Wellness Wednesday: New Year’s Resolutions

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

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

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

See more at:

Structure Sunday: Three Ways to Get Ready for the Week

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

Here is more on exactly how this works : 

The Importance of Inspiration

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

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

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

Happy New Year ! 

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

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

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

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

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

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

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

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

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

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

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

Wellness Wednesday: Holiday Wellness Collection

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

Holidays, the Happy Disruption

Holiday Wellness

Gratitude is at the Center of Wellness

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

Merry Christmas and Happy New Year. 

May the light of the season be within you. 

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

This weeks news is all about the facts and figures. Statistics is like pie. It is all about how you cut it. That is to say, the real meaning of raw data is challenging to correctly interpret. A great deal of the message from a study depends on how the data is presented. Be wary about drawing conclusions from studies where none can be drawn. 

The CDC report indicates that the number of abortions in the United States has hit a record low compared to 1990. This is true for all ethnic groups.

A new study has hit the press indicating that use of SSRIs, common antidepressants, in the first trimester is NOT associated with increased risk of autism spectrum disorders. Nonetheless the study also showed babies whose mother’s took SSRIs were 75% more likely to get autism than than their peers. Whether this is related to the mom’s condition, the medication or something else is totally unknown and cannot be known from this study. 

In the strange, counterintuitive and questionable department, a new observational study published in the Journal of the American Medical Association shows more complications among those with a planned C section compared to those with an emergency C section done after labor. This is against what has been show before, and against common sense. Authors at the NYT Blog Well speculate that somehow the labor is “ good” for babies. You just as well might speculate that people who chose elective C sections are less healthy to begin with. No conclusions can be drawn, although many will be. 

New findings in the Journal Cancer Epidemiology show that while cancer rates are declining in developed countries, they are increasing in the developing parts of the world. With development comes smoking, and more obesity, which increase the risk for certain cancers. 

The now ancient Women’s Health Initiative, which gathered data on a great many things, has been mined once again. This time it has revealed an association between smoking and infertility. No surprises there. 

I guess I am not the only one who doubts the work of the USPTSF on the issue of breast cancer screening and mammograms. Over 60 lawmakers, headed by Representative Debbie Schultz of Florida, have included a provision in the new budget requiring that the US government officially recommends breast cancer screenings at age 40 rather than 50 as the UPTSF does. Looks like they feel American women are willing to undergo some increased anxiety and discomfort in exchange for earlier detection, longer life, and less mortality. 

A new study out of Britain once again raises the question as to whether the use of the Ca 125 blood test can help detect ovary cancer and save lives. The results are by no means conclusive, but they will provide an impetus for much needed additional study. 

Back to pie. This week I hope you have several kinds, pumpkin, cherry and whatever is your favorite. Merry Christmas week ! 

Food Friday: Holiday Menu Planning

I don't know about you, but right now I am trying to figure out the menu for not one but several holiday dinners to come in the fairly near future. To try and minimize stress with these events which are supposed to be fun, I've decided to do a little advance planning and let you in on it too.

Sometimes it's best to stick to tradition, and include menu items you know are family favorites. But particularly when you have more than one meal to present during the holiday season, you can afford to be a little bit creative. Let's take a quick look at four different cuisines which you might consider. Christmas is really big in each of the five countries which I will present, but you can probably think of many more countries that cherish the holiday as well. You can explore their cuisines too. Suddenly there is no shortage of menu ideas when you consider it in this framework. The challenge will be choosing what to leave out ! 

A Mexican inspired Christmas “ Navidad” 

• Virgin Margaritas
• Quesadillas with fresh salsa for starters 
• Ponche - a hot fruit and cider punch 
• Mexican Christmas Eve Salad _ this is colorful salad mixture of lettuce, beets, apple carrot, pineapple, jicama, pecans and pomegranate seeds. 
• Tamales with a chocolate chili mole sauce. 
• Rosca dee Reyes- A sweet spicy fruity bread containing assorted dried  or candied fruits. 

