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

Policy News 

People across the political spectrum continue to debate the merits of Brett Kavanaugh for the Supreme Court. Since we now know that the political and judicial systems play such a large role in the health care of women, we’d all best pay close attention to this debate. 

Drug Shortages. We did not used to have them. Now it is common place on routine drugs, even IV fluids. No slight to third world countries, but sometimes it feels like we are in a third world country. The FDA is forming a new task for to more critically and quickly investigate and solve this problem. 

Companies that make formula are multinational. The Trump administration is avowedly pro business and this is particularly evident in the international sphere where of late, this had unsavory consequences. In its zeal to unfetter corporate interests, The Trump administration has taken an anti breastfeeding stance. At present advertisements of formula is limited regionally in areas where it could be misused or hazardous. The Trump administration has desired to “ reopen” these markets, under the auspices of free trade, seemingly oblivious to the perils of selling formula  in places where literacy (ability to mix correctly) and clean water is unavailable . The entire medical and public health establishment has reacted, concerned that breastfeeding continue to be encouraged as the safe and superior method that it is. Many are pointing out that formula manufacturers have no place at the health policy table. This baby feeding battle resurfaced last year when Ecuador proposed a resolution to the WHO (World health organization)  to support breastfeeding. The Trump administration through the US delegation at the World Health Assembly, tried to water down the resolution. When this did not work they threatened Ecuador with a trade war. Can you say “evil empire” ? ACOG (American College of Obstetricians and Gynecologists) and AAP (American Academy of Pediatricians) have responded formally. 

Did you know as little as two months of breastfeeding reduces risk of SIDS ? 

Did you know breastfeeding reduces mom’s risk of breast and ovary cancer, heat disease, and endometriosis ? 

Did you know the US ranks 26th among industrialized countries in breastfeeding ? 

The Trump administration seems to want people off the ACA. They have reduced the “navigators” fund from 36 to 10 million per year. Navigators are those who help people enroll in the ACA. The Trump administration says private health insurance agent and brokers do a better job. Do private brokers and agents get a fee for this ? 

Medical News 

Abortion facts were highlighted by NBC this last week: 

Death by childbirth is 14 times greater than death by abortion. 

Banning abortion does not reduce its incidence. 

Free birth control reduces abortion rates. 

Before legal abortion, 5000 women per died through complications of illegal abortion. 

Depression is not the only feature of postpartum depression. A new review has highlighted the fact that anger is often a big component of post partum depression. 

Your microbiome is the population of microorganisms that you have on your body and in your gut. This is affected greatly by what you eat. In pregnant women this microbiome is passed to the baby. Thus, what pregnant women eat can influence the microbiome of their child, for better or for worse. Newer research in multiple fields are beginning to describe the role of a healthy microbiome to overall health. 

The US birth rate is at an all time low for the second year running. Some site child care expense, wanting to spend time with existing children and concerns about the economy as chief reasons to wait. Germany and Japan have addressed their falling birth rates by putting better child care policies in place. Falling birth rates are not necessarily a bad thing, as they are associated with greater savings and higher levels of educational attainment. It is certainly an oversimplified falsehood to think that a larger population means a better economy. 

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

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

It is no secret by now that the Trump administration is systematically enacting policies to ban abortion and limit access to contraception. Medical experts have indicated their concern all along, saying these policies are likely to backfire, increasing unplanned pregnancies and abortions overall. 

Legal challenges to Trump administration policies are now coming from many quarters. Mississippi and Louisiana have pending legislation to ban abortion after 15 weeks. Both laws will now go to Federal court to be tested. Meanwhile, New Jersey is suing the Federal government against the exemption which permits corporations to purchase insurance without contraception coverage if they object to it on “moral” grounds. Since when can a corporation have morality ? People, owners, and board members can have morality or the lack of it.

The Federal Courts are going to have a big role in determining how much of this Trump era law stands. For example, a federal judge in Washington struck down the decision by the HHS (Department of Health and Human Services) to withhold funds for the teen pregnancy prevention program. The judge called the cancellation of funds “capricious”.  HHS actions have been struck down by federal courts four times to date. 

A survey of various health care groups has shown the 95% have strongly criticized the Trump administrations efforts to weaken the ACA (Affordable Care Act). The American College of Physicians has published a paper calling for recognition and addressing of the discrimination against women in health care. Health care disparities include those pertaining to reproduction, family and medical leave, domestic and sexual abuse and inclusion in clinical trials. 

