Wellness Wednesday: Safe Cosmetics

We think of cosmetics as luxurious little compounds we use externally to improve our appearance. But they are mixtures of chemicals of which we should be aware. We place them on our skin, eyes and near our mouths, and may not realize that they could have potential health impacts. We also store them in our homes where they could be obtained by little ones who may use them in unsafe ways. 

This week’s post deals with these concerns. To explore this complicated area, I have researched on two main site, fda.gov, i.e. the Food and Drug Administration, and breastcancerfund.org. They both make the following strong recommendation: To read the labels of any products you buy. They advise us to know what these ingredients are, and to look them up on FDA.gov if there are any concerns. They also state that products with unlisted ingredients should not be used. 

FDA site 

http://www.fda.gov/Cosmetics/default.htm

The FDA site is rather comprehensive so I will not attempt to reconstruct or summarize it here. Instead, I will highlight some points that I felt were noteworthy. 

FDA.GOV states that “ FDA regulates products that we think of as “makeup” –such as lipstick, blush, foundation, face powder, eye shadow eye liner, and mascara--as cosmetics under the Federal Food, Drug, and Cosmetic Act.” The FDA pays particular attention to color dyes used in cosmetics. Coal-tar based dyes are common in hair dye. They are known to cause eye injuries or allergic reactions. However, the FDA cannot take action against them since the package insert provides instructions and discloses this risk. 

Hair straighteners are also a concern. Some can release formaldehyde.The FDA advise avoiding exposure to formalin, methylene glycol or formaldehyde. 

“ Progressive dyes” are hair dyes which produce the desired color change after repeated use. They contain lead acetate - made for external use only and are unsafe to have around children due to the risk of lead poisoning. 

Mascara is associated with a significant number of complications. Apparently eye injuries are a common result of mascara application while moving, i.e. while one is in the car. Mascara can also cause infection or irritation. It should be thrown out after three months or if the eyes get infected or inflamed. Mascara is not to be shared, even with friends or relatives. Bacteria which may be friendly to you may cause problems in someone else. 

Do not use Kohl, aka al-kajal, kajal, or summa. Kohl is a traditional dark black eye decoration in many areas of the world but is not approved for use in the US. It consists of salt and heavy metals (! ) such as lead. It is linked to lead poisoning. I remember when this was in vogue in the 70s. 

Permanent tints and dyes for eyebrow and lashes have caused serious injuries. Those containing coal tar colors are not safe for use. Makeup experts advise against eyebrow pencils anyway, saying that they appear too severe. Additional definition is best achieve with a subtly applied dark eye shadow.

Parabens have been in the news as a suspected undesirable chemical. Parabens are preservatives to guard against microbiological growth. Studies show they are safe at levels up to 25 %. In cosmetics, they are typically used at levels up to 0.3 %. Parabens do have weak estrogen like activity and for this reason a public concern has been raised. However, they are 10,000 to 100,000 less potent than natural estrogen produced in our own body. In the small quantities in which they are used, they are believed to be unlikely to contribute to any cancer risk. 

Phthalates are a group of chemicals used in many materials from floor covering to food packaging. They are also used in numerous cosmetics. Their primary use in cosmetics is in hairspray, nail polish and synthetic fragrances. They too are endocrine disruptors, meaning they interact with hormone receptors. The FDA states “ It’s not clear what effect, if any, phthalates have on human health”.They continue to follow this question, but to date “ FDA does not have evidence that phthalates used in cosmetics pose a safety risk. “ However, some people prefer to avoid phthalates until there is more proof of safety. The particular compounds to look for are dibutylphthalate (DBP), dimethylphthalate (DMP) and diethyl phthalate (DEP). DEP is the only phthalate still commonly used in cosmetics. 

Talc is a common substance which shows up in baby powder and blush. It is a mined mineral and contains magnesium and silicon. Certain talc has been known to be contaminated with asbestos, which is a known carcinogen. For this reason, since the 1970s, it is purified before use. Pure talc has not been linked conclusively to any cancer, though in the 1970s it was rumored to be linked to ovarian and breast cancer. The IARC ( International Agency for Research on Cancer), which is part of the World Health Organization, has made the following statements about talc: 

• IARC classifies talc that contains asbestos as “carcinogenic to humans.”

• Based on the lack of data from human studies and on limited data in lab animal studies, IARC classifies inhaled talc not containing asbestos as “not classifiable as to carcinogenicity in humans.” 

• Based on limited evidence from human studies of a link to ovarian cancer, IARC classifies the perineal (genital) use of talc-based body powder as “possibly carcinogenic to humans.”

Breast Cancer Fund

breastcancerfund.org

This organization takes a more conservative point of view than the FDA. They advise avoiding any substance where there is doubt, or a lack of data, and advises reducing the total number of cosmetics altogether. They also advocate for making your own products with nontoxic ingredients from your kitchen. 

Their first piece of advice is to avoid synthetic fragrance, as it often contains Phthalates. Additionally many people are sensitive to it. Several people on my staff get an instant headache when they smell strong synthetic perfume. 

They urge caution about a products with unsubstantiated claims of being natural or organic. Only a USDA organic seal guarantees 95% or more or organic ingredients. "All natural" or organic does not mean hypoallergenic and does not determine safety. Anyone can be sensitive or allergic to anything. For example, many essential oils are fine when aerosolized, but irritating when applied directly to skin. 

Breast Cancer Fund advises caution when getting the nails done. In particular they suggest steering clear of shops with use polishes with formaldehyde, toluene, and dibutylphthalate, the so called "toxic trio” . There are many brands that are now “ three free”. Ask your salon to carry these. 

I support the advice to use minimal cosmetic products. I also support the idea of making your own. I will conclude this post by sharing what I use. Bear in mind that I am 54 with dry skin and long curly dry hair. For face, I rely on what my Dermatologist has told me. I shower twice a day with plain water. I exfoliate gently with an apricot pit scrub, and in the day use a Retinol ( vitamin A based) cream with sunscreen. In the evening after I wash with water only, I use a home made mixture of a stronger Retinol cream, a richer moisturizer and a concentrated vitamin C serum. On the body I take it easy since I have sensitive skin from Lupus. I use a waterproof electric shaver in the shower, so I need no shaving cream or razors. After the shower, I use a home made 1:1 mix of cocoa butter and coconut oil, both organically produced. ( It is actually a chore to melt, blend and re-temper.) For hair, I use only conditioner, no shampoo. I use a light mineral based moisturizing foundation with sunscreen, and mascara with a brush that I clean and replace every 2 months. Finally I use Burts Bees lipgloss for face color and lips. That’s it. 

