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Dear Loyal Readers,
Due to extenuating circumstances, Medical Monday will come out after lunchtime tomorrow, meaning in around 12 hours from this writing. Thank you very much for your patience and attention ! As you know, there are always sensational and important news items in a post dealing with Obstetrics, Gynecology and women's health. See you soon ! Dr. Gina
Summer cooking and eating is a special case. Here is a handy review post for you to access all of your summer tips I have written so far in one convenient place. Some are for safety, and some are for taste. You’ll be glad you looked at this quick review. Click on the links to see more.
http://drginanelson.com/drginablogs/2015/6/26/food-friday-picnics?rq=food%20safety
This has the most explicit information on food safety in the site, plus some helpful links.
This is right on time for your next outing. There’s a fair amount here about how not to burn the house down or end up in the emergency room.
You not find beer or sugary soda in this eclectic list.
http://drginanelson.com/drginablogs/2015/7/10/food-friday-drink-?rq=cold%20drinks
This is a recent post here in case you missed it:
http://drginanelson.com/drginablogs/2016/7/1/food-friday-hot-weather-cold-food?rq=cold%20food
This is one of my favorite older posts I really enjoyed making:
http://drginanelson.com/drginablogs/2015/9/10/food-friday-the-healthy-junk-food?rq=salsa
http://drginanelson.com/drginablogs/2015/8/28/food-friday-cold-desserts?rq=cold%20desserts
( My apologies to those in the Southern hemisphere who are in the middle of their winter.)
It is summer in the far north and the days are long...so long they stretch into the night. Farmers work until 11 pm and dinner is at about 9pm in broad daylight. Then the evening comes, and by 11 pm you feel the evening is just getting started. A movie is chosen and whoops, you are up way too late, especially since the sun comes blazing in shortly after 5:30am.
So I though I would take this opportunity to share with you some sketches I did for my wellness reminder cards that pertained to the importance of good sleep hygiene. Each card will hopefully remind the user of a key principle, with the image on one side, and the reminder on the other.
1. Adequate Restorative Sleep
With few exceptions, adults need 7-8 hours of sleep. You should wake, almost spontaneously, and feel rested. That is the meaning of restorative sleep.
2. Consistent Wake Time
Having a consistent wake time actually helps you fall asleep properly at bedtime.
3. Consistent Sleep Time
Once you get in a routine, you will start to get sleepy at the right time.
4. Correct Sleep Environment
The room should be dark, quiet and cool, without electronics or snoring people.
5. Medical Evaluation of Necessary
Most major hospitals have a Sleep Center or Department of Sleep Medicine. There is now the recognition that sleep health underscores all health. Rigorous studies can be done to assess sleep problems, and treatments are available.
To learn more see our webpage on sleep HERE.
Next week on wellness Wednesday we will continue with more wellness reminders.
Nighty Night !
Zika funding. It comes down to this. Even as Congress has reached its planned seven week summer break, there is still no Zika budget, the United States faces its first couple deaths from Zika virus, one in Utah, and the other in Puerto Rico. The AP ( Associated Press) reports that the main hang up was Democratic objections to GOP language which would block Planned Parenthood clinics in Puerto Rico from receiving money to fight the virus. Shame on them all.
The Imperial College in London has presented a bad news/good news scenario. Their modeling has indicated that Zika will likely last in Latin America for another two to three years. At that stage, herd immunity will hopefully develop.
The CDC (Centers for Disease Control) is working on preparing a protocol for the first locally transmitted cases of Zika. One of the biggest challenges is that 80 percent of Zika infections area symptomatic. Almost all stars of the Union are at risk including the northernmost United States of Michigan, New Hampshire, Washington state and Minnesota. There are currently 346 pregnant women with Zika in the United States.
Half a million people are excepted to travel to Brasil this year for the Olympics. However experts at the CDC are projecting that this will not spread Zika internationally. They have explained their position by saying that this half million represents only about 1% of all international travel to Brasil.
HERE is the link to the excellent CDC pages on Zika.
http://www.cdc.gov/zika/index.html
Happily much of the other news this week is good, though a fair amount of it falls in the "we already knew this" category.
One thing we did not even suspect was that a mouse could have a menstrual cycle. The spiny mouse has a tiny nine day menstrual cycle. Researcher hope the mouse will provide a model to study the reproductive cycle in women.
Moderate exercise in pregnancy has been shown to benefit both mother and baby. In particular, mothers who do moderate regular exercise in pregnancy have lower rates of hypertension, gestational diabetes, and C section.
Both mothers and fathers weight during pregnancy affect the weight of children later in life. This is believed to be true not only by virtue of lifestyle but by genetics. It appears that both mothers and fathers weight influence gene expression in the unborn, which postnatally can affect weight. This knowledge may help us counsel prospective parents and spare their children unnecessary risk and struggle from obesity.
