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This year my own small mountain town had an upbeat well attended Women's March. I would like to share some of my photos. I will report on policy and science a little later. For now, it is simply important that you know the government is shut down until there can be an agreement on a budget.
I am holding the sign saying, "Make America kind again ". I think this by itself would help so much.
Policy News this week is monumental. President Trump signed an “ executive order” which allows small businesses and individuals to buy cheaper less comprehensive policies which do not met the minimum ACA (Affordable Care Act) requirements. Critics have several issues with this legislation. First, it decreases money in the collective pot used to cover anyone with a catastrophic illness for which a large payout is required. Second, it will drive prices up disproportionately, hurting mostly older Americans.
Perhaps more impactful is the Administration’s decision to stop making federal subsidy payments to insurers. It is effective immediately. The President has further said that it may continue subsidy payments if a bipartisan agreement is made on health care. This last bit may illuminate the whole issue. When I first heard this announcement about cutting of subsidies, I ascribed it to wholesale lunacy. However now I view it more as blackmail. Without subsidies, the insurers will either bail or fail. Then the economy will follow, according to many analysts. No administration wants this. A bipartisan agreement has been impossible to craft, thus far. However, opposition to this move, and even opposition to the President himself may cause a high degree of motivation to compromise. Leading Republicans have called for continuing payments to insurers. As you read this on Monday, I wager you will be hearing fierce objection from both sides of the aisle.
Hot off the press is an announcement that the current Administration will allow health insurance sales across State lines. Many of us did not realize that health insurance is sold within a given state. Insurers and their plans must be approved within that State and must answer to that State's Insurance Commissioner. Trump and many other Republicans have endorsed this before. They have asserted that, through increased competition, premium prices will drop across the board. However, the National Association of Insurance Commissioners has called this a "myth". They have warned that this will start a " race to the bottom" wherein Insurance Companies will choose more lenient State regulators. Such regulators would require less and less coverage to consumers in order to maximize profits. This would result in healthier people getting cheap policies that cover little, and everyone else needing standard coverage getting steep rate hikes to compensate for the insurance company's loss in revenue.
Unbeknown to most of us, the insurance industry was the Wild West before the ACA came along. Most of us only knew about insurance in their own State. But, it turns out there were different levels of what was covered, different caps on out of pocket, and different limits to premium prices. That all got more standardized with the ACA. That standardization is now being deconstructed bit by bit by changes like this plan of selling across State lines.
The Department of Health and Human Services has put forth a couple of deeply controversial issuances. They have issued new rules on contraception. Without data or authority they have stated that “ Imposing a coverage mandate on objecting entities whose plans cover many enrollee families who may share objections to contraception, among some populations, affect risky sexual behavior in a negative way.” Importantly, this sentence uses confusing syntax. The subject of the sentence is “ a coverage mandate”. The verb phrase is “would…affect” the object is “risky sexual behaviors”. Thus the gist of the sentence it, a coverage mandate would affect risky sexual behaviors. Perhaps they meant to say the following: contraception WHICH could, among some populations, affect risky sexual behavior in a negative way. I suggest this because they have taken this position before: that contraception promotes sexual activity, particularly teen sex activity. A mass of available up to date and well derived data indicate otherwise. For example, no-cost contraception is associated with a decrease in the number of partners. Additionally, contraception is NOT associated in a rise in sexually transmitted infections. Available research data clearly show too that rates of abortion and pregnancy fell among teens, when no-cost birth control was provided. ACOG (American College and Obstetricians and Gynecologists) has voiced it’s objections to the weakening of the contraceptive mandate. They have shed light on the patently false claims of the Administration about contraception. Many States have sued the Administration over the weakening of the contraceptive mandate.
The second controversial issuance by the Department of HHS, Health and Human Services, has been to define life as “beginning at conception”. It has done so through a strategic plan document. This draft reads “HHS accomplishes its mission through programs and initiative that cover a wide spectrum of activities serving and protecting Americans at every stage of life, beginning at conception.”. Defining life at conception is not arguable in scientific terms. That is because it is a belief. In fact, it is a religious belief. As such, one might ask whether including this language in the strategic plan document of the HHS violates the separation of church and state. Clearly this language was advanced by those whose religious beliefs preclude abortion.
I do not believe there has ever been a time in history when government has been so intimately involved in matters pertaining to Obstetrics and Gynecology.
