Structure Sunday: The Structure of Friendship

Tonight I had dinner with a friend I have known since early high school, about 40 years ago. I love the the idea that we have been friends that long. I actually don’t like the idea of ever losing any of my friends, regardless of time or distance. And there has been a great deal of time and distance between me and most of my friends. Nonetheless, I think old friendships hold the world together. 

This friend took the initiative to keep in touch. We went to the same small high school and left there in 1977 and 1979 respectively.  Our high school was an intense, supportive and inspiring place, and as a group, we departed there meaning to do good in the world. He and I went off to separate colleges a continent away, and went about marrying, having kids, going to school, school, and more school. I became a physician and he became a researcher for the World Health Organization, among other things. 

After Facebook reunited many people, he decided it would be nice to visit. And so he did, especially since I live in eminently visit worthy place. Of course, truth is stranger than fiction, so during his visit, he naturally he fell right in love with my wonderful neighbor and returned later to stay many months with her. Eventually they parted ways as friends and he still visits to this day. 

So tonight I had my good neighbor and my old friend over for dinner since he is visiting. It was such a treat since I also invited my niece and nephew over as well so they could meet my old friend. For you see, my friend did go out and do good in the world, and I wanted to share it with these kids. 

He recently finished his residency in Anesthesia, as he decided later in life to become a doctor. At the end of his residency, the Ebola outbreak began, so he departed for Sierra Leone, one of the hardest hit areas, to help. He spent six weeks there, and at tonight’s table, he told us about all we wanted to know and more, from the percentages that lived, to the special suits he wore, to his American co-worker who contracted the disease and lived. I was so pleased that he could share all this, especially with the kids present. It not only tied us together, it tied us together with all the Ebola fighters, and even put us degrees closer to the Ebola patients themselves, and helped us understand their humanity in a near first hand way. Best of all, he told us about the preliminary announcement from about three weeks ago, that an effective Ebola vaccine is on the horizon. 

So as the night wore on, and the topic of Ebola played itself out, we realized that my nephew plans to travel to just the area of Italy where my old friends and my neighbor have visited: Venice. So I was the happy recipient of colorful descriptions of Venice. My nephew was given numerous recommendations about places to visit, things to do, and travel strategies to use. I got to listen to exuberant descriptions and enthralled questions about this place, which at this point, to me, is nearly mythical, yet now more real. 

So because of this long friendship, tonight, at my own table, I traveled from darkest Africa to brightest Venice. We were able to appreciate each far flung place as the real place that it is, and understand that hope blooms in both. We renewed bonds, and shared all this with the younger generation. 

Are your friendships in good shape ? They are so important to our collective well being, that I suggest having a look. 

Food Friday: Cold Desserts

It’s hot and fruit is in season. Here’s a little history of your favorite summer desserts and some tips on how to modify them to make them healthier. 

• Frappes- ice, milk of some sort, flavorings, blended as a drink, originated in Greece  in the 1950s, named with the French word for shake or strike. 
• Smoothies-a thick beverage made of  ice, milk of some sort, yogurt, fruit, blended as a drink. Some include vegetables, nut butters or protein powder. Recipes originated in Brasil, and were popularized with the invention of the blender. These became popular in the US in the 1960s. 
• Ice cream - In the US defined as having 10 % butterfat or more, frozen, with lots of air whipped in. Frozen dairy desserts date back many centuries to many countries. The English first published recipes for ice cream in the 1700s. 
• Gelato- Italian ice cream; must be at least 3.5 % butterfat; comes from Sicily since Sicily is near both mountains with ice and orchards with fruit. 
• Sherbet- frozen blend of milk and fruit flavors about 1-2 % butterfat, An lower fat American version of ice cream.
• Frozen yogurt - yogurt with flavoring like fruit, frozen and whipped. Originated in the Us in the 1980s during the fitness revolution. 
• Granita- water, large ice crystals, sugar and flavorings like fruit juice or coffee; also hails from Sicily. 
• Sorbet - dense frozen confection of water, sugar, flavoring, frozen and blended smooth; folklore dates it back to the Roman emperor Nero. 
• Popsicle- originally was frozen flavored ice on a stick. Patented in Oakland California in the 1920s. Modern versions may contain other ingredients like fruit. 

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Cuisinart

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You can find recipes for these in many places. My favorite sources are :

epicurious.com

Food.com

Foodnetwork.com

 Pinterest

Here are some general principles which will help you create desserts that people will enjoy. 

Ben & Jerry's Homemade Ice Cream & Dessert Book

$7.01

By Ben Cohen, Jerry Greenfield, Nancy Stevens

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• Get a good electric ice cream machine. 
• Get a good blender, preferably a Vitamix. 
• Get some popsicle forms and make your own healthy versions. Make icy or dairy versions; consider adding fruit slices. 
• You may use a simple metal pan placed in the freezer, combined with periodic stirring. Granitas work especially well this way. 
• Use sweet ripe fruit if you are omitting or reducing sugar. Consider adding half a banana or a few sweet grapes to certain desserts to sweeten. Those who like stevia may try that, though be sparing. The point is to taste the natural flavors. 
• Choose coconut milk if you are dairy intolerant. 
• Choose dark chocolate flavoring. 
• Choose decaf coffee for flavoring. 

It is a fun summer family activity to make healthy cold desserts. However, you have to have a good attitude if you are going to take conventional recipes and modify them to make them more healthy. You can’t expect them to taste exactly like store brands, and that’s just fine. 

Wellness Wednesday: Dealing with Disappointment

The other day, I inadvertently backed up into my husband's truck, for the second time in one month.  Both times it was parked in an atypical location, but both times I should've seen it. Both times I was going about 1 mile an hour. I have incurred enough damage to pay for two round-trip airfares to Europe. This was a disappointment.

