Consumer Awareness

Medical Monday: Weekly News Update in Obstetrics and Gynecology 

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The Republican dominated House voted to defund Planned Parenthood last Friday the 19th. About a week later, the Senate rejected the same bill by a vote of 52 to 47. It turns out defunding Planned Parenthood would have allowed lawmakers to come in on budget and avoid a government shutdown on October1st. Both sides of the aisle are woking on plans to keep the government going after October 1st. I will say this: that meeting budget and funding Planned Parenthood are really two separate issues and should be treated as such. It is not as though Planned Parenthood is the ONLY straw that could have broken this camel’s back. 

The Food and Drug Administration (FDA) held a public hearing this week about the relatively new method of sterilization called Essure. This procedure involves the insertion of small coils into the inner aspect of the the Fallopian tubes as they open into the uterine cavity. Is is an office procedure without incisions, which is its appeal. However there are now 5k plus reports of complications associated with the device and more pregnancies than were intially advertised. A panel of experts criticized both the maker, Bayer Health Care Pharmaceuticals, and the FDA, in the handling of device’s testing.  A long running social media campaign has influenced the convening of this hearing. 

Long acting reversible contraceptives (LARCs) like IUDs ( intrauterine devices) have been found to be 20 times more effective at preventing pregnancy that all other contraceptive methods. In more good news, almost everyone, even childless women and women with medical conditions, are eligible to use them. Their use is up in the last few years from 1.3% to 7.2 %. The American Academy of Pediatrics recommends that they be first-line contraceptives for sexually active teens.

Most women know there is a vaccine available to prevent cervical dysplasia and cancer. But now a clinical trial from Johns Hopkins University School of Medicine has shown effectiveness in a new genetically engineered vaccine to ERADICATE existing high grade precancerous cervical lesions in half of the test subjects. Wow, fantastic ! 

Stay tuned for more news from the wild world of Ob/Gyn in next’s week Medical Monday. 

Medical Monday: Weekly News Update in  Obstetrics and Gynecology

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It's a mixed week in OB/GYN news, as always.

A Swedish study indicates that women who are overweight or obese at the time of the first pregnancy are more likely to develop diabetes in the next decade or two of their life. The risk of increase is six times baseline.

The eighth circuit court of appeal in St. Louis Missouri has taken the position that forcing employers to cover the cost of contraception through their insurance “ violates the groups religious freedoms".

In other news in the war on contraception, the Congressional Budget Office has estimated that cutting off funds from Planned Parenthood for one year could "reduce healthcare access for about 390,000 people" and at least through the Planned Parenthood budget with sales tax payers about $235 million. They hasten to indicate that defunding the organization could result in"several thousand unplanned births that would drive up government costs elsewhere such as in the Medicaid budget which pays for 45% of all births in this country.

The Census Bureau reports that the percentage of people without health insurance dropped in 2014 to 10.4 % down from 13.3 % the year before.

In the department of general women's health the following finding is rather striking. When comparing the cost of institutional care for male Alzheimer's patients versus women's Alzheimer's patients the following is noted. The cost of caring for women with Alzheimer's is six times greater then for a man with the same diagnosis. This is because when man has Alzheimer’s, female family members put much more time and energy into their care, saving them from expensive institutionalization. The reverse is not true when male family members take care of women with Alzheimer’s.

In other gender gap news, the Journal of the American medical Association reports that the gender gap in academic medicine is alive and well. Despite the fact that half of all medical school graduates are and have been women for sometime, Men are 15 percent more likely to have the rank of full professor. It also shows that women generally do produce less reach her research than men, But that this may be due to lack of mentorship, institutional support, and most importantly research funding through research grants. According to the same study, men received over twice as much research funding from their employers for equipment and labs. Women researchers are also less likely to receive NIH grants than there male colleagues.

For some good news this week we will have to turn to the field of vaccines. The CDC or Centers for Disease Control found that about 90% of children under the age of three were vaccinated against the common disease entities in the years between 1994 and 2013. What did this do for us? The CDC estimates that this will have prevented 732,000 early deaths in United States alone.

Finally, also in the good news department, the flu vaccine may be more effective this year according to the CDC or Centers for Disease Control. It is estimated that it will be nearly 3 times as effective as last year’s preparation. Remember that even if the vaccine doesn't prevent flu entirely, it will decrease the severity of flu which is very important in children and other vulnerable populations.

Stay tuned for more news from the world of OB/GYN next week in Medical Monday.

 

Food Friday: Healthy School Lunches 

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Think this is going to be a bunch of recipes ? Think again. Here is what it really takes to have your kids' school lunches be healthy. It's not what you think, and it takes a lot more than a recipe. 

A healthy school lunch that is well received by your grade school child is one of the crowning achievements of parenthood. To engineer this amazing feat, you must be ambitious, disciplined, creative and start very early in the game, like before you are even pregnant with the child. Seriously ?