Pap smear frequency is again becoming controversial. As usual, the minimalist and government funded USPTF ( US Preventive Services Task Force) has interpreted the available data to mean the need for less frequent screening. They seem to consistently overemphasize the harms of screening (extra false positives, extra office biopsies) and consistently underweight the harms, i.e. more cancer cases. ACOG, various other cancer organizations, and patient advocacy organizations, give less weight to extra false positives and biopsies, with more concern focus on catching cancer early. ACOG still states that paps and HPV testing should go together from 30 to at least 65 years of age, and that for an average risk patient. Smokers, for example, would be screened, even more often.
In the we-already-knew-this department, a new study shows that epidurals do NOT prolong second stage (the pushing part) of labor. The study, published in Obstetrics and Gynecology, also show no adverse effects of epidural on mother or fetus.
Also in the we-already-knew-this department, a new study shows that women who have their fibroids embolized may need additional procedures. In particular, they have a fair chance of still needing a hysterectomy later. These women who go from embolization to subsequent hysterectomy were still better off in terms of complications than those getting myomectomies (removal of the fibroids from the uterus) to begin with.
Finally for a trifecta in we-already-knew-this department, we feature a new study which indicates that “intensive exercise may attenuate excessive gestational weight gain for obese pregnancy women”. Excessive weight gain in pregnancy increases the odds of gestational diabetes, large for gestational age babies, and need for C sections. Research elsewhere also indicates that exercise in pregnancy also produces many other good effects, such as increased likelihood of vaginal delivery.
Somewhere between politics and medicine we find people and society, and society has a lot to do with health. This week those in the entertainment industry have been reeling from all the revelations of sexual abuse and misogynistic workplace bullying by Harvey Weinstein. It has been sickening and yet illuminating to read the accounts of the women involved. The victims were abused in various ways. Those that escaped unscathed, had career setbacks by failing to acquiesce. They all suffered the shame and anger associated with such encounters, and even now are having to answer for why they did not disclose sooner, why they acquiesced, why they did not have more sense to begin with, etc. etc.
see:
http://www.vulture.com/2017/10/the-harvey-weinstein-sexual-harassment-assault-accusations.html
It is widely believed that Harvey Weinstein is not the only such perpetrator in Hollywood. It is also well known that Hollywood is not the only industry where this occurs. Although Weinstein's victims were generally celebrities, most victims are not. Yet even these celebrity women were caught off guard and were made to feel powerless and vulnerable. How much more so must the average woman feel, working a standard paying job on which they depend.
Harvey Weinstein’s methods were outrageous. The vaster number of abuses in the workplace today are far more subtle. They are microaggressions. They are just enough to make you uncomfortable, but not enough make you realize it is abuse, much less move forward to report it. All of this adds up over time, and it takes a toll professionally and personally, and on stress levels, which eventually impacts health. I had one patient who developed certain medical problems. In taking care of her and getting to know her better, it turned out she had an extremely hostile workplace environment. We encouraged her to speak to people at the local department of labor. After a lot of effort and gumption on her part, the case went to the courts, where she prevailed. She emerged empowered and eventually healthy. But it had been years that she had suffered before she understood what she had actually been dealing with and where it fit on the spectrum of normal social interactions.
Sometimes we do not realize that what we live with may not be normative. Our standard for what is acceptable behavior may be skewed due to a rough upbringing, or a innate tendency to think that we ourselves are the problem. If you think you may be living or working in some kind of an abusive environment, reach out to a trusted physician, attorney, local social services agency, community health center or mental health professional. Life is too short to let your quality of life or health suffer.
Stay tuned for more news from the work of Obstetrics and Gynecology her, next week, on Medical Monday.
Please remember to contact your elected officials to tell them what you think about all of this.
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 !)
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:
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.
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.
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.
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.
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:
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 !
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.
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.
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 ?
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:
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.
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.
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:
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.
Wearable Gifts:
Edible Gifts:
Themed gift baskets and “kits"
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.
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.
I have a large and closely knit family. But each and every one of us has travelled this last month. Some have travelled for work, some for play and some to reconnect with old friends. But we have all experienced a change in our usual routine, our place, and even our food. This week, we all will have returned home for the season.
