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

in , , , , , ,

Zika is still in the news this new year, but this is definitely the off season. In good news, the CDC (Centers for Disease Control) has released $184 million dollars to the states and territories to fight to Zika virus. The funds will be used to improve testing and to enable the states to track pregnancies and births affected by Zika. In other good news, two studies published in the New England Journal of Medicine and the Journal of the American Medical Association reported that the risk of Zika associated microcephaly maybe less than previously estimated. Microcephaly is one of the more severe side effects of perinatal infection with the Zika virus. However it is not the only side effect as Zika affects many other organs and many other aspects of the central nervous system, many of which are yet be fully quantified. It may be that while microcephaly is less prevalent than previously estimated, serious less well defined or obvious side effects are more common than previously estimated.

New research published in the Journal Gynecologic Oncology indicate that there is a new up-and-coming ovarian cancer drug. In this small study, progression free survival was increased from 6.8 months to 15.4 months. This may not sound like much but it's a step in the right direction which, ultimately, may be combined with other such steps.

Republican Representative from Georgia Tom Price has been nominated for Health and Human Services Secretary. This has been a controversial nomination. Dr. Price is an orthopedic surgeon, and as such has been endorsed by the American Medical Association. At the same time, many in the medical field voiced their opposition to this nomination. Several thousand physicians have signed a  petition indicating their displeasure and stated that the American Medical Association does not speak for them. Meanwhile, the President of the American Congress of Obstetricians and Gynecologists, Dr. Thomas Gellhaus, has expressed concerns that some of the bills supported by Dr. Price would “…not serve women's health well”.

In other political news the GOP is divided on the issue of the ACA (Affordable Care Act). Basically, the two camps are as follows: repeal and do not replace versus revise and rebrand. GOP leaders have tried to assuage concerns about the repeal or revision of the ACA promising that "no one is worse off". There is concern however that ensuring that "no one is worse off" will be difficult to accomplish, given that the GOP intends to repeal certain taxes which have been used to fund the ACA.

In sobering news, alcohol consumption, bingeing and alcohol related deaths are up sharply among American women. This is the case as reported by the Washington Post on analysis of Federal health data. Analyzing the data has revealed that this is particularly true among American white women. At the same time, findings published in the current issue of the Journal Drug and Alcohol Dependence show that between 2005 and 2013 binge alcohol use and alcohol use disorders are increasing among older adults.

The Journal of the American Medical Association has produced new research which has broken down how we spend on healthcare. Not terribly surprising are the first two diseases that cost us the most as of 2013: coming in at number one for $101 billion dollars is diabetes, number two at $88 billion is heart disease and a surprising tie for number two is back and neck pain at $88 billion. These are nontrivial numbers which are generally spent in the hospital setting. Therefore it comes as no surprise that hospitals have been voicing their warnings to the incoming  administration about the possible repeal of the ACA. They have calculated that they stand to lose $165 billion if the estimated 20 million people lose their insurance they gained under the ACA. They warned of “an unprecedented public health crisis" and possible collapse of the whole healthcare sector.

In perhaps the most interesting news of the week the American College of Obstetricians and Gynecologists is going head-to-head with the FDA over the issue of anesthesia for pregnant women. The FDA recently issued a warning against the extended or repeated use of "general anesthetic and sedation drugs in infants and toddlers and pregnant women in their third trimester”, indicating these "might damage children's developing brains”.  Their recommendation is based on observational studies on animals. ACOG has issued a statement indicating that they are unaware of data on pregnant women that support the FDA's claims. They go on further to state that these warnings may cause patients and providers to inappropriately reject the use of these medically indicated drugs.” As a practicing Obstetrician, I can imagine the difficulties this warning is going to cause with pregnant women who need surgery for trauma, gallbladder removal, appendectomy, or even C section where spinal blocks or epidurals do not work or are contraindicated. 

Back in the good news department, Texas, of all places, has produced seven lawmakers that have filed bills for the upcoming legislative sessions seeking to "eliminate the sales tax on feminine hygiene products". The state of Texas has a 6.25% sales tax on all retail sales. Additionally certain local entities can impose an additional 2% tax. Currently certain hygiene products such as pads, tampons and menstrual cups are designated as luxury items and as such are subject to the retail tax. Changing this law would repeal this so-called"Tampon tax" which is considered unjust because it targets only women. Besides, everybody knows these items are not luxuries, they are necessities.

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

Food Friday: The Impromptu Dinner Party

in , , , , , ,

Oh yes I did just throw an impromptu dinner party for 15 ! Truth is, this is not uncommon in my house. So, I thought I would share some strategies on how to manage this seemingly impossible feat. 

Who were these people ? These were nine guests from France who we were expecting. We were to house them for perhaps a week. So tonight, in what we thought was the first night of their visit, we thought they could simply settle in. However, it turns out they decided to stay only one night, so this would be our only chance to visit with them. Dinner was served. 

My family totals 6, not counting the baby granddaughter, so we had plenty of hands. This is the first tip.

1. You must train your children (and partner) from an early age to clean up after themselves in the kitchen, so the kitchen is not a fright when you go to use it. You must teach them basic cooking skills so they can effectively sous-chef (assist) you in a pinch. 

2. The next tip is similar: Keep the house reasonably tidy on a regular basis. Ensure your house is curated (meaning get rid of what you don’t need), clean and organized every week. Pick a day and keep to it. Then when opportunity strikes, you will be ready. 

3. Keep some basic decorations handy. I use candles and nice napkins. Guests seem reluctant to use our cloth napkins, so I keep some paper ones on hand. My candles are oversized white tea lights available at both Costco and Ikea. I place them in glass candle holders for ambiance. They come in little metal holders which prevent wax mess and get recycled. 

4. Have a set of dishes you can make quickly from things on hand, from the freezer and the pantry. Have ingredients for these recipes on hand most all the time. Have a ready-to-go festive drink as well. Mine is Pellegrino which I keep stocked in the pantry. 

In our case tonight, we made Paleo chili with all the trimmings, green salad and fruit salad. ( Always have those last two side dishes !) 