My initial reaction was that I was sad and dismayed. However I was on my way to a delivery, so I knew I had to be sharp. I knew it was nobody's fault really and that there was nothing to be done about it at that moment. The necessity to get out of my funk in short order was actually a really positive exercise. It caused me to think about the best way to deal with disappointment.

All the sources that I consulted on the subject indicated the same basic set of recommendations. Here is my personal redux on the matter. 

• Pause and breathe before reacting. Take a couple of minutes if need be.
• Acknowledge your own feelings of disappointment or anger, but do not act out.
• Accept the present state of affairs.
• Deliberately avoid blame and invoke an attitude of neutrality.
• Take responsibility for what you can.
• Remind yourself that all problems have solutions or at least strategies.
• Deal constructively with what you have to and postpone the rest until the initial shock wears off.
• After the initial shock wears off, reach out to others who you know will be helpful and supportive.
• After any big disappointment, stay in your basic routine. Observe a good sleep schedule and stick to your three meals and three snacks every day as well as your workout.
• Go out of your way to remind yourself about all the good things in your life. 

Keeping this routine will help keep your stress levels down and help you recover from disappointments. 

 

Medical Monday: ACOG weekly news

Headlines proclaim “ Aggressive Treatment for DCIS May Not Save Lives”.This sounds rather dismal. Reading further, what they should have said is “ Aggressive Treatment for DCIS May Not Be Necessary to Save Lives”, which is good news. DCIS is very early microscopic breast cancer, and as such its concerns everyone. Such an alarming headline got my attention. But once I found out the news was actually good, I was a little dismayed.  There must be a chapter in the Journalism textbook where it says bad news gets more attention than good. I don’t know. Read carefully out there ! 

Just to refresh your memory, ACOG stands for the American College of Obstetricians and Gynecologists. They send its Fellows, myself included, news updates throughout week. These are articles of pertinence to women’s health. Each Monday, I pick a small sample and present them to you for your consideration. More such articles can be found at www.acog.org. 

There is such a thing as “ distracted snacking”. The Journal of Health Psychology reported the results of a small study which indicate that distracted snacking results in greater intake even afterwards. I speculate that it has to do with the fact that distracted snacking results in greater intake that say “ mindful snacking “ ( my term)  causing insulin levels to spike more than they would have, and more hunger to be stimulated later. So be mindful about your snacking and remember to always include some protein. 

The venerable diaphragm has gotten an upgrade. A Seattle based nonprofit has developed a new more contoured model. It’s name is Caya. Go to Caya.eu to learn more. It is not yet available. 

Finally, ACOG has released new guidelines regarding the treatment of morning sickness. First line therapy should be in the form of the class A combination of doxylamine and vitamin B6, commercially available over the counter without a prescription in the US as Diclegis. ( Class A is the safest pregnancy category for a drug. ) This is not to say that we are not still going to need Zofran for certain patients. It will still be considered after Diclegis is deemed insufficient. 

When you read medical related articles in the mainstream press, read very carefully. It is tricky to report accurately if you do not have medical background. For more on that please see our section “ Your internet learning toolbox”. 

Stay tuned for more medical news next week on Medical Monday. 

Structure Sunday: The Structure of Childhood Memories

Childhood memories are an important part of who we are. It is up to parents to engineer varied and happy memories into their children's lives. This weekend we went down memory lane by virtue of hosting a wedding reception for the son of some of our closet friends. You would not think a wedding would focus a great deal on childhood memories. And yet, this weekend, it was a veritable memory fest. Of course there was the requisite slideshow of the childhood pictures of both bride and groom. But more than that, at the reception, clusters of conversations ensued, conversations between people who had done much together as children but little recently as adults. 

My extended family is large and we ourselves have three grown children. But, and this is one major point of this post, we have so many friends who are like family. These are families we have known for 20 to 30 years, and whose children have grown up with ours. Back in the day, we gravitated toward them because they were good and interesting people. More than that, they were creative and adventurous, and despite the fact that we were college students of modest means, we had adventures: us, our kids, our friends and their kids. These people have stayed our good friends all this long while. It feels like a tribe, or the proverbial village, the village it takes to raise a child. 

These adventures we had took time, planning and some wherewithal, but it all paid off in ways which we did not then entirely anticipate. Today we have grown kids who sit around the table and marvel at all they got to do as children. We look at old pictures and tell tales of glory. They know their experiences have shaped them. These children have grown to be inventive and resilient from their experiences. These are two of the greatest gifts a child can have. And now they are taking their kids out too.

It is fewer and fewer kids who have these experiences of rafting, camping, hiking or traveling for the sake of seeing a new place. I am writing to encourage you to find good people for your village. Find them and set off on adventures. You will have to take time off work, plan, get some gear, and maybe even learn a few new things. But that's all part of it. Go make some great memories for yourself and your children. You will get more out of it than you realize. 

Food Friday: Treats

This is a health oriented blog. And yet, I hope for all my readers to experience a wide range of culinary delights. Food is for celebration and rich sweet treats are served at celebrations. How can you participate without feeling like you’ve eaten poorly ? Here are ten tips to turn nutrition buffs into connoisseurs too. 

1. Eat properly on all regular days. 
2. Get your workout done before attending your party. 
3. Fill up on healthy foods before the dessert treats arrive. Savor them as much as the treats to come. 
4. Fill up on healthy beverages like water, soda water and herb tea before dessert arrives. 
5. Skip dessert if its not really well done. 
6. Skip alcohol if you chose a rich dessert. 
7. Be discriminating. Chose only the best for yourself, e.g. choose chocolate mousse over a cheap candy bar. 
8. Take a small portion. 
9. Savor your portion; Eat slowly and mindfully. 
10. Enjoy ! 

Wellness Wednesday: Physical Methods

Not uncommonly I have patients with pain issues, mood issues or both. Now, I suppose I write as many prescriptions for these conditions as the average doctor, but such a thing is hard to know. And yet, I am an advocate of what I like to call "physical methods" to control these problems.  

