrics and Gynecology. And don’t forget…. DEET is safe in pregnancy !! 

 

 

Food Friday: Portion Sizes 

For something so critical to nutrition and well being, I am surprised I haven’t written about this yet. We talk about what to eat, and when to eat. But this discussion is nowhere near complete unless we talk about how much to eat. And how much can be very subjective. Estimates of portion size can be critically flawed. Sometimes when I listen to patients recount dietary history, it sounds correct, and yet they are not losing weight as one might expect. I think in many cases this is because portion size may be underestimated, sabotaging their efforts. 

It’s no secret that portion sizes in restaurants and grocery stores have purposely catered to our gluttonous tendencies. Portions have grown to more than twice of those in the 1980s. Even our plates and cups are bigger. This keeps us coming back for more and allows them to charge us more. A win win right ? Not for us. Obesity is a huge public health problem, and one that has both physical and psychological consequences. 

Let’s examine various methods of portion size management, and you can see what can work for you.

1. Know your calorie requirements. Use the handy calculator in the link. 

http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/calorie-calculator/itt-20084939

2. Have a general sense of your nutrition proportions: ( These are from the US FDA, the Food and Drug Administration.)

 

3. Check reference or for labels to check the size and specifications of a serving size. Compare this to what you need for your meal or snack. Serving size on the container does not necessarily equal recommended size .

4. Have a set of measuring cups and spoons. Have a small kitchen scale. Until your are familiar with common units of measure, measure and weight things. Here are some common measures of volume: 

2 Tablespoons = ping pong ball

1/2 cup =tennis ball

1c = baseball 

 

5. Avoid eating out. If you do, order small portions and just eat part of it. 

6. Buy in bulk but repackage in smaller quantities and do not eat from the bag. 

7. Don’t skip meals 

8. Do eat in between meal snacks which pair protein with produce. 

9. Use smaller plates and make sure your plate is at least half filled with green vegetables before you take other dishes. 

10. Avoid doing other things while eating. 

11. Eat slowly. Your brain takes at least 15 minutes to register that you are full. 

12. Stop eating when you feel 80% full. 

 

Part of the pleasure of eating is the taste and the company you eat with. But I would like to point out that the pleasure of eating also involves knowing that what you are eating is good for your body. Finally part of the pleasure of eating is knowing you have not eaten too much. Watch portions sizes, and your meals with will be better than ever. 

 

 

 

 

 

 

 

Wellness Wednesday: Reclaim your Summer ! 

Setting Summer Goals 

I write this post as the beginning of summer approaches. I look forward to each summer as though I were a school child with a summer break instead of a physician with a steady job. All the same it is a special time, when children are more available, and when people are happily vacationing. We get an especially big dose of this spirit since we host guests in a vacation rental. They remind us of what summer is all about: excitement family, relaxation and adventure. 

To make sure you get all you can out of the summer, I suggest you plan. I suggest this since I am doing the same thing for myself right now. 

No matter your job, no matter your income, you should make sure to refresh yourself in this most sparkling of seasons. 

 

 

 

 

Here’s how.

1. Make a list of your summer goals. Make sure to include your goals in the following areas:

  • Fitness- Set realistic SMART goals for fitness. Make sure to incorporate active summer sports into these goals. Likewise, plan ahead to get fit before that big hike, so you can enjoy it best. 
  • Nutrition and Culinary- Make dishes you want to cook, eat and share, especially with fresh summer produce.
  • People goals- Who do you want to see this summer ? Make time for reconnecting. 
  • Project goals

Home improvement, garden, artistic- Take a summer themed classes, like water colors. Do some gardening. I believe everyone should garden, even if it is a nice tomato pot on the porch. 

Activities- Take advantage of the out of doors and the company of your kids. 

Staycations and Vacations - You can make time special right where you live, or strike out on the trail, for all day or all month as your circumstances allow. 

2. Consider making use of a wall calendar that comprises the whole summer. Block out the time so your goals are realistic.  Leverage your available technology to communicate and coordinate with others in your group of family and friends. 

3. Document your summer so you can best enjoy your memories later. Use photo, video, journalling, paper and mixed media scrapbooking or even digital scrapbooking. 

 

No matter your job or responsibilities,

summer is not just for kids.

Reclaim your adult summer !

The first day of summer is June 21st.

Make it your best yet.

Medical Monday: Breaking news From the World of Obstetrics, Gynecology, and Women’s Health 

To follow recent tradition, I will give the Zika update first. The WHO (World Health Organization) has reported that the spectrum of neurological damage to babies with Zika is greater than previously appreciated. Microcephaly is certainly the most obvious problem, but others such as spasticity, seizures, and vision problems are possible. 

This week a new method of acquiring the virus was confirmed. An American lab worker working with the Zika virus has contracted it though a needle stick. 