Oh yes, that photo of me was a joke but I guess it fits in here. 

Next week on Wellness Wednesday we’ll expand on this theme and go over natural home cleaning solutions. Thanks for reading. 

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

Good Monday.

The CDC continues to study the relationship of the Zika virus to a severe brain anomaly called microcephaly. No one really doubts the association; The goal in documenting the association scientifically it to understand the mechanism of how the virus dose the damage and therefore how, ultimately to prevent or interrupt it. Similarly, new research this week provides stronger links between Zika infection and Guillaine Barre syndrome, or post viral partial paralysis. 

Zika virus has been seen as far north as Washington DC. Aedes Egyptae mosquitos have been identified there as well, and it is speculated that they survive the winter by staying indoors or in subways. Apparently the mosquito maps in the US are “not complete”. 

Preterm labor and delivery has vexed Obstetricians for decades. We have little to prevent it. We did feel were making inroads into predicting it using two specific tests: ultrasound measurement of the cervical length and a swab for a chemical called fetal fibronectin. However, according to new research these may not be as useful as previously thought. Risk factors for preterm birth are young age, low pre pregnancy maternal birthweight, smoking, short inter conceptual interval, urinary tract infections, and periodontal (gum) disease. 12% of all births in the US are preterm. Preterm delivery is the leading cause of neonatal mortality in the US. For more information, see our section HERE on preterm labor. 

A study reported in the Journal of Adolescent Health has shown that only about 42% of men have heard of emergency contraception, aka the morning after pill. This is a safe effective solution to prevent unplanned pregnancy. It is available over the counter. 

Essure is a device placed in the fallopian tubes for sterilization. It turns out to have a far higher complication rate than was previously believed or advertised. A powerful social media campaign brought this to the attention of the FDA who has now studied the matter and given its recommendations. Essure will not be pulled off the market. Instead, Bayer AG will be required to perform new studies on the implant. The FDA will also require a boxed warning and supply a checklist for physicians to review with patients. The FDA is currently seeking public input on the packaging. 

From the chickens and eggs department, a recently released study in the Journals of Gerontology showed that “ higher education, positive wellbeing, overall good health, and higher physical functioning all contribute to women maintaining good memory health after age 80.”  This data comes from a study initiated in 1991 and is a subset of the huge Women’s Health Initiative Study famous for its revelations about postmenopausal hormone replacement therapy. 

A recent study in older first time pregnant women shows that induction at or after 39 weeks is NOT associated with a bad birth experience or a higher risk of C section. This is contrary to the prevailing wisdom. 

This last week, the US Supreme Court has heard arguments over the matter of abortion facilities. At issue is whether they must meet hospital grade surgical standards. Proponents state this will make the facilities safer. Opponents say that this is a ruse, cost prohibitive and simply a legal way to close down all but a few facilities (75% of them according to ACOG, the American College of Obstetricians and Gynecologists. Medical experts say this level of facility is not medically necessary for these procedures.

Meanwhile statistics in the US now indicate an 18 % drop in unplanned pregnancies between 2008 and 2011. One third of these pregnancies were averted though legal abortion. Further south, the staunchly Catholic South American countries grapple with the devastation of Zika induced microcephaly and the question of abortion should it be identified. 

Stay tuned next week for more breaking news from the world of Obstetrics, Gynecology and Women’s Health. 

Food Friday: Vitamin D

Vitamin D is in the spotlight. Is this celebrity justified ? 

Vitamin D is a fat soluble compound that is necessary to human health.Interestingly, it is not widely available in our diet. It is however, manufactured in our skin when the skin is exposed to UV rays from sunshine. It is of course available in supplements, supplemented foods, and a few foods naturally. 

You might wonder how we developed to need something that seems so hard for modern people to obtain naturally. I think it is a good bet that pre-agricultural people especially those along the coast got more sun and UV exposure than we do today. I suspect that plus their intake of vitamin D rich fish supplied their needs. Then as people began to move inland, wear more clothes, eat less fish and live long enough to have to protect against skin cancer, their vitamin D requirements became harder to meet. 

 Vitamin D is historically most “ famous” for its role in enhancing Calcium absorption. Calcium is critical for bone mineralization. Deficiency of Vitamin D leads to rickets and osteomalacia, which are failures of the bones to properly form. 

Those at risk for vitamin D deficiency are breastfed infants who aren't supplemented, dark skinned people, people who wear occlusive clothing, the home bound, the elderly, the obese, vegans, and those whose gastrointestinal tracts are inflamed or cannot absorb properly. 

It seems odd to me that breastfeeding does not supply all the necessary vitamin D a newborn needs. This is simply because the Vitamin D content of human milk is related to the mother’s vitamin D status. The infant cannot get vitamin D though UV exposure since it is not appropriate to expose infants to direct sunlight. There has been a big recent campaign to educate breastfeeding mothers about the need to supplement with vitamin D. 

Vitamin D also affects the general functions of cell growth, neuromuscular function, immune function, and the control of inflammation. These features are why there is more than the average amount of buzz around this mild mannered vitamin. Two hundred and fifty studies on vitamin D and various health parameters were done between 2009 and 2013. These were systematically reviewed by the Agency for Healthcare Research and Quality, and to date, it concluded that it is still not possible to specify a relationship between vitamin D and specific health outcomes other than bone health. As the number of studies indicates, there is widespread interest, or even hope that vitamin D therapy will prove useful for a wide variety of conditions, especially those involving autoimmunity. 

Adults need between 600 and 800 IU of vitamin D per day. It is best not to take more than about 4000 IU per day from all sources, unless specifically instructed to do so by your physician. Vitamin D is fat soluble, can be stored in the body and can, in excess, lead to toxicity. 

It is best to get your vitamin D from a combination of foods, fortified foods, and supplements. The best dietary sources of food are fatty cold water fish such as salmon, cod, tuna and swordfish. (As a side note, pregnant women should restrict their intake to salmon and cod, since tuna and swordfish may theoretically have increased levels of heavy metals. ) Besides these, egg yolks, fortified orange juice and fortified dairy products are the best sources. 