Since I practice evidence based medicine, I am committed to sticking to methods that have evidence supporting them. Believe it or not, the following methods are all evidence based. 

Let’s tackle pain first.

It’s pretty simple. If you have pain when stationery, you need to move. If you have pain when moving, you need to reduce movement or get help to find a better way to move. Physical therapy can provide this. 

Use heat and cold. Heat is to increase circulation which helps tight muscles or cramps. Cold is best for anything inflammatory or injury related in the first 24 hours. 

Massage is helpful in many cases of muscle pain. 

Abdominal binders, support hose, and wrist braces can be helpful in certain circumstances like pregnancy related pain. 

For the open-minded, I advise yoga for all sorts of pain: migraines, rheumatologic conditions like lupus, and for back pain pending approval of the back doctor.

Meditation takes a little more commitment, but it too, is evidence based and has been shown to favorably impact pain. 

Of course actual exercise is well known to improve resilience and to make people more resistant to pain. 

I consider music a physical method. Post operative patients have lower pain medication requirements when exposed to music they consider pleasant. The applications go way beyond that. 

Physical Methods for Mood 

All of the above also improve and stabilize mood. But did you know that the smell of natural citrus elevates the mood ? That’s why we have atomizers for natural essential citrus oils in our office. 

Simple adequate sleep is a proven method to improve the mood and increase the pain threshold. 

And if you haven’t heard this term before, you need to: Hangry. It is the combination of angry and hungry, which pretty much makes the connection between mood and blood sugar. Yes, something as simple as three meals and three snacks rich in protein can improve the mood immensely. 

All of these interventions and their effects are quite measurable and act via the nervous system and the circulatory system. Take the time to incorporate them into your life. They work. They’re cheap, and they’re fun. Because we all need to feel better sometime. 

To learn more see our pages: 

Meditation 

Yoga

Music and Health

Medical Monday: ACOG weekly news

What's an Ob/Gyn site without a little OB/Gyn news ? I like reading the Ob/Gyn News and I like translating science information into clear non medical language. So I'm going to give Medical Monday's another go. 

A large Finnish study has show that those who have depression and who are treated for it in pregnancy have lower rates of preterm labor than those who have it and are not treated for it. 

Most everyone has heard of BRCA1 and BRCA2, the genes conferring increased of breast cancer. Unfortunately there are many more gene mutations which are associated with the development of breast cancer. Fortunately, testing for 20 more of these genes may soon become available for select patients with strong family histories of breast cancer. 

Fully one quarter of American women 65 and older have osteoporosis. Thank our marginal diet, heredity, Big Soda, Big Tobacco, alcohol and our sedentary lifestyle. 

One third of ovary cancer patients are living in excess of 10 years. This is a substantial improvement over the last several decades. 

Finally, stats are in through 2013 and infant mortality in the US has dropped to a record low. Wow, finally ! I'm going to try to end on a good note, so with that, stay tuned until next week. 

Structure Sunday: The Structure of Education- Preschool

Education has been of foremost importance to our family. Most of my life has included  receiving education or supervising the education of my children. After all of this I have some definite ideas about education and I would like to share them with you.

I've been thinking about education because it is, of course, back to school time. As you know from my last post on school related matters, I'm a parent who believes that parents should be involved in their children's education. 

To me a child's education involves not only their scholastic pursuits. It also involves their sports, extracurricular activities and even the home schedule and enrichment activities the parents plan with family. This particular blog post will focus on a child's education before the school years even start. 

In the years before school there is a lot you can do for your child to enrich them. First and foremost, have a loving and orderly household. For example, try to have a peaceful sit down family dinner every night. 

Make sure your child is included in as many of the family activities as possible according to their stage of development. Once you reconcile yourself with the fact that doing things with the child takes more time and preparation, you will simply be more relaxed and so will the child. 

Here is a controversial and challenging recommendation: get rid of your TV. Those who know me well know that I am a big fan of certain forms of media such as music, internet and film. However, I believe in mindful consumption. TV decides your content for you, whereas if you have a screen connected to some sort of input device and parental controls you decide. I think it is critically important for children that mainstream commercial television not become their default activity or God forbid, their default reality. Where video content for children is concerned, I am a big fan of high-quality nature and science oriented programming. It doesn't matter if kids understand every scientific word; they learn very quickly to put it all together. 

When you have no TV, it behooves you to put many wonderful things in its place. Children before the age of school have a limitless sense of wonder and can be enthusiastic about anything good. Make plans to expose them safely and comfortably to all aspects of the natural environment, such as mountains, lakes, rivers and ponds. This may mean something as simple as going to the neighborhood park.

Get them involved in sports and other athletic pursuits. Before you do however, make sure you know what the sporting lifestyle entails. Getting young children involved in soccer, ballet, martial arts, equestrian pursuits, or skiing are all very different undertakings. In an ideal world, we would simply cater to the tastes and talents of our children. For the time being, we have to simply say, "where there's a will there's a way." I am a particular fan of ballet and a martial arts since they are available in most towns and are relatively reasonable in cost as sports go; Plus they give children great physical poise for the rest of their lives.

The great indoors also holds many fascinations. Teach children to play board games with other.  Give them access to all kinds of art and science materials. Absolutely every child should have a box of paints and a bug jar.

Consult with your local music teachers to find out what age their music education should begin. Consider taking lessons alongside them. 

Key among my recommendation is this: read to your child until he or she can read. Then, keep reading to them until they are absolutely fluent. Try using your fingers or their finger to track the words. All along the way provide them with a wealth of reading material. Take them with you when you go to the library or to the bookstore and consult with the staff about the best in children's literature.

Young children should be exposed to live theater, live music, museums and outdoor festivals such as county fairs, horse shows, farmers markets, and Renaissance fairs. 