Elsewhere in the world, Ireland has voted to repeal the countries ban on abortion. The popular vote passed by a margin of 2 to 1. To put things in perspective in this historically Catholic country, divorce was only legalized in 1995. Gay marriage has also been ratified in Ireland, and an openly gay man has served as Prime Minister. 

Medical News

We all know that genes influence our physical health. But they also influence our mental health. They are a number of genes which are associated with the development of Schizophrenia. However, even if they are present, the odds of actually developing schizophrenia are low. New research has indicated that pregnancy complications such as gestational diabetes and preeclampsia increase the risk of schizophrenia in susceptible individuals, as can smoking. This is all thought to take place via epigenetics and the placenta. More research is needed. 

A new study indicates what we have often observed; that those women who introduce a bottle in the hospital are much more likely to give up breastfeeding. Breastfeeding is recommended as the sole food source for babies for six months. 

The Nurses Health Study has produced data about nutrition and healing loss. Turns out those who had a diet most closely resembling a Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diet were 30% less likely to experience moderate or severe hearing loss later in life. 

You will hear all kinds of unscientific reasons from patients about why they will not get a certain vaccine. We all know vaccines stimulate the immune systems and we all know they can make you feel a bit flu like in the process- no fun. New research has now proven that HPV ( human papilloma virus) vaccine does not cause increased autoimmune activity in girls. This confirms two prior large cohort studies. Despite all this, there is still a lot of push back against vaccines. It is hard for a caregiver to persist when a patient or a parent declines a needed vaccine. However new research indicates that physician persistent leads to 94% of children being vaccinated against HPV. 

Many times I hear talk to the affect that obesity alone is not a problem. There must be other factors such as diabetes or hypertension for obesity to be a threat to health. FALSE.. Newer date now tells us that having obesity ALONE makes you 39% more likely to have heart disease. 

We have been finding a lot of vitamin deficiency up here in the North Country. This has been true in pregnancy. We have undertaken supplementation regimens with the input of Endocrinology and are tailoring better maintenance regimens for both diet and supplements. New research has now show some good news : that those who take vitamin D in pregnancy are 28 % less likely to have low birth weight babies or stillbirth. 

In other vitamin D related news, new research also indicated that women with sufficient levels of vitamin D are 10% more like to get pregnant after a miscarriage, and 15% more likely to have a live birth after a miscarriage. 

Folic acid is also important in pregnancy and is known to prevent birth defects such as spina bifida. New research indicates that poorer women rarely takeout before it during pregnancy. This is something that should have a really easy fix. 

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

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

Happy new year ! Hopefully this year we will benefit from the upheaval of 2017. Many of us became more political. The issues about which we care came into distinct focus. Perhaps we clarified our priorities. Hopefully health and quality time are high on your list. 

In that spirit, I am going to try to streamline what I hope has already been a streamlined blogging format, and go to what could perhaps be called “ bullet blogging”. Perhaps you have heard of “ bullet Journalling”  or “dot journalling”? I had been doing it for some time without realizing it. Instead of journaling in full sentences and paragraphs, I journal in bullet lists, small graphics and graphs. It is fun, fast, and lets me indulge my visual nature. 

If you have been into any Michaels, Joannes or any other craft store lately, you may have seen prominent displays showing fancy little bound or three ring journals, sticker sets, small format markers, washi tape, and specialized fill pages - all for such enhanced journaling. There are also many cool online resources for bullet journalling. 

I am an incredibly digital oriented person, and so it may seem a surprise that I would be interested in such analog things. I believe that for every person’s life or work management system, there is a particular optimal balance between digital and analog. Everyone one needs a little paper. In my office, I have suggested that my employees keep “ one notebook to rule them all”. Instead of a proliferation of sticky notes and other scraps to get mangled or lost, the one notebook, complete with dates and legible writing, held everything. I gave them some beautiful starter notebooks, and they took it from there. They seem to enjoy it. One co-worker in particular has made hers into what I would call an art form. That is the idea ! It is to take some joy and satisfaction in even the smallest things, like note taking and scratch calculations at work.

And so it has occurred to me to try “ bullet blogging”. It is my hope it will be faster, simpler and easier on the eyes. I’m going to give it a go. 

Policy News 

Via CMS( Center for Medicaid Services) : 

• 8.7 million signed up for Obamacare, federal health insurance made possible by the Affordable Care Act, likely underestimated 
• 95% of last years level, despite half the signup period and deep cuts to advertising
• Final figures due out in March

CAN YOU BELIEVE THIS ? 