Here’s the rough recipe for Paleo Chili : 

  • In a large soup pot, saute a tablespoon of green chilis, canned or fresh, in a couple tablespoons olive oil. You may also include minced garlic.  
  • Brown about three pounds lean red meat in this flavored oil. Season with lemon pepper, cumin and chipotle chile powder, coating the surface of the meat lightly with each spice all across the area of the pan. ( This could be done with ground turkey too.) 
  • Saute some Mirepoix (roughly chopped carrots, onion and celery at a 2:1:1 ratio) and add that to the meat. 
  • Add a cup of frozen or fresh corn. 
  • Sitr and get mixture dry, caramelizing, and very hot. 
  • Add 1-2 cans full flavored beer (not paleo) or just water. Keep your face out of the steam. The alcohol cooks right off. 
  • Then add a can each of tomato sauce, stewed tomatoes, and diced tomatoes. 
  • Bean eaters (not Paleo) can add two cans here. I kept ours on the side since you never know the dietary constraints of guests. 
  • Simmer and adjust all seasonings, salt last. 
  • Serve with corn tortilla chips, chopped scallions, (lactose free) sour cream or substitute, salsa, and guacamole. Cheese eaters may add grated cheese. These garnishes are all set out for people to add at their discretion. 

 

Here is my Gluten free but too-sweet-to-be Paleo Quick Berry Cobbler: 

Spread a 2-3 berry-deep layer of red fruits on the bottom of a 13X 9 "ish" baking pan. These could be frozen or fresh raspberries, strawberries, cherries, or even blueberries, or better yet, a random combo of these. Pour off any dilute water from melting fruit. 

Make the topping. Mix the following until crumbly: 

  • 1c gluten free flour 
  • 1c sugar
  • 1egg
  • 1 teaspoon baking powder
  • 1 tea spoon salt

Spread over berries. 

Melt one stick of butter or 1/2 cup coconut oil and pour evenly over crumbs.

Bake at 350 degree until crust is golden brown and berries are not watery. Pro tip: bake on an edged pan lined with parchment. Start watching the cobbler at about 25 minutes. 

Keep conversation going by offering herbal or decaffeinated tea after dinner. 

Let guests help if they arrive too soon and clean up afterward. It is better to be doing things together than to have people idle and awkward.  Don’t think that everything has to be perfect. It is more important that you are warm and inviting.

Now you are all set to throw an impromptu New Year’s Eve party. Happy New Year ! 

 

 

 

 

Wellness Wednesday: A Thousand Small Cures

in , , , , , , ,

Not a day goes by that I am not asked about one “cure all” or another. Wellness Wednesday has been a column devoted to just the opposite- the many, sometimes small things, which done repeatedly, amount to the “cure”. The “cure” offered by longstanding attention to wellness is none other than prevention. 

Even when unpreventable illness or injury happens, wellness behaviors can make the difference between a good outcome and a bad one. We have so much power over our health but people scarcely realize it. Some realize it but are not up to taking that responsibility. It feels better to ascribe their poor health to genes, “toxins” in the environment, or something else. Strangely, empathy rather than blame is in order here. Why ? Because empathy is empowering and empowerment works. Once people get the message (though empathy) that they are not alone, they have the courage to begin improving their health related behaviors. 

Taking charge of your health is easy and empowering from day one. That is the secret that popular media and medical professionals alike keep obscuring. It is not so much a matter of discipline as it is of planning. It need not take place all at once. Once people get the message that wellness behaviors are easy, and need not be hard to be helpful, they are more apt to do them. 

How do people get these messages ? There is of course the popular media. To find this material about health maintenance you must be seeking it. These people are already on the right track. But what about others ? Here is where I believe the responsibility falls on all doctors to talk to patients about their health maintenance. Even before that, I believe it behooves all physicians to set a good example in this regard, and keep themselves as healthy and fit as possible. Nobody is perfect, and nobody should be held to an unrealistic or extreme standard. Yet, doctors should practice what they preach and lead by example. 

Physicians offices should be set up to refer liberally to nutritionists, physical therapists, counselors and others who can specifically teach and monitor health maintenance behaviors. Physicians themselves should learn how to discuss sensitive matters like weight. They should ask about life at home and work to screen for interpersonal issues or abuse. 

It is my hope that popular culture will increasingly embrace legitimate ideas about nutrition, fitness, mental health, and health care.  By now, most people know how ideas travel though communities and social media. Good ideas are sticky, and should be circulated. For example, food and workout posts which we love to hate actually bring these ideas to the fore. 

My website is a repository for health information related to Obstetrics, Gynecology and Health Maintenance. However, it has a limited readership. My plan to curtail blogging to Medical Mondays only is an attempt to get "more bang for the buck” and try another format for distributing this information. There are a couple decent books out there in this subject area, but mainly the field is lacking. I will be looking at the possibility of an ebook versus apps to serve as resources for women looking to improve their health. I hope you stay with me along the way. 

 

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

in , , , , ,

For the first time in many months, there is nothing new to report about the Zika virus. I am going to take this is as a good thing and report on the rest of the news. 

With the end of 2016 approaching, ACA (Affordable Care Act) signups have reached a new high. At the same time many fear loss of their contraceptive method if the ACA is repealed. The ACA as it currently stands, pays 100% for contraceptives. 

The ACA seems to have enabled more people to keep up on preventive care. Also according to a new study, the number of adults who skipped recommended medical care fell about 20 % between 2013 and 2015. Similarly, a new Vanderbilt study showed that patients accessed emergency department care more quickly since cost was not a consideration in choice of hospital.  

Texas has noticed all Planned Parenthood Clinics that it is removing them from the Medicaid Program. This means that no Medicaid recipients may be seen at Planned Parenthood, which normally serves predominantly the Medicaid population. I’m wondering if this will have unintended consequences. For example, perhaps Planned Parenthood will have to start filing their clinics with well insured women, while the private and hospital owned clinics uptown will start to fill with medicaid patients ? It will be interesting to see how this will play out. It almost certainly will mean less access to care and a shift in who sees whom. Planned Parenthood is appealing the Texas Health and Human Services Division. 

ACOG (American College of Obstetricians and Gynecologist) has officially endorsed 30-60 seconds of delayed cord clamping. This procedure allow baby to get more blood from the umbilical cord. This is especially beneficial for smaller, early babies, but can be good for term babies as well. It results in higher blood hemoglobin counts, but also, understandably more jaundice, since jaundice comes from the breakdown products of blood cells. As an obstetrician, I can tell you that this works out most of the time. However, if baby is not breathing well, I get them to the nursery staff right away. Also, if there is excess maternal bleeding, we cut this procedure short, and move to get the placenta delivered. 