All of these activities for children will stand them in good stead socially, intellectually and physically for the future. Each of these activities, if done in an appropriate and supportive way, will enhance your child's skills and confidence. These traits will transfer over into all the other areas of his or her life. 

Food Friday: On the Glories of Summer Fruit

Summer fruit is not just something to eat. It is a family project. It is a creative endeavor, and it is Holiday preparation. Finally it's a great bargain. 

Most people think of boxes of ripe summer fruit as the mere predecessors of pies and cobbler. I love fresh pie and cobbler as much as anyone else, but there is only so much you can eat and stay healthy. 

Consider the price of frozen fruit at the grocery store, even Costco. Frozen fruit is a premium item, and if you have ever tended a tree or picked a bushel of fruit you will know why. But, to go to a produce vendor for a box of ripe fruit in season, you will pay a fair price for an excellent product. But you must buy it by the box or bushel, which might be daunting to some. 

Take courage ! To freeze you need only freezer worthy ziplock bags, some time, and some lemon juice. Freeze by the quart or by the gallon. 

To dry, you need patience, an oven, a very hot day, or a dehydrator. With a little more cleverness and maybe a recipe, you can make fruit leathers, which are a most welcome gift. Now is the time to get some made to give at the holidays. 

Jam has less sugar than jelly and is a suitable treat or gift when home made. Delve into the exotic fruit spiked salsas, and you will have serious trouble keeping it around. 

To be fair, you will need some equipment. First you will need large bowls and pots. You will also  need many hands to help wash and slice. The thrifty among you will want the largest good freezer you can afford. Canning pots and tools are relatively inexpensive, and jars are a common item at garage sales. Just be sure they are in good condition and not chipped. Finally for the connoisseurs, you will want a proper dehydrator. And by all means indulge yourself in one of the many beautiful books about preserving. You may as well get the gold standard, the Ball Blue Book Guide to Canning and Preserving. 

If you do this sort of kitchen magic with the kids, they will be fascinated. Photo document your fun and you will be blog- worthy and an instagram hit ! You will also have a really good spoon to lick. 

Canning for a New Generation: Bold, Fresh Flavors for the Modern Pantry

$16.63

By Liana Krissoff

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Ball Complete Book of Home Preserving

$15.30

By Judi Kingry, Lauren Devine

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Ball Blue Book Guide to Home Cannin, Freezing & Dehydration (Volume 1)

Alltrista

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Wellness Wednesday: My Specific Workouts

Do you understand the power of being specific ? Have you ever tried to give someone instructions and found that it didn't work?  It may have been because you weren't specific. 

Everything from parenting to counseling patients about fitness is easier when you are specific. Case in point: I have recently changed the way I counsel about nutrition. I used to tell people about protein, carbohydrates and fats. I told them about meals and snacks. Then I let them run with it. Not much changed. They would come back in, with no change in weight or inches. They were frustrated and disappointed, since they had made concerted efforts. 

Then I started asking people to do simple food journals over a couple weeks time. Most people used a paper journal. When they would return, I reviewed it page by page, which took surprisingly little time. I took a red pen to each page, and marked it like a paper for a class, with comments. Most particularly, I wrote in the changes I wanted to see. I even gave a grade, which everyone found amusing. After that feedback, they would go home with a very specific idea of the changes needed. This made changing very easy to accomplish. And it got great results every time, in terms of blood sugar, weight and inches. 

So today's Wellness Wednesday is devoted to some very specific fitness strategies. I have suggested cardiovascular exercise to people as long as I have been a doctor, but only a small percent actually keep a consistent workout regimen. But I have found that when I suggest specific workouts, adoption rates are greater. 

A workout is a very personal thing. A workout regimen is even more tailored. But to give you an idea of what one should look like for a healthy adult, I will present my favorite DVD workout which I use on a regular basis. 

As I indicated in a prior post, I think it is important to take one day off per week. Mine is Monday, since Monday is the beginning of my workweek and is generally challenging. Beyond that, I like to alternate harder workouts with moderate workouts. I like each workout to be for the whole body, but I like to vary them through the week, to be well rounded literally and figuratively. Finally all my workouts qualify as high intensity intervals since research shows they yield the best results in the shortest period of time. I go from 20 to 40 minutes a session, depending on the workout. That's not much time out of the day ! 

My current favorite workouts are from Beach Body. And while this series has a somewhat comical name, it is extremely well crafted, arduous, fun and comprehensive. It is, (drum roll please) the Brazilian Butt Lift Workout series. Among those, Sculpt and Rio Extreme are the Hardest, with Cardio Axe being the most fun. Tummy tuck is the most time efficient at 20 minutes. 

Jillian Michaels does a great job at crafting a balanced workout which is hard and fun. She is also very encouraging in a drill sergeant kind of way. I like her workout series Ripped in 30 (days) and the sequences are only 24 minutes long. Her cardio yoga DVDs like Yoga Inferno are very cool but not for the faint of heart. 

Zumba is fantastic if you like a dance type workout. Zumba is generally of lesser intensity, but Rush and Ripped can give you a respectable workout. 

Chalean Extreme is for those who want to increase their resistance part of their workout. Hip Hop Abs is for those who can dance hip hop. 

Cardio Burn Sculpt by Gaiam is one of the best for getting back into exercise. It can be done at any intensity and is very well rounded, with a warm up, a cool down and attention to both upper and lower body. There is even an express version. The teacher Tanja Djelevic, is very soothing and encouraging. 

Finally on those days when yoga is required, the GAIAM DVD Am and Pm Yoga is the best. It is relaxing, thorough and quite brief at 15 minutes per session. For a really creative and moderately hard yoga exercise, try any DVDs by Shiva Rea. I do the Daily Energy and Vinyasa Flow Yoga. 

I pick from these like a smorgasbord. It keeps all kinds of things going well, like my mood, joints, muscle mass, bone density, and energy. If you check with your doctor, and carve out some time 6 days per week, you too will be rewarded when you do appropriate and consistent exercise. 