If you are concerned your vitamin D levels are low, ask your doctor about testing your levels. We have been screening patients more proactively lately, and have found some astounding deficiencies. The good news is, they are quite easy to fix. 

Here’s my favorite go-to recipe for a great blast of vitamin D and protein: 

Salmon Salad

Simply mix one drained can of coho salmon with 1-2 tablespoons of olive oil based mayonnaise ( My favorite is called “Lemonnaise”.), Add a table spoon of dill relish, a couple Tablespoons of sliced olives, some capers, finely chopped celery, chopped sun dried tomatoes, and whatever else suits your taste. Mix. Do not feel compelled to put it on anything. Enjoy. 

Refererence: 

National Institute of Health Office of Dietary Supplements 

Wellness Wednesday: Menstrual Wellness

At first I thought the #freethetampon movement was a bunch of hooey. However, now I am giving it a second look. What got me thinking was a Tedx talk given by Nancy Kramer featured here on this website:

http://freethetampons.org

This site has some hard numbers about how many girls and women have to interrupt their school or work day to improvise a solution to an unanticipated period (86 % of us !) This is because restrooms the world over are stocked with toilet tissue, soap and something to dry hands, but there are scarcely ever any tampons or pads.

Granted there is an additional cost to providing these supplies, but in terms of school or professional environments, there are also benefits: less time away, less workplace stress, etc. Supporters of the #freethetampon movement advocate that tampons and pads should become freely available in every public bathroom, much like toilet tissue or soap. They view it as a public good and standard of decency in consideration for the everyday realities of normal body functions in women. Most women prepare as best they can and carry adequate menstrual supplies most of the time. But, as a Gynecologist I can assure you that irregular cycles and uncontrolled menstrual flow happen once in a while to most women. Even the best prepared among us has most likely struggled with an out of control period at one time or another.

Back to the cost of menstrual supplies. Did you know that in most places there is sales tax on tampons and other menstrual hygiene materials ? Sales tax criteria vary by state. Montana, Alaska, Oregon and New Hampshire have no sales tax on anything. Beyond that, Minnesota, Pennsylvania and Maine tax the customary items of “ tangible personal property” excluding necessities like food and medicine. Most notably these states also exclude menstrual hygiene products from sales taxation! In these states menstrual hygiene products are classified as necessities rather than “ luxury” or “ tangible personal property” items. Every other state taxes menstrual hygiene products. Every other state has what is being called the “ tampon tax.” Critics of the tampon tax say that it unfairly discriminates against women. They point out that it is a tax that women have to pay solely by virtue of being women, which is sex discrimination.

The tampon tax issue together with the #freethetampon movement has catapulted the menstrual cycle into the public limelight. For most of history however, the subject has been totally taboo. Most generally menstruation has been looked upon as an “unclean" state. In many cases menstruating women have been set apart from their family during this time. Even until recently it has been considered a topic not fit for polite conversation. And for reasons which are still not clear to me, menstruation has been a source of embarrassment or shame.

Many contemporary women are interested in removing the stigma of shame associated with this normal body function. To do so, they have taken several tacts. If you search the web on such matters, you will find all kinds of art from posters, pins and jewelry which flaunt these taboos, and demonstrate menstrual pride. There are references to “shark week”, “riding the cotton pony” and visits from “Aunt Flo”, normalizing and humorizing the subject. In one instance at one American high school

(https://en.wikipedia.org/wiki/Tri-Valley_Central_School,)

a security guard’s public search of a girl’s purse also included questions about whether she was on her period. The incident was considered intrusive. The next day, boys at the school came to class with sanitary pads taped to their shirts in a show of solidarity for the girl. Girls wore tampon necklaces. Finally, most of you have heard by now how Kiran Gandi, a Harvard business school student, ran the 26 mile London Marathon on her period, without a tampon and with visible bleeding, to “ transcend oppression” and to publicize the plight of those women who lack adequate menstrual products.

You get to decide how you feel about your period. But you should know a few things about it. No period is comfortable or convenient, but some get downright bad. If you meet certain objective criteria, you should call your doctor and get checked. Abnormal periods are not healthy, and should be treated.

Here is a section from our page on on adolescent and childhood Gynecology which describes the beginnings of periods :

The mean age of menarche (first menses) is approximately 12 1/2 years of age, with a range of about 11 to 14. Menarche typically occurs 2 to 3 years after thelarche after the breasts are fully developed. Ninety eight percent of females will have had menarche by age 15. Any adolescent girl who has not reached menarche by 15, or within 3 years of thelarche should be evaluated. Additionally, any vaginal bleeding before the age of 8 is a concern and should be evaluated by a a gynecologist.

- See more at: http://drginanelson.com/childhood-gyn-concerns#sthash.ykiQ4Hoh.dpuf

More menstrual facts you need to know:

Periods should not last longer than a week.

Period intervals ( time from day 1 of one period to day 1 of the next period ) should not be less than 21 days or greater than 35 days.

Total flow should not exceed 80 cc (1/3 cup) in one cycle.

Period flow should not make you lightheaded or anemic.

Period pain should not keep you from school, work or exercise.

You can get pregnant on your period.

If you experience any of these things, you should call your doctor. Depending on your age and medical history, an evaluation may be done. Depending on the results, a treatment can be planned.

Tips for menstrual management:

You may pick from either pads, tampons or both. You may use menstrual cups as long as you wash them as instructions indicate. None of the internal methods should be left in longer than needed, or they can foster infection. Apparently there are now unisex tampon necklaces you can wear, to use yourself or to “help a sister". There is even an app, developed by a Harvard freshman, Olenka Polak, called “ Code Red” which alerts sympathetic users in your area that you are caught in a “ periodic emergency”.

Menstrual health is a physical and psychological challenge. Don’t feel like you have to meet this challenge alone. 

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

Good Monday ! We will start our news this morning with a revelation that a once deadly virus is now under firm control via the three pronged approach of surveillance, treatment and vaccination ! I speak, of course of the Human Papilloma Virus,(HPV), responsible for causing cervical dysplasia and cervical cancer.