In the US, funding is still not present to fund the fight against the virus. Nonetheless, scientists at the National Institute of Allergy and Infectious Disease (NIAID) are “aggressively pursuing" a vaccine. 

Research is also taking place regarding how to alter the genes of the Zika carrying mosquitos so that they are sterile. Wiping out an entire species through genetic engineering may have unintended consequences. Researchers are examining this important issue. 

Over thirteen hundred cases of Zika are confirmed in Puerto Rico, but there are probably many more including those who are asymptomatic. ACOG (American College of Obstetricians and Gynecologists) is leading the effort to train physicians on the island to place IUDs for contraception. The WHO this week has finally issued a recommendation to women in affected areas to delay pregnancy. 

Both ovary and breast cancer therapies are in the news this week, and the messages are promising. For starters, research presented a the annual meeting of the American Society of Clinical Oncology has highlighted 11 additional genetic mutations associated with increased risk of ovarian cancer. This may ultimately give us expanded opportunities for screening and treatment of this disease. 

On the treatment side, it turns out that a combination of IV and intraperitoneal chemotherapy is more life extending than either therapy alone, for the treatment of ovarian cancer. Also on the treatment side, it turns out that extending anti-cancer hormone therapy such as Tamoxifen for 10 instead of 5 years reduces risk of recurrence or second primary in older women with early stage breast cancer. 

Syphylis cases have more than tripled in the last decade. At the same time, the majority of sexually active women between 15-25 have NOT been screened EVER for any sexually transmitted infections since they do not believe themselves to be at risk.

The CDC ( Centers for Disease Control) has reported the “ the US obesity epidemic continues to worsen”. Fully 40% of US women are obese. Obese is defined as a body mass index (BMI) at or greater than 30. Do you know your BMI ? 

Food Friday: Nutrition Reminders

In the office, most patients show understanding of good nutrition. And yet, when at home they say they have trouble actually eating healthy. The frustrates them and mystifies me. I would like to help. Sometimes I'd like to just come home with them to show them how easy it is to make it work. But that isn’t exactly practical. Instead I’d like to come up with something tangible that would remind them of all the principles and tips they have learned, so they can put them into practice. 

Sometimes I think this could be done with an attractive nutrition art poster to be displayed in the kitchen. Sometimes, I imagine kitchen linens featuring helpful suggestions in clever graphics, e.g. “ Eat your greens ! “ For quite a while I have been imagining a deck of cards. Each card would feature one nutrition reminder. 

The reminders would have to be attractive, both visually and tangibly.The principles they conveyed would have to be simple and clear. Right now I am trying to cook up a list of catchy little reminder phrases which will help people have an enjoyable and easy time making good nutrition at home. I would like to devote this post to sharing what I have so far, and to solicit your input about what reminders you could use. 

Here’s my list so far: 

  • 3m3s
  • Bring your Own Bags 
  • Buy in Bulk
  • Buy in Season 
  • Buy Local 
  • Celebrate 
  • Cook from Scratch 
  • Cook With Kids 
  • Don’t buy Junk 
  • Dress the Table 
  • Drink Tea
  • Drink Water 
  • Eat Cultured 
  • Eat Fermented
  • Eat Low Glycemic
  • Eat Salads
  • Eat the Rainbow 
  • Eat While Grains 
  • Explore Cooked Vegetables 
  • Eat Healthy Fats 
  • Eat Fresh or Frozen
  • Eat with Friends
  • Eat Fresh Fruit 
  • Eat Organic
  • Eat Sustainable Fish 
  • Explore Paleo 
  • Grown Your Own Food 
  • Hara Hachi Bu 
  • Keep Sharp Knives
  • Keep Your own Recipes 
  • Know Your Farmer 
  • Make Extra Dinner 
  • Nuts to You 
  • Order Your Way 
  • Pack Your Lunch 
  • PPP
  • Purchase Good Containers
  • Read Labels 
  • Read Cookbooks
  • Resect Food Allergies and Intolerances 
  • Prep Your Breakfast 
  • Share Recipes
  • Share Your Garden Surplus
  • Shop Twice per Week 
  • Sit Down for Meals
  • Spice it Up 
  • Take Food Pictures 
  • Use a Kitchen Scale  

I would really appreciate any other ideas you have about what might help make good nutrition happen for you. Meanwhile, if you haven't already, check our the blog on the website and scroll back to see the last several Food Fridays for more cooking inspiration. 

Wellness Wednesday: Summer reminders #1 Sun protection 

More than a few ladies came in to clinic this week looking like lobsters. So I write again to give you the perspective your future self would have wanted your present day self to have. 

Sun protection will reduce your cancer risk. It will also protect from general skin deterioration. We have all seen wrinkles, crepe-y skin, blotchy discolored skin, overtanned depigmentation spots and, yes, skin cancer.  