Travel is an exercise in contrasts. It is about how you feel just before you leave home, and how you feel just before you return. In those watershed moments, you learn things.
You learn that for better or worse, you were in a routine. When you leave, you cannot help but critically appraise that usual routine. And you should critically appraise your usual routine.
You learn how you feel about being with your spouse, and that is precisely because he is elsewhere. You may make new resolutions about what good things you will do when you get back. But beware, inertia is powerful, and there are reasons why you always did things the way you did. You must figure them out if you want your life and your relationship to move forward.
You will learn how people change over time. My daughter marveled at the changes she saw in her 18 month old daughter after a ten day adventure. I marveled at the changes I saw in her.
At reunion I visited with friends of 35 years duration. They are still themselves, but more so. I am glad I chose my close friends wisely so long ago. I still adore my sophomore roommate. Time loops back in a circle and we felt and acted like roomies for the span of one evening, then we went back to our alternate realities.
Some of us like to stay curled up in our Hobbit holes smoking our figurative pipes and drinking our tea. But adventures knock on the door, annoying us at first then compelling us. As the Hobbit's tale teaches us, the journey is the only way to learn who we are and where we are at home.
Halloween food can be goofy or elegant. But one thing's for sure: It should be good and not overly sweet. That's because is needs to buffer the sugar from the treats. Tomorrow we are having a Halloween birthday party, since our youngest was born on Halloween.
Decor is dark botanical, with raven feathers, black roses and peacock feathers. Candles will be plentiful and a large illuminated spider web graces the large window. Black cheesecloth is draped over a dark green tablecloth, and mismatched silver completes the look. I always feature some little treasure on the table, and this time it is organic chocolate peanut better cups.
For the menu, the main dish will be traditional. he side dishes will be more exotic. Accordingly, I will do roasted chickens with multicolored potatoes. Side dishes may include an exotic vegetable mix with mushrooms, asparagus, eggplant and anything else interesting and provocative. I will try to get some heirloom black tomatoes for a salad of dark greens.
Dessert will be cherry pie and a six layer chocolate cake. Drinks will be Pellegrino and a " cauldron" of fruit punch with dry ice.
So at this point I will share the prep work and the decorations, and tomorrow some actual food shots.
This is our last Wellness Wednesday post before Halloween, one of my favorite Holidays. It has been our family tradition to have a grand Halloween party and this year is no exception. In preparation, I would like to share with you how my view of Halloween does indeed bear on wellness, especially for children. Before I share my philosophy on Halloween and how that translates into our gatherings, I would like to go over some basic Halloween safety tips.
Go out with your children if possible. Cloak yourself and hang back near the street while they practice their confidence and their manners. If they are older and you feel it is safe, let them to go in groups or pairs. Older kids should take their cell phone and turn on tracking. On iPhone that is through an app called “ find friends.” Pushback ? Who pays for that anyway ?
For kids going without an adult, review a map in advance and agree on a route.
Set time limits beforehand.
Feed kids a healthy festive and favorite meal before nightfall, so they are not tempted to feast on Halloween candy as they walk.
Ask kids to refrain from eating candy until it can be inspected under good light. Discard anything opened or tampered with.
Discard anything that is not commercially prepared, unless you know the source.
Ensure that costumes are safe for the weather, and the dark. Use reflective tape if need be.
Make sure that decorations are safe. Be especially wary of open flames or electrical installations.
Give kids flashlights and or glow sticks for visibility.
Forbid children from entering the homes or cars of strangers.
Remind them to observe traffic laws as there will be lots of cars as well as pedestrians.
Remind them that some people drink and drive on Halloween.
Remember sometimes kids get creeped out by creepy costumes. Make it comfortable for kids to come home if they do not like it.
Here is an except from my Halloween post last year which I would like to share again.
My different perspective comes from the historical roots of Halloween which is a witches' brew of an ancient Celtic festival Samhain (pronounced Sow-in), the later Roman holidays of Feralia and Pomona, and finally the Catholic Feast of All Martyrs/All Saints/All Hallows day. The name " All Hallow's" literally says, " all that is holy”. These are beautiful holidays are full of respect for the harvest, the circle of life, ancestors, saints, and the turn of the seasons. They all included feasts, and outdoors activities late in the night complete with festive fires. Accordingly, " Halloween" is of course a contraction of the words " Hallowed" and " Evening".