A French Inspired Christmas “Noel” 

• Champagne, Perrier
• Amuse bouche ( hor d’oeuvres) - olives, seasoned nuts, vegetable platters with dips etc. 
• Boeuf (beef) Bourguignon ( A thick stew made all day with red wine and meat cooked until fork tender eaten with crusty baguettes. ) 
• Haricots Verts ( green beans roasted with olive oil) served with lemon 
• Salade Nicoise - Tomatoes, boiled eggs, and tuna on a bed of greens 
• Diverse fruit and cheese platter 
• Buche de Noel- An amazing rolled chocolate sponge cake filled with mocha cream, frosted with chocolate buttercream to look like a log and garnished with meringue mushrooms
• Sorbet 

An Italian Christmas “ Natale” 

• Pellegrino 
• Antipasti- tuna, fresh salmon, cured meats, olives, cheeses, bruschetta, crostini, Caprese salad- with fresh mozzarella, basil and tomatoes
• Pasta, such as ravioli filled with extravagant fillings, such as meat, spinach, ricotta, figs, and even chocolate and candied citron. 
• Parmesan chicken in red sauce 
• Lemon tart 
• Gelati

 

Scandinavian Christmas recipes “ Yul” 

Glogg- spiced mulled wine 

• A “ julbord” , meaning a smorgasbord especially for Christmas
• Cold foods like Gravlax ( salmon cured in sugar, salt and dill), cured meats, cheeses, pickles, beet salad, breads and butters
• Warm foods like meatballs in berry sauce, potato dishes and cabbage dishes. 
• Desserts like Pepparkakor ( gingerbread cookies) and saffransbullar ( sweet buns)

One traditional Christmas in America, with some twists

• Turkey
• Mash potatoes
• Cranberry sauce
• Green salad 
• Asparagus
• Pie À la mode

Turkeys is front and center at Christmas time as well as at Thanksgiving. But this time give it a little twist. Consider encrusting the bird with herbs, or having it smoked. For the stuffing, go beyond simple breadcrumbs and try wild rice stuffing. Try a twist on traditional cranberry sauce and add orange. For your salad, add every favorite salad ingredient you can think of from olives to capers, dried cranberries, two colors of tomatoes, and even candied nuts. For the mashed potatoes, consider the very exotic purple potato, or for a very healthy twist, sweet potatoes. If you really want some color on your table try all three. And whatever you do with the potatoes, flavor them well with olive oil, butter, sour cream, salt, pepper and even herbs, garlic, or cheese. Regarding your traditional pie, consider one two fruits not one. Great combinations are apple raspberry, or rhubarb strawberry.

Warning: Each of these menus require several days preparation and several people to accomplish. But, as I read through all my material about holiday and meal traditions the world over, I realized that the affectionate time and extra effort spent preparing these magnificent celebratory meals together is the essence of the holiday. 

Merry Christmas all week long to all the cooks ! 

Wellness Wednesday: Body image

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Food Friday: Special Holiday Food

Holiday food is not just the food on the holiday table. It is two weeks from Christmas and in many families and in many workplaces it is like one long holiday. Food is front and central in many places at this time of year. Make yours special. 

Here are are some categories of holiday food to think about: 

• Office food
• Cookie exchanges 
• Food Gifts
• Hospitality Gifts to bring to a party
• Potluck food to bring to a party 
• Foods for the stocking 
• Foods for the holiday table. 

Office Food

Office food at the holidays can be overwhelming. From deli and cheese plates to commercial thank you baskets to homemade confections and baked goods, it can really pack on the pounds. The best thing to do is to make sure to keep a good list to write thank you notes, have a small sample of one or two treats, then cover the rest up and put it in the office fridge until the end of the day when the food can be taken home to someone’s hungry adolescent horde. 

Cookie exchanges

These take the advance planning of someone with an MBA. The key is a good freezer. The other key is a source of good freezer friendly cookie recipes. For example, anything based in shortbread is good, whereas meringue cookies are right out, unless they are baked same day and carefully transported. Remember that there is good gluten free flour that is widely available that will bake up just like regular wheat flour. You may not know who you are feeding, and you want to be inclusive.