With the advance of medical care, technology and nutrition, we can expect ever increasing lifespans. This means we have to take of our bodies so that they will last even longer than before.

You might ask why skin deteriorates since the actual matter of our skin recycles about every three months. This is a very interesting question whose answer should motivate you to have good sun protection. 

If you injure your skin with a bad sunburn, one so bad that you peel, new healthy skin grows up from beneath. Aren’t you good then ? Well, the new skin is good. However, unbeknownst to you, the DNA of the deeper cells which have generated the layer has been damaged. This DNA damage is what reduces the error correcting ability of the cells over the long term. Error correction ? Aren't cells identical when one divides to two ? Yes and no. They are mostly identical. But over time, imperfections in the cell division occur and errors are generated and build up. Damaged DNA leads to more errors. This is what eventually gives rise to the skin damage listed earlier. 

The DNA is damaged by the uv light, whether it be from the sun, or a tanning booth. Protection is a matter of timing, clothing, and sunscreen. It is also a matter of the correct use of sunscreen. 

To review this critical information, please see the following posts: 

Skin Deep 

On the Virtues of Hats and Sun Protection

Have a sunny week. 

Food Friday: Better Carbs 

Authorities agree that we consume too many carbohydrates and that this has contributed to the obesity epidemic. However it’s easy to eat plenty of carbs, lose weight, and have lots of energy if you just shift the way you think about them. 

When most people think about carbs (carbohydrates) they think of starches like white potatoes, grains like rice, and of course wheat products like bread, tortillas and pasta. But carbohydrates also comprise sugar, honey, maple syrup, corn syrup, etc, and all the products which feature them prominently, like conventional soda, frappes, and lattes. These sorts of carbohydrates are unhealthy because they jet sugar into your bloodstream much faster than you can utilize it and it ends up being stored as fat. The fat ends up having a variety of toxic effects down the line. Even the white flours, pastas, rices and white potatoes do this. The white flour and white rice have been denatured of their fibrous structure and because of this breakdown very quickly into sugar. 

Whole wheat flour and brown rice are commonly thought of as better carbs, and they are, but not as much as you might think. Their glycemic index (rate at which they break down into sugar) is not that much better than their white counterparts. These should be utilized by people of normal weight and body composition with high energy requirements. This would include adolescents and athletes.

It has been shown that consumption of 2-3 servings of whole grains per day reduces risk of diabetes, high blood pressure, colon cancer and obesity, compared to rates in those that don’t eat these. The precise reason for this is unclear, though it may well be because of the fiber and additional nutrients that whole grains contain compared to refined (denatured) grains.  It is a sad commentary that the presence of 2-3 servings of whole grains per day constitutes a measurably higher caliber of diet than our general population’s diet.

Certainly whole grains are not the only readily available dietary source of fiber and nutrients. What if, in an imaginary prospective research study, conventional eaters were compared to those with 2-3 servings of whole grains per day, AND against those with an equivalent amount of fiber, BUT in the form of vegetables and fruits? I suspect that the third group that took their carbs as fruits and vegetables would do even better. I feel confident in speculating like this because, as a rule, produce (vegetables and fruits) is considerably more nutrient dense than whole grains. Depending on the particulars, they have fiber, vitamins, minerals, but also other types of nutrient such as healthy fats and antioxidants. Moreover, they have even lower glycemic indices. 

So, I propose that we learn to take most of our carbs as produce. What ? No bread at dinner ? No pancakes or cereal at breakfast ? No bread for sandwiches at lunch ? People are sure they will starve. What they will do is lose some of their belly fat. They will lower their blood sugars. Pregnant women will gain less excess weight, and be less likely to have gestational diabetes. They will also spend more money and time on food. But, they could also be spending money on treatments for obesity, diabetes, heart disease and worse. 

There are other differences that should go along with this approach. Portion sizes usually need to be larger. Additionally, there should is more emphasis on healthy fats such as coconut oil for high heat and olive oil for low heat and dressings. Also, from a culinary standpoint, there should be a greater utilization of flavors such as spices, garlic, lemon, chili and so on.  Healthy sauces and dressings figure more prominently. and Finally, there is more emphasis on lean meats, poultry and cold water fish. 

I wanted to take this post and show you how this might look. I think that while you will find it completely different, you will find it rather appealing. 

 

Breakfast idea: 

 

I would pair this with a small bowl of fresh fruit. 

 

 

 

Lunch: 

Stiff leaves of romaine make a crunchy manageable container for savory contents, much like a taco shell. 

 

 

 

 

 

 

 

Dinner:

These are cauliflower mashed “ potatoes”, also known as “faux”  potatoes, which can be served as a side dish at dinner, drizzled with olive oil or butter.