I have a soft spot in my heart for All Hallow's Eve as I like to call it, since our youngest child was born on that day. As a result, it has always been a big family celebration for us, and so we have always had a party. Accordingly I have never gone in for the typical commercial Halloween decoration and imagery. True, I like a very dark and mysterious Halloween. Particularly after I had children, though, I haver saw fit to incorporate images of violence into the holiday. For example, I am totally not into the blood gore and mutilation thing. Instead, Halloween is to me about the beauty and magic of the night and the natural world. For example, I have incorporated themes of stars, the moon, planets and comets. People consider these magical motifs but to me they evoke magical math and science which can describe their movements. I also incorporate anything botanical. At this time of the year the leaves are getting crinkled and brown, and the branches are bare. Some are dried all but the berries, but there is beauty even in this. You can make them even more evocative with paint, glitter, or interesting low lighting.
I incorporate the creatures of the night in my All Hallows' decorating. From mice, rats, bats, spiders, beetles, wolves, and owls to moths chasing a flame, these are all interesting and beautiful creatures who are worthy of our attention. Instead of vilifying them or presenting them in caricature, I try to present them as they are, almost like museum specimens. If I could have live ravens with their glossy black feathers, I would. For children I might do a faux insect display, with a little parchment note about the creature, and how they fit into the ecosystem.
And fire, of course fire, since fire harkens to the primordial processes in the heart of our sun which make life on this earth possible. Did you ever think about the fact that when you watch the flame you are watching matter being turned into energy? To bring fire to the home and patio in first must be safe. I like metal tea lights since they turned safely sat inside a beautiful container. These are easy to clean up as well. I use lots of candles and keep the regular lights down low. For fire outside, make a traditional bonfire. Check your local fire regulations and use common sense of this, especially with children.
So use branches, bugs, bats in mobiles, candles, and faux spiderwebs is done carefully, with dark elegant colors, or moonlit white. But whatever you do, make your party beautiful enough to transport your guests to different holiday "Hallowed" frame of mind.
Reference:
http://drginanelson.com/drginablogs/2015/10/15/food-friday-food-for-halloween-party?rq=halloween
Halloween can involve a healthy dose of fantasy. People of all ages love costumes and stories. There are so many fantastical costumes to try, there's no need to resort to the grotesque or sinister. Here's my Pinterest album of costumes and cosplay for your inspiration.
https://www.pinterest.com/drginanelson/costume-and-cosplay/
You might also like my collection of steam punk fashion which celebrates the popularization of science and engineering in Victorian age.
https://www.pinterest.com/drginanelson/steampunk-fashion/
Halloween should not be about fear and horror. Quite the contrary. It should inspire. Its historical roots lay in the efforts common people trying to encounter the wondrous. It recalls village life and the collective joy of the good harvest. It celebrates the interplay of chaos and order, day and night, summer and winter. This is the wellness of the holiday: that we gather together to express respect for the harvest, community, ancestors, Saints, the cycles of life, science, nature and hints of the divine.
I am back in Palo Alto, California for reunion and I hardly have time to think about food. But, in the course of my travels, I have come across some of the most beautiful grocery stores ever.
I have never been to Italy. But I have been to France. In these places, people care deeply about food in a way most Americans don't seem to. However, here in Palo Alto, these are my people. I watched in the stores how twenty something men would converse over the quality of fruit. Or how professorial types moved about with one meal's carefully chosen foods in a basket. I saw others asking questions about cheese, and the butcher explaining a fine point or two to some prospective buyers. I saw bakers, hatted in white, displaying desserts for the evening's customers. Even the checkers would comment on the items in my basket, like a Sommelier complementing my choice of wines.
I enjoyed this throng of like minded people. The beautiful displays of foods engendered conversations all around the store. Many people had phones to their ears, checking with companions elsewhere about what to purchase. These were not just grocery lists. They were menus that were being executed. Several were doing what I had been doing earlier in the day, holding a phone out in front sending a live video to another who would look over the wares and voice their preferences.
There were thoughtful conversations here and there, but at the same time, the group had a bit of hustle and bustle as if they all had somewhere to get to. People were expecting them. Within the hour, so many well considered tables would be set.
This would be my wish for every one on this evening of travel. The food you buy and the place you buy it should mean something. Moreover your dinners should be special in some way. Finally, do what you can to have special dinners with special people, in a special place.