Employees of the CDC ( Centers for Disease Control) and other federally funded health and science organizations were “discouraged" from using seven words in budget reports: 

• Vulnerable

• Entitlement

• Diversity

• Transgender

• Fetus

• Evidence-based

• Science-based

#RESIST 

Two separate letters have been issued from > 300 public health organizations urging the HHS ( Health and Human services) to ignore this. The second letter included signatures from

ACOG ( American College of Obstetricians and Gynecologists)

AAP (American Association of Pediatrics) 

APHA ( American Public Health Association) 

Blocking the blockers 

• Last week  Federal Judge in Northern CA blocked the Trump administration’s loophole which let’s objecting employers out of providing insurance with contraception to employees. 
• The Justice Department is “ evaluating” LOL. 
• Comment: No one ever has, because of Obamacare, made anyone else use contraception. 
• Fact: Contraception reduces teen pregnancy and abortion. ALOT. 

Kick the can

GOP has kicked the real budget and real health care bill into January. Stay tuned. 

Medical News

ACOG President-Elect Lisa Hollier, MD MPH, Houston, Texas, brings a new clear focus: the rising maternal mortality in America. 

• Missouri ranks high is maternal mortality, in the worst ten. 
• Oregon is creating a special commission on rising maternal mortality.
• One in four pregnancies in central Oregon are drug affected. 
• Mississippi has the highest rate of preterm birth, which is high cost in both human and financial terms. The CEO of Magnolia Health in Mississippi is taking aim at this problem. 
• Infant mortality in Kansas is about three times higher for black babies than it is for all babies. 
• Dr. Hollier's own state of Texas takes the cake, with the highest maternal mortality this side of the third world. 

STUDIES: 

Study: Breast pain is not a symptoms of breast cancer. Neither lack of pain nor lack or palpable lumps means lack of breast cancer. Upshot: Get your mammograms ! 

Study: Cervical Pessary may be of use in preventing preterm birth. 

Study: at home STI ( sexually transmitted infection) test kits may increase detection rates. 

Study: Post menopausal Estrogen therapy may protect against some forms of memory loss. 

Study: Income and weight are inversely related for women. This is not true for men. Contemplate. 

FDA (The Food and Drug Administration) plans to increase regulation of homeopathic remedies. Because there are no real studies on these. Contemplate. 

Marijuana update 

• Mj use in pregnancy has increased in CA from 4 to 7%. In pregnant teens it has increased from 10 to 19%. 
• ACOG recommends discontinuation of MJ for those who are or who are contemplating pregnancy. For reasons, see HERE: Marijuana Use During Pregnancy and Lactation 
• It's clear that we as a nation do not value science. Do we value drug induced relaxation over clear thinking or the cognitive development of our children ? Very little contemplation needed. 

Male Contraceptives ? 

NIH ( National Institute of Health) and the Population Council are sponsoring a clinical trial of a hormonal male contraceptive gel. Don’t expect it on the shelves for at least 5 years. I wonder how the GOP will attempt to regulate male methods of contraception. 

It’s best if you follow up on these leads to put together your view of women’s health care in this country. What I have given you should contain enough key words so you can google your way to the source material. Remember to seek out reputable sources like the NIH, the CDC, ACOG, AAP, APHA, or major academic medical centers like Mayo Clinic or Stanford.

2018 is a new year, and a new approach is needed to ensure the best for women’s health care. Get involved. 

Medical Monday Delayed due to First Frost

Gentle readers. We never know exactly when the first frost will hit until it is right upon us. Today we heard it will be Monday night for sure, complete with a Winter storm warning, snow flurries on the Valley floor and larger buildups in the mountains.

Since I will be in clinic in the morning and operating in the afternoon, I had to bring in the frost sensitive vegetables today.  All the tomatoes had to come in, red, green, large and small. All the peppers and zucchinis did too. This all took longer than expected. Then, with this embarrassment of beautiful produce, I had to cook up quite a bit of it, and store the rest. We had stuffed and roasted zucchini with pesto toast, kale salad with tomatoes, peaches, and balsamic vinegar, and crustless peach pie. Everything is safe in the barn, and tomorrow I will be able to write. 

Thanks for your patience. 

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

Actual patient care through the weekend prevented a timely publication of Medical Monday. Thanks for your patience ! 