Most depends on you, and this is both bad and good news. It means the obligation is upon you, but it also means you have the power. While you will see that I am emphasizing a strategy that works best if you start early in a child's life, these strategies can work on older children, teens, and in principle, even husbands !

You must lay the appropriate groundwork in your home. Your parenting should have that " just right" touch which is not too lax and not too firm. Your home should run smoothly, so that kids feel secure. Then you must learn what healthy food is, and learn to prepare it so it is easy to handle and appealing to eat. Then you start thinking about healthy school lunches. Here are your tips: 

  • Start very early on healthy eating habits for the whole family. 
  • Make sure you know about nutrition, and not just what marketers say. 
  • Lead by example, i.e. shop, cook and eat healthy yourself. 
  • Make superb healthy food a family hobby. .  
  •  Know your kids friends.
  • Foster this philosophy among your kids' friends by having them over to do cooking projects. Get them involved in the tradition of really nice healthy food. 
  • Know about school food situation. (Is there a hot lunch ?) 
  • Know about school policy ( Is food trading permitted ? ) 
  • Know the school social scene (Are there bullies ? ) 
  • Be aware of social sensitivity surrounding home packed lunch. ( Is it cool ? Uncool ? ) 
  • Involve children in the school lunch making process. 
  • Look up healthy school lunches online together. 
  • Make a shared Pinterest album of school lunch ideas. 
  • Choose and purchase their lunch containers together. Let the child have a much say as possible.
  • Observe Food safety when packing lunches. Consider a reusable ice block. 
  • Get kids involved the night before in composing and packing their lunch, at the same time you make yours ! 
  • Don’t be a purist. Include some healthier treats like dark chocolate or covered almonds ! 
  • Consider the classic note of encouragement. Consider variations such as riddles or anagrams. 
  • Enjoy the process ! 

 

 

 

 

 

 

Wellness Wednesday: The Benefit of Trying New Things 

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Nutrition, fitness and good relationships can keep us healthy. But... trying new things ? Yes, being adventurous has physical as well as psychological benefits to our health. (1) 

Adventure is a relative thing. For one person it might mean trying a new cookbook (me) while another may need to paraglide to 5000 feet above sea level (my son). But in all cases it means doing something different than your usual, and, for best results, it means getting out of your comfort zone. Comfort zones vary considerably in size.  

Does adventure have to be dangerous ? Of course not. But it should expose you to a new environment and require you to do things you have not done before. So why does it have to be all that? 

Before I explain, lets take a look at the American vacation. It is an endangered species. We are one of the few developing countries without a national policy of paid leave. Those companies who do provide paid leave do not always encourage its use, even though research shows it greatly improves employee productivity and satisfaction. When the companies do provide leave AND encourage its use, employees are reluctant to take it. Why ? Forty percent are afraid of coming back to " a mountain of work" , a third feel no one can do their work but them, a third feel they cannot afford it, and about a fifth feel guilty.  Forty-three percent of adults do not remember the last time they tried to have an adventure. Reasons for avoiding adventure range from lack of money to embarrassment. (2) Fear of one thing or another plays a role in skipping vacations. Ironically, it should be the opposite, since skipping vacations is associated with a measurable and significantly increased risk of heart disease in men and women, according to the Framingham study. (3)

And yet, we bemoan our lack of time off and we make bucket lists all of the things we don't and won't do. We execute what Tim Ferris calls the " deferred life plan". (4) Moreover, we note how every year seems to pass more quickly. 

Enter adventure. If we do get around to it, here is what happens. First, our narrow view of the world opens back up. We experience different ways of living, and see ourselves and others in a new light. Novelty and some degree of challenge have to be a part of it. This way, our confidence and competence is enhanced. A 2015 Study on newly graduated nurses found that a nontraditional outdoors adventure leadership program increased feeings of competence and confidence. When they returned to work, their transformation was felt to have impacted their entire work culture. (5) 

Adventure may even be an antidote for the accelerated passage of time. Dave Engelmann, a neuroscientist, notes that the more familiar the world becomes, the less we remember, and thus the faster times seems to pass. (3). I deduce that novelty and adventure may help us savor the time we have. 

Check out these fun resources: 

30 New Things to Try by Lifehack.com

The Beginner's Guide to Trying New Things

Staying on Top of Your Game

References: 

  1. http://www.huffingtonpost.com/laurie-gerber/are-we-having-fun-yet_b_7948588.html
  2. http://www.huffingtonpost.com/2014/08/19/americans-vacation-days_n_5682576.html
  3. http://www.newyorker.com/magazine/2011/04/25/the-possibilian
  4. http://www.bothsidesofthetable.com/2010/01/10/what-can-you-learn-from-the-4-hour-workweek/
  5. http://www.ncbi.nlm.nih.gov/pubmed/25608096

 

Wellness Wednesday: Workouts for your Mind and Soul

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Have you ever heard of TED talks ? If I had to think of the SINGLE BEST USE of media, TED talks would be it. Now aren’t you curious ? 

