Structure Sunday: The Structure of Family

So much has changed in six weeks. Grandpa passed. His memorial brought a tide of family and friends together. And now our daughter  has delivered a baby girl named Emery Helena. 

Those tasks once reserved for adults have passed to those who still to my eye look like children. Our roles have changed and our titles have too. This morning I heard a call for grandpa, which sounded out of place, on account of his passing,  until I realized they were calling my husband. Mom, which was reserved for me, has passed to my daughter and I am becoming grandma. 

My exact title is still under discussion. I've been working a lot on labor and delivery lately, and the nurses are trying out different versions of grandma,  seeing which ones fit, and which ones will stick. 

I would like to think this is because I do not seem exactly like a grandma.   I think this is true for many women in my situation. Our culture has evolved in such a way as to allow women of my age to continue very active lifestyles. Many fifty something's are much healthier than their counterparts from decades past. The way we can live and the roles we can play at any given age are not nearly as limited as in the past. Perhaps we live less by convention or stereotype than in days gone by. 

That said, a grandmother is still a grandmother and she has a role to play. I and all the other members of my family, seem to have eased into our various new roles without much deliberation, just some common sense. However I would like to give my new role some thought in that I'd like to be a grandmother for the new age. I'd like to teach my granddaughter to code, and I'd  like to go to Zumba with her and my daughter. I'd like to keep what's good from grandmothers past while augmenting it for the present day. I'd like to be grandmother 2.0. 

Food Friday: My labor basket

The time has finally come for my daughter to have her labor induced. She is overdue and it is time. And, since gift giving is one of my "love languages" I was inspired to create a "labor basket" full of goodies. 

Now I know as well as any Obstetrician that one is restricted to clear liquids during induction of labor. This is because a patient under induction should, at any time, be prepared to go to C section. C sections are much safer when the mother has a virtually empty stomach, or only clear liquids on board. This is because pregnancy, labor, anesthesia, and C sections all make patients more likely to aspirate, which means to breathe in something they should have instead  swallowed. It is basically choking, and it can lead to pneumonia. The other reason is that clear liquids absorb quickly, and should the patient become nauseous, she will have an easier time getting rid of it. She will feel less badly. 

So my labor basket for my daughter contains the finest clear liquids I could find. First, I got our favorite: Perrier, in three flavors: plain, grapefruit and lime. Next I got a couple flavors of IZZEs, peach and blackberry, the ones which were truly clear and had no visible particles. To round things out, I picked up some of her favorite tea, Earl Grey decaf, and then, lest she be tired of all the sweetness, some seasoned organic chicken broth in little single serving containers. Finally I found some nice stainless insulated mugs. 

Then I considered the whole environment. We had covered taste, so I decided smell was also important. I chose some natural citrus body spray. Then I tucked in our favorite body cream called Booda Butter. No kidding it smells just like chocolate, but looks and feels like soft butter.

 Then, I covered sound. I know she has her Pandora on her phone, but I didn't think headphones would work. So I sprang for a little USB powered waterproof bluetooth speaker. And, being the veteran mom that I am, I enclosed a 12 foot USB extender cord for convenience. For sight, I put it all in a pretty green picnic bag and brought a blooming orchid along as we prefer living plants to cut flowers.  

I was tempted to overdo it since I had all kinds of other ideas. For example, you could include a cozy throw for mom, as long as its washable. You could tuck in some healthy chewing gum. The best idea I have seen was from the very cool older patient I had many years ago. She brought a bag of beautiful textiles and draped them all over her labor room, i.e.  over closet doors, etc. The room looked like a Casbah. And last week I had a lovely patient who used an aromatherapy atomizer with essential oils in her labor room. 

Your gift may not fit in a basket. You may be asked to help in the labor room, but only if she asks. Perhaps she will need help with her other children or pets while she is in the hospital. You may also be needed afterwards, helping with chores. Baskets are great, but perhaps the best gift of all is to be present.

Wellness Wednesday: Quantify Yourself

I have always said that knowledge is power. This is especially true in this digital age since we have access to so much searchable knowledge. I have also always said that one of our primary goals in our medical practice is to empower women to take charge of their own health.  It is therefore natural that I am very interested in helping women to empower themselves through the use of technology.