The Journal of Pediatrics has published research indicating that breastfeeding reduces the incidence of diarrhea and otitis media (ear infections) in infants. At the same time, the USPSTF (US Preventive Services Task Force) used US taxpayer dollars to create recommendations which support but no longer promote breastfeeding. ACOG (The American College of Obstetricians and Gynecologists) has sent their objections in writing regarding this important change. The breastfeeding discussion needs to be continued, and very publicly, since we all have a stake in the outcomes.
Stay cool this week, and take precautions from mosquitos. Remember, DEET is safe, and safe in pregnancy.
In my quest to help people enjoy good nutrition and attain a healthy weight, I have discovered several challenges. Some particular challenges are processed food high in processed carbohydrates, bad fats, sugar and salt, drinks like soda. People consume these, though almost everyone knows they’re bad for you. On the other hand, everyone knows veggies are good for you. And yet, they are seldom eaten by those who really need them.
People don’t use vegetables because they don’t know how to obtain and prepare them. I call this poor vegetable literacy. The exception is of course simple salads. Everyone in America knows salads are healthy, but most salads are so small and plain that they are hardly nutrient dense. I have posted before about hard salads and also about salsas. Our post today is about cooked vegetables.
Cooked vegetables are easy to prepare. As with other foods, they can be steamed, sautéed, broiled, baked, and grilled. There are only a few vegetables that I do not serve cooked. They include lettuces, radishes, and cucumbers. Otherwise, vegetables can be divided into the following categories:
These include collard greens, spinach, kale and chard. How you prepare then depends on whether they are hard or soft. If they are soft like spinach or chard, then you can simply sauté them. If they are hard, lightly steam them first, them saute in butter, or olive oil. Do not salt or pepper them until they are wilted or you will overdo it. Dress lightly with seasoned rice vinegar or a squeeze of lemon. You may also prepare them with other things like bits of prepared meats, red pepper, or tomatoes. Warning: they cook down dramatically.
These include carrots, beets, parsnips, turnips, and rutabaga. Some would include kohlrabi. They are best roasted or sautéed. They can also be steamed to reduce saute time. Most of the work is in the cleaning. All but the smallest and most tender need be peeled. Once sliced, they can be roasted in a hot oven (425) with olive oil salt and pepper. You can roast them in foil with butter or oil or roast them on a shallow pan to get them almost crispy. They can be steamed and then sautéed in a pan with olive oil or butter and flavoring. They then benefit from a sauce. My favorite sauce for root vegetables is herbs, butter, orange and a little honey or agave. The orange is conferred with a tablespoon of frozen orange juice concentrate. I like them cooked until fork tender.
Here are some healthy carbs. They are vitamin rich too. Since I am impatient and like shorter cooking times, I often peel and cut up my squash. They can be steamed or roasted, then dressed like root vegetables. They can also be made into soup when blended with broth, milk, sour cream or even parmesan cheese. Acorn squash make little bowls when cut in half and the seeds scooped out. For those, I fill them with slivered almonds, dried fruit soaked in wine, mushrooms, onions, and fresh fruit like apples. Then I bake them in moderate heat (350) until soft, which takes the better part of hour. Softer squash like zucchini can be grilled, sautéed quickly in a pain with other vegetables, or tossed into a spaghetti sauce or soup.
These include tomatoes and eggplant. Eggplant is underutilized. When roasted it has significant umami, that meaty satisfying savory-ness. Tomatoes have to be one of my favorite foods. I like them fresh, roasted or dried. They are full of vitamin C and lycopene. They enhance the flavor of other vegetables almost universally. They are good alone.
Learn to love cooked vegetables. Eat them by the plateful. They will love you right back.
Healthy habits are the basis of peak wellness. Heathy habits are something we can develop. Whether the healthy habit is taking vitamins, being grateful, exercising, or eating fiber, the practice only works if it is done over and over for extended periods of time. This repetition is achieved through habit formation.
What does science say about how habits are developed ?
The brain is designed to form habits. New behaviors or tasks can be challenging. Over time, the brain “chunks” small possibly difficult behaviors into automatic routines which becomes easy or even effortless. This is a habit. Habits are adaptive and have helped us survive. Habit formation is our brain’s way of automating certain key behaviors, so more conscious attention can be paid to novel situations. If we understand how this works we can form new habits at will.
What do we need to form new habits ?
In simple terms there are three steps:
This is called a habit loop. These are well explained in Charle’s Duhigg’s book "The Power of Habit”. The cue triggers the routine, and the routine triggers anticipation of the reward. For example, my exercise routine is cued by changing into exercise clothes. From there, I go downstairs to workout, and the reward is the endorphins and the satisfaction. There is no doubt that at first, it is hard to link the steps. But it becomes easier with each cycle. To be realistic, it takes somewhere between 6 weeks and 3 months to form a new habit.