TED talks are short (usually less than 18 minutes) powerful talks by people with important and timely insights. Originally they were by just the very best and the brightest, people such as Bill Gates, Steve Jobs and Steven Hawking. To this day, they are still given by those who have a deep special interest and expertise in a subject. 

The TED talks were originally conceived in California. They have close ties with the California University system, Stanford, and all major universities the world round. They are international in scope. To be invited to speak is a rare privilege. To attend in person is enormously expensive, but all talks are provided free to everyone over the internet.  TED talk conferences have branched into all major cities, and TEDx has been developed to give smaller communities the chance to participate. 

Oftentimes Ted speakers are researchers, or high level thought leaders, heads of state, or industry innovators. Commonly they are scientists or extreme athletes. Occasionally they are artists of note. They are always fascinating, and always worth watching.

And while you can listen to TED talks on iTunes radio, podcasts, and elsewhere, they are best watched. There is nothing like seeing these sorts of people give these usually intense distillations of human wisdom and brilliance. If you want to see a great example, check out the Talk by Jill Bolte Taylor. In video format, it brings it so much more down to earth. The speakers seem more accessible, as though you might run into them in the grocery store. 

I can tell you why a TED talk is so potent. This is because I was asked to to do one at the first TEDx conference in our area. I had done public speaking before, so I thought it would be straightforward. Wow did I have a lot to learn. A TED talk is not like an academic lecture. For our conference in northwestern Montana, I had several coaches, starting weeks in advance. One came all the way from Southern California to coach us. The coaches had to tear my style apart and put it back together again. I was lecturing, whereas they needed me to actually connect on a personal level over my material. I had to explain myself in clear ordinary nonmedical language.  I had to connect, which was my biggest challenge, and I had to end with a call to action. Plus I had to get it all done in 18 minutes or less.  

 

There are so many stories you and your family NEED to watch at TED.org and TEDx.org. I have been showing them to my kids, family and friends for years, and they are an endless source of inspiration. The TED.org website is great in that you can chose a talk by speaker, topic, or even rating. You can get an app on any platform or you can use a computer and a browser to go to TED.org. I cannot recommend then any more highly. 

 

Medical Monday : Ob/Gyn News Weekly

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News about Ob/Gyn topics has GOT to be important to all women. I like to read this stuff since it makes a difference in people's lives. So with a more recognizable title, I will continue to report on it. 

A paper in The Journal of the American Society of Nephrology has properly substantiated what Obs have always observed: that women who suffer from hypertensive disorders of pregnancy like preeclampsia are prone to high blood pressure later in life. Newsflash: so are their siblings, including brothers. 

Apparently prevalence studies of the breast cancer genes BRCA1 and BRCA2 in breast cancer patients were done predominantly in white populations. Taking a preliminary look at 400 black breast cancer patients, a Florida study shows 12 % of them carry one of these genes. In a similar population of white breast cancer patients, the rate is only 5 %. This has implications for screening and prevention. 

New help for older women with osteoporosis (bone thinning) may come from Human Growth Hormone. It's helpful effects seem to be particularly long lasting. 

The CDC reports we have achieved a 90% vaccination rate on polio, measles, mumps, rubella, hepatitis B and varicella (chicken pox virus). I realize this is better than it was, but, this doesn't sound too great where herd immunity is concerned. 

The CDC ( Center for Disease Control) reports that since 2012, school lunches are measurably healthier, with metrics being more fruits, vegetables, whole grains and salads. Thanks to all those lunch ladies and gentlemen as well as FLOTUS Michelle Obama. 

And in other good news, the great State of Texas has passed a strong "right to breastfeed" law. Public employers must give breastfeeding mothers time and space to pump during workdays. The law also prevents discrimination or firing related to breastfeeding at work. 

Stay tuned for more news from the world of OB/Gyn next week on Medical Mondays. 

Medical Monday: ACOG weekly news

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Headlines proclaim “ Aggressive Treatment for DCIS May Not Save Lives”.This sounds rather dismal. Reading further, what they should have said is “ Aggressive Treatment for DCIS May Not Be Necessary to Save Lives”, which is good news. DCIS is very early microscopic breast cancer, and as such its concerns everyone. Such an alarming headline got my attention. But once I found out the news was actually good, I was a little dismayed.  There must be a chapter in the Journalism textbook where it says bad news gets more attention than good. I don’t know. Read carefully out there ! 

Just to refresh your memory, ACOG stands for the American College of Obstetricians and Gynecologists. They send its Fellows, myself included, news updates throughout week. These are articles of pertinence to women’s health. Each Monday, I pick a small sample and present them to you for your consideration. More such articles can be found at www.acog.org. 