 

 

 

These are zucchini noodles which just need a hearty meat sauce.

 

 

 

 

Dinner is in some ways the easiest, since you still have your “main dish” and your salad. All you need is another cooked vegetable, like these vegetable fries, and perhaps some fresh fruit. 

 

 

 

There are an infinity of substitutions like this. When families are transitioning from conventional diets to more of a paleo style diet like this, they may find it politic to try to make their new healthier dishes resemble old conventional ones. Eventually, this pretense can be abandoned, as more exciting approaches to healthy cooking are discovered. Check out any number of the new Paleo cookbooks out there. For more information, see the last four Food Friday blog posts on food inspiration. 

Wellness Wednesday: How to Tell if You’re a Workaholic

Most people say they are busy. But are they ? Americans are famous for being workaholics (fully 25 % of us). How busy is too busy ? 

I would like to present my thoughts on the issue. Then I would like to present some other sources which are more authoritative.

It is important to understand what is not too busy. If you work full time, but have no time to work out or see your spouse, and yet you have time to game, watch TV or get a professional pedicure, you are not too busy. 

You are not too busy if you find that working at your desk leads to hours of randomly surfing the web or checking social media. You can only assess yourself once you have cut all the unintended time wasting from your life. If you are mindfully watching a film, or checking specific things in social media for a few minutes, that is fine and does not count as time wasting. 

So let’s say you have optimized the way you work and spend your time (a topic for another day). Let’s say you have reviewed your schedule and have decided that everything on it is important and nothing can be cut. Then you have met the “ inclusion criteria” and can ask yourself these questions: 

  • Am I getting less than 7 hours of sleep on a regular basis ? 
  • Do I feel a constant sense of frustration at not getting things done ? 
  • Do I lack time to work out for 30 minutes per day ? 
  • Do I lack time to eat three healthy meals and snacks ? 
  • Am I getting sick too often ? 
  • Is the quality of my work getting lower and lower ? 
  • Am I neglecting important relationships ? 

 

If you met the inclusion criteria and you answered yes to any of these things, you should consider thinking about whether you are overcommitted. These would be the relevant endpoints for me, after 54 years of living with, working with and being an overcommitted person. 

WEBMD

http://www.webmd.com/balance/features/are-you-a-workaholic?page=2

This article places workaholism in its psychiatric context. It is a compulsion to go work, combined with discomfort when not working. So it is much more than working hard, or working a lot. They site signs like trouble delegating, thinking about work while on vacation, or neglecting one’s nonworking life. They indicate that cognitive behavioral therapy and support groups can be helpful. 

US NEWS 

http://money.usnews.com/money/careers/slideshows/17-signs-you-might-be-a-workaholic/2

This feature described signs you might be a workaholic. Noteworthy signs including having no hobbies, working through lunch every day, coming to work when sick, being accessible to work all the time, and consistently overbooking. 

The WORKAHOLICS ANONYMOUS site is a real eye opener. 

http://www.workaholics-anonymous.org/10-literature/24-twenty-questions

Surprises in their list of 20 questions include "Do you regularly underestimate how long something will take the rush to complete it ?” This is a more in depth read and I recommend it. 

FORBES 

http://www.forbes.com/sites/deborahlee/2014/10/20/5-signs-you-might-be-a-workaholic/#430847d833d1

Forbes showcases a very worthy article about work-life balance, citing some interesting statistics including the following : "Americans put in more hours than workers in other wealthy countries and are more likely to work nights and weekends.” They alsogive an introduction to Bryan Robinson’s book “ Chained to the Desk”, which is available on Amazon. 

The follow up articles in the same series 

http://www.forbes.com/sites/deborahlee/2014/10/20/6-tips-for-better-work-life-balance/#5ae8fd25dbc9

details 6 tips for a better work like balance. The two tops which appeal to me the most are “ Letting go of perfectionism” and “ Limit time wasting activities and people”. 

SCIENCE DAILY

https://www.sciencedaily.com/terms/workaholic.htm

This site highlights some more surprising aspects of workaholism including the observation that workaholics lose track of time. They also highlight some chilling aspects of workaholism including the problem in Japan, where early death related to workaholism has its own word, karoshi. We all know that workaholism takes a huge toll on mental and physical health, but death by karoshi is hard to fathom. 

I am going to strive in the next few weeks to make my posts more brief. I will feature more outside sources. It is my hope that these posts will be easier to write and easier to read. This is one step I will be taking toward a better work like balance. 

Send me your thoughts on the matter. I would love to see what you think. 

 

 

 

 

 

 

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

Zika infections in the US have taken sharp uptick of late, presumably due to the weather and mosquito activity. Zika infections in American pregnant women now number around 300, the largest number of which are located in Puerto Rico. Numbers are also up since the initially reported numbers did not reflect asymptomatic infections, which can affect fetuses as well. The CDC ( Centers for Disease Control) estimate about 80% of Zika virus infections are asymptomatic. 