On a personal note to readers, I have appreciated all the attention to my posts. However, I plan to curtail my blogging to once a week come January 1st, 2017. I will continue Medical Monday since I believe this information to be very important to you. Additionally, I do plan to put out an occasional digest of existing website pages and posts on selected topics, which I think will be high value. However, based on my numbers of readers and subscribers, it seems clear to me that I need to get my information out in more accessible forms, such as in books or apps. There is so much material on the site now, that most topics are really well fleshed out, though the material is deep in the pages. I will need some time to pull this content out and organize it. At the same time, you are of course welcome and encouraged to access the website anytime via the menu, the search page, or the blog tags on the right of the home page on your own and free of charge. My website will be there free for all as an up to date medical resource.  

Food Friday: Food Traditions and People

in , , , , , , ,

Winter is here and Christmas is upon us. Our family and friends are assembled. The serious cooking has begun. 

Christmas and Hannukah coincide this year, which is nice for our family. My husband has Lutheran roots, and I am Jewish. We have learned to be inclusive, and both holidays hold real meaning for us. Plus, we get all the good foods ! 

While we partake of many traditional holiday dishes, some treats have taken hold in our tribe. Each dish has a champion and ... a relationship to go with it.  Here is how it is playing out. 

One friend presides over the mass creation of decorated gingerbread houses every year. Another friend is the undisputed pie expert and can always tell what you are doing wrong. My son in law is the grilling king. My sister in law reliably arrives with snickerdoodles. My brother in law is a master of soups and chilis. Two nieces could go pro with cake decorating, and like to do their work here, in my kitchen. Great Grandmother roasts lamb. 

My husband is all about a fancy breakfast. He is one of those Nords who gets up early with a smile on his face. He makes waffles with fruit. Even at dinner we " give him a job he likes" which is making fruit salad. 

The youngest is starting to correspond with me from college about main dish recipes, usually with deer or elk, our red meat of choice. I owe him a custom cookbook, but have been slacking. Last week it was pot roast, and I got pictures. I think our culinary relationship is still forming. 

Our middle child cooks all the time. We have several dishes that bind us, but the most fantastical is our Buche de Noel. We also make fancy non-traditional Latkes. No mere white potatoes for us. We use sweet potatoes, yams, carrots, scallions and the like. I think this year we will fry in coconut oil. 

Our oldest is a skilled self taught chocolatier. This is what she and I do for the holidays. It is epic. We make moulded chocolates filled with ganache. I make the ganache, she makes the molds. Facebook and Instagram light up. So I though I'd share this little slice of our holiday with you. Have a Merry Christmas and a Happy Hannukah. 

Wellness Wednesday: Good Relations with Family

in , , , , , , ,

Holidays bring family together and that is good. However, family issues that were never resolved may come to light. To help your family time during the holidays be peaceful and bright, I have collected a few insights and recommendations for your consideration. 

Accept that family relations are complex. Accept that high stress during holidays is real. It relates to the practical demands of decorations, gifts, entertaining, finances and family relations. It also has to do with the inevitable taking stock of the year in conversations in one’s own mind and over the holiday table. People inevitably present their year in holiday card humble-brag style, and it is difficult not to make comparisons between one family and the next. 

Establish a realistic idea about who you are going to see and how they are likely to interact with you. Behavior patterns (also called dynamics) between people are very durable. That is, they are challenging to change. If you have a dysfunctional or uncomfortable dynamic with someone you are likely to see, prepare for it. Consider developing responses in advance should difficult topics come up. Remember to make “ I statements ”, i.e., "I feel", "I think". 

Set your own boundaries and stay within them. Begin by going to a family gathering focusing on the positive about yourself. Hold to those positive beliefs. Likewise, be tolerant of others and their idiosyncrasies. Focus on the positive in others. 

When you are reconnecting with people, greet them directly and warmly. Ask simple open ended questions but don’t pry. There is often no need to evaluate what they say or respond, just to listen with empathy and understanding. 

Do not go outside of your boundaries. Do not defend yourself if challenged. Just agree to disagree. Do not try to control or persuade others about old or new issues. Do not get drawn into an argument in a family gathering even if you have stake in the issue. It is not the time or the place. 

Remember the reason you celebrate holidays. They should be a time to celebrate the wondrous healing power of hope for the future. Holidays should be about celebrating the value of relationships. If your family relationships have not been well cared for, holiday time is a good time to start your part in this. Medical science has shown that we are happiest and healthiest if our relationships are healthy. Attaining optimal nutrition, fitness, and physical health are not easy. These take considerable learning, patience, and routine. Relationship health is no different. 

 

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

in , , , , , , , ,

A total of 4575 Zika cases have been documented in the United States including 1172 pregnant women. We are now beginning to collect data on these pregnancies and the resultant births. It turns out that about 6% of Zika infected pregnant women in the US had a baby with at least one birth defect. This new research was published in the Journal of the American Medical Association. The data was gleaned from a total of 442 Zika infected women who completed their pregnancies this last year in 2016. In stratifying this group it was discovered that those who were infected in the first trimester had an 11% chance of delivering a child was birth defects, higher than the average of 6% indicating that Zika poses the greatest risk earlier in the pregnancy. Moreover, these rates are on a par with what is being seen in Brazil at this time indicating that the virus is working in a similar way in both populations. 

Personally I see these numbers evolving as the duration and post natal effects of Zika virus have yet to be fully described. CDC (Centers for Disease Control & Prevention) researchers have indicated that Zika can replicate in the fetal brain for up to seven months after the mother has become infected with the virus. They have noted that babies born to Zika are very likely to have brain damage even in the absence of obvious abnormalities like microcephaly and that the virus may keep replicating long after birth.

The CDC  has added Brownsville Texas to its list of Zika travel advisories. This is because five locally transmitted Zika infections were recently reported. Texas has had a total of 274 Zika cases.

Also in Texas news, it has been discovered that a booklet titled “A Woman's Right to Know" was revised earlier this year to contain misinformation about the relationship between abortion and breast cancer risk. This booklet must, by law, be given to any woman seeking an abortion. 

New research published in the journal Science Translational Medicine as reported that researchers have described two antibodies that appear to be important in the fight against Zika. Apparently these two antibodies were able to eliminate Zika virus in animal subjects in the lab. Hopefully we will hear more about this in the future.

In other news, fears about the repeal of the Affordable Care Act continue. Republican lawmakers are gaining appreciation for the ramifications of a fast repeal including the loss of insurance by over 50 million people and a huge loss of revenue for hospitals across the country, on the order of $165 billion dollars. Even with fear of a repeal looming, sign-ups for the ACA are occurring at a higher rate compared to this time last year. Moreover the Fed is extending the healthcare.gov deadline until Monday, December 19th. 

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

Belated Food Friday: Paleo Party Shots

in , , , , , , ,

This year we joined our sister offices of Family Born Midwifery for our office Holiday Party. We decided to go Paleo, and every one gave it a go. 