It turns out that one of the most powerful things we can do to take control of and change our own behaviors is to observe, record and track them. This habit is called quantification. People who do this regularly as a part of their self improvement are participating in the "quantified self’ movement. Livescience.com defines the quantified self movement as a “movement which aims to measure all aspects of our daily lives with the help with technology.” 

Quantifying ones habits such as hours of sleep, minutes of exercise, or calories eaten, does not necessarily need to be done with a high tech device. It can be done with paper and pencil. However, since smart phones are nearly ubiquitous, these records are most often kept on these small powerful personal devices.  Of course there is a proliferation of different apps for this, one for every topic and several for many parameters. Not only is there a proliferation of different software apps to help with quantification, there is a proliferation of different hardware such the Apple watch and the FitBit. 

If the patient and I decide to follow some detail of her health such as her blood sugar, we begin some sort of record keeping. The patient makes the measurements, records them and naturally evaluates them herself as she goes through the week. This alone often results in substantial improvement in her numbers, since she can begin to discern patterns and the reasons behind them. Taking measures to push the data toward better performance is gratifying day by day. It becomes like a game that the patient is determined to win. This is called ”gamification" and it too, it is powerful in behavior change.

When the patient comes in to review her data, she can get even more benefit when we analyze her data together. If we add another layer such as her diet, and superimpose it graphically on the blood sugars in her records, we can see a cause and effect relationship between what she eats and her blood sugars over time. Sometimes a third layer of data such as activity can be added into her records and we can use this variable to improve her blood sugar control even more. 

This kind of record keeping puts the facts and the control in the hands of the patient. It is much more effective than a doctor simply telling her to eat better and exercise more. It has been my consistent observation that all sorts of patients have success with this type of approach. Moreover, in reading about this "quantified self movement" it seems apparent that this technique can be used for many types of conditions, like weight, exercise, autoimmune activity, sleep problems and even mood disorders. It can also be used for broader issues of life performance, in relationships and on the job. 

I hope this introduction into the quantified self movement has inspired you to learn more. Here are some fun references which makes for very interesting reading.

The Quantified Self, a TED talk by Gary Wolf

The Quantified Self at Livescience.com

The Beginners Guide to Quantified Self, at Technori

Why You Should be tracking Your Habits ( and how to do it well) at Lifehacker.com

The Quantified Self: How Cold Hard Data Improves Lives, at Bloomberg.com

The Data Driven Life, at the New York Times 

How Self-Tracking Apps Exclude Women, at The Atlantic

Medical Monday: Skin Deep

What does it take to be beautiful ? I mean physical beauty. It it feels so awkward to even ask this since, in general, beauty is mostly a matter of the heart.

 You might be surprised to hear about my idea of physical beauty. Basically, to me, physical beauty equates with health. Every face, every age, every body type, hair type or skin color is beautiful when it is healthy. 

Skin is especially telling. It is the first thing we see. The skin of the face is vulnerable and worthy of our protection. It is sun season again, and I would love to see everyone take pride in and care of their skin. 

What are the main steps to beautiful skin ? 

• Optimize your fitness, nutrition and hydration. 
• Cleanse and moisturize twice per day. 
• Exfoliate once per week.
• Sun (UV) protect ardently. 
• Never tan. Never. 
• Be assured sunscreen is safe.
• Chose a broad spectrum sunscreen with SPF 30 or greater. 
• Chose a water resistant brand. 
• Apply 15 minutes before going out so it will soak in. 
• Reapply every 2 hours. 
• Consider a hat or SPF clothing. 
• Get a partner to "watch your back" for any suspicious moles. 
• See your dermalogist for any concerns. 
• Enjoy summer. 
• Be beautiful. 

Structure Sunday: The Structure of a Family Road Trip

Family road trips are traditionally fraught with stress. But yours doesn't have to be. The road trip season is upon us and you will want to prepare.

irst of all let the kids in on the plan. Get them involved in the preparations. It won't hurt them a bit to learn the organizational skills necessary for a small vacation. In fact you can delegate age appropriate chores to kids from 5 To 95 and that will make everyone all the more engaged. 