I found myself a little out of my comfort zone this week. I was working on a little app for the App Store, and I am new to developing. I had done my due diligence, reading, and going through the tutorials. And yet, things were just not working out how they were supposed to. I got a little down about it. I got a little mad about it. Tech support sent me a lame email back not really addressing the questions I had clearly asked. I put the project aside for a couple days. I thought, maybe this is just not my thing. Then Monday morning rolled around, and thought, I am going to wend my way through the phone networks of Apple Computer and find someone who can help me. Three layers deep, I did. The person I reached was amazing. She agreed that I had done all that I should have; She took on my cause and bumped it up the chain of command. Ultimately the advice she gave me worked. I looked back on the incident and realized how silly I was to have gotten discouraged. Only when I got proactive and reached out, did things get better.
Proactive is the opposite of reactive. To be proactive is to be psychologically healthy. It means being the one who takes the steps to make your life what it is. It means to be responsible for one’s self, one’s thoughts, actions and circumstances. It means to be self-determined.
To be reactive, on the other hand, is to be a victim of life. You life is determined by other people and other factors. What you do is a reaction to other factors which have happened “to” you. You may feel out of control or like a victim.
Wouldn’t anyone want to be proactive ? You may want to become a proactive person. And yet, until you adopt the mindset and behaviors of being proactive, it would be very difficult.
How do you become a proactive person ?
The first step is to realize that you are responsible your own well being and success. Life hands people circumstances which range from good, to bad to ugly, and yet, mindset is the main determinant of how people feel and how they do in life. Remind yourself you are empowered in your life. Pin a pin, put up a poster, or do what you need to do to train yourself to remember this.
Also central to the process of being proactive is to understand your starting point. This requires honesty with one’s self about one’s present state. It is like talking a good hard look at the balance sheet of your life. What are the assets, and what are the liabilities ? Only then can you realistically plan for going forward. Train yourself to honesty.
To be responsible is to be accountable for yourself. In literal terms, you are the accountant of your life. You have the ability to set a budget, or a goal, and work backward to meet it. You are more than dreams and talk. You have real steps to realize your plans. You may even use the so-called SMART goals. (Click HERE to learn more.)You are reliable to others and to yourself. Train yourself to take regular inventory or your life. Train yourself to use SMART goals.
When you use SMART goals, you will get used to the idea that big goals are achieved with small steps. Furthermore, you will get used to taking small steps. Many people who haven’t realized their goals are simply not used to taking steps outside their normal routine. Being proactive means training yourself to get used to taking new and different steps as part of a larger, realistic plan. It also means training yourself to get used to the fact that meeting goals proactively takes time.
When you become proactive in your life and start to take steps toward realizing your life goals, you usually encounter obstacles. These may derail or discourage you temporarily. This is natural. However, the proactive person must have resilience. This is the trait which embodies the best response to adversity. With resilience, the problem is acknowledged, analyzed and the steps of the plan are reworked. They are iterated, and reiterated. With resilience, one has to train oneself to keep a flexible positive attitude, along with the idea that continual reiteration is part of the process.
In everyday life, being proactive is easier said than done. Everyone feels pressured, angry or frustrated at times. These are small everyday examples of being reactive. Sometimes even bigger situations like peoples' jobs or relationships are the result of being reactive rather than proactive. Learning the emotional and communication skills associated with being proactive is no easy task.
During challenging encounters, the natural reaction is fight or flight. Proactive communication requires acknowledgement of these reactive feelings, but not acting on them. Simply pausing, and breathing is an essential first start. In that moment, the feelings of anger, frustration or sadness are acknowledged and set on the back burner. Then a constructive response can be proactively made in accordance with the speakers highest and best ideas.
A proactive person also knows she has the right to defer. She can take time to think about things, calm down, or gather more information. She knows how to say these things the right way. She uses responsible closed loop communication. Responsible communication uses "I statements”, i.e.“ I think”, ,”I feel”, or “I need” or “ I want”. In this way, you speak for yourself. You may not be listened to, but at least you have spoken up for your self, and your statement has the weight of authenticity which may well continue to sink in after the conversation.