What about bad habits ? They too have cues, routines and rewards. Basically, they have to be understood in terms of their rewards, namely, what you get out of it. In many cases, smokers smoke to get a moment of peace in a busy day. This is obviously legitimate. However, the cigarette is unhealthy and chemically addictive in addition to being behaviorally addictive. It turns out we should not exactly delete bad habits since this leaves a void. Instead we are better off to overwrite them with good ones. To illustrate, a smoker could use patches to wean down on the addictive nicotine, while overwriting her smoking habit with a healthful tea drinking habit. Perhaps to make it more engaging, she would brew the tea from loose leaves. Her reward would be the moment of peace, the taste, smell, and mental clarity that followed.
My subject in this post are the cues. In simple terms, they are reminders of health habits. I decided to expand my set of reminder cards to include not only the subject of nutrition, but also the subjects of sleep, exercise, communication, and creativity. I believe these are some of the elements in total peak wellness. Here are my cue phrases so far.
Sleep
Exercise
Creativity
Work
Communication
You can find nutrition reminders HERE discussed in a prior post. I plan to devote a few wellness Wednesday’s to the development of these reminders or cues.
For more reading :
http://jamesclear.com/three-steps-habit-change
https://www.psychologytoday.com/basics/habit-formation
https://www.sciencedaily.com/releases/2014/08/140808111931.htm
http://www.scientificamerican.com/article/power-of-habit-excerpt/
Women in Latin American are more likely to get Zika than men. We presume they are exposed equally to Zika carrying mosquitos. This difference appears once girls become sexually active. How do you put it together ? Here is what doctors and researchers think. They believe sex may spread Zika more than was previously believed. Furthermore, getting Zika though sex is easier for a woman than for a man. Other sexually transmitted infections follow this pattern and in their case, it is because sex in women causes undetected micro abrasions which allow greater access to the bloodstream.
President Obama has come out and said that Congress should not recess for summer until Zika funding is secured. With this funding, a vaccine will be produced sooner. Some speculate that the issue of Zika calls to mind issues of contraception and abortion, and that is why Congress is unable to deal effectively with it. Zika is bringing reproductive rights into focus. ACOG ( American College of Obstetricians and Gynecologists) representatives have noted that the southern states likely to have the most Zika are the same ones which have high unintended pregnancy rates and poor access to family planning resources. But Texas is taking a different angle anyway. They are trying to scratch up enough funds on its own to provide mosquito repellant to it’s poor women, budgeting 2 bottles per month per women.
In other news, US maternal mortality rates have doubled in the last 25 years. Black women fare the worst, with mortality rates quadruple that of white women.
The president of ACOG has come out stating that we should have a much more critical attitude toward chemicals in the environment which may cause birth defects. Project TENDR has been created from a variety of expert disciplines to advocate for greater government oversight on the chemicals. TENDR stands for Targeting Environmental Neurodevelopmental Risks.
Newborns get about two months of flu protections from a shot given to mom during pregnancy.
Despite the demonstrates efficacy of the HPV vaccine, it is still woefully underutilized. Moreover, HPV related cancers are on the rise. Between 2008 and 2012, they have increased about 17 %. HPV cancers are not just cervical cancer in women. They also include head and neck cancers in both men and women.
Finally, in the good news department, an eight study meta-analysis out of Europe has shown that obese infertile women who have trouble ovulating do better with lifestyle intervention than fertility drugs. Six months of interventions resulting in weight loss were four times more likely to conceive than their counterparts who used fertility drugs alone.
It’s summer and the kids are home. Why not take advantage of their company and get serious about some awesome family dinners ? Sounds like fun, right ? But it’s much more. According to a considerable body of research on the subject, family dinners are important to well being. (Reference: thefamilydinnerproject.org)
Family dinners are associates with the following findings:
Let’s think about why.
The family dinner is a testing ground for the performance of a family group as a team. And yet, pulling it together to make a family dinner is not all that hard. It is within most every person's or every family's reach. Engineering the family dinner is an exercise destined for success. Most people are grateful when someone makes them something to eat, no matter how simple. It is a primal act of caring, usually free of strings, that one person does for others. Thus a dinner is easy to produce and easy to accept.
Children and teens can and should help prepare the dinner, even if is just setting the table. They learn preparation and cooking skills, and they learn to pitch in. They also learn that if they don’t pitch in, they will stand out.
The family dinner is a time when most families put aside conflict, since conflict at the dinner table just doesn’t work. The ritual and the food cause us to make a deliberate change in our behavior for the better. We cease to be isolated individuals and come together to make something more, a family or a even a social group. Thus, it is very hard for someone to be lonely at the table. At the table, it is graphically obvious that you come from somewhere, and that you have a place.
Our family table has extended into the adulthoods of our children and to the younger cousins and their friends. We are very lucky in that regard. Most of them have gone off to college and have come back, bringing spouses, girlfriends, friends and grandchildren in tow. They have each developed family table specialty skills. Echo bakes and is an award winning amateur chocolatier. Forest is lately enamored of our Instant Pot, a cool pressure cooker, which enables you to make impressive meals with little planning or tending. Geri does veggies and my son in law does smoked meats and salads. Vale is smoothie man. Hanna my niece is a cake decorating expert. They are all serious students and professionals, but they have all come to be serious foodies too.