The idea is this: You bake a good sized batch of cookies every couple days starting a couple weeks before Christmas. You freeze each batch. You do at least 3 types of cookies but 5 is better. You make sure to vary the flavors and form factors, so they will look interesting on a gift platter. On the day before the exchange, or whatever activity demands batches of festive cookies, you bring them out and arrange assorted cookies on said gift platter, making sure to package and decorate them well. Voila, now you know you could run at least a small company. 

Food gifts

These have been addressed previously HERE.

Hospitality Gifts

When you are choosing your party outfit, chose your party gift. Some people call them hostess gifts. Think of it as an accessory to your outfit. It’s good form, breaks the ice, and makes everybody feel good right away at the front door.

If you are attending a potluck and are bringing a dish, it does NOT count as your hostess gift. Classic gifts are a wrapped bottle of wine or champagne, but can just as easily be Pellegrino, Perrier, or sparkling cider. Another route is cut flowers, but I myself prefer a live plant such as an orchid. 

Potluck food 

First rule is to ask the host what they would like you to bring, smile, say yes and do it. Second rule, is make an extra special version of whatever it is. Third rule: try to steer clear of common dietary intolerances. Fourth rule: make enough. Fifth rule: present it well. Sixth rule: observe standard food safety practices. 

Foods for the stocking

Filling stockings is one of my favorite things to do. I bet if you thought about it, you could list the favorite treats of everyone in your family, and maybe a few of your friends. Think a bit more broadly and cover spices and condiments; then consider food related items like pretty toothpicks, and soon your “ foodie “ stockings will be overflowing. Here are some ideas: Hard candy in pretty small tins, actual high end natural cough drops, favorite gum, of course chocolates, but make sure they are not crushed, candy canes or licorice (but only if people actually like them), bottles of culinary extracts for cooking like vanilla or lemon, exotics like pomegranates, star fruit, cumquats, fancy nuts, and their nutcrackers. Capers, tiny jars of indian chili paste, colored peppercorns, teas, tea infusers, jams, and hot sauces. You get the idea. Just troll through a nice organic store and santa’s little helper will find lots of stocking sized treasures. 

Foods for the holiday table

I have covered this a bit before, but the essence is this: Bring people together in a spirit of wonder, gratefulness and congeniality. If your cherry pie can help with this, by all means make it. As far as healthfulness is concerned, yes, there is a healthy hack to every traditional recipe. I would like to write a bit more about this, and so this will be my topic for next’s week’s Food Friday. 

My best wishes to all the busy elves. 

Wellness Wednesday: Wellness Gifts

Still searching for that perfect gift ? Why not give something that promotes health and wellness ? I propose considering a “ wellness gift”. Here are some useful categories: 

1. Books on health and wellness. These could be books on mental or physical health. 

The Seven Habits books by Stephen Covey are some of my favorites. 

2. DVDs for exercise, yoga or meditation- Try those by Gaiam or Jillian Michaels. 

3. Basket of healthy drinks: herb teas, decaf coffees, matcha, or chai

4. Basket of healthy foods 

5. Healthy cookbooks ! - Try the Mayo clinic cookbooks, as well as the series by Jonny Bowden PhD, CNS. 

6. Tuition for a series of health classes, but only if you are sure they want them. 

7. Cool workout gear, or a gift certificate for it. 

8. Certificates for spa treatments, massage, or even a personal trainer session.

Spread cheer this season with some of these worthwhile wellness gifts. 

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

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

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

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

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

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

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

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

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

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

Food Friday: Food Gifts

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

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

Holiday food gifts divide themselves nicely into several categories: 

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

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

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

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

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

6. Spice mixes in nice containers. 

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

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

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

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

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

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

Wellness Wednesday: Cold Weather Workouts

Now that the temperatures are dropping and the outdoors is frosty, there are a few cold weather tips you need for working out outside. 