A new CDC study published in The Journal of pediatrics reports states that" thanks to a vaccination program that began decade ago fewer US women are entering adulthood infected with” HPV. Apparently this study is the first to show falling levels of dangerous strains of the virus in women in their 20s. Human papilloma virus vaccine also known as Gardisil, has been available for use for children ages 9 through 26 for many years now. It was initially only available for girls because the studies were done first on girls but subsequently it was released also to boys. 

Zika is our newest viral threat. It has ravaged South and Central America and proceeds northward into areas where the Aedes aegypti mosquito can live. Zika is blood borne and spread by this mosquito. Male to female sexual transmission of ZIka is now also confirmed. It is also vertically transmitted, meaning from mother to unborn child, and is strongly linked to the development of microcephaly in the the growing fetus, which produces severe brain damage. Conclusive proof of the connection is likely to come in June when a large cohort of nearly 5000 women mostly in Columbia will give birth.

Zika infection is also a threat to the nonpregnant in that it is strongly associated with a much higher risk of developing post viral paralysis, Known as a Guillain-Barré syndrome. World Health Organization researchers note that there is been a spike of Guillain-Barre "everywhere that we are seeing to seek a virus".

In the good news department, breast cancer survivors are now believed to be able to safely use vaginal estrogen therapy. Vaginal estrogen therapy is used to treat vaginal atrophy, often see in menopause or after breast cancer treatments which stop a woman from producing estrogen. Vaginal atrophy is a painful condition which causes various problems and prohibits intercourse. We do not give systemic estrogen to breast cancer survivors since we are concerned it could encourage a cancer recurrence. Vaginal treatments are not believed to produce a systemic dose. 

In more good news, a cheap easy to use vaginal ring is helping to curb HIV transmission rates in Africa. The rings slowly releases an antiviral drug to combat HIV and it needs to be changed every 4 weeks. It reduces transmission by 30 %. 

In concerning news, preeclampsia in pregnancy seems to be associated with a measurable risk of cardiovascular disease later in life. The effect is so pronounced, that left ventricular functional abnormalities can be seen on imaging family soon after delivery. 

Also concerning is new research indicating that breast cancer risk may be increased in those with hyperthyroidism. 

Finally, in the news-that-sounds-like-science-fiction department, the first uterus transplant in America has been performed. The recipient is 26 years old. She will have to wait year before attempting In vitro fertilization. If she succeeds, she will be permitted to keep her uterus for one of two children and then it will be removed. 

Food Friday: Gastrointestinal Health, Bloating, IBS and FODMAPS

FODMAPS is the newest of the dietary buzzwords in the blogosphere today. If you struggle with bloating or irritable bowel symptoms, learning about FODMAPS may help.

FODMAPS stands for fermentable oligosaccharides disaccharides monosaccharides and polyols.

FODMAPS include:

Fructose – fruits honey high fructose corn syrup, Etc.

Lactose–regular dairy products

Fructans-wheat garlic onion etc.

Galactan-Legumes such as beans, lentils, and soybeans etc.

Polyols-sweeteners like mannitol, sorbitol, and xylitol; stone fruits such as avocado, cherries, apricots etc.

You will notice that a lot of the foods on this list appear to be what we normally consider to be healthy. However if eaten in excess or by those who are sensitive to this phenomenon, they can produce undesirable symptoms such as excessive gas, bloating, diarrhea, and constipation. Such a situation is uncomfortable in and of itself but may also produce a systemic increase in inflammation.

According to the Stanford FODMAPS protocol, FODMAPS eaten in excess cause problems because they pull water into the intestinal tract, may not be digested or absorbed well and therefore could be fermented by the bacteria which reside in the intestinal tract. Fermentation produces gas and other by products which irritate the lining of the gut. This can produce increased intestinal permeability, also known as leaky gut syndrome. This produces the symptoms of bloating, pain, excess gas, and inflammation.

This sort of thing can happen to anyone who eats these ingredients to excess. However, in those for whom this occurs easily and chronically, and for whom other disease is ruled out, it is called irritable bowel syndrome or IBS for short.

Click below for the Stanford FODMAPS protocol diet handout which will will elaborate on these concepts and give you a handy chart for foods to use and foods to avoid. 

Stanford FODMAPS protocol

Bear in mind that water and fiber are part of this equation. Either too much fiber or too little fiber can aggravate symptoms. You simply have to experiment to find your unique sweet spot. I think a good place to start is a small bowl of soft (not sticky) hot oat bran cereal every day. I have taken a page from the Giada DiLaurentis playbook and take my oatmeal with a little olive oil and kosher salt. This is pleasant in a popcorn kind of way and avoids the sugars that make symptoms worse.

On the other side, drinking plenty of water can fix a multitude of ills. Drinking water all through the day aids digestion, helping to avoid fermentation in the first place. It also flushes out any irritating by products of unwise dietary choices sooner rather than later. It resolves constipation and rehydrates after diarrhea. 

If you are really struggling with symptoms of bloating, abdominal pain, excess gas, diarrhea and constipation, consult your doctor. Discuss the advisability of a low FODMAP diet for you. Remember that this is cutting edge thinking, and pertains specifically to FODMAP induced symptoms. Your doctor may discern other patterns in your clinical presentation that prompt him or her to check lab studies or imaging which they believe may be pertinent to your condition. If in the end, they think this would be helpful, try it with concerted effort for about 6 weeks. After that, you may find you can “ add back" desired items one by one, in small quantity. If your intestinal tract calms down and heals well, things that irritated you before may no longer do so. 

Wellness Wednesday: Hair Care

Hair care is a case of less being more. I am of the opinion that if something is healthy, then it is beautiful. I believe this is true for hair, but also for skin and bodies in general. Here are some tips from the American Academy of Dermatologists on evidence based hair care. 

The basics: 

Oily hair and scalp require more frequent shampoo washes, perhaps even daily. Older or chemically treated hair may tolerate it less. To get the best of both worlds, massage shampoo into the scalp only. Do not scrub shampoo into your hair; let it run through the hair from the scalp. Washing too infrequently may foster the development of dandruff. 

Use conditioner after each shampoo, even is hair is oily. Concentrate it on the ends or dry parts the hair. If hair is very dry, it may need additional treatments. 

Dry hair by a loose towel wrap or air drying. Do not rub the hair with a towel. Blow drying, while popular, adds to damage. Wet hair is not unattractive. It can even be seen on the runway as a “look”. 