• Pick a destination. 
• Pick a route. 
• Research attractions along the route and at the destination. 
• Make sure everyone gets some say on the activities.
• Go over the fine art of packing light and packing layers. 
• Make sure everyone has a duffle and a backpack of their own.
• Choose some activities for traveling. Choose a mix of electronic and paper content. 
• Choose a mixture of packed food and culinary stops along the way. 
• Always plan for minor illness and inclement weather. 
• Plan your stops if there is any question of availability of lodging. 
• Encourage each traveller to document the trip in their own way, i.e. Diary, sketchbook, iPhone, camera, etc. 
• Confirm you have necessary charging and connectivity cords, batteries, etc. 
• As the trip leader, personally confirm the travel arrangements from the condition of your car to the AAA membership.  

What could go wrong? : ) We ourselves are on the road heading down to Missoula for the Lindsey Stirling concert. It is turning into a bit of a culinary tour since when I left home, I stopped by the natural food store and got a bag of healthy car foods and drinks. Then going past the lake, grandma offered us waffles with berries. In Ronan we stopped by a little red and white taco place and I just knew the tacos would be crispy and hot. They were. Our intentions were then set on a bakery further down the road whose reputation had preceded it. Alas it was closed, but it made a good picture. (See photo.)

Travelling is an important family activity when learning takes place and memories are made. Takes these steps to make sure that both are good. 

Food Friday: The Joy Lunch Club

Who doesn't look forward to lunch during a busy day tending kids at home or a hard day at work? I look forward to lunch. However, when I interview patients about their eating habits, I find all too often that patients skip meals, especially breakfast and lunch. 

I understand. We're busy. Sometimes we're not even hungry. We think skipping meals will help us lose weight. But as I have mentioned before, skipping meals actually causes us to lose muscle and slow down our metabolism and our thinking, making us feel sluggish and perform poorly. If we skip breakfast we are even less hungry than we would be had we jumpstarted our metabolism with a good breakfast. 

So, I have decided to promote the idea of a homemade workday lunch by issuing a challenge called the Joy Lunch Club. I will give the readers of this blog two weeks to submit a picture of their awesome lunch on a typical busy day. The best workday lunch photo at the end of two weeks will receive a custom "yoga girl" lunch box complete with containers and ice. To qualify, the lunch must be healthy, contain protein and produce like fruit or vegetables, be homemade, and if  brought to work, be in suitable containers. Photos may contain the lunch itself or you with the lunch. They should be posted to my office Facebook page linked to this website. Finally, to be eligible for the prize, you have to be subscribed to the site. (Please see the "Subscribe and Comment" section in the menu.)  At the end of the two weeks I will announce the winning photo, who's owner will then need to Facebook message me for the prize. Unfortunately I need to limit this offer to the US and Canada.

Others can order this unique lunch box through our Zazzle Store found HERE. Have fun, enjoy your lunch and good luck! 

Wellness Wednesday: How to have a Healthy Argument

I would like to say that couples and families can get to a point where they do not have arguments. However I believe that is unrealistic. Instead, I would present to you a list of rules which will help the arguments that do occur be fair, responsible and healthy. 

Click HERE to learn more.

Medical Monday: You asked for it… Endometriosis

Women are curious about endometriosis because it is a curiosity. The causes of endometriosis are not precisely understood but we have a good working knowledge.

We do know that it involves endometrial tissue being extruded out of fallopian tubes and into the pelvis. There, in a subset of women, the tissue implants and becomes active. Then, in a subset of these patients, this tissue secretes inflammatory mediators. Finally, some of these women develop autoantibodies. Pain and infertility can result from all of the inflammation and the damage that it causes. Cysts full of liquid can form; scarring can block tubes and distort anatomy. 

Treatments are of two types: medical and surgical. Medical therapy makes good sense because we know that endometriosis is hormonally responsive. Conservative surgical therapy is helpful to drain cysts, cauterize lesions, and release adhesions such as the ones in the photo. Definitive surgical therapy includes removal of the tubes, uterus and ovaries. 