To learn more, see our sections below : 

Fitness

The Quantified Self 

Structure Sunday:The Structure of Back to School Preparation

I loved school. But I always hated those back to school signs in the stores. I still do. It always made summer seem shorter than it really was. And yet, now that I am a seasoned parent, I think there are real benefits to preparing for back to school. 

Just about now, it’s time to check in with your kids about any summer assignments they might have had. Don’t be that parent who declines to ask since they want their child to “ do it on their own”. Ask and get involved. Yes, it is nice when kids are self starters, but each kid is different, and you should at least know what is going on. 

It’s time to get together with your munchkin and deep clean their room. Give them some advance notice so that it is not a shock and so it does not interfere with their remaining summer plans. Let them know you might be willing to make some improvements if a good job gets done. Great examples would be a new bulletin or marker board, or perhaps a cool shelf.

Make sure that once their room is clean that everything truly has a place. Sometimes kid get blamed for having messy rooms when in fact there really is nowhere to put anything. Make sure there are enough hangers, shelves, baskets, boxes, or whatever it takes to fulfill the maxim “ A place for everything and everything in its place. “ And of course, most importantly, set a good example and keep your house clean, tidy and organized. People, especially kids, get used to whatever they’re in. You do your kids a big favor to model organization to them in this way. Being spatially organized does so much to lower stress in the house. 

Make sure to supply what they need for school. Make sure the basics are there, but also try to show you value education by going the extra mile for them with their school supplies. Make sure they have an excellent backpack to carry it all. Allow them to express their personal style. 

Make sure you know about the lunch and PE situation to come. Consider a well done home made packed lunch if school lunch quality is marginal. You can even teach your child to make her lunch eventually. Food is a great place to show kids values in action. Make sure your child has a chance to choose how they carry their lunch. 

Attend any orientations or registrations with your child, all the way through twelfth grade if you ask me. 

Finally, survey the back to school clothing situation. Assuming the room cleanup went well, ill fitting, damaged, or unwanted clothing has been given, donated, or recycled. Introduce the idea of starting your school shopping at a good thrift store such as Goodwill. Offer to take some of your child’s friends along. It is a truly fun treasure hunt. It is hip, green, and cheap.Then after that, check online for any swaps or sales, then get what you must new. 

You are the parent and you have a lot of influence. You can have this influence better by what you do, compared to what you say. Your day to day choices about how you interact with your kids convey your values. These back to school  tips will help you your convey your interest in their education, life habits, and health. They help you convey that you care about them. 

Food Friday: Summer Guests

Summer should be full of guests. Where there are guests there should be great food and drink. And yet, it is important that the work of food preparation not get in the way of entertaining. Here are simple, easy ideas for summer entertaining. 

1. Give at least a week of notice, so the gathering is informal but not too informal. Be open to drop ins. 

2. Be aware of any food intolerances or limitations. Have at least three dishes everyone can eat. 

3. Incorporate the out of doors somehow. 

4. Invite guests to contribute a dish but let them know to come even if they are too busy to prepare something. You may also simply ask them to bring soda water if you suspect they are busy. It is a good idea to invite guests to bring what they are good at cooking, within the constraints of your theme. 

5. Favor foods which can be prepared in advance, especially the main dish. An example would be meatballs in a slow cooker. 

6. Favor food which are presented, more than actually prepared, i.e. fruit and vegetable platters with dips. Similarly, favor foods which are assembled by the guest, i.e. a taco or fajita bar. 

7. Serve buffet style. 

8. Have a great selection of drinks, especially in hot weather. People love a big punch bowl. We make ours with 2 parts club soda with one part 100% fruit juice such as apple raspberry juice from frozen concentrate. We cool it with ice, but also frozen berry mix. We may also float some citrus slices. The variations on this punch can be endless, and it the flavors can morph as the bowl needs refilling. 

9. Don’t be afraid to decorate a little. You can be fun, festive or sophisticated at your whim. 

10. Finally, don’t forget the most important part of entertaining: Making your guests feel welcome. 

Wellness Wednesday: Healthy Communication Skills

Communication skills are intrinsic to our wellness. They are central to our relationships and our effectiveness in life. I have distilled a list of six main steps in healthy communication. I discovered I have lots of room for improvement. Hopefully you will find something helpful too. 

1. Attitude adjust.

• Consider your purpose in the conversation. 
• Assume the best intentions in everyone. 
• Stay positive - honest, patient, optimistic,  sincere. 
• Value everyone equally. 

2. Check physical factors.

• Put away distractions like phones. 
• Make comfortable eye contact.
• Watch your body language.  
• Watch your tone. 

3. Listen actively.

• Listen first.
• Ask open ended questions.
• Set aside judgement while listening. 
• Listen actively -  Don’t interrupt; read back, aka clarify and reflect. 

4. Guide your reaction. 

• Use empathy; Try to see the other person’s point of view.
• Practice self awareness -recognize emotions and stresses as they arise and rather than react to them, handle them appropriately. 

5. Say your piece. 

• Pause and ponder. Think before making a point.
• Understand how your message might be received.
• Tailor your message to your listener.
• Use empathetic assertiveness. 
• State needs, express feelings; Value your own point of view as well. 
• Be direct; Be BRIEF - Give the "b"ackround, "r"eason,"i"nformation, "e"nd, and "f"ollow-up.

6. Connect and conclude. 

• Connect personally.
• Encourage the other.
• Focus on the result.
• Ask for input and feedback. 
• Follow up with a plan. Close the loop. 
• Show appreciation for the person and the conversation.  