It was a fantastic spread of roast turkey, root vegetables, as well as green salads and fruit salads. We had a selection of paleo cookies and a very easy berry cobbler. Unfortunately, the cobbler got eaten before it could be photographed. However, I would like to enclose the recipe for you since it is easy, quick, tasty, paleo, and colorful. 

 

And here are some other shots from our dinner just for fun. 

Wellness Wednesday: Help for the Elves

in , , , , , , , , , ,

Are you that truly time strapped gift giver with the finite budget ? Have you been reading all that advice about scaling back this holiday ? Are you tired of the materialistic holidays, the stress, and the excessive spending ? Here is some SMART advice to help you through. SMART means specific, measurable, attainable, relevant and time bound. Instead of saying, I’m going to do better this year, have a SMART plan for getting your tougher gifts done. 

They say the best things in life aren’t things. Here are some: 

Home made paper or gift certificates for activities with YOU ! Examples: 

  • a movie
  • lunch out or lunch in 
  • a hike in the outdoors 
  • spa day 
  • craft day 
  • joint workouts 

Here’s athoughtful gift for that person who has enough “stuff” : A donation to their favorite charity, cause or advocacy group, (usually able to be made online). You can send a card or a decorated email to announce the gift. 

For those who would like to give, but are perhaps late on mailing things to faraway relatives, ebooks and audiobooks come to the rescue. You can send an inexpensive but special ebook instantly even on Christmas eve and be right on time. Amazon.com is my go-to for the instant gifts. Your recipient can read them on any device, not just a Kindle. Kindle apps are available on virtually all platforms including the desktops PCs and Macs, as well as Android and IOS. Your gift can combine an ebook and an experience if you gift the book and buy one for yourself, then propose that you and even a faraway friend can read it “ together”. 

Audible.com is my source for ebooks since I am a member. This service is certainly worth looking into, especially if you ever have long commutes, flights, or road trips. 

For an even more economical gift, you can send music, even just one song, or an app, as a gift. These too are electronic, and thus accomplished at your desk in the wink of an eye. 

It’ s the small things that count. So send valuable information ! Most of us have a recipe or two that is special to others. Write it up with nice paper or digitally with graphics, and send the recipe or a collection of them as a gift. 

Other small things include thumb drives - perhaps one filled with your best photos of activities you and your recipient have shared. Tie it with a ribbon or some twine and you have a very easy, very economical and very special gift. 

Making celebrations and gift giving is fun but can be overwhelming. Get inspired, and stretch a little, but do not stress or worry yourself. That would be missing the forest for the Christmas trees ! 

Enjoy these last few days before Christmas ! 

Medical Monday: breaking news from the world of obstetrics and gynecology

Here is some good news on the Zika front. It is been over 45 days without anyone in South Beach Miami contracting Zika virus in from a local mosquito. For this reason Governor Rick Scott has lifted the Zika zone warning in South Beach. Miami's Little River area was cleared earlier this week. Officials are still warning pregnant women to avoid the entire area and to protect against mosquito bites.

Five babies in New York City have been born with Congenital Zika Virus Syndrome. Interestingly, eight other infants have tested positive for Zika virus in New York City but have not shown evidence of the syndrome.

Zika remains a threatening and somewhat mysterious disease. A woman in Columbia has been the subject of study because her Zika virus infection lasted so long. Normally the disease is mild and runs it's course over a few days time. However the pregnant patient in question tested positive for Zika for 107 days after the onset of symptoms. Because of this, researchers speculate that the baby may serve as a reservoir for the virus. When this baby was ultimately born at 37 weeks gestation, it did indeed show microcephaly, indicating that it had been infected by Zika as well. However, interestingly, the baby tested negative for Zika in serum, urine and cerebrospinal fluid. Even though the Zika virus had done it's damage as evidenced by the babies microcephaly, the baby had already developed Zika antibodies prior to birth.

Three experimental Zika vaccines are under development. One of them has finished the first round of human testing then will move to phase 2 trials in the first quarter of 2017. Four or five more Zika vaccines are expected to begin development next year.

Perhaps the most important comments about Zika came from a Dr. Antonio Crespo the Chief Quality Officer at Phillips Hospital at Orlando Health. Writing in the contributors blog for The Hill, Dr. Crespo indicates the northward migration of Zika virus is probably the first of many such diseases. He cautions that the nation's response to Zika and the outcomes that we will see should be studied in preparation for future such threats. 

In other news, youngsters are not the only ones skipping their vaccines. Older people are more vulnerable to influenza, pneumonia and shingles. Vaccines are available for all of these things. 

Young people between the ages of nine and 26 should be vaccinated against the human papilloma virus (HPV). However, vaccination rates in this case fall short of ideal. A new study indicates a counterintuitive result. It turns out that short conversations between Dr. and parents or Dr. and patient are more likely to result in vaccine utilization than are long conversations. Researchers have interpreted this finding by speculating that long conversations raise more doubt than short ones. I would speculate, by contrast, that when a patient shows reluctance or asks questions, the conversation goes longer. Such patients who are disinclined to vaccinate to begin with are less likely to vaccinate even after the conversation takes place. I think the conversations between caregivers and patients need to be as long as they need to be and they certainly very greatly between patients and circumstances. I'm going to file this in the chickens and eggs category.

Also in the chicken and eggs category is the following study. It turns out that researchers have identified a link between pubic hair grooming and sexually transmitted infection (STI) risk. There is a direct relationship between pubic hair grooming and sexually transmitted infection risk. In fact, there is nearly 4 times the likelihood of having an STI among those who are groomed as infrequently as weekly. I ask myself, is this because grooming inherently makes the tissues more vulnerable? Honestly I doubt this. Do those who groom have more partners? Do those who have more partners groom more ? Which comes first?

Officials from the incoming Republican administration have reiterated their plans to repeal the Affordable Care Act (ACA). However reporting on more detailed discussions among leader elect reveals a realistic understanding that this change might take two or three years. They even have a name for their strategy: "repeal and delay".

Meanwhile the American Hospital Association has warned the new administration that "repealing the affordable care act could cost hospitals $165 billion by the middle of the next decade" And "trigger an unprecedented public health crisis". 

Similarly the Urban Institute has reported that 30 million people stand to lose coverage if the Affordable Care Act is repealed without putting anything in place to replace it.

Many women are aware of the likelihood of some form of curtailment of the ACA, particularly of reproductive health care coverage. A Kaiser study indicates that many women are flocking in to obtain contraceptives, including longer acting methods to see them through a longer period of time.