• Chose safe routes. Avoid iced over rivers of uncertain stability. Winter roads can be icy. One winter run of mine a few years ago landed me in a CT scanner, since I slipped, fell and hit my head on the ice. All was well, but it was no fun and showcased my imprudence to all my friends in the emergency room. Plowed roads or snowpack can work well, but you still have to be on your guard for black ice. Despite your best efforts, you may fall and injure yourself, so always carry your cell phone or go with a buddy. Some have suggested a loop close to home so you are are never far if you have to limp back. 
• In your first excursions of the cold season, go for less time than you usually do, to see how you adapt. You can always work up gradually later. This is especially good advice if you have asthma or other medical conditions. 
• Don’t forget sunscreen, especially in bright snow white conditions. Likewise wear appropriate eye protection for sun, snow and ice .
• Warm up and cool down as always. However, in the case of cold weather, do it inside. 
• Dress in layers, so you can stay warm but not overheat and sweat too much. Start with a wicking layer, followed by insulation, and then a shell. Always include a hat, which adds warmth without bulk and can help prevent frostbitten ears if it has earflaps. Consider a neck gaiter to keep the mouth and nose warm. Absolutely wear gloves to prevent frostbite. 
• Check the forecast before you go, factoring in not only temperature but precipitation and windchill. Tell someone where you are going and when. 
• Have an indoors workout alternative if it is just too challenging out of doors, preferably an indoor alternative at home, such as a workout DVD you can do in your living room or basement. 
• Do not mix alcohol with any workout. Be aware that alcohol degrades decision making, and masks symptoms of hypothermia. 
• Know and recognize the symptoms of frostbite, whiteness, tingling and pain. Know, recognize and heed the signs and symptoms of hypothermia: shivering, confusion, fatigue and slurred speech. Hypothermia is medical emergency and must be corrected right away. 
• Avoid cold weather exercise in the face of dehydration, inadequate calories or sleep deprivation. These can limit your bodies ability to thermoregulate. 

Working out outdoors in the winter requires extra preparation and mindfulness. However, there are some major benefits: Winter workouts produces a bigger endorphin boost than working out in warm weather. You burn more calories in the winter and train a bit harder. And it is invigorating to be out in the weather, and the landscape is often stunningly beautiful. Getting outside in the winter is important for fitness, but it also improves attitude and mood as well. All in all, is it something you should add to this season’s workout mix. 

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

California and Oregon will soon allow pharmacists to screen patients and prescribed birth control pills. While the American College of Obstetricians and Gynecologists considers this a step in right direction, they believe they should be available over-the-counter, plain and simple. While it is true that low dose combination birth control pills can have medical complications in a very small percent of people, by and large their health benefits far outweigh their risks.

As most of you probably are already aware, hepatitis C has a new medical treatment which provides a cure in a very high percentage of people. However, hepatitis B has remained a challenge, and in particular, we have had to deal with the problem of vertical passage of the virus from mother to baby during pregnancy, labor and delivery. However recently at the meetings of the American Association for the Study of Liver Diseases, new research was presented. In the course of a randomized controlled trial, a drug called Tenofovir was shown to be able to reduce vertical transmission. 

Yet another encouraging recommendation about exercise in pregnancy has been released. According to the American College of Obstetricians and Gynecologists, nearly half of US women gain too much weight while they're pregnant. We all know that women who gain too much weight in pregnancy are very uncomfortable. However they also have higher rates of miscarriage, premature birth, stillbirth, and babies with birth defects. They’re also more likely to have heart problems, sleep apnea, gestational or pregnancy associated diabetes, preeclampsia also known as toxemia, and abnormal blood clots. They are at higher risk for cesarean section. So there are ample reasons to find ways to control this weight gain. 

The new memo released by ACOG advises pregnant women to exercise regularly and more often than they currently do. The memo states that while walking is the best exercise, jogging, Pilates, yoga, cycling, swimming, and other forms of exercise are perfectly acceptable. ACOG cautions against contact sports such as skiing, and other specialized sports such as scuba diving.

More good news: it appears that breast-feeding for two months or more reduces a gestational diabetic’s risk of developing type II diabetes later in life by 50 %. Moreover, the risk of diabetes lessens as the patients breast-fed longer.