Awesome references that expand on these tips: 

http://lifehacker.com/top-10-ways-to-improve-your-communication-skills-1590488550

http://www.lifehack.org/articles/communication/9-tips-to-improve-communication-skills.html

http://www.wikihow.com/Develop-Good-Communication-Skills

http://www.skillsyouneed.com/ips/improving-communication.html

http://www.skillsyouneed.com/general/emotional-intelligence.html

http://www.skillsyouneed.com/ips/improving-communication.html

http://www.inc.com/kevin-daum/8-ways-to-improve-your-communication-right-now.html

http://www.citehr.com/11334-6-good-tips-increase-your-communication-skills.html

http://advancedlifeskills.com/blog/14-very-effective-communication-skills/

http://www.wfm.noaa.gov/workplace/Comp_Conf_Handout_1.pdf

http://www.helpguide.org/articles/relationships/effective-communication.htm

Structure Sunday: What I do to stay healthy

I am 53 and I have lupus. But I am pretty darn healthy, thank goodness. People often ask me what I do to stay healthy. It's really no mystery. So today's structure Sunday is about the structure of my week. 

Sunday- the beginning of my week

• Breakfast with family
• Team clean - ( Housecleaning) especially laundry
• Clean desk, pay bills ( which I have recently mostly automated yay ! ) a big stress reducer
• Grocery shopping 
• small scale recreation 
• longer workout 
• family dinner 
• Prep for the workday per usual routine- down to packing lunch and snacks, and picking morning outfit ! ( a stress reducer and time saver ) 

Monday -workday

• The usual routine of am protein drink, midmorning snack, second breakfast, lunch and midafternoon snack. Daytime intake must include one large glass of water, one large bowl of ground green tea, and one small cup of kefir, a probiotic.
• pm- break from workout 
• family dinner per usual routine 

Tuesday- workday 

• usual routine 
• longer workout 

Wednesday - surgery and chores

• grocery shopping 
• shorter workout 
• entertain if possible 

Thursday workday 

• longer workout 

Friday - workday 

• shorter workout 
• special family dinner
• evening outing 

Saturday - 

• family breakfast 
• longer workout 
• larger scale recreation 
• entertain 

Everyone thrives on routine, from adults to children.  It gives your system signals of peace and plenty. With a reasonable routine, stress hormones decrease and everything from thinking to healing improves. 

You can also use routine help with taking medications and supplements, and to regulate your sleep schedule. If you are having a tough time meeting your health goals, just build a routine. Routine can make hard things easy. 

People say they do not have the willpower to eat well and exercise regularly. Here's the newsflash: It's not so much a matter of willpower as it is engineering. You simply schedule your healthy habits and stick to the schedule, no questions asked. 

Food Friday: Fast Food

I am loathe to miss a meal and can hardly tolerate missing a snack. My patients know they aren't supposed to either. Metabolism, energy, a bright outlook, ability to exercise, blood sugar control, weight management and sharp thinking all depend on it. So often my patients say they don't have time to eat, especially breakfast. These are the same folks who are struggling with their weight. So instead of repeating this point, I am going to give you my down to earth, personal go to suggestions when you really have next to no time to make and eat food. 

First, however you have to shop correctly. Remember super basic is key, and one real cooking episode is needed: dinner. Most people don't struggle with dinner. Cook extra at dinner so you will have leftover protein rich foods and cooked vegetables. 

Here is my basic grocery shopping list for fast food, by section.

Freezer: 

• Lean meat, chicken, turkey, fish, shredded cheese
• frozen fruits for smoothies: mixed berry, mango, blueberry etc 

Fridge: 

• Milk, cottage cheese, plain yogurt, sour cream, cheese, kefir, eggs
• salsa, condiments like pickles 
• whole grain low carb wraps
• nuts like walnuts and almonds 
• healthy broth mix 

Pantry: 

• whole grain bread, corn tortilla chips, oat bran cereal, healthy cold cereal like muesli 
• canned salmon, canned tomato products, sauce and stewed
• your favorite complete protein powder
• dried fruits like craisins 
• oils - olive and canola 

Produce: 

• cooking greens like chard, kale and spinach
• Salad greens like spinach and lettuces 
• cucumbers, tomatoes, broccoli, green beans, zucchini, carrots, colored peppers, avocados
• Strawberries, watermelon 
• apples, bananas, oranges  
• red and green grapes 
• stone fruits in season 

"Recipes"

Breakfast : 

• bowl of cottage cheese or plain yogurt with any fresh or frozen fruit. optional : nuts, craisins
• healthy cold or hot cereal with dollop of yogurt, and some fruit
• chopped fresh or leftover veggies with a couple scrambled eggs with or without cheese. Dress with salsa, sour cream or avocado. 
• wrap with leftovers 
• 2 cups milk with protein powder 

Snacks: 

• hardboiled egg, cheese, dairy, fish chicken or meat with fruit or veggies like carrot sticks

Lunch: 

• Salad greens with  hardboiled egg, cheese, dairy, fish chicken or meat. Try mixing canned salmon with mayo olives and pickles for a great spread. On a cold day, make soup with broth and leftovers. Make it the blender to speed up the process. 

Dinner: 

• Main protein rich dish, green salad, cooked vegetable and fruit for dessert. Cook extra for wraps later.

Note:

• A hefty blended smoothy with yogurt and protein powder, fruit and even vegetables can substitute for any meal. 

Give some of these fast foods a try. Bon appetite. 

Wellness Wednesday: Curing Procrastination

Is procrastination an illness ? No. But it can affect your health. Let’s take a look at what it is, why it happens, and how to cure it. 

What is procrastination? 

Procrastination is putting off things that need to be done. How big is the problem ? About 20 % of people are chronic procrastinators and these percentages increase significantly during college. People who are chronic procrastinators perform more poorly in their family, in high school, in college, in jobs, and in relationships. This sounds like an unfortunate nuisance, but it is actually a health problem. According to many sources, procrastination creates stress which interferes with sleep, weakens the immune system and makes heart disease more likely. It is also very hard on mental health. 

To understand why procrastination happens, we have to look deeply into issues like self control, self image, inner honesty, fear of failure and distress tolerance. 