There is such a thing as “ distracted snacking”. The Journal of Health Psychology reported the results of a small study which indicate that distracted snacking results in greater intake even afterwards. I speculate that it has to do with the fact that distracted snacking results in greater intake that say “ mindful snacking “ ( my term)  causing insulin levels to spike more than they would have, and more hunger to be stimulated later. So be mindful about your snacking and remember to always include some protein. 

The venerable diaphragm has gotten an upgrade. A Seattle based nonprofit has developed a new more contoured model. It’s name is Caya. Go to Caya.eu to learn more. It is not yet available. 

Finally, ACOG has released new guidelines regarding the treatment of morning sickness. First line therapy should be in the form of the class A combination of doxylamine and vitamin B6, commercially available over the counter without a prescription in the US as Diclegis. ( Class A is the safest pregnancy category for a drug. ) This is not to say that we are not still going to need Zofran for certain patients. It will still be considered after Diclegis is deemed insufficient. 

When you read medical related articles in the mainstream press, read very carefully. It is tricky to report accurately if you do not have medical background. For more on that please see our section “ Your internet learning toolbox”. 

Stay tuned for more medical news next week on Medical Monday. 

 

 

 

 

Food Friday: On the Glories of Summer Fruit

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Summer fruit is not just something to eat. It is a family project. It is a creative endeavor, and it is Holiday preparation. Finally it's a great bargain. 

Most people think of boxes of ripe summer fruit as the mere predecessors of pies and cobbler. I love fresh pie and cobbler as much as anyone else, but there is only so much you can eat and stay healthy. 

Consider the price of frozen fruit at the grocery store, even Costco. Frozen fruit is a premium item, and if you have ever tended a tree or picked a bushel of fruit you will know why. But, to go to a produce vendor for a box of ripe fruit in season, you will pay a fair price for an excellent product. But you must buy it by the box or bushel, which might be daunting to some. 

Take courage ! To freeze you need only freezer worthy ziplock bags, some time, and some lemon juice. Freeze by the quart or by the gallon. 

To dry, you need patience, an oven, a very hot day, or a dehydrator. With a little more cleverness and maybe a recipe, you can make fruit leathers, which are a most welcome gift. Now is the time to get some made to give at the holidays. 

Jam has less sugar than jelly and is a suitable treat or gift when home made. Delve into the exotic fruit spiked salsas, and you will have serious trouble keeping it around. 

To be fair, you will need some equipment. First you will need large bowls and pots. You will also  need many hands to help wash and slice. The thrifty among you will want the largest good freezer you can afford. Canning pots and tools are relatively inexpensive, and jars are a common item at garage sales. Just be sure they are in good condition and not chipped. Finally for the connoisseurs, you will want a proper dehydrator. And by all means indulge yourself in one of the many beautiful books about preserving. You may as well get the gold standard, the Ball Blue Book Guide to Canning and Preserving. 

If you do this sort of kitchen magic with the kids, they will be fascinated. Photo document your fun and you will be blog- worthy and an instagram hit ! You will also have a really good spoon to lick. 

 

Ball Complete Book of Home Preserving
$15.30
By Judi Kingry, Lauren Devine
Buy on Amazon

Medical Monday: ACOG weekly news

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I have noticed that this is not the most popular column. I thought hard about reducing to three posts per week, eliminating this one. For now I have decided to keep it since it helps me keep up to the minute on news pertinent to the field of Obstetrics and Gynecology. Please let me know what you think.

The state of Delaware has banned the dispensation of formula from the hospital to new moms in an effort to promote breastfeeding. Some mothers have weighed in with opposition saying that many workplaces stigmatize breastfeeding making formula feeding necessary. Two comments: those little sample from the hospital aren't enough to make or break your formula supply. Buy your own formula if you want to. And, wouldn't it be better to help the whole situation by introducing some sort of " Freedom to Breastfeed" program in the workplace ?

An entirely useless article came out about a number of mortalities among those who experienced complications during Robot surgery. Non medical media didn't bother to compare these numbers with the numbers of mortalities in those with complications from non Robot surgeries. Also, it is unclear whether or not attention was restricted to new resident doctors, of whom a greater percent use the robot, seasoned surgeons, or both. It would obviously make a difference. 

Recent studies indicate breast cancer survival is aided by aromatase inhibitors, as well as good old fashioned bisphosphonates like fosamax. Cheap help ! 

Republicans want to defund Planned Parenthood in the wake of the recent videos discussion the disposition of the products of conception after abortion. Some say the videos are controversial, some say they aren't. The republican House speaker, John Boehner, has stated he wants the " facts first". FYI Planned Parenthood also does routine check-ups, cancer screening and provides birth control at low cost. 

Breast cancer death rates have declined 33.5 %  from 1988 to 2010 !  Good news. I bet it has decreased more since then. 

Finally, 60% of women over 60 are sexually active. Stereotypes be gone ! 

Stay tuned for next week's Medical Monday ! 

 


Wellness Wednesday: Exercise Statistics

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Most people who come into my office for an annual exam report that they live an active lifestyle. Of course this means different things to everyone, but it is an interesting starting point of discussion. 