The health care sector’s initial responses to the Trump administration’s approach to health care policy ranged from shock to anger. Now people and corporations are starting to take action, especially in the face of the administration’s disarray and impotence. 

The Trump administration through the Department of Health and Human Services slashed $200 million from the Teen Pregnancy and Prevention Program. (Can anybody tell me the process that made this possible, or does the President just decide like a dictator ? ) The spokesperson of the National Campaign to Prevent Teen and Unplanned Pregnancy has spoken out and disputed the administration’s position which stated that there is “ very weak evidence of positive impact of these programs. “  Experts everywhere are dismayed since the programs are believed to have produced a 41% drop in the teen pregnancy rate since 2010. The CDC (Centers for Disease Control) and ACOG ( American College of Obstetricians and Gynecologists) both credit the declining teen birth rate to these programs. 

The Trump administration is bit by bit, trying to dismantle the ACA’s protections on reproductive health care. Most recently, the contraceptive mandate for employer sponsored programs is on the chopping block. ACOG has stated that the contraceptive mandate has driven the unintended pregnancy rate to a 30 year low, and eliminating this feature would be a threat to public health. 

The Trump administration has indicated its support for abstinence only sex education, which has no evidence to support its efficacy. However, the CDC has produced two meta-analyses which indicate that comprehensive sex education results in reduced overall levels of sexual activity and increased levels of protection among those that are sexually active. 

Indiana law classified the use of aborted fetal tissue as a felony. A group of Indiana researchers has challenged this legislation with a federal lawsuit. The group bringing the suit is from the National Institute of Health funded Alzheimers Disease Center where they do study brain tissue from aborted fetuses. 

A recent article in the Dallas Morning News has highlighted the new voice of corporate American in social policy. Corporate America needs a diverse and inclusive workforce, and it understand that inclusiveness is good for business. Accordingly, it has begun to stand up for diversity. From various quarters, highly placed business leaders have spoken out and defied the current administration’s divisive policies. Recent examples of these divisive policies and positions include the President’s reaction to the Charlottesville violence, as well as recent controversy regarding LGBT rights, i.e. the so-called bathroom bill. 

The writer of the Dallas Morning News editorial, Dr. Daniel Grossman of the Department of Obstetrics and Gynecology University of California, San Francisco, has called upon the business community to begin speaking out on women’s reproductive rights as well. He cites the fact that fully 70% of Americans support women’s access to full reproductive services including abortion, and this is also the position of the American College of Obstetrics and Gynecology and the American Medical Association. A broad based field of research has shown time and again that access to comprehensive and affordable reproductive health care for women leads to better health, higher levels of educational attainment, and improved economic stability for women, families and society at large. To learn more see https://www.ansirh.org, Advancing New Standards in Reproductive Heath, a division of the UCSF Bixby Center for Global Reproductive Health, http://bixbycenter.ucsf.edu. 

As mentioned in several past posts, States are starting to take matters into their own hands. They are, on their own State legislative calendars, enacting various bills that safeguard the requirements for insurance to cover various benefits such as birth control or prenatal care. The latest is Arkansas, which has passed a law which will require insurers in the State to cover indicated mammograms. 

In the good news department, we have word that there are bipartisan meetings planned in the first part of September, which will include Governors as well as State Insurance Commissioners. The goal of the meetings will be to stabilize existing insurance markets under the ACA. Things may actually start to get real. 

In medical news, the truth is starting to come out, as truth eventually does. New data published in a recent study shows that yearly mammograms starting at 40 (rather than every other year at 50) would prevent the most deaths due to breast cancer. According to this study out of Cornell and New York Presbyterian, for those aged 40-80, screening at 40 reduces breast cancer deaths by 40 % beyond current protocols. Those who read this column regularly already know that a whole segment of the health care world including ACOG, the American Cancer Society and the American College of Breast Surgeons among others, have always taken this view. They have taken serious issue with the short sighted recommendations of the US Preventive Services Task Force (USPTF) which has taken the position that mammograms in the 40s confer no benefit. 

All parties concerned recognize that this earlier and more frequent approach mammograms produces a higher number of false positives. However, actual clinicians ( doctors, nurses and nurse practitioners who see patients) do not take the position of the USPSTF(statisticians and epidemiologists largely)  that fear of mammograms, pain of mammograms, breast biopsies with benign results constituting a false positive, or even infected or bruised breast biopsies compare with a breast cancer death as a harm. In fact no number of these types of “harms” could ever add up to even one breast cancer death. 