1. Procrastination may start as a form of silent rebellion against parents. This becomes a vicious cycle as adolescents avoid parents in favor of friends, who do not hold them accountable as parents would. 

2. Certain necessary tasks or even the idea of the tasks make people uncomfortable (distressed) , either because they dislike doing them or they are perceived as difficult or overwhelming. Those who cope with their feeling of dread or discomfort (distress) by avoidance may procrastinate, only making matters worse. Those who have poor coping skills or distress tolerance are likely to do other dysfunctional things to cope with life’s daily challenges and discomforts, such as abuse substances. 

3. When people do not want to risk failure, they will subconsciously "arrange" to have insufficient time for a task, thereby providing themselves with a ready excuse for their suboptimal performance.

4. Procrastination is self sabotage. People procrastinate to fail in order to show others they have been mistreated, to “get back at them” or to acquire victim status. ( This is, by the way, passive aggressive behavior.) 

5. Some people who procrastinate simply want others to pull up the slack in whatever it is that needs doing. 

6. Some people who really want to succeed procrastinate. They deceive themselves about several things: 

•      They will be more motivated tomorrow.
•      They have plenty of time left. 
•      Their task will not be that challenging nor take that much time. 
•      They will do better when they are feeing more motivated or inspired. 
•      They think they do better under pressure. 
•      They are talented enough to pull it off. 

     These are white lies we tell ourselves. 

What can be done about procrastination ? 

1. Procrastination is hard to overcome but it requires honesty with oneself and usually firm persistent guidance from others. 

2. Strong feelings of interpersonal conflict should be evaluated by a qualified counselor. 

3. Problems with procrastination in the setting of substance abuse should also be evaluated by a qualified counselor. 

4. Simple methods to beat procrastination are as follows: 

•      Fortify your will power and your distress tolerance with adequate sleep, healthy meals, snacks and regular exercise.      
•      Become a list maker. Get a system which is either digital, paper or both and include reminders such as sticky notes or alarms. 
•      Use SMART goals criteria for your list items. See more about SMART goals HERE. Nutshell version: SMART goals are specific,measurable,attainable, relevant and time-bound.
•      Overestimate the time it will take you to get something done. 
•      Ditch perfection as a goal. It gets in the way of progress and accomplishment. 
•      Divide large tasks into a series of small manageable tasks. 
•      Practice mental “ time travel” to see how you will really feel tomorrow. 

5. All of this requires self regulation. Practicing self regulation with small tasks has been proven to improve self regulation with big tasks. 

•      Realize that self regulation is critical to healthy relationships and success in life. That should be plenty of motivation. 
•      Pick several easy small tasks, and stick to them. Larger tasks WILL get easier as a result. 
•       Yoga or meditation is especially good training for the nervous system where self regulation is concerned. 
•      Be easy on yourself for lapses. 
•      Pat yourself on the back for all successes. 

References: 

Cal Poly’s Procrastination PDF - WOW amazing document ! http://sas.calpoly.edu/asc/ssl/procrastination.html

Psychology Today: 

https://www.psychologytoday.com/blog/dont-delay/200903/self-regulation-failure-part-4-8-tips-strengthen-willpower

https://www.psychologytoday.com/articles/200308/procrastination-ten-things-know

https://www.psychologytoday.com/articles/200909/ending-procrastination-right-now

https://www.psychologytoday.com/articles/201109/procrastination-oops-where-did-the-day-go

https://www.psychologytoday.com/articles/200308/procrastination-ten-things-know

Mindtools: 

http://www.mindtools.com/pages/article/newHTE_96.htm

The Procrastination DOOM LOOP 

http://www.theatlantic.com/business/archive/2014/08/the-procrastination-loop-and-how-to-break-it/379142/

Procrastination and the great Stanford Marshmallow experiment 

http://youarenotsosmart.com/2010/10/27/procrastination/

University of Cambridge 

http://www.counselling.cam.ac.uk/selfhelp/leaflets/procrastination

Princeton

http://www.princeton.edu/mcgraw/library/for-students/avoiding-procrastination/procrastination.pdf

Procrastination and Your Heart

http://nymag.com/scienceofus/2015/03/procrastination-is-not-great-for-your-heart.html

Eat That Frog!: 21 Great Ways to Stop Procrastinating and Get More Done in Less Time

$8.74

By Brian Tracy

Buy on Amazon

Procrastination: Why You Do It, What to Do About It Now

$13.47

By Jane B. Burka, Lenora M. Yuen

Buy on Amazon

Medical Monday: ACOG weekly news

I have noticed that this is not the most popular column. I thought hard about reducing to three posts per week, eliminating this one. For now I have decided to keep it since it helps me keep up to the minute on news pertinent to the field of Obstetrics and Gynecology. Please let me know what you think.

The state of Delaware has banned the dispensation of formula from the hospital to new moms in an effort to promote breastfeeding. Some mothers have weighed in with opposition saying that many workplaces stigmatize breastfeeding making formula feeding necessary. Two comments: those little sample from the hospital aren't enough to make or break your formula supply. Buy your own formula if you want to. And, wouldn't it be better to help the whole situation by introducing some sort of " Freedom to Breastfeed" program in the workplace ?

An entirely useless article came out about a number of mortalities among those who experienced complications during Robot surgery. Non medical media didn't bother to compare these numbers with the numbers of mortalities in those with complications from non Robot surgeries. Also, it is unclear whether or not attention was restricted to new resident doctors, of whom a greater percent use the robot, seasoned surgeons, or both. It would obviously make a difference. 

Recent studies indicate breast cancer survival is aided by aromatase inhibitors, as well as good old fashioned bisphosphonates like fosamax. Cheap help ! 