The Zika virus is transmitted by mosquito bite and by sexual contact. Consumer Reports has studied the so called natural mosquito repellants and, sadly, found that they last no more than an hour. DEET is much more effective, and has been found to be safe in pregnancy. 

The CDC and Harvard Public Health have analyzed preliminary data. Women who get Zika in section in the first trimester have about a 13% chance of having a baby with microcephaly. The background incidence of microcephaly is on the order of .02 to .12% in the US. So far, it appears that infection in the second or third trimesters is not as consequential.

I wonder if Zika related brain damage is either present or not present, versus a spectrum of damage. If it is spectrum, what do the other 87% of babies have that we should know about ? 

The CDC director has made an impassioned plea to Congress. The House and Senate each have separate Zika funding plans, but they cannot agree. Meanwhile days could make the difference as summer approaches. 

A new study out of U Penn indicates that pregnant women who use marijuana increase their risk of preterm labor by five times. I am more interested in what it may be doing to the brain of both the mothers and the babies, and would be glad to see more research done on this important topic. 

The whole pelvic mesh situation is seemingly going from bad to worse. Mesh sheets are used in surgery to reinforce tissue. Various types of mesh in sheets or ribbons are used for hernias and for urinary incontinence. Johnson and Johnson developed mesh for use in pelvic prolapse patients. However, complications started arising including migration or erosion of the mesh. People were indeed injured, and lawsuits arose.  Washington and California are filing lawsuits against Johnson and Johnson, alleging that the company misrepresented the risks of its use. 

Now some of those same pelvic surgeons who installed mesh are removing it. Is is fitting and customary for a surgeon to handle any of her or his post op complications However in this instance, American Medical Systems has recently alleged that some physicians and lawyers are “ persuading” women to remove their mesh implants in order to make money and inflate damage claims. They also explain that there are now lending companies who work with physicians to fund these mesh removal cases. For shame !!! I will be following this story closely.

I have used Monarc “ ribbon” to suspend the bladder to help incontinence. It has an acceptable complication rate. However, years ago, when a fellow doctor friend of mine and I went to get trained on Monarc insertion, we were also asked if we wanted to train on mesh. I distinctly remember that moment when she and I looked at each other and made bad faces. It gave us both the creeps. We said no because our gut impression told us it seemed prone to complications. Lucky guess. Or maybe it was that the idea of having a piece of screen door sewn just under your vagina skin did not sound OK to us. 

The Republican Governor of Oklahoma Mary Fallin has ignored the party line, and vetoed the recent bill making abortion a felony. This brave politician described herself as “ the most pro-life governor in the nation” but vetoed the bill on the basis that it was “ambiguous and vague" and “ would not survive a constitutional challenge” , i.e. it would be illegal. The Governor was under great pressure from the Christian right to pass the bill. She also received information and pressure from the Oklahoma State Medical Board, the American College of Obstetricians and Gynecologists (ACOG), and the Center for Reproductive Rights.

Acting this presidential could get you a nomination. Similar bills are being put forth in South Carolina and Louisiana. 

Many of you have read my rants about various and sundry public health generated guidelines about women’s health screening tests. These would include mammograms, paps, annual exams and the like. My rants have generally been about the more lax approach seen by generalist governing bodies like the American College of Physicians, and the American Academy of Family Physicians. ACOG guidelines are more stringent, and I believe this is because we rely on more rigorous data produced by specialists in the field. Even so, generalist guidelines hit the press just the same as ACOGs, and it is difficult for a layperson let alone a community physician to understand why the recommendations are so different. 

As an example, ACOG believes the evidence supports mammograms in the 40s for women of average risk, whereas the American Preventive Services Task Force does not advise them until the 50s. In a nutshell, this is because the APSTF did not choose their study endpoints in the most meaningful way. Their harms included trivial things like fear of mammograms, and their endpoint was death rather than years of life. The public and many providers were thrown into confusion. 

Fast forward to the present for some good news.. ACOG will now be partnering with these same organizations to develop what will hopefully be an evidence based rigorous set of Women’s Preventive Services Guidelines. 

 

Stay tuned for more news next week on Medical Monday. 

 

 

 

 

Food Friday: Cookbooks

Todays's post is the last in a series of 4 posts about cooking inspiration. It is about cookbooks. As I survey my wide ranging cookbook collection, I can see that they sort themselves into a few key categories: 

Reference Material- These are books that encyclopedically categorize a small category of foods or ingredients, ie. The Spice Bible.  