Stepping back, I see that no matter what their fancy, the whole thing is one big shared hobby, and when we do food, everyone is pretty happy. A happy hobby. Moreover, while it was simple and easy when they were little, they have, on their own, leveled up, as the gamers say. They relish the acquisition of skills needed for their culinary hobbies, and that gives them social confidence. Finally, they relish the presentation of their dishes to others. The “ breaking of bread” has always been a bonding experience and in a family this is nothing but good.
Think about all this this summer, when your kids are around more, and hopefully you have a little more time. All you have to do is start something fun in the kitchen. Put your heart into and it and invite others to join in the process of creation. It will take on a life of it’s own.
Here is a convenient comprehensive kit to keep you safe this summer. It recaps some posts from the recent and more distant past, all in one convenient place and on the theme of having a safe and happy summer.
This deals with the importance of time off and the concept of summer vacation for adults.
Contains some amazing facts and figures about heat stroke.
This is especially important to review in this season of the Zika Virus.
Tells of the little known perils of playing in the dirt.
This critical post has concrete information to help you stay out of trouble this summer.
In Zika news, it has become clear that we do not yet know the length of time that Zika stays in the reproductive tract of a man. Thus, we do not now how long he may be able to transmit it sexually.
In a recent poll, 73% of Americans feel Congress should pass the funding to fight the Zika virus as recommended by the Obama administration. However, reflecting a poor grasp of the situation, only 46% feel they need to pass it immediately.
In the we already knew this department, ACOG ( American College of Obstetricians and Gynecologists) has issued new evidence based guidelines to help prevent perineal lacerations. These include using episiotomy selectively, and well as using warm compresses before birth.
SCOTUS ( Supreme Court of the United States) has struck down a restrictive Texas abortion law. This law would have required that abortions be provided at an ambulatory surgical center by a physician with hospital privileges. There is no scientific data saying that either of these elements is necessary for safety of the procedure, which is normally done in an office by a midlevel provider such as a nurse practitioner. Many abortion clinics would have had to close had this law stayed o the books. The Court ruled by a 5-3 vote largely along gender lines that these laws placed an undue burden to women seeking legal forms of health care.
In other SCOTUS news, the Court has refused to hear a legal challenge to the Washington State rule that pharmacies must deliver all prescribed medications, even emergency contraception. This ends a nine year legal battle in which some pharmacists and a pharmacy refused to stock or fill the morning after pills. The Court voted 5 to 3 not to accept the case. Four Justices must agree to accept a case if it is to be heard.
In the pendulum swings department, there are two items. First, Obs are giving serious consideration to the optimal time for delivery. In the past, 42 weeks was considered a reasonable time for induction. In my tenure, this has become 41 weeks. Now 39 weeks is under consideration.
Secondly, women with a statistical risk of ovary cancer of 4% or more who is over 40 may be better off with her ovaries and tubes removed. When I finished residency in 1994, we encouraged women facing a hysterectomy to have the ovaries out as well if they were over 45. In recent years, this has become more of a patient choice. Now, we are refining this judgment to include family history and other risk factors in a statistical model to determine the best course, and it may favor removal of the ovaries earlier than previously recommended.
Once again the USPTF (US Preventive Services Task Force) has cited the lack of evidence supporting the annual pelvic exam, and how it should be done only when symptoms are present. And yet, when examining their published statements, one sees that they do not highlight the fact that there has been nothing done to prove or disprove the utility of the exam either way. This is because doctors the world over have taken it as common sense to do the exam, thus no study has been done. The public should know that saying that there is no proof that something is not useful is NOT the same as saying that something has been proven TO BE not useful. Personally I find important things every week if not every day I do a pelvic exam, and that includes both speculum and bimanual exams. Furthermore, nobody is traumatized by their exam. Children and those with disabilities who need exams and who might be traumatized are examined with the aid of anesthesia supervision.
Stay tuned next week for more breaking news from the world of Obstetrics and Gynecology.
Despite my best efforts, many of my patients turned into hot messes this week. I’ve seen dehydration requiring hospitalization, kidney stones, preterm labor and urinary tract infections. All the wonderful summer activities have started and it has been over 90 degrees in the daytime. People are going and out and doing things and simply not keeping cool and hydrated. A couple days ago on Wednesday, I did a post about hydration. Today, I am going to highlight the cool summer foods.
Main dishes do not have to be hot. They just have to be tasty and nutritious. Why heat up the kitchen ? Having said that, there are some foods like chicken which require cooking in bulk, and then refrigerating after. Today we will be thinking of food that can be served cold.