Finally, here is some good news that initially sounds a lot like bad news. Since 2010, there has been a significant increase in the number of women under age 26 who have received a diagnosis of early-stage cervical cancer. In the next age group, 26-34, the numbers were unchanged. What changed for the younger age group? The answer is the availability of insurance. One of the features of the ACA, The affordable care act, was to allow children to stay on their parents insurance plans through the age of 26. Most likely the increase in diagnoses came from increased compliance with recommended screening, i.e. pap smears. Once again, we are reminded that appropriate screening leads to early diagnosis, which leads to less invasive treatments, fewer complications, and higher rates of cure. 

Stay tuned for more breaking news from the world of OB/GYN next week on Medical Monday.

Food Friday: After Thanksgiving

How was your thanksgiving ? Not flawless ? That's ok. Take this time to decide how to make the rest of this weekend worthwhile. 

Our family and friend group has a leftover party every Thanksgiving Friday. Pies are featured as well. Turkey soup and turkey pot pie are great options. 

Consider this time, your leftovers, your pies, friends and family and be grateful.

Wellness Wednesday: Holiday Wellness

Here are just a few tips to make this most intense part of the holiday season less stressful, more relaxing and more celebratory. 

1. Take a look at your calendar from now until New Years. Make sure you are neither overbooked, nor forgetting about events that are meaningful to you. Make sure the schedule is realistic and that your family members are all on board with the plan. 

2. Take a hard look at your budget and stick with it for your Holiday expenditures. A great source of holiday stress is financial. Reduce costs by decorating with natural elements, entertaining pot luck, and by making or baking homemade gifts. Consider also gifts of outings. For example, give a certificate good for “one Sunday afternoon walk in the park with me”. 

3. Ramp up the consistency of your workouts. You will feel better about yourself and avoid the Holiday weight gain. 

4. Be choosy about your indulgences. Eat slowly and savor your treats. Drink ample water through the day, and be sure to consume the sights and sounds of the season, not just the tastes. Consider being the amateur event photographer of the family. It takes your appreciation of the season far beyond the food. 

5. Relatives coming from out of town ? Make a sound plan for their accommodations. A little advance planing can save a lot of stress. 

6. Anticipating stressful interpersonal encounters ? Plan ahead and adjust your attitude. Try to see the good in everyone. Blessed are the peacemakers. 

7. Bon chic, bon genre - This is a French saying meaning that if you dress well, you bring your best self forward. Dress to present yourself thoughtfully, and to indicate your respect, enthusiasm and cheer. Never dress to impress. Dress to delight and to put others at ease. 

8. Consider the deeper meaning of the season. This is, of course, the best way to put the shine on the season. 

Happy Holidays from Dr. Gina 

A very nice reference for more reading : 

http://www.clevelandclinicwellness.com/Features/HealthyHolidayCelebrations/Pages/introduction.aspx#

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

Happy Monday on this short week ! This week in honor of Thanksgiving I plan to apply the filter of gratitude to the news that I feature. Let’s see how this works out. 

The LA Times recently reported on the actual C Section rate in the US ( 33%)  as compared to the theoretical ideal of 15 %. An ACOG (American College of Obstetricians and Gynecologists) spokesman indicated that this discrepancy was largely about risk tolerance of the involved parties. Gratefulness filter: Le’t be glad we live in a place where C sections are readily available to those who need them. 

Findings coming out of the African American Cancer Epidemiology Study indicate that black women with the healthiest diets were 34 % less likely to develop ovarian cancer that their counterparts who ate the most unhealthy diet. Gratefulness filter: Diet is an easy factor to modify !

Findings presented at the American College of Rheumatology indicate that Denosumab was superior to Zoledronic Acid ( Zometa) at restoring low bone density due to osteoporosis. Gratefulness filter: This is great news for all with low bone density ! 

The Supreme Court rejects the case against Planned Parenthood. Justices Scalia and Thomas dissent. Gratefulness filter: Let is be glad we live in a country that respects free speech of differing parties, that observes due process and the rule of law. 