Our impressions of our exercise patterns are rarely accurate unless we take the time to chart them. I am going to devote this post to a reality check for us collectively. Number lovers are in for a treat. 

Children: 

  • Only 1 in 3 children is physically active every day. 
  • Only 6 of the 50 states require PE in each grade. 
  • The CDC recommends children be physically active for one hour each day. 
  • One third of high school students plays video games for more than 3 hours per day. 
  • In 2013 only 27 % of all high school students had 1 hour of physical activity in each of the preceding 7 days. Fully 15% of high school students reported NO physical activity in any of the prior 7 days. 
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Adults: 

  • Less than 5 % of adults get 30 minutes of physical activity each day. 
  • Only 1 in 3 adults gets the recommended amount of physical activity in a week. 
  • The 4 states where adults have the highest incidence of exercising 3 or more times per week are: Vermont, Montana, Alaska and Hawaii. In these states about 60 % of adults meet this criteria. 

Appropriate physical exercise comprising both cardio and weight bearing exercise has numerous mental and physical benefits for children, adults, and seniors. Exercise these days has become more evidence based. We know more than ever about how to tailor it to a patient's specific health needs. Exercise certainly does not need to be onerous or miserable. Without exception, people who exercise regularly derive great satisfaction from it.

Check with your local health club or YWCA. Get some exercise DVDs for home use. Find my DVD recommendations in the RETAIL THERAPY section. Learn more in our section on FITNESS. 

Medical Monday: ACOG weekly news

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This is the second in a series of reports on current events and research reports in Obstetrics and Gynecology. We hope you like the new format for Medical Mondays and invite you to comment. 

A recent study showed that about 50% of women gain more weight than they should in pregnancy. This has serious effects on the health of the newborn as well as the mother. Institute of Medicine guidelines indicate weight should be about 30 pounds if pre-pregnancy weight is average, less if the patient is obese, and more if the patient is underweight. 

Maternal mortality in the US is on the rise, sitting at 18.5 per 100,00 births. This is against the trend of most developing countries. The conditions most likely to cause maternal death are hemorrhage, severe hypertension and preeclampsia, and venous thromboembolism ( abnormal clotting). 

There is an effort to make birth control pills available over the counter, without a prescription. This is already the case in Oregon and California. The interesting thing is that this is a bipartisan effort. These efforts come in the wake of the accomplishment making birth control "no- cost" under the Affordable Care Act. 

Speaking of the Affordable Care Act, it is currently not true that patients can see whoever they want. A recent analysis indicates patients insured through the ACA chose from one third fewer doctors and hospitals than patients insured otherwise. 

Plans were confirmed by the House last week to approve the creation of a commemorative gold coin and to donate the proceeds to The Breast Cancer Research Foundation. The Susan G. Komen foundation was originally to have also been a beneficiary, but GOP members required they be removed to due their "funding" of Planned Parenthood. It turns out Komen does not fund Planned Parenthood. 

Ob/gyns the world over disapprove of douching since it disrupts normal vaginal flora. However now it appears that common commercially available douches contain a chemical known to be an endocrine disruptor, diethyl phthalate. 

For this and more medical news from the world of Ob/Gyn, tune in every monday for Medical Mondays. 

 



Medical Monday: ACOG weekly news

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Today I'm going to do Medical Monday like a good old fashioned news cast. I am going to take the weekly news items of most importance to the American College of Obstetricians and Gynecologists and summarize them for you. What's  important to ACOG is important to us. Let me know if you like this format. 

 

( newscaster voice here... ) 

Medicare, which is for those over 65 or who are officially disabled, "will now pay for women to get a joint Pap smear and Human papilloma virus test every 5 years to screen for cervical cancer. " Never mind that ACOG and The American Society for Colposcopy and Cervical Pathology (ASCCP) state they should be done this way every 3 years. 

A Yale study found that the cost of a delivery varies from $1200 to $12,000 depending on the hospital. Unpacking this revealed that birth was costlier at poorer facilites that served higher percentages of Medicaid moms. They also found higher complication rates in those same higher cost hospitals. CBS news reported on this, and opined that this contradicts the notion that more spending leads to better outcomes. Never mind that poorer patients have been less well served in their lives, are unhealthier and have higher risk pregnancies on average. Maybe the complications come before the high cost but what do I know. 

The European Journal of Preventive Cardiology published the obvious in saying that women who smoked and had preterm deliveries went on to have higher risk of heart disease. Had they not yet heard that smoking is associated independently with both preterm birth and with heart disease ? 

Of importance, the FDA nows states that use of NSAIDS like ibuprofen and Aleve are associated with increased risks of heart attack and stroke. Discuss this with your doctor and buy stock in Tylenol's parent company. 

The Salt Lake Tribune, right in the heart of the conservative Mormon heartland, featured an editorial, which among other things, advised that the best way to reduce abortions was to provide contraceptive choice ! Well done Salt Lake. 