The next item is in both the good news department and the we-already-knew-this department. A recent analysis published in the journal Menopause has indicated that vaginal estrogen does NOT confer increased cardiovascular risk. Vaginal estrogen does not appreciably enter systemic circulation. It stays local to the vagina, and does its job to relieve postmenopausal vaginal dryness. Vaginal estrogen was found to NOT increase risk for breast cancer or for any of these: colon cancer, uterus cancer, stroke, clots in the lung (pulmonary embolus) or deep vein thrombosis. Sheepish gynecologists should prescribe with confidence. 

A concerning new report published in the journal Pediatrics has brought to light that less than half of new moms are consistently putting their babies on their backs to sleep. Not doing so raises the risk of SIDS (sudden infant death syndrome). Three quarters state they “ usually" do so. Current guidelines clearly state that babies should be in their parents room, in their own bed, and on their back to sleep for the first six months of their life. 

Breast and ovarian cancer patients are not getting genetic testing at adequate rates. Genetic testing for these patients informs the care of their children. Moreover, it can also provide insight into their own treatment. Finally, it may ultimately provide information that could help us screen for and treat cancer in new and better ways. I look forward to the day when disease is understood and treated at a genetic level. To get there, we must as a society, contribute our personal genetic information in a meaningful way. 

That’s it for this week; Stay tuned next week for more news from the exciting world of Obstetrics and Gynecology. 

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

As of Friday, intentions were to hold a vote on the ACA bill in the Senate this next week. This, despite the fact that Senator John McCain (R-AZ) has been diagnosed with brain cancer and will not be back next week for the vote. He would have been a supporter of the bill.

It is clear that there are at least four GOP Senators who have already gone on record saying they will oppose it. Only two opposed are required to kill it. 

For a detailed review of the bill and the consensus on its ramifications, see last week’s blog post which was pretty comprehensive. Really nothing has changed since then. 

Two prominent antiabortion activists who are now on staff with the Trump administration have informed 81 (EIGHTY-ONE !) teen pregnancy centers that their Federal Funding will end in 2018. How can these decisions be made without any due process whatsoever ? 

On to medical news.

 There is not one but two Zika vaccines under development. Zika is the dreaded virus carried by mosquitos in temperate climates which causes central nervous system and eye defects in the unborn. On of the vaccines is in human safety trials, and another is in safety trials for pregnant animals. Vaccine trials may be hampered by reduced funding to the CDC ( Centers for Disease Control) through the Trump administration. 

Another approach to Zika is to introduce genetically modified strains of mosquitoes that die in one to two days. However, some on Texas object to this strategy citing possible unintended consequences. 

Two to three years from now, in 2020, it is predicted that there will be a shortage of nearly 10,000 Obstetricians Gynecologists. This applies not just to rural areas, but to big cities as well. The training is hard, the hours long. The work is risky, from both a medical and a legal point of view.  Costs are high if one is not employed by a large organization. Private practice Ob/Gyn is nearly extinct. Sure it can be rewarding and fascinating. It often is. Lately, though, the lack of regard for women’s health pose new concerns. 

Many rural hospitals are removing maternity services. This should come as no surprise since maternity care is acute care and is potentially intensive or surgical on a reasonably regular basis. Staffing and facility needs for such care is high, and the availability of those who can render it is getting lower all the time. According to recent study, over half of rural counties in the US lack hospital based Obstetrics. In all fairness, this is a big country, unlike Europe for example, and people here sometimes choose to live way out in the boonies. It goes a long way to explaining why the US has the highest maternal mortality rate in the developed world. That, together with the obesity epidemic, its complications of diabetes, hypertension and preeclampsia, and the defunding of women’s health care resources explain it well enough. 

How bad is the obesity epidemic ? Perhaps you have no objections to a full figure. Ok, but do you object to life shortening disease ? Of course. The CDC now reports that over 100 million US citizens have diabetes or pre diabetes. Most with pre diabetes do not even realize they have it. If you are overweight, ask your caregiver to screen you with fasting blood sugar, 2 hour blood sugar after eating, and also screen your cholesterol and triglycerides ! Knowledge is power. 