Do it Yourself Cookbooks- These are books which have recipes and methods for making that which we commonly think of as " store bought" stuff.  These books often collect food preparing techniques which are in danger of being lost from the general population. How many of you know how to make crackers, cheese, pickles or ice cream ?   i.e The Home Creamery by Farrell Kingsley. 

Cookbook travel- These books explore a region dish by dish. They are often noteworthy for their fabulous photography.  i.e. My Paris Kitchen by David Lebovitz

Health related cookbooks- These are focused on foods, dishes and menus which have health benefits. There are many such books claiming this feature, but not all actually have it. I have included a few which I think have genuine health benefits.  i.e. The Autoimmune Paleo cookbook by Mickey Trescott, NTP. 

Coffee Table Cookbooks-  These books are typically large format, and magnificently photographed. They are sumptuous tomes which are meant to be works of art in and of themselves. Example: Culinaria, eds. Andre Domine, and Michael Ditter

Chef Based Cookbooks- These feature one famous chef who gives presents their unique recipes but also their versions of the classics, i.e. Mastering the Art of French Cooking, by Julia Childs. 

Category Cookbooks- These are cookbooks which focus on a particular category of cooking, i.e. The Essentials of Roasting by Williams Sonoma. 

Comprehensive Cookbooks- These are cookbooks which aspire to cover everything comprehensively, ie. The Best Recipe, by Cooks Illustrated. 

Here are some homegrown photos of my cookbook shelves as they are tonight. 

My personal favorites shift every few months. Right now, I am biased toward the health related cookbooks since I believe more and more that one can make healthy food delicious. We understand more than we ever have about food science and human nutrition, and many well educated and creative writers are producing excellent cookbooks by marrying this information with their skill and taste in cuisine. 

I also believe that once you taste healthy food from well written recipes, that you will not be able to go back to ordinary unhealthy food. 

With this in mind, I am going to plug one cookbook series and two particular books by different authors as my top choices at this time: 

The Jonny Bowden series on The Healthiest Foods

Paleo Takeout by Ross Crandall

Nom Nom Paleo Food for Humans, by Michelle Tam and Henry Fong 

I love all the online recipes and sites. But sometimes, the large glossy photos and thoughtful prose in a traditional paper cookbook is uniquely satisfying. Paper cookbooks also permit annotation. I can tell you all of mine are written in, with dates, who I made the recipe with, and any modifications I saw fit to make. 

Take a walk on the culinary wild side, and read a good cookbook. Better food is pleasant step toward better health. 

Wellness Wednesday: Healthy Boundaries

Boundaries are essential to our physical and mental health. And yet, they are rarely discussed in everyday conversation. This post is to put the concept of boundaries on your radar, and into your vocabulary and to encourage you to learn as much as you can about them. 

Boundaries can be physical, mental, emotional, or even functional. At essence, a boundary is the line between you and everything else. To have good boundaries means that you maintain a truthful view of yourself. You know how you are distinct from others and honor that. Additionally, you take responsibility for all that is yours, from the state of your body, to your thoughts, your emotions, your skill sets, and the way you perform in life. 

Bad boundaries allow numerous problems to occur. For example, weak boundaries allow one person to tolerate mistreatment from another. Another kind of weak boundary allows one person to blame others for their problems. Bad boundaries produce abuse, resentment, chronic victims, pleasers, controllers, bullies, the overcommitted, enablers, entitled freeloaders, martyrs and guilt trippers… The list is endless. 

Boundaries are established as we grow up and have life experiences. We may learn from experience that standing up to a bully causes them to leave us alone. Or we may learn that it makes the situation worse. We may learn from parents that misbehavior has clear consequences, or we may learn that we can get away with anything. We may learn that when we apologize, it is accepted and life goes on. Or, we may get a never ending stream of resentment. All these types of things can affect the integrity of our boundaries. 

Those who have suffered abuse have particularly damaged boundaries. They tend to tolerate much more mistreatment than they should. In fact they may not even know to classify mistreatment as mistreatment since they do not even know what healthy relationships look like.  To them, an abusive relationship is sadly normative. And since boundaries are like fences in that they have gates, abused people have trouble with gates as well. Is particular,  abused people often shut out those trying to help. 

Few people have perfectly healthy boundaries. To have healthy boundaries, one has to be aware they even exist, if only on an intuitive level. To really understand them requires examples. Having healthy boundaries is about setting limits for oneself. While it is not about setting limits for others, it is about setting limits on what one will tolerate from others. Likewise, it is not about reacting to others. Rather, it is about communicating clearly specifically directly and honestly from a first person point of view ( "I statements") and giving responsible feedback to others. 

We all need to be aware of our personal boundaries and how to keep them healthy.