About 10 % of all new mothers suffer from post partum depression. New York is rolling out a ambitious program which will require that all expectant and new mothers will be screened for depression. Gratefulness filter: Thank goodness awareness is increasing about this important and treatable problem. 

Rhode Island has a new state mandate requiring HPV vaccine for youngsters. Nearly three quarters of seventh graders received it by the start of the school year. Gratefulness filter: Thank goodness we have a way to prevent cervical cancer. 

Count your blessings this week and stay tuned for more news from the world of OB/Gyn next week on Medical Monday ! 

Food Friday: Fruit Muffins 2.0

Fruit muffins were originally an attempt to use up borderline fruit and to make regular muffins (Fruit muffins 1.0) more healthy. They have since become a family favorite. 

You may not need to make fruit muffins before Thanksgiving but you will most definitely need to make them afterwards. That is why I am giving you the recipe this week. You see, you will have left over items from Thanksgiving, and most likely you will make soup out of these premium ingredients. It follows therefore that you will need muffins to go with your soup.

Fruit muffins 2.0 is a flexible recipe. You will see a lot of variations and there are a lot of workable substitutions. 

Adjust your shelf to the upper third of the oven and preheat to 350 degrees F. 

Equipment

• Two cupcake tins each holding 12 cupcakes.
• Unbleached cupcake papers, usually available at a natural food store

Ingredients

• 3 1/2 cups whole wheat pastry flour or whole wheat flour fine grind ( use white if you must but the result is less rich.. you may need more flour too) 
• 2 teaspoons baking powder
• One half teaspoon salt
• One and 1/2 half teaspoons baking soda
• 1/2 cup butter, or one half cup coconut oil can be substituted
• 1 1/2 cup sugar, can be cut to 1 1/4 cup
• Two eggs
• 4 tablespoons lemon juice (equals one quarter cup)
• Six bananas
• or 3 bananas +3 cups mixed fruit such as strawberries, diced fresh apple, dried cranberries.
• Zest of one orange if you have it

Most baking recipes like this one proceed along a typical pattern:

• Cream the liquid ingredients first starting with the butter in the sugar by themselves.
• Add eggs at this stage and whip mixture until fluffy. 
• Add the lemon juice and whip again. 
• Mix in all the fruit and the zest. 
• Whisk together the dry ingredients so they are thoroughly mixed. 
• Stir or fold them thoroughly into the wet ingredients. 
• Scoop with a large ice cream scoop into the muffin papers. 
• Bake 19 -24 minutes ( usually 23) until golden and slightly firm, and passing the sharp knife test. 

Transport in their tins to serve warm to happy friends and family, or to crabby ones and watch their mood improve. These are great served with cold milk. 

Have fun cooking this week. Clean , decorate, cook, and forget perfection. Make cooking a fun group activity. Make it healthy with selected treats and family traditions. Get along with everyone as best you can. Most of all, be grateful. 

Wellness Wednesday: Nature and Health

Tonight I attended the Banff Mountain Film Festival as I have done almost every year for the last 20 years. This film festival is a celebration of mountain culture and the outdoor lifestyle.

Mountain culture means a certain thing to me, my family and my friends. Understanding what this means can shed some light on what it means to be healthy. 

I could say it means high adventure like ice climbing, parasailing, and extreme skiing. I could say it means having a community where fitness is highly valued. I could say it means being outdoorsy. I could say it means being active in the environmental community. But it is not exactly just these things. 

It is a little but of each of these things. But mostly it is this: it is connecting WITH  people IN nature. We know from the social sciences that being connected to others is critical to health and wellness. We also know that immersion in nature is critical to our well being. Numerous studies have demonstrated that exposure to or immersion in nature improves the following: 

• mental health

• immune system resistance

• reduced stress

• reduced anxiety 

• reduced anger

• reduced fear

• increased positive mood

• increased feelings of unity with others, more sense of community

• more concern over helping others 

• enhanced social interactions 

For children, exposure to nature has been associated with the following:

• reduced stress levels, increased fitness 
• reduction in ADHD symptoms 
• enhanced student performance on tests of critical thinking 

The data on the subject of nature and health are fascinating, overwhelming and encouraging. Check some out for yourself: 

University of Minnesota

Health Promotion International

National Wildlife Federation

American Public Health Association

Stanford University via Science Alert

The Lancet

University of Washington

Norwegian University of Life Sciences

No matter where you live, be it city or country, this is important for you to know. You and your family need your time in nature, no matter the season, no matter whether you live in the mountains. coast, desert or plain.