Sports: 

Restrain your hair without tension. Use bands covered with fabric to avoid damaging the hair. 

Wear a cap for routine swimming in pools. Rinse hair thoroughly after swimming in chlorinated or salt water. Wash with a swimmer’s shampoo and deep condition as well. 

Wear at hat to cover your hair. Your scalp with thank you. Wear a brim and your face will thank you. 

Styling: 

Go for a natural style, with a minimum of handling and products.

Keep brushing to a minimum. To minimize damage, straight hair should be brushed or combed when dry, and curly hair should be combed or brushed when wet, using conditioner to relax the curls. 

Irons should be used only on low or moderate heat, and no more than every other day. 

Minimize the use of braids, cornrows, ponytails and hair extensions, which can produce tension. Tension leads to breakage and even permanent hair loss. 

Avoid long lasting hold products, which can predispose the hair to breakage. 

Color, perm or relax as infrequently as possible. Have only one such service at a time. Choose professionals to accomplish these potentially damaging services. 

What if your hair needs a doctor?: 

If you have overall hair thinning or patchy hair loss, a visit to the Dermatologist may be in order. Treatments are available. Hair loss can be due to illness, childbirth, stress, high fevers, surgery, excess weight loss, or even stopping birth control pills. 

The best fashion is a good body.

The best makeup is healthy skin.

Likewise the best hair is hair in good condition. 

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

Pope Francis has done something unprecedented. On Thursday the pontiff has suggested that women threatened with the Zika Virus may use contraception. This historic and, dare I say inspired move has given me great hope. The Roman Catholic church has had a longstanding ban on contraception. However, the Zika virus scourge traveling though south and central America, with its devastating effects on the unborn, has caused him to announce this exception. Pope Francis has made it clear that the exemption is “ rare and specific”. This announcement is likely to have a profound and widespread impact particularly on poor Latin American countries where the dictates of the church are absolute and where Zika virus is the most prevalent.

It is becoming better and better established that Zika, virus infection, especially early in pregnancy, is associated with the development of microcephaly. Microcephaly refers to small head, but it also entails a small dysfunctional brain. Researchers are now becoming concerned that normal appearing, non- microcephalic babies of mothers who had Zika during their pregnancies may have more cognitive and mental heath problems as they age. The potential social effects of this are enormous. 

Links between Zika infection and post infection paralysis, aka Guillaine Barre, are becoming stronger. Of course this will potentially affect men as well as women. The exact incidence of Guillane Barre after Zika infection is as yet, unknown. 

In other news, new research indicated that babies should get vitamin D supplementation whether or not they are breastfeeding and are eating solid foods. Breastfed children need 400 IU Vitamin D daily, even if they are also receiving formula. 

ACOG (American College of Obstetricians and Gynecologists) continues to push for contraception as a quality measure. This means it is a feature of medical care and insurance coverage that is routinely assessed. The ACA ( Affordable Care Act) requires all insurance plans to cover all FDA approved contraception, but this has not yet been fully implemented. 

For about 25 years “steroids” have been used in mothers under 34 weeks to accelerate the lung maturity of their growing unborn baby. This is done if an early delivery is suspected to occur. However new research in the New England Journal of Medicine indicates there may be benefit to giving steroids through 36 weeks. 

The CDC just released a report indicating that 1/3 of adults are getting insufficient sleep. Less than 7 hours of sleep is associated with increased chance of diabetes, heart disease, stroke and all- cause mortality and “ frequent mental distress”. 

So to prevent these things, I should go to sleep soon. However, I will leave you with this: My patients often bring me things from far flung places since they know I do not get out much. Tomorrow, when I sit down at my desk, I will see one gift that is more special now than it was before: a souvenir photo of Pope Francis and a miniature rosary from Rome, where one of my Catholic patients heard him speak. To this Jewish girl, Pope Francis is a hero, a real “mensch ". 

Food Friday: Protein for Healing

Most of you have been following the saga of my son’s recovery from his fractured femur. He is coming along nicely and that is due in part to his fantastic physical therapy support. They have done physical work, cognitive, and have even talked about the nutritional end of things. In particular, they have emphasized the role of protein, along with Calcium and Vitamin D. 

Protein comes from meat, seafood, poultry, and certain combinations of legumes and grains. (Legumes are foods like peas, beans and lentils.) Under normal circumstances, people need about 0.36 grams per pound of body weight of protein. This is about 50 g per day for a women and 70 g per day for a man. However, during pregnancy, athletic training, and recovery from illness, even more is needed. 

Our son’s therapists have noted that his protein requirements have increased to nearly 100 grams per day as an injured young adult male weighing about 175 #, who is trying to rebuild a femur. This is about a 40 % increase. 

Protein is composed of a string of amnio acids. All animal food are complete proteins, in that the ratio and types of amnio acids present meet human dietary needs. Plant sources of protein need to be combined to fulfill this criteria. For more on this see THIS SECTION on the website. 

In practical terms,  I had to help Vale figure out how to meet this nutritional requirement at a time when his mobility was restricted and his time for cooking was nil. Additionally, we had to take into consideration that more protein intake requires excellent hydration, since metabolism of larger amounts of protein in a dehydrated state is hard on the kideys.  We had to make sure he consumed just the right amount, and not too much since metabolism of excessively high amounts of protein can also cause the bodies calcium to be depleted- not what we want. Finally, I had to take into consideration the following: that protein is best utilized when interspersed evenly throughout the day. 

Here is how we set him up. First I made a one page schedule of meals and activities. I posted it all over his house and set up a google doc for the friends and family who would be helping. Secondly, I made a menu. There would be some constants, and some variables. The constants would be as follows: 

• Morning:16 ounces of skim milk with a protein powder
• Midmorning would be a high protein, high fiber oat cereal, and hopefully a hardboiled egg.
• Lunch would be a can of salmon made like tuna fish salad, with olive oil mayonnaise, relish, and olives. He could also have whatever else he wanted.
• Mid afternoon would be another high protein snack like a mozzarella cheese stick
• Dinner would be a traditional cooked dinner with meat chicken or fish, and salad with veggies cooked by family or friends.
• Fruit could be eaten all through the day
• A hospital pitcher would be used to measure water intake which was to exceed three liters per day, titrating to nice clear appearing urine (sorry… i’m a doctor, not a food blogger. ) 
• I had him take a gummy prenatal vitamin and two tablets of Calcium Citrate with D. 
• The items are simple, edible, and met the criteria. Of importance, I created a routine schedule that would be the same every day to foster compliance. I created checklists in different convenient locations. In other words, I have tried to engineer his nutritional success.