Recently I was asked to review a blog post posted on my Facebook page. (See blog post HERE)  It was by a naturopathic doctor who was proposing a different approach to endometriosis. She was postulating endometriosis as an autoimmune disease. Apparently she had read a speculative literature review article, (Reference HERE) which noted an increased prevalence of inflammatory mediators and auto antibodies in those with endometriosis. Despite anything like a high level of evidence, (See levels of evidence HERE) she drew a causal relationship between these findings in the occurrence of endometriosis.

I think the authors of the study would consider these findings noteworthy associations, but would not feel entitled to draw any further conclusions such as causality.  I myself would say her blog post thesis is a case of confusing eggs with chickens. In other words, endometriosis probably causes inflammatory mediators to arise and fosters the development of autoantibodies, not the other way around as she proposes. Some people are more immunologically reactive than others, and those that are will likely develop more autoimmunity of whatever type. 

It is important to note that the author of the blog post draws a conclusion from this paper from which no conclusion can legitimately be drawn. She goes on to propose therapy, including modifications in diet, i.e. going off dairy and gluten. She then suggests her book which further discusses endometriosis and the "natural immune-modulating treatments" which she offers. 

I see two main differences between legitimate medical websites and others. First, legitimate medical websites are evidence based. This  means that not only must they cite medical research, but that they must cite it correctly, and not draw unfounded or speculative premature conclusions for associations which may be suggested. Secondly, legitimate medical websites are realistic. Others are boundlessly optimistic, offering readers and customers results that invariably surpass conventional treatments. 

I say, follow the money. Also, if it seems too good to be true, then it probably is. Finally, the proof is in the pudding. 

Click HERE for your internet learning toolbox. 

To learn more about endometriosis, check out our straightforward page on this common disease HERE. 

Structure Sunday: The Structure of Time

For life to be good, we need a rhythm in the day, the week, the month, the season and the year. These circles within circles allow us to feel accomplishment, and to look forward to celebration. These finite periods allow what is overwhelming to become manageable. Structuring time helps us take the one lifetime that is ours, and fill it mindfully. 

I need to feel I am making progress on my long term goals every year. I use the annual holidays like Thanksgiving and New Years for self assessment. I can look back at the same time one year back and see the changes. 

The seasons hold a different joy. Each time I am sad to see the leaves fall, I am, shortly thereafter, shocked by the beauty of frost and snow. I am reminded that all seasons hold beautiful surprises, and that I am foolish to imagine that nothing exciting is around the corner. 

My business cycle is the month. This is how bills are paid, and accounts are balanced. Accountability is examined month by month. Actual money is one representation of work and effort, and as such it is a useful tool to use in gauging how we are meeting our responsibilities. 

My work cycle is the week. I want a chance to get stuff done, and I want to be creative in that work. I try to pace myself all week long, with a lighter day midweek, then forge on to the weekend, when I would hope to be creative. 

My personal cycle is the day. I believe we all thrive with a good day's work. However, in my opinion, this includes some important health and productivity features. Consider the basics:  sleep , nutrition and exercise. Most people need at least 7 hours of sleep. With this, you will have more concentration, stamina and productivity. You might even have a better mood. Life is just more fun and you will be more successful with a modicum of sleep. 

Food is so important! It is your fuel. You should frontload your day with a healthy breakfast of protein, fruits, vegetables, and whole grains. That will turn on your metabolism and your brain. Later in the day, food can give you several healthful recharges: your midmorning snack, your lunch, and your afternoon snack. This way you will not tank your metabolism, feel sluggish, or hardly be able to think. Eating three meals and three snacks per day is a foundational principle of nutrition, and will help you feel better and perform better. 

Somewhere in the course of the day you must carve out at least a half an hour for exercise. It is best to schedule this formally, just like a meeting or an appointment, and to take it just as seriously. The magic of routines will reward you if you persevere. The more you do it, the easier it will be. 

 Everyone from a teen mom to the CEO of a large corporation needs a schedule. To achieve mastery over your time, you must invest in either a paper or electronic system. Smartphones generally come with everything you need in this regard, but the old school day runners can do just as well. But these alone won't do the trick. You must develop a routine of sitting down with the schedule to look it over and fill it in mindfully. I recommend looking at your schedule every Sunday to assess the coming week, and also looking every evening to prep for the next day. Make your schedule check a routine. The habit will stick better if you do it at the same time and place every day. 