Stay tuned until next week. 


Wellness Wednesday: Music and Health

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Yesterday Apple debuted its all encompassing music service. With a subscription, one can listen to the entire contents of the iTunes music store 24/7/365. There are infinite permutations and possibilities for creating playlists and stations. It is the music service to end all music services. 

The association of Apple Computer with music has been long and fundamental. Much of their product inventory has been about consuming and even creating music, and other forms of art such as as film. There is a belief within Apple and indeed, within many decades of California Bay area culture that music is essential to the good life. I believe modern science is beginning to substantiate that belief. 

Listen to music.jpg

 

 

Since I have been totally immersing myself in music since the services inception 18 hours ago, I decided to learn more about what is happening to me when I listen to music. What follows is a characteristically nerdy report on the relationship between music and health. It's amazing and stirs hope. 

A rather casual Google search promptly unearthed a plethora of research and commercial articles on the subject. I will give you the "digest" form and, of course, the references. The oldest work I evaluated was from 2009. Study designs varied, but many were randomized and controlled. Many of the studies were done in the setting of assessing benefit to peri-operative or hospitalized patients. 

 

 

 

In short, exposure to "pleasant" music, self chosen or otherwise, was associated with the following: 

  • decreased preop anxiety,
  • decreased post op cortisol levels, blood pressure, heart rate, pain level, thus decreased requirements for post op sedation and pain medications 
  • decreased pain and depression in fibromyalgia patients 
  • decreased heart rate and pain in hospitalized pediatric patients 
  • improvements in both branches of the immune system, cellular and humoral, in the elderly 
  • improvements in athletic performance 
  • improved sleep 
  • improved cognitive function 

 

 

How does our body and mind produce all these responses through music? The precise science is not entirely worked out. However, studies using measurements of hormones and neurotransmitters by blood tests and targeted neuroimaging reveal the involvement of the dopamine, serotonin, and adrenal pituitary axis systems, among others. 

The cardinal work on this matter seems to be an article produced by one of my old college housemates, Dan Levitan, and his colleague Mona Lisa Chanda. (See reference below.) They evaluate and ultimately support the claims that music produces its effects through the bodies systems for reward, motivation, pleasure stress, arousal, immunity and social affiliation. And these responses, of course, work through various brain centers which produce the aforementioned hormones and neurotransmitters. 

So how you feel on music is very very real. So I suggest you indulge yourself. Find your music and bring it into your life. Better yet, make your music. And if you have small children, do everything you can to get them into music education as early as possible. It helps develop the brain and enhances the power of all the good things music can do for us. 

 

 

Structure Sunday: The Structure of Our Practice

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Some say medical care in America is deeply flawed. Some say it is the best in the world. On some level, I think both are true. But one thing is sure: Medicine is evolving. We are evolving with it. On July 1st, we will be joining Kalispell Regional Medical Center. 

This is a decision that has been some time in coming. My staff, hospital administration and I have put a lot of time and care into crafting us into a new thing: a medical practice that embodies the best of solo private practice, while benefitting from the support of a larger medical center. 

We want to be on the cutting edge. We want to be a part of the future, where care becomes more rational. Rational care means that duplication of services in the community is avoided. It also means that gaps in care are filled. It means that everyone can get the care they need when they need it.

To this end, our hospital is embarking on an expansion that will bring much enhanced services to women and children here and in our surrounding region. It is a very exciting time to be here and I and my staff are excited to be on board. 

I'm lucky because I work at a hospital with a philosophy of service, teamwork and congeniality. My solo office has worked this way for 21 years and will continue to do so for at least another 15. Our patient care has been based on evidence based medicine, but it has, just as much, been based on quality relationships. My patients can rest assured that none of this will change. 

Our billing will change and our overhead will go down. Eventually, I will have some call coverage, which will be more inline with current practice recommendations and with my health. The office, the staff, and our style of medicine and management will stay the same. There will still be music playing in the rooms and essential oils wafting through the halls. 

I am proud to say that in the course of merging with the hospital, we have received numerous compliments about the way we have been doing things. For that, I have to give credit to our brilliant managers, Tara and Dorothy. I have been truly blessed with these and my other staff members past and present. My only worry is that that administration will find out how truly valuable these women are. 

We look forward to seeing you in clinic and online as per usual. 

Medical Monday: Are there really any low risk pregnancies ?

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In today's post I report on some recently presented work which questions the validity of classifying pregnant women into either low risk or high risk groups. 

These categories have been important to women and their caregivers since they have used the information to determine the most appropriate site for delivery, from freestanding birth center, to community hospital to university medical center. 

But while Obstetricians have gone along with the use of the category " low risk", we know from anecdotal experience that ANY patient can unexpectedly have complications with out any warning or risk factors. A cross sectional investigation published in the American Journal of Obstetrics and Gynecology, February 7th, 2015, has shown us in precise numerical terms just how often this happens. 