So far so good, as he is already crutching around to class, grateful, and enjoying being back at school. 

Wellness Wednesday: Following up on Serious Injury: the Role of Physical Therapy

When you are injured badly, you are in pain and you are shaken up, sometimes literally. You lose perspective. You may have temporary alteration of your memory mood and judgment. You need guidance on how to recover, and your instincts aren’t a good guide. That is why in good medical care environments, you have a team of people, from family and friends, to doctors and nurses who help you get better.

In the very best of medical care environments, you have those, plus the group of therapists: physical therapists, cognitive therapists, occupational therapists, and family therapists. These are the people who take you from healing and back into high functioning. We underutilize them. I write today to make you aware of all this by sharing what our experience has been thus far with my son Vale and his physical therapy.

As those of you who have been reading this blog know, our son Vale had a serious ski injury on Saturday February 6th. He sustained a comminuted (broken to pieces) fractured femur, a mild concussion, a broken rib and a mild pulmonary contusion. That evening he had a long emergency surgery requiring a great deal of internal fixation. The next day he was discharged home as per is customary. He required pain meds, and still had memory deficits, though he was basically himself. Appetite was slow to come and he was quite discouraged. 

Much to our surprise, they requested his first physical therapy visit the very next day, or post operative day two, Monday the 8th. I couldn’t imagine what they would be doing with him at that early stage, despite my familiarity with surgical recovery in general.

When we arrived, they informed us they had spoken with his surgeon and were appraised of his hospital course. They proceeded to perform consultation much like we doctors do, beginning with a history and then proceeding with a physical exam. However, this exam was precise, detailed and recorded, covering all neurological aspects, range of motion, and strength. 

I expected all this. What I didn’t expect was the best part. The facility was beautiful and open, and all the staff were fit and upbeat. There was even a freshly shampooed dog randomly going from area to area to cheer people up. The whole encounter brightened our son’s spirits, and renewed his hope. They told him all about the typical post op course with injuries like this. This showed him a light at the end of the tunnel. It gave him some tasks to do and milestones for progress, thereby dispelling feelings of powerlessness.

There were so many more things to do to help his recovery than we had anticipated. I often recommend that patients enter physical therapy. Not uncommonly they ask me, “ What could they possibly do that would help ? “ The answer is, go and see. Since Vale has entered PT, he has gotten serial cognitive testing, passive range of motion exercises, strength exercises, electrical stimulation and deep oil massage of the muscles near the fracture. Soon, when the incision is better healed, he will have water therapy. 

His sessions are not necessarily comfortable. Nonetheless he looks forward to them. He can see his own progress because it is actually measured. Thus he is consistently encouraged. They tell me this is typical. Today is post op day ten and it was his first day back to his University classes. He felt himself, and did not notice any problems in following the material or using his crutches. I credit his ongoing PT for his speedy recovery.

I encourage all of you to look into physical therapy if you have chronic pain, injury, or problems getting around. There are many other conditions which can benefit from physical therapy. Discuss this with your doctor at your next appointment to see if you might stand to benefit. 

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

Zika virus again begins the headlines. It has now been well established that Zika virus can be sexually transmitted. The CDC ( Centers for Disease Control) has recommended that men returning from Zika affected countries take special precautions if their partners are pregnant or apt to become pregnant. They are advised to abstain or use protection through the duration of the entire pregnancy. The primary method of transmission is still believed to be through mosquitos, however, Zika has recently been isolated from both saliva and urine. 

Zika’s devastating effects on the unborn are similar to effects caused by the more well known viruses Rubella and Cytomegalovirus (CMV). Zika virus is associated with microcephaly (small underdeveloped brain and skull, with attendant developmental disabilities) and eye defects, and so are CMV and Rubella.  Researchers are turning attention back to these better understood viruses to get clues about how the ZIka virus functions. 

Additional recommendations from the CDC and ACOG ( American College of Obstetricians and Gynecologists) include testing all women living in or returning from ZIka infected countries. The US Olympic Committee has reiterated the CDC cautions, but has not issued any prohibitions against anyone going to or participating in the games. 

In the interesting and promising department, Columbia has recorded over 3000 cases of Zika infected pregnant women. To date, no cases of microcephaly have been reported there. The reasons for this are uncertain. Post Zika Guillaine Barre syndrome has been studied in Columbia as well. Guillaine Barre is a reaction to certain viral infections which produces a usually temporary paralysis. It can be life threatening since it can paralyze the respiratory muscles. Columbian officials have noticed a 66 % increase in Guillaine Barre reactions compared to baseline. 

President Obama has asked Congress for 1.8 billion dollars in funding to combat the Zika Virus. As of Friday, there are 79 cases of Zika in the United States. 

Influenza is another viral danger which continues to deserve our attention. The good news there is that we have an effective vaccine. Flu vaccine is very important to pregnant women, since pregnant women are much more vulnerable to serious disease if they contract the flu. New research indicates flu vaccine in pregnancy is most effective if given in the first trimester. 

There are other situations which can cause serious birth defects. One is exceedingly common: alcohol. Last week the CDC made news by recommending that pregnant women abstain from all alcohol. They also advised health professionals to advise women to stop using it even if they are just trying to become pregnant or, more interestingly, are simply having unprotected sex. 

Frankly, these do not see like radical recommendations to me.  They certainly do not seem mysogynist or anti-women. However, that is how some women are reacting. The blogosphere has been ablaze with what is, in my opinion, inflammatory rhetoric, saying that the government is trying to "take over women’s bodies", and other such nonsense. I wonder what these commentators think of the draconian measures recommended by South American governments to keep pregnant women from getting Zika ? Authorities have advocated that women not get pregnant for two years, and if they already are, to cover themselves and stay inside. 

Here is an issue that may have a feminist component. Consider that only women must buy feminine hygiene products. They buy them in profusion, regularly, and all throughout their reproductive life. Some people believe that women should not have to pay sales tax on such products. President Obama is in favor of ending the so called “ tampon tax”. 