Routine lowers stress. Breaking up goals and plotting them over time encourages success. These are among some of the most important things I want for my patients. The particulars I teach them about disease conditions and health maintenance will not help them unless they can follow through on the recommended treatment or prevention steps. Fostering patient success will continue to be a big thrust of this blog and the website in general. 

For more information, please see the hyperlinks in the text. Have a great week ! 

Food Friday: Manage your weight the counterintuitive way !

It seems to make sense that to lose weight we should eat less. On the other hand we all know certain people who seem to eat all day long and are quite slim. Indeed, the French who are known for their small figures, have food as a centerpiece of their culture, a lot of it, and all day long, well into the night. 

How is it possible? It's all about metabolism. It's not about the calories you eat in one sitting, and it's not about the calories you burn in one exercise session. It is about the rate at which you feed calories into your system and your body's ability to utilize them as they come in. 

To have good energy all day, you must have a moderate steady input of calories all day long. If you have a span of time without enough fuel, you body will turn down your metabolic rate and you will feel fatigued and be sluggish. If we eat episodically, then binge, we create a slow metabolism, then overwhelm it with an excess. Such an excess is stored as fat, even though then total number of calories eaten in that day might have been low. This strategy leads to feeling sluggish, losing muscle, and gaining fat all in the course of one day. 

Anyone would rather feel energetic and improve their body composition, but few know how.  Surprisingly, you have to eat more of the right kinds of food, and eat them more often. This produces a steady release of calories. To accomplish a steady release of calories into your system, you need to choose foods which singly, or in combination, release slowly. Unprocessed natural foods tend to release slowly, whereas process foods release quickly. If you combine high quality carbohydrate containing foods like fruits and vegetables with healthy fats or proteins, then you will have energy even longer. 

The rate at which a food digests and release energy in the form of glucose is called the glycemic index. Slow release foods have a low glycemic index, and that is what we should be choosing. If we choose high glycemic foods like sweets or breads, we stimulate a spike in our insulin levels, which leads to cravings. Thus, the less we eat of high glycemic foods, the less we want them. 

Do you want to leverage the system even more? Build up some muscle through a mixture of cardio and resistance. Muscle is lean body mass and has a much higher metabolism than body fat. Either cardio or resistance will increase your metabolism all day long, far beyond your exercise session, but together, they synergize. 

If you are willing to eat three moderate meals and three small snacks composed of some protein, fruits, vegetables, healthy fats and low glycemic grains, you will have more energy and you will drift toward your ideal weight. If you are willing to do a half an hour of cardio and light resistance every day though a gym or a DVD available at any big box store, you will make progress even faster. 

To learn more, see this following section in our website. 

Nutrition 

Bon appetite! 

Wellness Wednesday: Common Illnesses in Pregnancy

I was inspired to write this post in light of the significant spring cold season we are now finishing. It is common knowledge on the medical hill that this spring's common cold was a bad one.  For most people, the cough lasted several weeks, even though the illness itself was over. It was not pertussis, it was not flu. It was just a garden variety virus that hit hard. 

So I am going to take a moment and talk about prevention. Prevention takes three forms: 

1. Vaccinate for what you can: Pertussis, and Influenza

2. Hand washing and avoiding the sick. 

3. Keeping up on self care with exercise, sleep and nutrition. 

They really are immensely effective. 

Outside of pregnancy, when we get a cold or stomach flu, we doctor it ourselves. But in pregnancy it is different. In pregnancy, it is a good idea to touch base with your doctor about your symptoms if they are anything more than slight. She can give you a few guidelines and recommendations, even if no antibiotics are prescribed. On that note, just as a reminder, most of these common infections are viral, and as such, do not respond to antibiotics. That said, some viral infections can be followed by a bacterial infection. This may be the case if one gets better, and then worse again. Additionally, some viral upper respiratory infections can set off asthma and we can help with this too. 

I set up a page for common illnesses in pregnancy HERE and I couldn't help but notice that in all cases, treatment included, lots of liquids, like tea, soup, and water. Self care included tylenol, since ibuprofen is not recommended in pregnancy, rest and lots of baths and steamy showers.

Perhaps we shouldn't wait for an illness to take good care of ourselves. 