In the good news department, the Senate has passed a landslide vote ratifying the 21st Century Cures Act. This is a $6.3 billion measure to "increased federal support for medical research, mental health care, and controlling the opioid epidemic". The bill had strong bipartisan support and cleared by a vote of 94 to 5.

We will finish with a fantastic study on the relationship between optimism and health.The Nurses Heath Study is a very long running and large study of 70,000 women between 2004 to 2012. It is been mined for all kinds of research. In this most recent study released out of Harvard Public Health, those with the most optimism had 40% lower risk of heart disease and stroke compared to those with the least optimism. Optimism was linked with lower inflammation and healthier biomarker levels including lipid levels. Researchers concluded that the correlation between optimism and longevity was the result of optimistic people having healthier lifestyles such as diet, sleep patterns, and other factors.

 

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

Food Friday: Holiday Food Preparation

in , , , , ,

This was going to be a post about Holiday Cookie Exchanges, and how I was going to make mine paleo, but then I realized there was so much more to do than that. There is so much more to do with holiday food on this, the 10th of December ! The time is now to get prepared. I share my list with you ! 

First things first: Make a list of all the food requirements that must shortly be met. 

  • Determine donation at the door for upcoming holiday party- canned goods ? T-1 day 
  • Order turkey from the organic people so I will not have to worry about them selling out. ASAP
  • Order fruit boxes for gifting.( Make fruit box list !) ASAP ! 
  • Raid pantry for homemade jams for neighbors on Christmas eve or Christmas day. Decorate jars. T-10 days 
  • Decide on thank you gifts for office- tea and chocolates in gift bags. By Monday 
  • Decide on thank you gifts for “ helpful people” list: ( First review the helpful people list for this year, i.e. UPS man, insurance lady, dentist, eye doctor, etc. ) Maybe also tea and chocolate depending. By Monday 
  • Try to pull together people who are interested in a Paleo cookie exchange. Tomorrow 
  • Decide what cookies I would like to make for the cookie exchange. Next Wednesday 
  • Decide menu for office holiday party, and see what I can get purchased before the rush. This weekend.
  • Buy decorations for homemade chocolates. ( Amazon !) Tonight ! 
  • Assess the current collection of stocking stuffers for family members and what still needs to be obtained. Be sure to get the correct chocolate percent to each of the kids (Chocolate snobs-all of them ! ) This weekend 
  • Plan the baking and assembling of the “ Buche de Noel” or Yule log, in chocolate and buttercream with piped meringue mushrooms. - Talk to my sous-chef son Forest : ) - Do the Saturday before Christmas. 

It seems like a lot, but I do it because it’s fun and because it brings people together. 

Take at look at your fun list for this holiday season, and have some fun with food. Just make sure to keep up with your workout in the event that there are a few extra calories on the holiday menu. 

Wellness Wednesday: Holiday Parties

in , , , , , ,

It is the party season. Instead of avoiding or stressing about parties, take a new tact: RSVP yes and prepare just a little. Attending parties is a skill like any other and can be learned. Preparation and a dose of common sense is all you need. 

Holiday parties come in three varieties: 

Family parties

Social parties 

Office parties 

Each has its special considerations. But they all have one thing in common. Their highest and best purpose is to reaffirm personal connections. Some people go to parties for other reasons, for example to impress, drink, or hook up. But these are not the highest and best purposes of a holiday party. 

Social connections in families, among friends, or coworkers are endlessly complex. Challenges and problems among people are inevitable and natural. There are times and places for working on these issues. A holiday party is not one of them. Parties should be easygoing and enjoyable. 

How is this accomplished ? 

 

Prepare 

 

Be prepared to be sociable, i.e. positive, interactive. Get enough sleep, don’t be rushed, and eat something healthy before you go so you are not “ hangry” or sluggish. Eating something before hand will help you avoid binging on lesser quality party foods. 

Know who you are likely to meet and be prepared to be cordial to them, no matter who they are, i.e. your ex, your hostile co-worker. I would say think up some topics for conversation, but that seems too contrived. Instead ask them about their holiday plans, or something that you know interests them. Here’s the secret: 

The key to feeling comfortable at a party

is making other people feel comfortable. 

Try to be inclusive of those who seem shy. Do not monopolize the host or any high profile guests. In conversation, take a moderate approach, avoiding both awkward silences or talking above everyone. 

Do not introduce controversial topics such as politics. If such a conversation takes place, and you notice some uneasiness, try to smooth it over or change the topic. You may also excuse yourself from the conversation. 

Make the rounds. Try to touch base with most everyone you know. If you are with someone at a party, touch base with them periodically. You are not obliged to be glued at the hip. Do however, look out for their comfort. 

Be liberal with introductions. Be quick with eye contact, a firm handshake and your name. You will put people at ease. Some may be taken aback and you may have to gently ask them their name. 

Come with a gift for the host. Wine is cliché unless you and the host are wine aficionados. Flowers die. Consider a small indoor plant, or better yet some potted culinary herbs.  If your gift is modest and personal, it will be appreciated. A ribbon, some raffia or a brief note will show forethought. 

Love your outfit if you possibly can. Consider black, because…black. Go festive, as this shows an admirable enthusiasm. Do not, however, conduct fashion experiments at an office party. Do not go overboard on risqué or glitzy. You want to maintain your professional reputation. 

A social party is different. There you may show more flair and more skin. However, do not assume you will be as comfortable in your dressing room at home as you will be under the lights at a party. Some people will be taller than you are, and even with heels, they can look right down that cleavage. You will realize this at just the wrong moment and there will be nothing you can do. Remember too, that you may want to dance. Hopefully your sequined sheath and your platforms will permit this. 

Do not under any circumstances drink to excess. In fact, As a physician, I suggest club soda with a wedge of lime. It looks just as sparkly in your hand, and gives an air of restrained elegance. Why ? Because it is restrained, and it is elegant. If you drink, limit yourself to one beer, one glass of wine, or one glass of champagne. Social interactions are complex and challenging. You will want to be within your full faculties at parties. 

Do not overeat. It’s not even fun. Take small portions of just the best things. Hydrate with your elegant soda. 

If you are asked to bring a dish, you must. Do your best and present it well. Consult liberally with the host beforehand to be sure you are getting it right. If it is a DIY kind of casual party, and it seems appropriate, offer to help clean up. 

Do not bring extra people with you unless you have the host’s encouragement beforehand. Do not come early and do not come too late. Do not stay too late. Better that the host should ask you to stay rather than ask you to leave.  