Smoothies
Smoothies can be a meal if you are on the run. What make this successful are a couple things: the presence of protein, and a good large portable cup for your smoothy so you can take it with you. The fruit part of a smoothy is easy to make since you can use almost any fruit combination that you like. The challenge is adding enough protein that will not detract from the taste. Some non pregnant folks add raw egg, but this is not recommended. Egg whites powder can be obtained at a health food the store, as can whey and vegan protein powders. These classic protein powders are a good choice in moderation. To add more protein, kefir, a cultured milk, or plain yogurt is a good choice, conferring a pleasant tanginess to the smoothy. You can also add zing by lemon or lime juice, or even a teaspoon or so of frozen concentrated orange juice. Speaking of sweeteners, restrain yourself. Your sense of sweet will become more sensitive as you use less and less sweetener. Trust me. Half a banana per smoothly would be plenty. Do a tiny bit of agave if you must.
Salads are an obvious choice in the summer. But let’s not restrict our thinking to leafy green salads. Salads can be made entirely without lettuce or fresh greens. In some ways in the summer, this is safer, since other vegetables spoil less readily. I call these hard salads. This is because they are made with harder vegetables. Some people call these chopped salads. For example, we commonly make a salad of diced cucumber, tomatoes, olives, and various colors of peppers. It is tossed in a vinaigrette and keeps forever. This is akin to the classic bruschetta.
You can also make a shredded hard salad from grated carrots and two colors of cabbage. Dress this in a creamy vinaigrette and you have a version of cole slaw, which might as well be called cold slaw since it is served cold. Do you add raisins ? Take a walk on the wild side.
Hard salads are not limited to vegetables. They can also be made from roots, such as diced carrots, beets, turnips, and even squash. Steam or roast these in advance, then toss in a boldly flavored vinaigrette. Throw in some peas for color and protein. Those who tolerate legumes can add canned beans. There is even a three bean salad in most picnic cookbooks. Get corn involved and one gets tantalizingly close to salsa when the tomatoes and peppers end up in the same salad.
Notice I have have not strayed into the wheat, rice potato or pasta based salads. Those can be healthy for some with high energy requirements, (adolescents or athletes), but most people do not need starchy storage foods such as these.
Do add fish, chicken eggs and meat into your salads. These make them a meal. One caveat: Spice these complete proteins more than usual since the salad will dilute the flavor. Fresh sweet flavors like tomato paired with savory spiced meats are perfect for summer. An easy source of fish is canned salmon. Of course leftover meats and poultry from a large dinners can be used to round out a cold summer salad meal. Grilled foods also go well in salads, adding smoky flavor.
Finally, fruit salads make an ideal summer dessert. Fruits are in season and taste their best. Pair your fruit with a foil, a contrast, such as balsamic vinegar, or the more traditional cream.
Stay cool in the kitchen this week as you celebrate.
Our part of the planet is pointed much more directly at the sun and you can feel it. Sun protection and hydration become critical. Last Wednesday we covered mosquito protection and this week we will recap hydration.
A July post from last year has some facts that bear repeating:
So… the fluid requirement for a pregnant woman hiking on a hot day is 5 Liters !!!
And to recap…
Consider a woman weighing 154#=70kg
Taken from the World Health Association (WHO) website
Hydration does a number of great things
Firstly, it protects you from harms:
Finally, hydration makes you feel good and look good.
Break out of the old routine of sodas and beer which do nothing but dehydrate and put fat on the belly.
Try these instead :
Drinking a tall cold glass of something healthy and fun is good for you both physically and mentally. It gives you a little creative outlet, and a chance to sit down and take a micro break.
Be sure to catch all of our blog posts at
Good Monday. This week the news is again dominated by the specter of Zika. I reported earlier that the Puerto Rican chapter of ACOG (American College of Obstetricians and Gynecologists) is working hard to deliver donated contraceptives to women in this vulnerable population. However, IUDS are not common there due to cost, and as a result, few doctors know how to insert them. Approximately 60,000 IUDS and 80,000 packs of birth control pill packs have been donated by Bayer, Allergen and Medicines 360. The donor companies have also started training physicians to use and presumably teach the use of IUDS. However, their dispensation is held up since the CDC has yet to line up a licensed distributor in Puerto Rico.
This sounds like a problem that can be solved. IUDs are not that hard to put in. I cannot help but think that telemedicine, i.e. videoconferencing, could not help train doctors to put in IUDs. By some accounts there are about 150 Ob/Gyns in Puerto Rico, and about 138,000 women there who are vulnerable to pregnancy.
A little more Googling on my part indicated that the Puerto Rico Obstetrics and Gynecology is holding a “ Sunshine Seminar” August 4-7 this year at the Wyndham Grande Rio Mar Beach Resort and Spa. Really ? Instead of studying morcellators and bioidentical hormones, maybe conference attendees should put some gloves on and start seeing as many patients as they can.
I am going to contact the chair of the Department of Obstetrics and Gynecology Dr. Sharee Umpierre at the University of Puerto Rico and see what she has to say about the situation.