Fake sweeteners are not helpful. A new meta analysis of 7 studies has shown that people consuming these do not lose weigh compared to those who do not consume them. Moreover, these studies also show that those consuming artificial sweeteners are at increased risk for obesity, diabetes, and cardiovascular issues over time compared to non-users. This probably has more to do with the misbegotten habits of the users rather than something intrinsic to the artificial sweeteners, but we simply do not know. 

We always need some news in the-we-already-knew-this department. This week, we again learned that healthy diet and exercise in pregnancy are associated with lower rates of gestational diabetes and C section. 

Finally, in very interesting and early work, thyroid hormone and metformin (a common diabetic medication) seem to be able to reduce memory and learning problems in rats exposed to alcohol during pregnancy. This groundbreaking work was published in Molecular Cytology and will hopefully spur more research on the subject. 

Stay tuned for more exciting news next week, on Medical Monday. 

Medical Monday Delayed

Dear readers, 

Welcome back to the week. The weekend was grand. We had company from out of state and celebrated our granddaughter's second birthday. It was far too busy for me to include a timely blog post, and still eat and sleep. As you know eating and sleeping are big priorities.... We will catch up very soon. There is no shortage of news. 

Medical Monday: Postponed a Little for Passover

Hello Readers ! 

I am dropping you a quick line to let you know that medical and policy news proceeds apace, and that I will report on it shortly. However, this weekend I was much engaged in preparations for Passover and Easter. Yes that's right, both. Our family is blessedly mixed and we celebrate the fusion of spring and new life. Tonight we will attend Seder and Sunday we will have an egg hunt in the possibly snowy forest. Stay tuned for pictures and for Medical Monday News. 

Happy Spring. 

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

We start this Monday with the piece of grossly under reported news. few seem to be aware of the fact that prenatal cannabis use is linked with cognitive impairment academic under achievement in children. Both the American Academy Pediatrics and the American College of Obstetricians and Gynecologists advise against its use because best. Many patients assume that because it is legal it is safe. Marijuana’s main psychoactive ingredient THC or tetrahydrocannabinol crosses the placenta to reach the fetus. It not only affects brain development and cognition but also birth weight as well. Have you seen anything about this lately? 

Planned home birth is again in the news. A new study shows that planned home birth  is associated with increased risk of complications, especially in women who are having their first baby or in those 41 weeks or more. This particular study looks at the rate of neonatal death, the most severe complication.  Researchers found that those who delivered with midwives at home had a neonatal death rate of 24.4 per 10,000 birth compared to 5.09 per 10,000 births delivering with a midwife in the hospital. 

300,000 babies are born in United States every month. Typically 273,000 women take time off of work to care for newborn whereas 22,000 men do the same. A recent study in the American Journal of Public Health as shown that maternity and paternity leave rates in the United States have been constant over the last 20 years. This may be related to the fact that only 12% of workers in the private sector have access to pay family leave. This lags far behind other developed nations of similar socioeconomic status.

Recent work from the Pew Research Center revealed the new president's views on vaccines are not shared with the majority of Americans who overwhelmingly support requiring children to be vaccinated before attending school. 82% of Americans support children receiving the MMR vaccine before attending school. 

Representatives from numerous physicians organizations have descended upon the halls of the Senate offices to lobby their respective representatives about the need to retain certain characteristics of the Affordable Care Act (ACA). These organizations include the American Academy of Pediatrics, the American Academy of Family Physicians, The American College of Obstetricians and Gynecologists, and the American College of Physicians, and the American Osteopathic Association. They have placed particular focus on the provisions for the care of women and children as these provide the foundation for lifelong medical care and wellness. They have placed particular emphasis on the need to have a replacement in place before the current plan is repealed. The same groups, representing over half a million United States physicians, sent a letter to the White House and Congressional leaders leaders asking them to ensure that women's health, including preventive prenatal and neonatal care, be protected. 

A subcommittee within the House is beginning to work on replacing the ACA. They are looking at the issue of preexisting conditions, and at age ratings which determine the charges paid for insurance by age. They're also considering a shorter grace period for those who fail to pay premiums on time. The process is contentious between Democrats and Republicans,  but it is also reportedly contentious between different Republican legislators as well. Republican lawmakers nowassert that they intend to “repair not repeal” the ACA. 