Republicans want to defund Planned Parenthood in the wake of the recent videos discussion the disposition of the products of conception after abortion. Some say the videos are controversial, some say they aren't. The republican House speaker, John Boehner, has stated he wants the " facts first". FYI Planned Parenthood also does routine check-ups, cancer screening and provides birth control at low cost. 

Breast cancer death rates have declined 33.5 %  from 1988 to 2010 !  Good news. I bet it has decreased more since then. 

Finally, 60% of women over 60 are sexually active. Stereotypes be gone ! 

Stay tuned for next week's Medical Monday ! 

Structure Sunday: The Structure of a Hobby

Who could have imagined that the love of horses could lead to so many good things. 

When I was a child, I was enamored of horses. I always asked my parents to let me have a pony ride at the fair. When my family moved into the beautiful Palos Verdes Peninsula in Southern California, horses became a major part of my world. You see, all the homes were situated around a network of riding trails and riding rings that were maintained by the city. Every house had a stable, and every family a rider or two. I got some riding lessons locally and really liked it. My parents and I decided this would be my sport and that we would pursue it as a family. 

I was accepted by an established trainer and he obtained a proper quarter horse. We trained until we were ready to show. It required about an hour and half drive out of town each way, and we did it at least four days per week. I did my homework in the car. When I arrived, I would train for several hours each time. It was dusty, intense and stressful, but I liked it nonetheless. Eventually I showed with my stable, all up and down the Pacific Coast in what was then called the Pacific Coast Hunter Jumper Stock Horse Association circuit.  It required a lot of time away from school which was hard. 

Riding has a way of building you up, no matter how hard it is. You learn tolerance: tolerance for your trainer, tolerance for your parents, and tolerance for your horse. You learn tolerance for the invariably bad weather, like intractable rain making muddy arenas, or broiling dusty heat in the Indio sun. You learn to control your fear and steel yourself as you wait to enter the competitors ring. Nowadays we call this distress tolerance. 

You learn to win, and you learn to lose. You are being trained, but at the same time you are training yourself. You have a chance to meet a great goal by meeting lesser ones along the way and you learn right away the winning takes a long long time and more work than you imagined.

I truly believe everybody should have a chance to pursue something seriously. I think all children especially should be raised knowing that they will be taught many things, and that when they find one that is special to them that they will be encouraged and even expected to learn it well. When young children attend classes for hobbies like ballet, music, riding or marital arts, or when they play sports like soccer or football, they learn that success requires practice over time. 

These traits of distress tolerance, perseverance, courage, and ability to work on a goal are key for success in life. I believe hobbies right from childhood foster these priceless traits. 

When I attended the horse show at Rebecca Farm today, I thought a lot about my horse show days. I was full of pride for all the riders and all they had accomplished. I hope you will go out and attend such sporting and arts events in your community. More than that, I hope parents will introduce their children to something inspiring they can pursue. 

For more information, see rebeccafarm.org. 

Food Friday: Food Joy and Fat ?

Food joy. Does all this enthusiasm about food contribute to the obesity epidemic ? Consider everything hot now in food : food magazines, the food channel, food trucks, street food, farmer's markets and local food ! Vegan, Paleo, Pegan, organic. 

I say a resounding NO. All this food joy is a great step in the right direction. It does not contribute to the obesity epidemic. I have no data here. I only have 30 years in medicine, most of which is focused on women’s health. 

Those with poor nutrition and problems with obesity are most often those who have not discovered the joys of food. Many times they are those that eat whatever food they can get. This ends up being the stereotypical top ramen, soda pop and boxed mac and cheese, or the iconic white bread. I remember unkind comments from adults I knew as I was growing up, as they wondered how people with so little money could get so much food to get so big. This reflects a profound misunderstanding of nutrition poverty and obesity.

Many times overweight people do not eat very much. They have little and eat little. What they do have is cheap carbohydrate, and they need to eat it as their whole meal since protein sources and fruits and vegetables are or are perceived as less available. Because of this diet, these folks suffer from chronically low metabolism and have low energy. They therefore become less active. Their extra weight compounds their insulin resistance, which results in more fat deposition. It is very hard to get out of this vicious cycle.

Many times I see young women in this predicament while they are pregnant. In this instance they have access to better resources such as food stamps as well as nutrition teaching. I have found that they are as eager and able as anyone else to learn. Once they do learn about the correct composition of meals, as well as the correct timing and quantity, they are astounded about several things. First, they are astounded about how much they enjoy their new diet. The are almost universally shocked at what large quantities they are supposed to eat. And, given this, they are amazed that their pregnancy weight gain levels out appropriately. Finally, they begin to enjoy food preparation, but note that it is a time commitment that they did not have before.

Some have odd reactions from significant others, and find themselves isolated. The partners may not want to change the way they eat. Sometimes partners even make fun of the one trying to be healthy and tease or taunt them back down to their level of poor nutrition. 

Most of the time this change toward nutrition awareness, and eventually toward food joy, is life altering. They never want to go back. Sometimes it becomes a source of pride and accomplishment in the family, and mealtimes become social in a way that they had not been. 

To me, the final stage of food joy is the social and cultural aspect. I took a walk down my own Main Street. I was amazed at what our little town had to offer. We had artisanal breads, real sushi, Thai food, genuine French macarons, and handmade watermelon chili sorbet all on one block. Granted, most of these delicacies were treats. But they were foods that made people appreciate food, other people, and other places. I saw people clustered in cafes, and out on the sidewalls. I saw people working on laptops, socializing, and flirting, all the while over special foods and drinks. They all seemed rather vibrant. 

It appears that people who take the time to walk about to find beautiful food like this are not apt to “ waste” their calories or carbs on junk. They become conoisseurs who are interested in the best for themselves. 

It is always a step in the right direction when people start to focus on quality, in nutrition, food, or even cuisine. When people focus on quality in one dimension of their lives, it tends to spread to others. My favorite part of this whole process is watching patients start to embody quality and enthusiastically take good care of themselves.