The New England Journal of Medicine reports an increase in abortion medication in Zika affected South American countries.
In some good news, the FDA has given the go ahead on human clinical trials on a Zika vaccine known as GLS-5700. The safety and immune response will be studied in about 40 subjects. Thank you very much you brave souls.
In more good news, the NIH ( National Institute of Health) have started a massive study on Zika in affected countries.
The House has approved $1.1 B to fight Zika. This would come from $750M in savings, $107M unused Ebola funds, $100M in cuts to the Department of Health and Human Services (Medicaid and Medicare) and $534M from Obamacare in the US territories. This does not add up. And, it will not pass the Senate or the President’s Desk.
Ten cases of Zika were confirmed in Dallas County, Texas as of Friday. So it begins.
In other breaking research news, there is quite a bit of what we already knew or suspected: Cranberry juice may help prevent UTI (urinary tract infection). Physical inactivity increases risk of ovary cancer and healthy lifestyle reduces cancer risk. Leading oncologists push for greater use of the HPV (Human Papilloma Virus) vaccine. Healthcare is more affordable since Obamacare. Age of puberty for girls is going down. Soy isoflavones reduces menopause symptoms. Women who work long hours face more chronic disease.
Why are studies done on matters that already seem established ? One reason is that prior studies may have been done to get a rough indication of a cause or pattern. Later, better designed studies can establish something closer to proof. However, some of these things are just common sense. If we took full advantage of the knowledge we already have and actually put it into clinical use with our patients, there would be so much more health and so much less disease. Case in point: HPV vaccines usage.
Stay tuned next week for more news from the world of Obstetrics and Gynecology.
I have a kitchen gadget fetish. But I am not ashamed. Food…including the taste, the process, and the nutrition, is very important to me. It is worth my time and money. I have my priorities. Over time, I have learned what I really need in the way of kitchen gadgets. I would like to share my thoughts with you, so you don’t end up spending your money on stuff you don’t use.
Good kitchen equipment is nice, but not essential to delicious healthy food. Many memorable meals were made in tiny European kitchens or over an open fire by a river with very little in the way of gadgetry.
Some basics as needed, and most can be obtained at your local goodwill store. Moreover, parents and family are usually willing to part with older serviceable items like blenders, thus making it possible for them to get the latest greatest model. Use your ingenuity, save up some money for nice things, and place food and food preparation high on your list of priorities. Food is a critical part of your health and cuisine a delightful part of your social life.
Must have
Nice to have
Objects of Desire
My new favorite gadget is my Instant Pot Pressure Cooker. It is the opposite of a slow cooker. It is a fast cooker, but the result is the same: tender flavorful meat from inexpensive cuts, and rich well developed sauces. For a long time I had the great idea to set food cooking in the slow cooker before I went to work, and when I returned 8-9 hours later, it would be all nicely done. Well, that did not materialize for a variety of reasons. I failed to prep the night before. I worried about burning the house down when I was gone. I didn’t want to leave it overnight, or I thought I might not come home as planned.
When Michelle Tam of Nomnompaleo.com turned me onto the Instant Pot, I knew it was a match made in heaven. I could come home from work anytime and have a thoroughly cooked hearty meal ready in thirty minutes or less. Last night I spent 15 minutes of prep time on a brand new recipe, threw raw chicken thighs in the instant pot with sauce and onions, and 15 minutes later I had steaming fragrant lemongrass coconut chicken that seemed like it had simmered all day. Everyone was intrigued and there were no leftovers.
Cooking is one of the best hobbies, along with fitness. I have prepared a little collection for you to illustrate just how I feel about the the tools of the cooking trade. Enjoy !
Mosquito season is here. This has taken on a critical importance in many states in the south and eastern parts of the United States and in all of Central and South America. This is because mosquitos can carry, among other things, the Zika virus, which has been shown to produce serious brain damage in the unborn, and potentially serious disease in adults. Mosquitos also carry other serious diseases, including some which affect dogs and horses. Examples include West Nile virus, Heartworm, Dengue fever, Malaria, and even Ebola. It is high time to discuss mosquito bite prevention.
First one must note that mosquitos need standing water to reproduce, and even a tiny amount will do. Natural bodies of water such as ponds, puddles, and sloughs can breed mosquitos. Manmade water collections such as buckets, tarps which have collected rainwater, birdbaths and the like will provide very suitable breeding ground as well.
Step One:
Eliminate standing water around your home. Get rid of any debris in your yard or patio (e.g. toys, wheelbarrows, pots etc.) which could harbor mosquito larvae. Change the water in your birdbaths at least once per week. Fill in any low spots in the yard.
For larger bodies of water such as a pond or fountain, purchase “ Mosquito Bits “ or “Mosquito Dunks”. These are pellets or pucks of biological agents which interfere with mosquito reproduction. Once example is Bacillus Thuringiensis, which does not harm the environment.