Medical Monday: Gardasil Gets an Upgrade

Most of you are familiar with Human Papilloma Virus, aka HPV. This is the very prevalent virus which causes precancer and cancer of the human anogenital area. When I first started training in gynecology, fighting HPV seems like such an uphill battle, since it spreads so easily and is so prevalent. And then came the idea of a vaccine. It seemed too good to be true. 

Gardasil was developed and released. I am proud to say one of my friends was involved. It protects against two strains of HPV known to cause cancer, and two which cause condyloma or warts. Physicians all over the world rejoiced, but adoption rates weren't what we had hoped. 

Gardasil was initially studied in girls and women since the disease caused in women is more common and more severe. And so it was initially approved only for women. I got all my children vaccinated, and even the boys before it was approved for boys. One of my sons did some research after he got his shot, and approached me later, asking, " Mom isn't this just for girls ? " I reassured him that nothing bad would happen. It works just as well in boys and men, who distribute the virus, usually without having any disease themselves.  It eventually was approved for boys. 

Now Gardasil has been expanded to cover NINE viruses ! It is worth noting who is eligible to receive it: 

Boys ages 9-15.

Girls and women ages 9-26. 

 I expect that the age differential in eligibility between boys and girls is simple a case of what groups have had validating studies done, and I anticipate that the boys group will be expanded to the same age group as girls eventually. 

Chilling statistics anyone? 

" In 2013, coverage of at least one dose of HPV vaccine was 57.3% among adolescent girls and 34.6% among adolescent boys2. According to the CDC, for every year that coverage does not increase, an additional 4,400 women will develop cervical cancer3. Furthermore, if health care providers increase HPV vaccination coverage to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years." 

reference: ACOG Clinical Practice: The 9-Valent HPV Vaccine 

Gardasil has had a very good side effect profile, with just some arm soreness at the site. We believe its benefits far outweigh the risks. 

To learn more about HPV, please see Pap Smears, HPV and Cervical Health. 

Structure Sunday: The Structure of Mothers

In my practice, we do gynecology, surgery, prenatal care and deliver babies.  However, sometimes I think we are helping to make mothers. Usually we spend 30 weeks with a woman and then go through some very intense and uplifting experiences with her. Along the way, we learn all about their background. We help them face challenges that arise. We try to address whatever needs addressing from eating habits to referrals for domestic violence. We try to uplift, we try to empower. We try to help them become good mothers. 

At the beginning, I tend to notice the things I need to address, the problems.  But as the weeks pass, I notice the things that are unique and special about each patient. Somehow, the problems and the virtues are all wound together. These complex dynamic women most always do their best, learn a great deal, and are sent home with a newborn, who will respond to everything they are, and the new world they inhabit.

These worlds are seldom perfect. I think back to my mother, the last of 8 children, born in 1917 in Oklahoma to a poor coal miner's family. Her father, once a foreman, had saved his team of men after an explosion deep in the mine. He suffered severe burns and disfigurement. Thereafter, the family descended into poverty. When she was 14, she was married off to an alcoholic older man. I later learned she endured extensive abuse. 

When I was adopted, she was already 45 and remarried to my dad. She was not easy to be with. Even as a young teen, I knew she was not like my friends' mothers. It was only as a young doctor that I began to understand what she had gone through, and the effect it had on her. Without a doubt, she had PTSD. She was angry, insecure and sold herself short. I could go on. I was angry and disappointed at her for not trying harder in life. 

As my medical career developed, I saw more women like her. As my role as their doctor taught me compassion, I developed a compassion for her. But of course, this was near the time she passed in 1990. At the time I lived with her, dealing with her difficult behaviors made it hard to experience the good things about her. Of course there were good things. I can see them better now.

I can remember the joy she had shopping for nice clothes for me, something she never had when she was a girl. I can remember how she liked high heels and going out to dinner. She made excellent pie crust. She admired Jackie O. She loved the sound of black women singing. She loved Christmas, and carols, and gave lots of gifts. She told me my education would make it so I would never have to rely on any man. 