You should keep an eye out for any outdoor film festivals in your area as they are sure to inspire. Our local festival out of Banff is sponsored in part by National Geographic. I was intrigued by their stated interest which was the intersection of “science, adventure and storytelling” . Go out and get some for yourself. 

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

The HPV vaccine has recently been vetted at the European Medicines Agency (EMA, the equivalent of the FDA). The EMA concluded that the benefits of Cervarix and Gardisil outweigh the risks. CDC (Center for Disease Control) Director Tom Frieden estimates that increasing the HPV vaccination rate to 80% would prevent 50,000 cases of cervical cancer in women.

Echoing results from last week, a study published in the Journal Hypertension has shown that those who had high blood pressure in pregnancy double their risk to develop the condition later in life. For diabetes, the risk quadruples.

Our largest and most foundational study on postmenopausal hormone therapy, the Women's Health initiative, (2002) was noteworthy for the fact that overall “estrogen plus progestin hormone replacement therapy" increased risk of "heart disease and breast cancer”.

Well the devil is always in the details, and sometimes angels too. It turns out that age makes a big difference the development of heart disease risk. If you “unpack" the data, you will see that women between the ages of 50 and 59 actually had a protective benefit to using hormone therapy, while women over 60 did not have the same advantage. Is interesting to remember that in this study all study participants  had never before taken any postmenopausal hormone replacement therapy. Therefore those who were 60 and older entering the study were beginning their hormone therapy approximately 10 years after the onset of menopause. Some researchers believe that it is that block of time after menopause but before initiation of hormone therapy in which silent atherosclerotic developed. If this is true then cardiovascular disease manifesting during the course the study would not really have been caused by the hormone replacement under study. Optimistic speculation leads us to wonder if women over 60 would do as well as their younger counterparts if they're hormone therapy has been started at the onset of menopause. It would be nice to know whether or not it is the youth of the women that caused them to do well with hormone therapy in their 50s or the fact that they started their hormone therapy immediately after the beginning of menopause.

It is interesting to note that age at the beginning of the study did not affect a woman's risk of breast cancer. Use of "estrogen plus progestin hormone replacement therapy” was and is clearly associated with increasing risk of breast cancer. (The same cannot be said for those who are able to use estrogen alone as their hormone therapy.) The lead investigator in this most recent study, Dr. Joanne Manson, indicated that "for every 1000 women per year not using hormone therapy, about 3 develop breast cancer” versus 4 out of “every 1000 women” using combined estrogen plus progestin hormone therapy.

A recent study has shown that only about half of women visited the dentist during pregnancy. Dental care in pregnancy is critical since many oral and tooth diseases have a direct impact on the pregnancy including increased risk of preterm labor.

Former Republican representative from Georgia Phil Gingrey has criticized the recent US Preventive Services Task Force (USPSTF)  recommendations on mammography citing the differing recommendations of the USPSTF, the American Cancer Society, and the American College of Obstetricians and Gynecologists. He has urged for more time to study the basis of these differing recommendations, so that we can "analyze the research and arrive at a medical consensus”. He has introduced a bill entitled “Protect Access to Life-saving Screenings”, (PALS). This bill would place a two year moratorium on the USPSTF recommendations.

I am all for this and I dare say a great deal of unpacking the data will be necessary here. What will be important in the conversation is identifying the “harms" of screening. And please don't talk to me or the breast cancer survivors in my life about fear of and pain from mammograms, which have been cited by the USPSTF as harms. Besides this, it will also be imperative to study endpoints, not only survival, meaning and lack of death, but years of life. It seems like a subtle distinction but it seems to have been lost on the US Preventive Services Task Force thus far.