 

  • First is to realize boundaries exist.
  • Second, we must realize we have an innate right to maintain our boundaries.
  • Third we must become self aware of our own thoughts and feelings regarding what we are comfortable or uncomfortable with in ourselves and others.
  • Fourth, we must be honest and realistic about our needs, and employ self care to meet them.
  • Fifth we must be willing to enforce our boundaries if they are violated. This is done for the long term good, but we must realize that in the short term it may cause conflict.
  • Sixth, we must reach out for support and knowledge as we strive for healthy boundaries. This is because we are trying to learn that which, by definition, we did not know before. It is also because we may encounter resistance from those who encroached on our boundaries before. Sometimes, this requires professional counseling or a supervised support group. 

 

Healthy boundaries are critical to our self respect, integrity and optimal functioning. Here is some great reading to learn more:

 

http://psychcentral.com/lib/10-way-to-build-and-preserve-better-boundaries/

http://tinybuddha.com/blog/how-to-set-healthy-boundaries-3-crucial-first-steps/

http://www.essentiallifeskills.net/personalboundaries.html

https://www.ipfw.edu/affiliates/assistance/selfhelp/relationship-settingboundaries.html

https://www.psychologytoday.com/blog/prescriptions-life/201311/7-ways-protect-your-energy-enforce-healthy-boundaries

http://www.loveisrespect.org/healthy-relationships/setting-boundaries/

http://www.huffingtonpost.com/jennifer-twardowski/6-steps-to-setting-boundaries-in-relationships_b_6142248.html

http://greatist.com/happiness/how-to-set-boundaries-in-relationship  

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

Zika Virus was front and center at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG) this last week. Hospital protocols are being developed to handle Zika affected births. Additionally, research continues into the the way that the virus affects babies, some utilizing the placenta. 

The annual ACOG meeting also presented a medical legal panel which presented evidence that latest cluster of TRAP (targeted regulation of abortion providers) laws were not based on medical indications. Many such laws are introduced under the auspices of medical necessity, where the available medical literature does not indicate such. It seems to me that abortion opponents should be truthful about promoting pieces of legislation based on their moral and religious views, and not medical science, for which there is none. 

In Brazil, where Zika virus is rampant, abortion is illegal, even for anomalies. Recently, evangelical politicians there have introduced stricter penalties there for those who illegally are found to have aborted a baby with microcephaly. There are nearly one million illegal abortions in Brazil each year. The number of women who are hospitalized for complications from these illegal abortions is ten times the number of women who are not. 

Oklahoma just passed a law making it illegal to have an abortion. It is a felony there, punishable by up to three years in prison. Physicians performing abortions would have their medical license revoked. 

And no matter where you stand on the issue of abortion, it comes as good news that abortions in the US and other developed countries have significantly declined since the 1990s. In my experience, abortion is a tough decision for people and is fairly hard on women. 

Also in the good news department, new research in JAMA (Journal of the American Medical Association) indicated that exercise wards of a variety of different types of cancer, even in those who smoke or are obese. There is a 20 % risk reduction for about 13 different types of cancers including esophagus, lung, kidney, stomach, endometrium and others. 

And in some news which I consider to be outstandingly good news, a panel at ACOG has generated a strong statement of consensus that 39 weeks is the optimal time to delivery a baby.  They have stated that there is little to gain and considerable to lose thereafter. We Ob/Gyns are committed to practicing evidence based medicine, and so I have managed patients according to the existing algorithms of the day supported by the best available evidence at the time. But, as my 22 years of practice have ticked by, I have had a stronger and stronger hunch about this 39 week point. Now there is finally a high level consensus about it. The presentation was so strong the the 63% opposed to the consensus before the talk turned into a 81% for the consensus by the end of the meeting. Inductions at 39 weeks had a lower complication rate than previously appreciated, and the C section rate did not increase. 

The vaccine rate for HPV (Human papilloma virus) has been low in this country. However, it is more than it has been in last years, and the rates of high risk HPV disease are decreasing. To really stamp out cervical cancer, we need to achieve the so-called “herd immunity” conferred by near universal vaccination. 

More good news…. In 2010, 16 % of Americans were uninsured. In 2015 this dropped to 9.1 % of Americans. Of course this is related to the ACA, the Affordable Care Act. Of course this has a cost. But, as a physician, I would like to remind the non-medical public that it is much cheaper for the taxpayer to pay for early prevention of illness and pregnancy than to pay for delayed treatment of illness and unintended pregnancy. 

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

 

Food Friday: Food in Literature

This is the third in a series of four posts about food inspiration. The first was on food websites, and the second on food movies. This one is about food in literature. 

The body of food literature out there is astounding. It is generally nonfiction, however some fiction does food so well the I shall include a sample of it here. In my research for this piece, I discovered not only new food writing to complement what older material I have unearthed throughout the years, but books about writing food writing. I also discovered food writing collections, and “best of” food writing collections. That’s how popular it is getting. 