Closed loop communication has to do with listening well. When you speak, you are obliged to listen. Listen with full attention until the speaker is finished. Then use another “ I statement” , which is “ I heard….” then repeat back a nutshell version of what you thought you heard the speaker say. This is especially useful for challenging or complex conversations. It honors both the speaker and the listener and greatly reduces the chances of misunderstanding.
Train yourself to breathe, pause, use "I statements", and closed loop communication.
So you see that being proactive is a training process. Nobody has a charmed life. But everyone can use the methods of responsibility, honesty, accountability, action, resilience and communication to be more proactive and move toward the life they want.
I generally shy away from this topic. But a few things have happened recently causing me to realize that there are some issues that can make the process better.
I did say process. I have observed a range of situations, from a young person with a couple of years to plan, to a middle aged person who died suddenly and unexpectedly, to an elderly person whose passing was entirely anticipated. In all cases it was a process. They were all hard, and they were all different. As an inexperienced observer, I did notice that several things had a big impact on how the whole process went, for the patient and the friends and family.
Wellness in dying comes from wellness in living. It comes from the most basic of things.
These are the Days of Return and Repentance in the Jewish Calendar, a time of self examination. It is the week between Rosh Hashanah and Yom Kippur, the High Holy Days. The liturgy refers to the Book of Life. It refers to those whose names will be inscribed for the coming year and those that will not. The traditional blessing reflects this imagery. The whole service is very much a contemplation of mortality and the need to be mindfully present in the time we have.
May you be inscribed in the Book of Life for the coming year. May you have a good year and a sweet year.
I am in black and with me is Kyra Bobinet, MD, MPH of drkyrabobinet.com
Although travel is often arduous, it has the capability to be really invigorating. Travel is meant to refresh both the body and the spirit.
I travel seldom. Often, when I do, it is for a specific reason such as a conference. Nonetheless, it gives me perspective on the destination and on home. I also learn things about myself. Here is a sampling of my insights from a recent trip to Stanford Medx.
Traveling inspires me to do more and be more. It makes me appreciate both home and the destination better. If I go back in time by going back to a place I’ve lived before, I gain understanding and compassion for my younger self.
Traveling can be expensive and challenging to arrange. However, I believe that it is worth it.
Here are some older posts I wrote about travel:
Food always factors greatly in my traveling. First, I am concerned about healthy snacks that are allowed on the plane. It ends up being nuts, chocolate, and dried meats like jerky. I buy fruit, veggies and drink as soon as I get past security.
On the plane I either get a club soda with a splash of cranberry juice, or a bloody mary mix with no alcohol: a Virgin Mary.
For layovers, I like to keep it light but ethnic. My favorite in Salt Lake is the Greek place, since I seldom get this kind of food. In Seattle, it is Asian of some kind, usually Japanese or Chinese.
Once to my destination, I had the good fortune to be hosted some lovely people who came originally from the south of India. She, a Biology professor at Stanford, and he an engineer with a company, they were both a bit older, and had freedom in their schedule. They used this time in some part to putter around in a lovely cottage garden that they both maintained. Big sweet oranges were falling off the trees, while diverse peppers, tomatoes and strawberries decorated their respective bushes.
We shared similar sensibilities in everyday foods, which took my worries away. Additionally we went out a couple times, once to a traditional Indian restaurant and ate family style. It was so much fun since each new dish was a discovery. The second time we went to a old style steakhouse with clients. The dinner was spiced with political conversation.
The most amazing use of food was at the conference itself. I laughed when I saw the schedule. As there were not one, but two or three breaks between breakfast and lunch. Tables were set all over the place amidst and some times in auditoriums. The food at morning break might be poached pears, or filled croissants. Lunch was often salmon with several vegetables. Mid afternoon, tea with something on the sweet side was served, from strawberry shortcake to cups of fresh fruit. Fruited ice water was everywhere.
All of this abundance encouraged a relaxed attitude. People sat with each other ate short frequent meals or servings. Before long another session would be called, and then another break, so it kept people mixing in a very genial fashion. The food was entertaining as well as delicious, so it was an instant conversation starter, fostering very positive feelings.
Finally my travels usually include some exotic purchases. This time I headed to an Indian grocery store which we lack, and picked up some very fresh spices. Small and light, they were easy to bring home.
I have long advocated that my patients pay more attention to their food. If you do, you will enjoy it more and it will be of a better quality. This fits my vision that enjoyment of good food, good social life and good health go together.