Support has come out for treatment of subclinical hypothyroidism (low thyroid) in pregnancy. A new study presented at the International Thyroid Congress has shown that treatment with synthroid or Levothyroxine in pregnancy for those with subclinical hypothyroidism “was associated with decreased low birth weight and Apgar scores". It was not however associated with a significant decrease in miscarriage. This will probably tip the wobbling scales in favor of universal thyroid testing in pregnancy. 

Any study recently published in the December issue of Obstetrics and Gynecology has shown that yoga is safe even late in pregnancy. Study participants were put through various yoga postures and measurements were taken of heart rate, blood pressure and other vital signs for mother and or baby. Although mothers often opted for various modifications of their poses, no ill effects were found.

In more happy news, the United Nations and the World Bank jointly issued a report Thursday noting that maternal death rates have dropped 43% worldwide since 1990. This is attributed to better access to higher quality health and sex education services.

Stay tuned for more news from the world of OB/GYN and women's health, next week on Medical Monday.

Food Friday: Wild Rice Stuffing

You will not believe the ingredients for this recipe. When you assemble the ingredients, it looks like you're going to make a salad. But the result is as hefty and savory as the Thanksgiving turkey itself.

This recipe is best made by crowd since there are a lot of ingredients to prepare. Additionally it is best to start a day ahead. On Thanksgiving day, ingredients should be prepped two or three hours ahead of when the turkey will be done. Finally, be advised that this stuffing does not actually stuff the turkey. It is much safer, much quicker, and just as delicious to bake the stuffing in its own separate pan, which incidentally, is anything ovenproof, such as metal, glass, or ceramic.

For cooking you will need at least two large frying pans, prep bowls, and a big bowl for mixing.

Budget at least one cup of stuffing for each guest. This recipe makes at about 8 cups.

Ingredients

• At least 4 cups of cooked wild rice, cooked the day before
• 2 cups dried fruit soaked overnight in the wine of your choice, and minced. Our favorites are craisins, dried pears, dried apples, or dried plums. 
• One cup sliced or slivered almonds, toasted carefully on a metal pan under the broiler. Be careful since they go from perfect to burnt in a few seconds.
• Two tablespoons minced garlic
• Two onions diced 
• One generous bundle of parsley chopped
• Two bundles of green onions chopped
• 2 cups celery chopped
• One green apple and one red apple, diced
• Zest and juice of one orange
• 2 cups mushrooms, sliced if desired
• 1/4 cup dried spice of your choice; See my recipe for "family spice" below
• About 2 cups strong turkey or chicken broth
• Olive oil to sauté
• Kosher salt and freshly ground pepper to taste

Directions

As a general rule, you will begin sautéing the ingredients one by one or in groups from hard to soft. That is to say, you cook the ones that take the longest first. Cook each of these until they are almost perfectly done. Sauté the minced garlic, onions and celery in olive oil. Go slowly enough so that they caramelize and do not burn. Set these aside and sauté the apples. Add green onions and parsley and sauté these. Set aside. Sauté the mushrooms until slightly browned. Salt and pepper each batch lightly as you go. You can always add more at the end.

Mix all of this with the rice, the dried fruit, the flavored wine, the almonds, the zest and juice of the orange, and the spices. Mix everything thoroughly. Adjust seasonings. Press the mixture evenly into the pan or pans. Moisten everything lightly with the broth. Do not feel compelled to use all of the broth. 

At first, you will be cooking the pan with foil on top at 375° to finish cooking the ingredients and blend all the flavors. This will take somewhere between 30 and 45 minutes. The mixture should end up moist but not soupy. In the last 15 minutes you will want take take the foil off and watch carefully to brown the top. 

Serve beside the turkey or separately. Once served, refrigerate promptly. It reheats very well.

Family spice

• Two parts ground rosemary
• Two parts thyme
• One part basil
• One part tarragon
• One part of oregano

Happy cooking !