We will start with a selection from fiction: children’s fiction. If you have not read Little House on the Prairie, by Laura Ingalls Wilder, you should. It is a classic children’s book despite the unfortunate TV series from the 70s. The descriptions of prairie meals or the maple syrup collection have stayed with me to this day. 

In college I was a vegetarian for two years. I was interested in this from an environmental standpoint. By some calculations the energy and water needed to produce a feedlot beef gram of protein was much greater than that to produce a gram of plant based protein. Also I lived in Synergy, a vegetarian row house at college where they knew how to combine foods to make complete proteins. At that time, the culinary bible in my life was Diet for a Small Planet by Frances Moore Lappe. This book connected the dots between bringing food to our table and the environmental consequences to soil, water, air and people along the way. Fast forward to the present and you can read very well written, researched and photographed books on the same subject, chief among which are books by the wonderful Michael Pollan. You cannot go without reading these. 

My soon to be husband lived in Synergy with me. We married after my fourth year and moved to the north woods, where he became a professional outfitter. There we got our cake and ate it too in the form of sustainably produced wild game, mostly elk and deer. To this day, we eat it almost exclusively, except for salmon and organic chicken. 

I became a young mother, and like all young mothers, read books to my children. Among them were the lovely Brambly Hedge Series books by Jill Barklem. I don’t know who was more fascinated, me or my daughter Echo. The illustrations and prose were exquisite, and conjured little mouse size kitchens full of flour sacks, jams, preserves, drying herbs and wheels of cheese. The author went beyond that and described the elaborate country picnics of the mice, with their fruity gelatin molds, pies, tarts, and syllabubs. 

Upon my arrival to the countryside, I had to learn a number new skill sets beyond parenting. Chief among them were gardening and cooking. I had come to the marriage with one Good Housekeeping cookbook from my mother. It was no nonsense with good illustrations, and from this I learned that I could hardly abide a cookbook without illustrations.

I read about cooking. I also read about gardening. I discovered you could read about gardening and cooking at the same time if you read about kitchen gardens, or potagers, as the French call them. I acquired a divine volume entitled The Art of French Vegetable Gardening, by Louisa Jones et alia. I pored over its pages and tried, with no money, to make my garden look the same as the potagers within the walls of ancient french castles, a noble effort indeed. 

I discovered food writing in earnest. I discovered there was such a thing as a food writer, and read Ruth Reichl’s Comfort Me with Apples. Ms. Reichl was the last editor in chief of Gourmet magazine, and now makes food shows at PBS. She introduced me and all her readers to a world of food writing. 

Meanwhile,our sons were born, and their literary mice were warriors, not bakers. They loved the Redwall series. This series caught on with all my kids, and as they worked their way through over twenty volumes, they often made mention of the magnificent feasts within those pages. Indeed, our son Forest and I wrote to the British publishing company for the Redwall series offering to develop recipes for a Redwall cookbook. They wrote us a very warm but formal letter back indicating plans for such were already underway. A couple years later, one appeared in bookstores. You can still find it on Amazon as the Redwall Cookbook. 

Our family meals became very important to us. The idea of a family meal was very old. However it came into popular modern focus again with the advent of the Slow Food Movement. A book of the same name appeared by an Italian author Carlo Petrini, and I devoured it. It was a counterpoint to the fast food culture that American had become. 

Food was very international for us. It was a form of armchair travel. We were very busy with young children, med school and residency and we did not vacation much. Learning about food and making it from my own garden gave me some of the same satisfaction. Accordingly, I fed this interest with some of the most famous food writing, Pater Mayle’s A Year in Provence. 

I have always been a lover of all things French. This is because my French teacher in high school was very dear to me. She was an important figure in my life, and I keep in touch with her to this day. Somehow, magically, she was able to teach me discipline with affection. Not surprisingly, she was very strict in class, and made us learn the language and culture very well. So naturally I gravitated toward books about french food.

This brings me up to the present day. On my active shelf I have several books about French food, the voluminous Julia Child volumes, Mastering the Art of French Cooking, French Women Don’t Get Fat, by Mireille Giuliano and The Sweet Life in Paris, by David Leibowitz. Of course a couple of these are books by Americans about French Cooking. To read a French book in French about French cooking is another matter for another day. 

I will leave you with something sweet to finish. I love to read about cooking. I also love to give books about cooking. Regular readers will also recall that l adore chocolate. Naturally therefore I love to read books about chocolate, its origins, production, etc. I once gave all my children a great coffee table book about chocolate, called The Ultimate Encyclopedia of Chocolate, by Christine Macfadden and Christine France. The next Christmas, I forgot and gave it again. Would you believe the next Christmas I gave the eldest the same book once more ? Such is the nature of adoration. 

Until next week, happy reading.