Step two:
Install replace or repair your screens. You will want to enjoy the summer breeze without worrying about the mosquitos.
Step three:
Invest in some lightweight cool summer clothes. White gauze shirts with long skirts or lightweight palazzo pants are a pretty option. Most outdoor clothing companies such as North Face or Patagonia offer mosquito resistant shirt which are also usually sun protective as well.
Step four:
Buy some DEET based mosquito repellant. This is the only mosquito repellant which has been proven to work. Moreover, it has been shown to be safe in pregnancy. Use your insect repellent correctly.
Step five:
Stay indoors during the twilight hours when mosquitos are most active.
Stay tuned next week for more summer health tips on Wellness Wednesday.
The CDC( Centers for Disease Control has revealed that there are 6 cases of Zika related birth defects in the mainland US. These are those that have delivered so far. Overall, there are 234 cases of confirmed Zika in pregnancy women in the US. All of these Zika infections were acquired elsewhere and brought here. Accordingly, New York has the most cases of Zikaa in the US, being a port of entry. So far there have been no cases of Zika infections transmitted by mosquitos in the US, though Aedes mosquitos are due to being bitting in the Southern states this week.
Another preliminary study has come out suggesting that contracting Zika later in pregnancy confers less risk of perinatal malformations. This study was done in Columbia where there are over 12000 pregnant women who have the virus. It is interesting to note that about 80% of Zika infections are asymptomatic. These asymptomatic cases cause microcephaly all the same.
The WHO (World Health Organization) has come out stating that there is little risk that the Olympics will case Zika to spread around the world. I personally question this, but hope they are correct.
In other news, California Governor Jerry Brown has signed a bill potentially allowing illegal immigrants to buy insurance coverage on the state’s exchange. This seemingly radical idea is interesting to consider, since these people do come in for care. Without this coverage this care goes unreimbursed but still costs the taxpayer money. With the coverage, these people would presumably come in for preventive care or at least for earlier treatment which would mean a savings in both money and human suffering.
A study released this last week predicts that if the next president repeals the ACA (Affordable Care Act) the 24 million Americans will lose health insurance coverage. Most doctors feel this would cost us more than the insurance in the long run. Speaking of the ACA, premiums may rise as much as 10% next year.
CMS(Center for Medicaid Services) has adopted a policy encouraging the use of LARCs (Long Acting Reversible Contraceptives). They have concluding that this is good way to reduce the incidence and cost of unintended pregnancy. An article this week in the Atlantic has highlighted how many communities in the south the so-called “ Bible Belt” discourage discussion of contraceptives, especially IUDs, preferring instead “ abstinence curriculums” .
New research published in Obstetrics and Gynecology has indicated that most websites and apps for fertility are inaccurate in predicting fertility window. Really ? This is not rocket science.
In the good news department, there may finally be some help to prevent vertical ( mother to child) transmission of Hepatitis B. When Tenofevir is used before birth, infant’s viral load and 7 month infections rates are lower than those who did not get the treatment.
Stay tuned next week for more news from the world of Obstetrics and Gynecology. And don’t forget…. DEET is safe in pregnancy !!
For something so critical to nutrition and well being, I am surprised I haven’t written about this yet. We talk about what to eat, and when to eat. But this discussion is nowhere near complete unless we talk about how much to eat. And how much can be very subjective. Estimates of portion size can be critically flawed. Sometimes when I listen to patients recount dietary history, it sounds correct, and yet they are not losing weight as one might expect. I think in many cases this is because portion size may be underestimated, sabotaging their efforts.
It’s no secret that portion sizes in restaurants and grocery stores have purposely catered to our gluttonous tendencies. Portions have grown to more than twice of those in the 1980s. Even our plates and cups are bigger. This keeps us coming back for more and allows them to charge us more. A win win right ? Not for us. Obesity is a huge public health problem, and one that has both physical and psychological consequences.
Let’s examine various methods of portion size management, and you can see what can work for you.
1. Know your calorie requirements. Use the handy calculator in the link.
2. Have a general sense of your nutrition proportions: ( These are from the US FDA, the Food and Drug Administration.)
3. Check reference or for labels to check the size and specifications of a serving size. Compare this to what you need for your meal or snack. Serving size on the container does not necessarily equal recommended size .
4. Have a set of measuring cups and spoons. Have a small kitchen scale. Until your are familiar with common units of measure, measure and weight things. Here are some common measures of volume:
2 Tablespoons = ping pong ball
1/2 cup =tennis ball
1c = baseball
5. Avoid eating out. If you do, order small portions and just eat part of it.
6. Buy in bulk but repackage in smaller quantities and do not eat from the bag.
7. Don’t skip meals
8. Do eat in between meal snacks which pair protein with produce.
9. Use smaller plates and make sure your plate is at least half filled with green vegetables before you take other dishes.