Please note that in this study, those with no prenatal risk factors were classified as low risk. Those with one or more risk factors were classified as high risk. 

Here are their results: 

Of 10,458,616 pregnancies analyzed, 38% were identified as low risk, and 62 % as high risk. 

It turns out that 29% of those classified as low risk had unexpected complications. 

It is not surprising that high risk pregnancies had complications. It turns out that 57% percent of them did. However, 29%, almost a third of the low risk patients had complications. For certain outcomes, like use of vacuum, forceps, meconium and infection, so called low risk pregnancies had a higher incidence than those in the high risk group. 

If you look at all pregnancies and add the 62% who are high risk to begin with and the 29 % of the remaining low risk 38% group who ended up having complications despite their low risk designation, it adds up to 73% of the total group. 

So, according to this large study, 73% of all pregnant women can either be classified as high risk from the get go, or are low risk and going to have a complication. This 73% of all pregnant women are those that belong in the care of Obstetricians or Certified Nurse Midwives working in the hospital under the care of Obstetricians.

Here's the problem. While we can select out those in the high risk group for higher level hospital care, it is not so easy with those classified as low risk. When we consider the low risk group, who are over the third of the whole group, we know about a third of them will have complications. WE JUST DONT KNOW WHICH WOMEN THEY WILL BE. That is the problem. That is why, in my mind, all women deserve access to a high level of care in a congenial but fully equipped setting...the hospital. 

It is imperative that birth be congenial but even more critical that it be safe... 100% of the time. To achieve both does not require taking birth out of the hospital realm, instead it means transforming the hospital birth environment to be all that it needs to be.. comfortable, accommodating, beautiful, as well as fully equipped for any medical or surgical contingency. 

Here is the link to this current research: 

http://www.ajog.org/article/S0002-9378(15)00268-9/fulltext

 

 

Structure Sunday: The Structure of Grocery Shopping

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I am interested in grocery shopping since it has a great deal to do with what we eat. What we eat has a lot to do with our health. Since this is all so very important I am going to break it down into ridiculous but useful detail. The following is a primer on how to go grocery shopping. 

First reflect: 

First and foremost, think about your nutrition goals for the week. Remember that Dr. Gina wants you to consume primarily meat, fish, chicken, vegetables and fruits in three meals and three snacks every day. Review our Nutrition section if you have questions. Think about some of the awesome healthy dishes you would like to make. Include those ingredients on your list. 

Inspect, tidy and make lists: 

Be brave and look into the depths of the fridge. Find any science projects (spoiling food in containers) and get rid of them. If you consolidate things like ketchup bottles and wipe out the refrigerator shelves a little bit it will make you feel so much better. You will see that feeling better is actually important, since it will help you avoid buying things you don’t need. Look in the freezer, and all the cabinets too. Make room for the new groceries. Go to your laundry room and your bathrooms, and check and tidy there as well. After you are done inspecting and tidying, make your lists of all the things you need to buy. You can group them any way you want, either by store like I do, or by store section. Make your list on paper or on your phone. I tend to lose paper lists. 

The idea here is that with a list you will buy only what you need, and nothing that you don’t need. Sure enough, you may run into excellent and discounted produce you didn’t know was in season, and that I believe is a legitimate reason to go off list, but just any old bargain is not. 

Prepare yourself to shop: 

Research clearly shows that we often suffer from “needs confusion”. When we are tired, hungry, bored or angry, we soothe ourselves with retail therapy. Buying, like many pleasant things, produces a surge of potent neurotransmitter, not dissimilar to those felt with accomplishment or good fortune. In unpleasant states, we are more vulnerable to marketing ploys and subliminal suggestion, and we are anxious to resolve our uncomfortable state. So, I suggest that you work out, shower, dress and eat at least a healthy snack before going out to shop, hereby calling up happy neurotransmitters in more legitimate ways.  

Pack for the trip: 

Make sure and collect all your reusable and attractive shopping bags. Get rid of the ugly downer bags, my goodness. Life is too short for ugly shopping bags.

Bring healthy snacks so you will not fall prey to the samples. Bring all the equipment and healthy snacks you need to keep kids happy. This will help both kids and parents resist child-initiated impulse buying. 

When to go: 

I am a firm believer in twice per week shopping. Any more is onerous and any less results in a lack of fresh food, which is so important. I have chosen Sundays and Wednesdays since that is easiest for me. 

Where to go: 

Assuming you have already gone to your own garden, your own freezer, and your own farmer’s market first, you must then consult your list. To get exactly what I want (and I am very picky) I have to go to at least two stores. Usually one is Costco, which has more organic food all the time. The other is my local organic/natural/whole food store. 

 

Once you get there:

Understand that everything in the store environment is designed to get you to buy. This goes from the print, the colors, the displays and the music. Use your own mind. You have already decided what you need.