After she escaped her first husband and before she married my dad, she worked in a factory assembling bombers. She was a real Rosie the Riveter. After that, she became a bookkeeper at a firm in Los Angeles. She looked ten years younger than her age, even though she picked up smoking as a young women in order to look elegant and independent. She quit smoking cold turkey on post op day one after her quadruple bypass, but died of heart disease anyway eight short years later. 

I am looking back through time so you can too. I am also looking back so perhaps you will look at the present differently. Your mother may not be perfect. But it is still incumbent upon you to see the good with the bad, to see her as a whole person with understanding, compassion, and appreciation.

I also write to remind us that there is a good mother inside all of us. She just may need a little help coming out. 

Wellness Wednesday: Enthusiasm

I like to think that that when someone close to us passes on, that we can pick from among their good traits to inherit. Recently, my father in law, Dr. Van Kirke Nelson passed on at the age of 83. He was an Ob/Gyn, but also a business person, philanthropist, and art collector.

I studied the stages of grief in medical school just like everyone else, but I'm not sure where I am in the official stages. However, I can say that I am in a stage of deliberate inheritance. I am remembering all of his wonderful traits:  diplomacy, devotion, optimism, energy for endless projects, cleverness at crafting the win-win solution, and above all enthusiasm.

There are several of these traits on which I have dibs. I am hoping to inherit quite a bit of his diplomacy. I have always been short there. Then there's the optimism. I am the cup half empty girl, and to some extent I own that.  I am always trying to figure out what could go wrong so I can keep it from happening. I guess that is written into my job description. So I would like more optimism. Not the blind unreasonable kind. Not the kind that says things are always going to work out fine. Instead, I'd like the kind that says we can almost always find a solution. And even though I'm pretty darn enthusiastic, I'd like some more of that. You can't have enough of that. Grandpa, as I called him, was a great inspiration to be enthusiastic, and that is not going to end. 

In that spirit of enthusiasm, I'd like to share with you some simpler sources of enthusiasm. I have started work on our links page. There is already enough inspiring material on there to keep you awake all night. But take a page from Grandpa's playbook: Read about cool things other people are doing.. and then do some of your own. 

Check out our inspiring links HERE. 

Medical Monday: Participatory Medicine

Are you an empowered patient? Do you participate in Medicine 2.0 and Health 2.0? Learn more about these terms and the interesting and beneficial changes that they describe.

Click HERE to learn more. 

P.S.  We would be very pleased if you would consider subscribing. I have placed a Subscribe and Comment page in the navigation menu for your convenience. When you subscribe, you will receive a White Paper (see definition HERE) entitled "How to Become an Empowered Patient " with our compliments. 

Structure Sunday: The Structure of a Website and ….YOU

Just last week Google lowered the boom and decreed that sites that are not mobile friendly will suffer in search rankings. At first I felt a little threatened, but after a little research, I have discovered that it is all about….YOU! Yes you. As they say in TRON, “I fight for the users.”. 

I love nothing better than to come into a patient’s room and see her on a smartphone. Do you realize any garden variety smart phone of the present day is literally powerful enough to have run the entire Apollo space program that landed a man on the moon? A smartphone is a very powerful computer and almost every girl and woman I know has one, even the ones of modest means. It is fantastic. Not only do I remember the Apollo missions, but I remember the days when women did not touch technology, not even stereo components. 

Technology is empowering. Information is empowering and the whole world of information is at your fingertips. Patients read about diagnoses, medications, and communicate with others who share their experience. So it is with great satisfaction as I watch my patients as they not only use technology, but make it. I have in my practice graphic designers, filmmakers, website designers, software engineers and IT administrators. I do believe it is technology combined with the goodwill of people, that will solve many of the world’s problems and inequities. As a force in neutralizing gender inequalities, technology is formidable. 

In blogging, and in making this website, I have wanted to provide easy access to what I would like my patients to know. My education has made me  familiar with the best sources of medical knowledge, i.e. institutions like the National Institute of Health (NIH), and the Center for Disease Control (CDC). It has enabled me to tell the legitimate from the bogus. So I feel obliged and enthusiastic to give you all key to all the doors that lead to the best paths to all this valuable information. I want to make it easy, and I want to make it fun. Additionally, I want to make it beautiful. Perhaps this last goal is a universal desire for website designers of all genders, but I think a beautiful website is more welcoming to women. 