Viruses and alcohol can cause serious birth defects. While smoking does not, it is strongly associated with growth restriction, low fluid, abruption, and preterm birth. CDC data indicate 8.4 percent of pregnant women smoke. 

There us no doubt that our collective concern over the exotic and seemingly uncontrollable threat of Zika virus is justified. However this threat to pregnant women and others should be blended with renewed and commensurate concern for equally serious threats which we can address: smoking and alcohol. 

Food Friday: Food for Healing

As most of you know, we spent the better part of the week nursing our 22 year old son after his ski accident. He sustained a badly fractured femur requiring a long surgery which entailed significant blood loss. He also had a mild concussion, pulmonary contusion, and a broken rib. He is stable and improving. But his course has illustrated several important things about nourishing those who are recovering from illness or injury. I thought we might take a moment and discuss them here, especially since it has been on my mind. 

When people come home from the hospital, most of time, their IV is removed. They will come home adequately hydrated. However, that can quickly change, since their capability to hold down food and drink is often limited. Your job as caregiver is to help minimize nausea which may be interfering with hydration, and to provide appropriate enticing liquids for them to sip. If your “ patient” did not come home with anti-nausea medication, and needs it, do not hesitate to call their doctor. Most of the time this can be prescribed over the phone, but sometimes, nausea heralds a concern, and the patient will be asked to come in for an evaluation. 

Another way to minimize nausea and maximize intake is to avoid overuse of narcotic pain pills. The most common are lortab and percocet, aka hydrocodone and oxycodone. These are necessary with early post ops, but they can cause nausea and constipation. Ask your doctor how they should be used if you are not sure. 

Sick or injured people do not always know what they need. It is up to the caregiver to encourage them in the right direction. In this regard, many patients will not want to drink as much as they ought. So you have to be clever. 

Hydration of the unwell is best accomplished gradually and continually. This way they are more apt to tolerate it. It is also best accomplished by fluids which contain some sugar and some electrolyte (like IV fluid!) . 

For starters, let’s do water. Some who cannot drink water can drink soda water, aka plain club soda. Even more can drink this with a splash of fruit juice or a wedge of lemon or lime. Some do well with dilute fruit juice. Decaf instant iced tea works well. Oftentimes having it quite cold will help, but this is suboptimal if your patient is chilled. Some do better with frozen cubes of the aforementioned drinks. 

On the other hand, many patients prefer hot drinks. Herbal tea is the go-to here. You can make it more appealing by adding honey or agave, and a little lemon. Decaf coffee is not a bad choice, but lots of caffeinated coffee is dehydrating. 

Some patients prefer savory or salty drinks. This is an advantage since it will better expand their intravascular volume. Here broth is the best solution, unless they can take something like Bloody Mary mix, or salted tomato juice. The best of all is a brothy chicken soup, just like tradition teaches us. Nowadays organic broth mix is widely available commercially in chicken, beef, and vegetable flavors. 

You can also hydrate your patient with watermelon if they like it. Most fruits will help, and a smoothie of fruit, ice, water, juice, and even plain yogurt can be very agreeable, even to one who is sick. 

When patients are doing well enough to take solid food, there are a few key nutritional points to bear in mind. Healing from illness and injury takes more resources than ordinary life - lots more resources. A man needing 70 g of protein a day will come to need over a hundred. He will need more nutrients too, though he may not necessarily need more calories. Therefore, everything a recovering person eats should be nutrient rich. Leave the top ramen, Pepsi, and white bread for another day - like NEVER. Present choices such as chicken, salmon and red meat, but prepare them in a way that is easy to eat. For the meat and chicken, cook it well, ground or in small pieces. For salmon, consider getting canned salmon and making it up like tuna fish salad with mayonnaise, relish and olives. But beware, if your patients are picking at their food or dairy containing drinks, the dishes cannot stay out too long, or they will spoil. The last thing you need is a recovering patient with food poisoning. With the same goal in mind, don’t put too much on a serving plate. Start with a small serving and get seconds if you need to. And, for best results, offer small quantities of food quite often. 

Caregiving is hard work. With a little forethought and a few tricks of the trade, your well hydrated, well nourished patient will have the best chance at an optimal recovery. 

Wellness Wednesday: Recovering from a Serious Injury

This last weekend my son Vale had a major skiing accident. He broke his femur, had a pulmonary contusion, a broken rib, and a mild concussion.  He had to have emergency surgery. We quickly travelled to attend him, and since then we have been making arrangements for his recovery care. 

Though he will be off school for a time he will stay at college and we will return home. Therefore, I have been working with a team of friends and relatives to accomplish his care. This will, of course, consist of a series of wound checks, physical therapy appointments and post op appointments. It will also consist of a calendar of people doing shopping, making meals and doing laundry. When he returns to school in two or three weeks, it will mean getting driven to campus and wheelchairing around. It will mean seeing how it goes.

It has also meant getting correspondence passed back and forth between the doctors, physical therapists and the university faculty. To coordinate all this, I have had to send no end of contact information. I have had to create shared calendars and documents in the cloud, and distribute them to all his friends and family who have stepped forward to help.

Vale has had to deal with pain, disappointment and disruption. It is taking all of us together to shore him up during this trying time. It is taking everything from favorite foods to ice packs, but it is worth it. Even though it has been only four days, we can see distinct and major improvements every day.

 I am in awe of his caregivers. The surgeon and anesthesiologist spent significant time on the phone with me both before and after the case. It was easy to tell they were top notch, but they were also genuinely invested in my son, and empathized with me having to be so far away during the surgery.  I will be forever grateful for the time and energy they spent. I later leaned that that they spent this kind of energy during the entire weekend, since Vale's hip fracture was one of five such cases. The winds in the mountains had been high, and had swept the ski slopes to a hard shiny gloss. It took its toll.

Vale's physical therapist was a ray of hope. She came from both academic and clinical practice backgrounds, and was deeply invested in her field. She was immediately able to put us at ease and to identify all kinds of helpful strategies. Vale felt 100 percent better after one appointment, from a combination of the physical treatments, but also the encouragement of knowing his prognosis.

All this touched me as a mother and as a physician. It sheds renewed light on what I do.