So many rules ! Yes and no. Most of this is just plain old common sense. But, I daresay, common sense is not exactly common these days. 

So, pick a gift, pick an outfit, stand up straight and enjoy the parties of the season.

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

in , , , , , , , ,

Zika has crossed the Atlantic to the United Kingdom. There are 265 known cases there already, including one whose transmission is believed to have been sexual. People traveling from moderate or high risk areas are asked to abstain, or contracept and use reliable barrier methods. HA ! That’s an oxymoron: reliable barriers. 

It is winter in North America, and that includes the US territory most affected by Zika: Puerto Rico. While Zika transmission continues, it is decreased at this time of year, due to reduced mosquito activity. Attention turns now to the pregnant Zika infected women. There have been 2600 confirmed cases of Zika in pregnancy in Puerto Rico. Many have miscarried, but many are yet undelivered. 

Texas now joins Florida as the only continental US state to document a local transmission of Zika. Local transmission means a Texas mosquito bit a person in Texas and transmitted the Zika virus. What this says about the number of mosquitos in Texas which have Zika is unclear, but it says something. Until now, all other Texas cases of Zika have been linked to travel. 

In other news, the ACA (The Affordable Care Act) has top billing. As mentioned last week, the ACA is now integral to our healthcare system and cannot be easily dismantled. Twenty million Americans now depend on the ACA for their health care. It is becoming more widely acknowledge that for the time being, it will have to stay as it is, notwithstanding the change in administration. Enrollment for 2017 is beginning, and it seems, continuing apace, 2.1 million so far, despite GOP’s vows to dismantle it. 

GOP lawmakers have started discussions with insurers to try to prevent a collapse of the insurance market if they pass a repeal of the ACA. GOP lawmakers are now indicating that it may take them “ years” to repeal the ACA, hopefully more than four. 

As a physician, completely unrelated to politics, I am for some form of the ACA. I have seen women whose only health care was during their pregnancy, who can now come in with pride just for their annual. They are able to get the recommended screening tests, and can begin to think about health maintenance and limiting family size if they chose. I know, as a physician, that prevention saves money. I also know that disease caught early and treated is far cheaper than disease caught late. GOP lawmakers MUST factor this in if they are to modify the ACA or create their own plan in such a way as to make it affordable and sustainable in the long run. 

The GOP is mixed on the Medicaid expansion. Many Republican Governors are glad to get so many more or their poorest patients insured. 

New research published in the Journal of Women’s Health indicates that women with chronic conditions do worse without access to the internet. This may have to do with access to information and social connections with others, especially others who share the same conditions. 

Many women and many providers believe that there is an age cutoff after which mammograms are no longer beneficial. I am unaware of such data. New research using data from 6 million mammograms between 2008 and 2014 confirms there is no clear cutoff point. Mammogram decisions should be made between a patient and her caregiver, and factor in the best available data and the patient’s overall health. 

Tom Price, the Health and Human Services Secretary elect is said to be both anti-abortion and anti-birth control. It is beyond me when someone who is anti-abortion is also anti-birth control. The theoretical planned repeal of the ACA will not ban these things per se, but a report out of Kaiser indicates  that the costs of contraception will rise during this time period. Drug costs across the board will likely rise whether or not the ACA is repealed. 

In the good news department, the House, in a landslide vote, passed the 21st Century Cures Act. This provides an increase in finding to the FDA ( Food and Drug Administration) by $500 million, for drug development and testing,  and would also provide $1 billion to address opioid addiction. There’s a billion dollars we theoretically should not have to spend but, we do. This is why we cannot have nice things. 

Planned Parenthood, ACLU, and the Center for Reproductive Law and Policy are filing lawsuits which challenge several laws which limit women’s rights to various reproductive services. The lawsuits are arising as quickly as the limitations these days. 

The House Energy and Commerce’s Subcommittee on Health has taken what I consider to be a monumentally positive step in reigning in the US Preventive Services Task Force. They have recommended that the small, non-clinical committee receive more input on formulating their recommendations, from (surprise!) medical authorities before they make recommendations which influence patient care and insurance coverage of various screening procedures. The bill comes from Republican Marsha Blackburn from Tennessee who has pointed out that USPTF recommendations on many issues pertinent to women’s health including mammograms differ from those of, for example, ACOG, the American College of Obstetricians and Gynecologists. The bill provides for input from both primary care medicine and specialist authorities. Bravo Representative Blackburn, and bravo to you for reading all this. 

Stay tuned next week for more exciting news from the world of Obstetrics and Gynecology. 

 

Food Friday: More on Edible Gifts

in , , , , ,

There are 23 days until Christmas ! There is still time to assemble some economical, healthful and delicious food gifts ! 

Traditionally, holiday food gifts are sweets and baked goods, and this is great for special occasions. If however, you’d like to focus on more healthful choices, here are some suggestions. Think savory, and think beyond food, per se. 

 

Recipes for all these are easily found on the internet and especially on Pinterest. Please feel free to follow me and check out my boards on Paleo Nutrition and Gifts. 

https://www.pinterest.com/drginanelson/

When you prepare a holiday food gift, make the containers part of the gift. Baskets, jars and decorative boxes are widely available at craft, sewing, or even hardware stores. 

To make your gift really nice, include an artful hand lettered card or tag about how to use the gift. Perhaps include it's recipe if it is prepared. To make the gift really deluxe, include a book. For example, A spice oriented gift could be a selection of jarred and labelled spices in a nice basket, complete with a book on spice mixes. 

Be sure to make a list of all the people you wish to acknowledge, thank, or regale with gifts. Start now if you haven’t already. Have a plan and keep it simple. Doing so will reduce stress during the busy holiday. More importantly, it will give you more joy during the process. 

Wellness Wednesday: Making and Giving

in , , , , , , , ,

There is a good book called “ The Five Love Languages” which I recommend. My husband and I read it together long ago. It turns out that our love languages are very different and this understanding helped us. One of my primary love languages is gift giving. As such, it is hard for me to understand people who say they cannot figure out what to give. My problem is editing my gift giving plans. 

This post is approximately 25 days until Christmas. That, in my mind, is enough time to come up with several clever, inexpensive gifts… Homemade gifts… before Christmas. I am taking a stand here and recommending that you consider home made gifts this year. You could save money, and really touch the heart of the recipient all at the same time. 