And that user experience, in short, is what Google’s directives have been all about. I see from my website analytics that over 50% of you view the site on mobile devices. Had I looked to author my site looked on mobile? Not enough! The main page was cluttered, the font was too small, links were too small to push and you had to scroll way too much. All this gave me a very bad mobile rating on Google. Plus, page loading times were a bit long, and I admit, that is because of the higher definition photos that I chose to upload. This was all a very unpleasant but useful revelation. I felt bad but grateful for all of you devoted readers on mobile who slogged through all of that. 

I read a great deal in Google’s website design and mobile responsive design guidelines. At their heart, the recommendations are meant to enable you, the user, to see the site clearly, and to get the information you want as conveniently as possible. It is all about enhancing the user experience. I spent this weekend changing things around, using fewer main pages, and tucking more within them, so now you will do more clicking and less scrolling. And I promise, if you have a little wait for a photo, it will be a good one. More mobile friendly changes are coming next week. I fight for the users! Those of you who really want to get your geek on can learn the origin of the phrase in this clip from the movie TRON Legacy. 

Food Friday: Food for the postpartum mom

Food is a traditional gift. But, for the postpartum mom, it is best given with some forethought. 

Consider whether it would be best to do a fresh, ready to eat meal or maybe a freezer dinner for later. Make sure to find out about any allergies or food preferences before you prepare. If you do choose a freezer dinner, make sure she has enough room in the freezer. If you need recipes for make ahead meals, there is a wealth of them on food.com, epicurious.com, and of course Pinterest. For a deluxe gift, get together with a few of her friends and assign each person a meal for each day of the week for the first week she is home.  Friends did this for me once and it was so much fun. 

The breastfeeding mom needs between 300 and 500 calories or extra nutrition after the delivery of the baby. She especially needs high quality proteins, healthy fats and fluids. As far as food restrictions because of baby, there really are none. I have always taken the view that baby will to learn to like garlic, chili and chocolate just like I do! There really are no medical reasons to avoid strongly flavored foods when you are breastfeeding. 

Food gifts do not have to be meals. They can be baked goods or even a basket of healthy snacks or a case of healthy drinks like Pellegrino water. 

Gifts do not even have to be food! If you are fairly familiar with the new mom and her home, consider a gift of housekeeping, gardening, pet care or personal shopping on her behalf. You can draw up a cute certificate to present to her if you like, and she can cash it in when she prefers. 

Just remember that the new postpartum mom is bound to be tired. While your gift is almost certainly welcome, your postpartum friend might not be up to a great deal of socializing. So keep your visit short and sweet. 

If you are interested in information about breastfeeding and nutrition, please see the links below at on drginanelson.com. 

Breastfeeding 
Nutrition 

In other news, I am happy to report that all of the pages on drginanelson.com finished. Of course we are still polishing them, adding new handouts, and perhaps an occasional new graphic. Nonetheless, our collection of topics provide a cohesive overview of knowledge from Obstetrics, Gynecology and healthy lifestyle that is up to the minute in accuracy.

In the next week or so, I will be reorganizing the site a bit to make navigating this content simpler and easier, especially for mobile. In all cases, your input about content and ease of use would be most welcome. There is a feedback box you can access in the left menu bar from every page on the site. 

Stay tuned for more posts on Structure Sunday, Medical Monday, Wellness Wednesday, and Food Friday. 

Wellness Wednesday: The Postpartum Period

So much attention goes into preparing for labor and delivery. I'd like to take a minute and focus on the next important period: the postpartum period. With forethought, preparation and help, the postpartum period can be made enjoyable and smooth. 

First you needs to know what to expect in the postpartum period. Next, you needs to know how to prepare for it. Finally you need to know when to reach out about concerns and questions. 

Learn more HERE.  

Medical Monday: C Section Delivery

Do you know about VBAC, TOLAC and RCS? Obstetricians love acronyms. The website section about C sections has been updated and expanded to include a comprehensive section on VBAC (vaginal birth after C section), TOLAC (trial of labor after C section) and RCS (repeat C section). Go to the general C section page, then scroll down to the part on Repeat C sections and VBAC.  

Click HERE to learn more about this hot alphabet soup.