10. Avoid doing other things while eating.
11. Eat slowly. Your brain takes at least 15 minutes to register that you are full.
12. Stop eating when you feel 80% full.
Part of the pleasure of eating is the taste and the company you eat with. But I would like to point out that the pleasure of eating also involves knowing that what you are eating is good for your body. Finally part of the pleasure of eating is knowing you have not eaten too much. Watch portions sizes, and your meals with will be better than ever.
I write this post as the beginning of summer approaches. I look forward to each summer as though I were a school child with a summer break instead of a physician with a steady job. All the same it is a special time, when children are more available, and when people are happily vacationing. We get an especially big dose of this spirit since we host guests in a vacation rental. They remind us of what summer is all about: excitement family, relaxation and adventure.
To make sure you get all you can out of the summer, I suggest you plan. I suggest this since I am doing the same thing for myself right now.
No matter your job, no matter your income, you should make sure to refresh yourself in this most sparkling of seasons.
Here’s how.
1. Make a list of your summer goals. Make sure to include your goals in the following areas:
Home improvement, garden, artistic- Take a summer themed classes, like water colors. Do some gardening. I believe everyone should garden, even if it is a nice tomato pot on the porch.
Activities- Take advantage of the out of doors and the company of your kids.
Staycations and Vacations - You can make time special right where you live, or strike out on the trail, for all day or all month as your circumstances allow.
2. Consider making use of a wall calendar that comprises the whole summer. Block out the time so your goals are realistic. Leverage your available technology to communicate and coordinate with others in your group of family and friends.
3. Document your summer so you can best enjoy your memories later. Use photo, video, journalling, paper and mixed media scrapbooking or even digital scrapbooking.
To follow recent tradition, I will give the Zika update first. The WHO (World Health Organization) has reported that the spectrum of neurological damage to babies with Zika is greater than previously appreciated. Microcephaly is certainly the most obvious problem, but others such as spasticity, seizures, and vision problems are possible.
This week a new method of acquiring the virus was confirmed. An American lab worker working with the Zika virus has contracted it though a needle stick.
In the US, funding is still not present to fund the fight against the virus. Nonetheless, scientists at the National Institute of Allergy and Infectious Disease (NIAID) are “aggressively pursuing" a vaccine.
Research is also taking place regarding how to alter the genes of the Zika carrying mosquitos so that they are sterile. Wiping out an entire species through genetic engineering may have unintended consequences. Researchers are examining this important issue.
Over thirteen hundred cases of Zika are confirmed in Puerto Rico, but there are probably many more including those who are asymptomatic. ACOG (American College of Obstetricians and Gynecologists) is leading the effort to train physicians on the island to place IUDs for contraception. The WHO this week has finally issued a recommendation to women in affected areas to delay pregnancy.
Both ovary and breast cancer therapies are in the news this week, and the messages are promising. For starters, research presented a the annual meeting of the American Society of Clinical Oncology has highlighted 11 additional genetic mutations associated with increased risk of ovarian cancer. This may ultimately give us expanded opportunities for screening and treatment of this disease.
On the treatment side, it turns out that a combination of IV and intraperitoneal chemotherapy is more life extending than either therapy alone, for the treatment of ovarian cancer. Also on the treatment side, it turns out that extending anti-cancer hormone therapy such as Tamoxifen for 10 instead of 5 years reduces risk of recurrence or second primary in older women with early stage breast cancer.
Syphylis cases have more than tripled in the last decade. At the same time, the majority of sexually active women between 15-25 have NOT been screened EVER for any sexually transmitted infections since they do not believe themselves to be at risk.
The CDC ( Centers for Disease Control) has reported the “ the US obesity epidemic continues to worsen”. Fully 40% of US women are obese. Obese is defined as a body mass index (BMI) at or greater than 30. Do you know your BMI ?
In the office, most patients show understanding of good nutrition. And yet, when at home they say they have trouble actually eating healthy. The frustrates them and mystifies me. I would like to help. Sometimes I'd like to just come home with them to show them how easy it is to make it work. But that isn’t exactly practical. Instead I’d like to come up with something tangible that would remind them of all the principles and tips they have learned, so they can put them into practice.
Sometimes I think this could be done with an attractive nutrition art poster to be displayed in the kitchen. Sometimes, I imagine kitchen linens featuring helpful suggestions in clever graphics, e.g. “ Eat your greens ! “ For quite a while I have been imagining a deck of cards. Each card would feature one nutrition reminder.
The reminders would have to be attractive, both visually and tangibly.The principles they conveyed would have to be simple and clear. Right now I am trying to cook up a list of catchy little reminder phrases which will help people have an enjoyable and easy time making good nutrition at home. I would like to devote this post to sharing what I have so far, and to solicit your input about what reminders you could use.
Here’s my list so far:
I would really appreciate any other ideas you have about what might help make good nutrition happen for you. Meanwhile, if you haven't already, check our the blog on the website and scroll back to see the last several Food Fridays for more cooking inspiration.