You may assert, and I have heard people say, that they have no artistic talent. This just hurts me to hear, as I believe it to be uniformly false, and one of the worst forms of self talk. I think with the resources that we have these days, Pinterest, magazines, and the internet at large, there are instructions for everything. Pro tip: Search " best DIY gifts". The key is to keep it simple and heartfelt. The other key is to stretch just a little each time, and you will learn more and more. Pretty soon you will be making stained glass windows. 

Here are some other keys to making and giving: 

  • Be kinds to yourself and keep your sense of humor. 
  • Prepare your time, your workspace, and your supplies before beginning. 
  • Establish a budget and stick to it. 
  • Read through all the instructions first !
  • Be prepared to goof up and fix things. 
  • Enjoy the process. 
  • Consider the pros and cons of doing it yourself, versus together with a supportive friend. 

 

Here are a few ideas for categories of home made or home assembled gifts. You know your own skill set and will be prepared to build on it. You also know your recipient. Trust yourself and move forward.

 

Made Things: 

 

Wearable Gifts:

  • e.g. infinity scarf of some special fabric
  • colorful rice filled heat packs with essential oil 
  • felted wool hats and mittens from shrunken thrift store sweaters

Edible Gifts: 

  • e.g. flavored salts and sugars 
  • holiday foods in nice containers, including baked goods in festive ceramics, or treats in exotic jars
  • jerky, jam, dried herbs

Assembled Things:

Themed gift baskets and “kits"

  • movie night basket with gift cards and popcorn
  • bath basket - with oil or fizzy bombs
  • garden baskets- with new gloves and seeds
  • art basket - with supplies 
  • cooking themes; Try going by country, i.e. Italian, French, Mexican, Cajun, Japanese, etc. 
  • knitting or crochet kit
  • crafting kit 
  • fishing kit
  • hunting kit
  • sports related kits 
  • workout kit 

 

Don’t worry if your gift is not perfect. Just take care that it reflects the connection between you and the recipient. 

Making and giving is a soul growing exercise. Give it a go this year. 

Medical Monday: Breaking News from the World of Obstetrics andGynecology

in , , , , , , ,
Upset pregnant woman crying.jpg

Regular readers of this column know that for many months we have started with news pertaining to the Zika virus epidemic. This is of special interest to those in the field of Obstetrics and Gynecology, since it is both perinatally and sexually transmitted. This means that once a person acquires Zika virus from a mosquito, she may pass it to her unborn child, and anyone may pass it to a sexual partner. Zika has been widespread in South and Central America and has come as far north as the southern part of the United States. During the warm spring and  summer months, officials were frantic to control it, employing measures of all kinds, but without anything truly effective. Many thousands were infected, and many of those were pregnant. This column has not only served to educate readers about Zika; it has also documented in realtime the painstaking progress of work that has been done, bit by bit, to understand and control the disease. 

As a physician of 27 years, I have read about many disease processes. I have never, however, witnessed the observation, diagnosis and gradual clarification of a new disease quite like this. I was in college when HIV/AIDs came to the fore (1979-1983), but by the time my third year of medical school (1987) had come along, we had wards of patients with HIV/AIDS related complications like Kaposi’s sarcoma, pneumocystis  pneumonia, and disseminated herpes. We understood only a bit at that point, and we felt rather helpless. I am by no means a caregiver on the front lines of the Zika Virus battle. However, I can imagine how they must feel, based on my limited experience with HIV. 

Zika is different in that in can affect the next generation. HIV can also be passed perinatally and also by sex. However, when it affects a baby, it leaves that baby neurologically and developmentally alone. Not so with Zika. For some reason, Zika targets the baby’s brain and sets some process into motion which disturbs and potentially stops the brain's growth, while the rest of the baby continues to grow. As with other perinatal viral infections, contracting Zika early in pregnancy makes matters worse, and interferes with development at an earlier stage. This makes sense. However, the latest revelations about Zika are even more troubling. A new study by the CDC (Centers for Disease Control) indicates that a Zika affected mother may produce a term baby who appears entirely normal at birth. However, that baby may well go on to develop microcephaly, the hallmark of the Zika's affect on the central nervous system. This seems to indicate that we do not know how long the effects of Zika virus infection can last. It raises questions about newborns, toddlers, or growing children getting their own Zika infections. This has far reaching implications for how all families in Zika affected areas live their lives. It clearly has implications for the medical community and society at large. 

Meanwhile, the WHO (World Health Organization) has declared that Zika is no longer a public health emergency. Well, of course it is. However this designation simply means that the crisis should no longer tap emergency funds, but rather should have it’s own proper ongoing budget. Nonetheless, some authorities feel this is premature, and have urged the WHO to reevaluate the decision come warmer weather. The CDC, by contrast, will retain Zika at the highest emergency level. Brazil, the epicenter of the outbreak, will continue to consider it an emergency. The hope is that these deliberations and administrative designations will not get in the way of efforts at infection control, basic research and of course, the much hoped for VACCINE. 

In other news, a new study has emphasized the importance of thyroid function in pregnancy. The immune system changes in pregnancy and so does thyroid function. Not uncommonly pregnancy is the time when low thyroid is diagnosed. This new study has highlighted the very important fact that optimizing thyroid function in pregnancy improves birth outcomes in measurable ways. We know that seriously low thyroid functioning pregnancy is associated with mental deficits in children, a condition called Cretinism. However, optimizing thyroid replacement also prevents still birth, and low birth weight infants. 

 A majority of the news otherwise on this short week had to do with the new administration’s plans to dismantle or alter the ACA (affordable Care Act). As time goes by, we hear different things about this. I get the feeling that reality will set in and that pragmatism will have it’s way with lawmakers and their promises. Perhaps the new administration will be satisfied if they can shuffle and rename a few things, then take credit for the good ideas. 

Wellness Wednesday: DNA testing

in , , , , , , , ,

Your DNA is the code to your programming. It is literally your genetic code. It determines your physical makeup, from appearance, to reproductive potential, to disease states. It may also determine certain hardwired aspects of temperament and cognition. Wouldn’t such information be useful for maintaining health and curing disease ? The answer is of course yes. However, the science of the use of DNA for medical purposes is still in its adolescence if not its childhood. 

DNA (deoxyribonucleic acid) is made like a set of modular children’s toys, K’nex for example. The subunit is a pair of tiny molecules called bases which bind to one another to make a base pair. These are held in a long structure like rungs on a ladder, and this ladder itself bunches and curls depending on the particular molecular sequence of base pairs. A certain series of base pairs codes is a gene for the manufacture of a certain animo acid, and strings of amnio acids are the proteins of which we are made. One famous gene mutation is BRCA, which allows breast and ovary cancers to form much more easily. Another is the gene for ALS ( Amyotrophic Lateral Sclerosis) or Lou Gehrig’s disease, which afflicts Stephen Hawking. 