Last week, a meeting between State Insurance Commissioner's and brokers met with the Senate Health Education Labor and Pension Committee. They warned the Committee that more healthcare plans are likely to”defect from the Affordable Care Act marketplaces unless Congress and the Trump administration provide concrete assurances within the next two months”. They also warned that those insurers that remain are likely to increase their rates by as much as 20% if this occurs. Specifically, the insurance industry wants GOP lawmakers to ensure that they will fund ACA subsidies in 2018. They need this information so that they can make their budgets for the next year. ACA subsidies are currently the subject of court battle between Republican Representatives and the White House. Amidst all this, the Department of Health and Human Services introduced a rule, the "Patient Protection and Affordable Care Act; Market Stabilization”, which is meant to stabilize the health insurance market for individuals. The GOP appears to understand that it is in everyone’s best interest to stabilize the insurance markets. 

Threat of repeal of the ACA continues to spur women women into seeking long acting reversible contraceptives (LARCs) such as MIrena (IUD) and Nexplanon (subderrmal insert). Month-to-month adoption of these methods is at record highs and continues to rise. Women are also stockpiling prescriptions of contraceptive and the prescriptions Some states such as New York are addressing the problem by requiring State governed insurance agencies to cover contraception with no or minimal copays. Massachusetts has developed a bill to provide free contraceptives to all of its residents. 

The is busy time for women’s health  and health care in general. Find out the names and contact information for your elected officials. Make your views known. 

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

Food Friday: The Impromptu Dinner Party

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 ! 

Food Friday: Food Traditions and People

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

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. 

Wellness Wednesday: Help for the Elves

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 ! 

Food Friday: Holiday Food Preparation

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

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.

Food Friday: More on Edible Gifts

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. 

• Spice mixes
• Flavored salt mixes
• Nut mixes, roasted, spiced, and flavored
• Pickled foods, even quick pickled foods
• Tea selections 
• Paleo granola ( My favorite is http://nomnompaleo.com/post/63395402592/tropical-paleo-granola)
• Dried veggies and fruits 
• Flavored oils 

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

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

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

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/

Food Friday: Paleo Thanksgiving

I have an ongoing debate in my mind about using recipes. Sometimes I’d rather just use good ingredients and good cooking principles. 

But this is an artifact of having cooked for family and friends for some time. It is also related to the fact that I am in possession of a rather large cookbook collection. It is from using good recipes that we learn to use good ingredients and good cooking principles. These days, it is only for certain novel or complicated dishes that I actually use a recipe. But it is not uncommon for me to crack open one or several cookbooks at once, spread across our table to get inspiration for any one dish that I want to prepare. I pick and choose elements from various recipes and combine them into something I will really like.

This Thanksgiving I'm going back to the books, albeit books like Pinterest and websites,  as well as my trusty cookbooks. This because I plan a Paleo Thanksgiving dinner. Numerous foods of the season lend themselves to the Paleo approach to eating. For instance, squash, as featured recently in another Food Friday post HERE. This is because squash is a complex carbohydrate which is nutrient rich. Along with sweet potatoes, it is the healthy eater’s white potato.

What makes a Paleo approach is tailoring foods to fit optimal human nutrition and metabolism. Not only does Paleo avoid foods such as simple processed carbohydrates like sugar and flour, it also avoids foods with harmful components, be they artificial colorings, flavorings, preservatives, trans fats, high fructose corn syrup and anti nutrients like alcohol and caffeine. 

Enough about the don’ts. What’s on the menu ? Turkey, venison, elk, and oftentimes salmon. Squash will be paired with cooked fruits, dried fruits, toasted nutrient rich nuts, and healthy fats like coconut oil and olive oil. Vegetables will come in grand combinations, such as brussels sprouts, with bacon, nuts, and pomegranate arils. (Scrabble word there…arils) And of course, faux potatoes made from cauliflower. Cranberry sauce will make it onto the menu, but this year paired not only with orange, but with applesauce for sweetness. I include wild rice stuffing, which I have featured before HERE. 

Pies must be made. This year I am intent on learning the nut crust. We always have pumpkin, and two flavors of fruit, one of which is cherry. There will be a little sweetener involved, perhaps agave with a lower glycemic index, and coconut cream to top. 

Beverages will be Pellegrino, and new this year, Kombucha, which to me is as delightful as Champagne, but with health benefits. Afterwards, we will make looseleaf organic Earl Grey Decaf, and french press water process decaf from freshly ground coffees. Coffees can be served with chocolate and coconut cream, and teas with lemon wedges and cream. 

That is my vision. Check out my Paleo album on Pinterest HERE if you like.  I thank you for letting me incorporate my planning here in your blog post, but this is the way a great meal starts. Happy Thanksgiving Week.