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

ZIka virus news continues to be front and center. Zika virus causes an illness which is usually mild or moderate but is strongly associated with the development of a severe birth defect known as microcephaly. It is also associated with a post illness paralysis called Guillaine Barre.

This weeks changes include new mandatory reporting of confirmed case for all states in the US. Calls for Zikus virus research funding are being made. The WHO ( World Health Organization) has declared that the virus is spreading explosively. They have convened an emergency meeting, and in a rare move, has declared the virus a global health emergency. Brazil is the worst affected, the over 4000 cases of microcephalic babies born through the end of January.  Additionally Brazilian health authorities are fearing a wave of illegal and unsafe abortions among women who have no access to contraception or insecticide. Florida has declared a health emergency over Zika. Health workers in Texas have confirmed the sexual transmission of the virus. 

Brazil is using the military to spread insecticide.Two vaccine approaches are underway but will not likely be ready this year. Additionally genetically engineered mosquitos are being released into the wild, to sharply reduce the mosquito population. The US Senate plans to meet about the outbreak and plans to work closely with ACOG ( The American College of Obstetricians and Gynecologists) to address the problem. 

In other news, ACOG has issued a statement urging Ob/Gyns to support new mothers whether they breastfeed or not. In the same brief, it continued to advocate for policies that support a working woman’s right to breastfeeding. 

In more breastfeeding news, the Lancet has reported research indicating that if “nearly every new mother breastfed, that more than 800,000 children’s lives would be saved each year and that thousands of future breast cancer deaths would be avoided." Compelling ! 

Stay tuned for more breaking news from the world of Ob/Gyn. Thanks for reading !

Food Friday: Setting the Table

When I was growing up, my parents had a sit down dinner since that’s how they had been raised. My mother had nice china and table linens, but we rarely saw them since she used them only for special occasions. Instead we had everyday plates and cups, often plastic. The margarine was set out in its own tub. (Remember that this was the 70s, when margarine was thought to be healthier than butter. )

My father had business contacts from all over the world and they would come to visit us. In one case, a German guest showed me a photo of his daughter. She was sitting at their table. I would never have thought to take such a picture of a person at a table since our table was nothing special to look at. But their table was beautiful even though they had already finished their meal. Each plate was white glass, and crowded round each plate were clear glasses of various deep jewel tone colors and shapes, some cylindrical and thin, some globular, and yet others like cones. A light went on in my mind, and ever since then I started to see table settings differently. I began to notice the beautiful dishes and table settings in my friends' houses. 

Fast forward to college, when freshman year and dorm food banished all thoughts of table settings. Then came second year, when I moved into a campus co-op named Synergy. The house was organic and vegetarian way back in 1981. We had a big hippie kitchen in a huge hippie house right on campus. Since we were a co-op we cooked all our own food in a big kitchen in rotating teams. There would be no chefs or housekeepers for us.

The ethic of this house also required a communal sit down dinner as a deliberate act of culture. However the table settings in Synergy were like none I had ever seen. Since we were all about conservation, with reuse happening before recycling, our cups, plates, and serving utensils were a motley collection of all that had come through the kitchen. We drank from a selection of old jars, such as those from sauces or jam. Our plates were all completely mismatched. Bowls were just old plastic containers from things like bulk peanut butter. Most wonderfully, the center of the table held as many as a dozen great steaming loaves of bread: home made whole wheat bread. It was the signature of the house. We would cut slices or tear chunks, and slather it with butter, jam, hummus, or whatever mystery stew the cooks happened to create. Kids from other dorms would come by just for the bread. There is a reason for the expression, “breaking of bread”. It seems to bring people together.

Greg and I bonded while making this bread since it literally took all four of our hands to knead it. We had met while cleaning the kitchen at Synergy. We took it upon ourselves to clean this hippie kitchen, since he and I seemed to be the only ones who noticed how dirty it was. We met over a filthy sink, and there was something about me turning on the garbage disposal at the wrong time. No one was hurt, but he did have to take a shower after the incident. 

Greg sometimes ate a couple of houses down the row where there was a clean kitchen, a chef, and of course, meat. His sister lived there and she had made friends with the chef. I think they had an arrangement since not uncommonly Greg would go there and use their massive Hobart mixer which would hold a 16 batch of his mother’s chocolate chip cookies. As you could smell the bread of Synergy wafting down the row, you could smell the chocolate chip cookies coming from the other direction. From then on, our collective memory would be infused with the aroma of bread and cookies. 

After graduation, we married and lived in a little farmhouse far away from University life. It was a bit run down, so we repaired and decorated it. Happily, among our wedding gifts were many table linens and pretty dishes, so it followed that the table got set very nicely. The cutting boards were set with bread and platters filled with cookies. When our daughter and the boys came along, they helped with all of this. Ever since then we have set the table and had a sit down dinner. 

Today I believe in the power of the sit down dinner more than ever, to promote communication, coordination and peace in the family. And for me, all my best dishware is out all the time. I think it sets a festive mood and makes people feel valued.

What would I do if I were just starting out, of modest means, and wanted to bring some inspiration to meals ? There are two possibilities. First, I could go minimalist and get all clear glass dinnerware from the dollar store. Everything would match, and design interest would come from the food itself, the table, or the table linens.

A more colorful and more ecological choice would be to thrift. I would have a fantastic set of non matching antique plates. I would shoot for a reasonably common size, and perhaps a common theme, say a color scheme or a design element like birds. A physician friend of mine did it complete with mismatched silverware, and mismatched but coordinating goblets. It was nothing short of magnificent. It was all thrifted, very inexpensive, and truly delightful.

And that is the point: to delight. Making the food and setting the table is a gift to others, and a joy for you. 

Wellness Wednesday: The Medicine Cabinet

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

First the dont’s. 

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

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

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

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

Now the Do’s 

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

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

Do have upper respiratory remedies. 

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

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

For allergic reactions: 

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

Stomach rememedies are trickier.

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

For skin, eyes, hair and teeth : 

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

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

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

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

For Hair: 

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

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

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

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

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

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

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

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

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

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

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

Food Friday: Easy Weeknight Meals

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

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

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

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

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

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

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

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

Wellness Wednesday: Winter Skin Care

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

Facts: 

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

Recommendations: 

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

Happy midwinter. 

references:

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

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

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

Good Monday.

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

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

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

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

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

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

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