DNA contains the keys not just to disease, but to health as well. Understanding DNA can help us understand any inborn vulnerabilities to disease in time to take action against them. Understanding which genes go with which diseases may help us come to understand how diseases are caused, and thus, how to cure or mitigate them. The vast majority of human genetic material, also called the human genome, is not understood. However we all have DNA, and we all have a health history, even if all that it says is that we are healthy.  Just think: If we had lots of people record their health history, and the same large number of people sequence their genome, we could use modern computing power to look for patterns between the clinical histories and the DNA. 

DNA tests are now sold direct to consumer (DTC). People are using them to search for their ethnic heritage. This is an imperfect science, and it can only narrow it down to a continent level. Some people use DNA tests to find long lost relatives, but results depend on your long lost relatives having been tested as well. 

I have been thinking about giving my family members the gift of DNA testing. My initial thought was simply to throw our data into the big pool, and add to the collective accumulating accuracy of DNA and disease correlation. It was also my hope that in the process, it would be useful in the future, when hopefully, health enhancing measures could be taken based on a person’s specific DNA profile. 

There is another kind of DNA testing which I should mention for completeness. It is testing for specific genes, and not just testing to view the whole genetic code. Physicians and researchers test for specific genes when a person’s family history is strong for a certain disease process, say colon cancer. If the unaffected relative tests positive for the risky gene, preventive measures may be able to be implement to help them avoid the disease. Genetic tests can also be done on tumor cells themselves to determine what treatment is the absolute most targeted for the specific tumor cell type. This is becoming the norm when treating breast cancer. This helps both improvement in outcomes and decreases side effects of treatments not likely to be helpful. 

In doing the research for this post, I have discovered some good advice. First, it is important to think about why you want this information. Do you really want to know about long lost relatives ? Do you really want to know your ethnicity ? What if it is not as you expected ? What if you discover a gene for a bad disease that you do not already have ? 

There are several companies that do DTC DNA testing. I found a good chart which details some of the differences. 

 

http://isogg.org/wiki/Autosomal_DNA_testing_comparison_chart

 

Some systems of testing, analyzing and reporting are better for genealogy, and some are better for medical care, and still others are best for research. Some tests go deeper, and research paternal or maternal family lines, but this requires analysis of the X and Y sex chromosomes, rather that just the autosomal chromosomes. 

All of the tests are expensive, ranging from $79 to over three hundred. My research has raised more questions that it has answers. I plan to speak to our genetics counselors at our hospital to see what they think and I will get back to you about what they say. 

Meanwhile, it is Thanksgiving week. It is a good time to think about being grateful for what you are and what you have in the present. You may be coded by genes, but that is not the whole story. Our genes are not a static set of molecules. Instead, they switch on and off like the holiday lights that people are putting up this season. Additionally, a lot of this gene regulation depends on lifestyle choices. This is where we can leverage our health habits to make the most of the genetic cards we have been dealt. 

Happy Thanksgiving 

 

More reading: 

http://www.legalgenealogist.com/2015/02/02/2015-most-bang-for-the-dna-buck/

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

in , , , , , , , , , ,

The World Health Organization will have convened on Friday to evaluate whether Zika is still to be classified as a “ public health emergency of international concern.” I am not sure of the criteria for such a classification, but it does not seem to me that we have yet seen most of the consequences of Zika in those yet to be born. Furthermore, it is not clear how Zika will fare though the turn of the seasons. 

The effects of Zika are generally serious to devastating. It is fascinating and confounding that these effects vary by geography. This means Zika has different effects depending on where the infection is contracted. The American Society for Tropical Medicine recently convened and examined this question which needs much more formal study. 

Women are more likely to get Zika from men than men are to get it from women. This is because the virus is now believed to suppress the vaginal immune response (Vaginal immune response ! Who knew ? ) and thus go undetected so it can establish infection in both mother and baby. 

Blood banks in affected states have been screening for Zika. Only 40 out of 800,000 positives have been found. This is not meant to represent an assessment of Zika prevalence in these states since the people who come to donate are screened and kept from donating if they have risk factors for the infection. 

In other news, there is another option for women with vaginal atrophy. Many older women and those who have had cancer have vaginal atrophy, which manifests as dry, thin, inelastic tissue. It also manifests as pain during intercourse. Fourteen percent of all women have low equal desire and sex related personal distress. Part of this in older women may related to vaginal atrophy. Unfortunately, this is not always addressed at the doctor’s office. Many such patients are not able or wiling to use vaginal estrogen. They may now use DHEA, dehydroepiandrosterone, an adrenal androgen, as a daily vaginal capsule, to help with this. The trade name will be Prasterone and it has recently been approved by the FDA ( Food and Drug Administration) for this use. 

The idea of using vaginal estrogen in breast cancer survivors has, until recently, not been considered due to concerns that the hormone enters the systemic circulation and might cause increased risk of recurrence. However a recent study published in JAMA Oncology has shown that estradiol secreting vaginal rings and intravaginal testosterone cream are both safe and effective therapies in those breast cancer patients who are receiving aromatase inhibitor (AI) therapy. 

In insurance news, President elect Trump has indicated that he favors preserving the prohibition against insurers denying coverage due to preexisting conditions. He also favors allowing parents to keep children on policies until the age of 26. An article in the Wall Street Journal recently opined that keeping these provisions without keeping the universal mandate (requirement for everyone to have insurance or be fined) and the funds it would bring in, would strain the coffers of health insurance companies bound to keep the first two provisions. 

At this point, hearsay reigns in matters of the new administration’s policies. Before the election, Republican politicians spoke of eliminating the individual mandate on health insurance. Now, there is talk of revamping it. Similarly, and more realistically, it is said that Medicaid under the new administration is more like to be altered than it is to be shrunk, as Republican candidates suggested. 

This column has covered the falling teen birth rate. Recent analysis of this data has shown that this is the case much more in urban compared to rural areas. Between 2007 and 2015, the teen birth rate fell 50% in cities, but only 37% in rural areas. Teen birth rates fell most among white and hispanic girls. 

In related news, a recent study in the American Journal of Public Health showed some interesting relationships between childbearing and longevity. Over 20,000 women were followed for over 16 years. Researchers discovered that a larger number of children is associated with less longevity in black women, but more longevity in white women. They also found that women who delay their first birth until at least 25 are more likely that their counterparts to live until age 90. 

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