  • Be skeptical, stick to your list, and be a label reader.
  • Be wary of health claims on product packaging.
  • Stick to real fresh food, which is mostly located on the periphery of the store. Stay out of the middle of the store without good reason.
  • Be cautious about budget brands. They may be cheaper for market reasons, or because they use cheap fillers which are not healthful. 
  • Be cautious about coupons and sales. Do not let these cause you to buy something you don’t need or more than you can use. 

 

 

 

 

 

Enjoy yourself: 

Your nervous system is right. You have every reason to feel a thrill right down to your neurotransmitters when you pick up you a big crate of ripe strawberries. Eating is one of the great joys of life. To be able to acquire beautiful varied foods as we do is unprecedented in human history. Think about what it takes to bring us this food: all of the people and places and knowledge that come into play. It is nothing short of amazing. 

 

 

 

 

For more reading : 

 

How to Buy Food, at Bon Appetite

The Psychology of Shopping: How Grocery Stores Make Rational Shopping Nearly Impossible

Supermarket Psychology, by Weight Watchers 

Surviving the Psychology of Sneaky Supermarkets, at National Geographic 

A Few More Ways that Supermarkets Mess with Your Mind, at Business Insider 

11 Psychological Tricks of the Supermarket Trade, at Food Network

Ten Ways your Local Grocery Store Hijacks Your Brain, by Psychology Today 

 

 

 

 

Food Friday: Healthy Barbecue, Grilling, and Picnics.

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Everybody loves to play with fire, especially people who like good food and who don't want to be stuck in a hot kitchen in the summertime. 

Check out this comprehensive list of tips for barbecue, grilling and picnics and you will be the smartest flamethrower on the block. 

 

 

 

 

Grilling: 

  • 7000 people each year suffer grilling injuries. 
  • Read your grill's owner's manual. 
  • Use propane and charcoal grills outside only.
  • Use in a well ventilated area, away from combustible material and at least ten feet from a structure. 
  • Ensure the grill is stable. 
  • Do not move a hot grill. 
  • Have long handled cooking utensils.
  • Have fire extinguisher, baking soda, a bucket of sand, or water handy. 
  • For propane grills, check fittings to make sure they're tight. Check propane hose for gas leaks by applying soapy water and checking for bubbles. 
  • Never turn on a gas grill with the lid closed or you will risk explosion ! 
  • For charcoal grills, use a chimney or electric starter. Never add lighter fluid to a flame. 
  • Dispose of cool coals in a metal container. 
  • Keep younger children away from the grill. 
  • Never leave a grill unattended. 

 

Food Handling: 

  • Buy cold foods like meat and poultry last, when you are about to head for home. Bag them so liquids cannot contaminate other foods that will not be cooked. 
  • Wash hands with soap before handling food, and keep surfaces and utensils clean. 
  • Thaw in the refrigerator or the microwave NOT the counter. 
  • Keep raw food separate from cooked food. 
  • Marinate in the fridge, not on the counter. Poultry and cubed meat may marinate only 2d, other types 5 days. 
  • Trim fat to minimize hazardous flares and unhealthy charring. 
  • Consider precooking to shorten grilling times. 
  • Consider buying a food thermometer. They're inexpensive. 
  • Cook food thoroughly. 

Poultry 165 degrees

Ground red meat 160 degrees

Beef pork lamb and veal 145 degrees, and allow to rest three minutes. 

Reheat cooked meat like hot dogs to 165 degrees. 

  • Keep cold food cold and hot food hot. 
  • Don't let cooked foods sit out more than an hour if the temperature is greater than 90 degrees. 
  • Discard food left out more than 2 hours. 

 

Healthy Grilling recipes: 

Cooking Light 

Food Network

Eating Well

Fitness Magazine

Food and Wine 

Health

 

ENJOY ! 

 

References:

FDA Barbecue Basics

UDSA on food safety

National Fire Protection Safety Association 

 

Medical Monday: One step closer to a " female Viagra"

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There is no doubt that female sexual dysfunction (FSD) is a problem in need of solutions. FSD takes many forms. The drug Flibanserin, the so-called "female viagra"  is under evaluation for treating hypoactive sexual desire disorder (HSDD). It is worth taking a moment to define HSDD. 

  • "Persistent or recurrently deficient (or absent) sexual fantasies and desire for sexual activity."
  • This state must cause "marked distress and interpersonal difficulty "
  • This state must not be caused by "another...disorder, ...a substance (e.g.drugs of abuse, a medication) or a general medical condition." 

DSM IV, the Diagnostic and Statistical Manual of Mental Disorders 

When the FDA evaluates a drug, it must demonstrate both safety and efficacy. After three go rounds at approval, Flibanserin has been marginal on both counts. On June 4th, during this third round, it has passed recommended from the Bone , Reproductive and Urologic Drugs Committee to the Drugs Safety, and Risk Management Advisory Committee. 

Currently there are no drugs approved by the FDA to treat any form of female sexual dysfunction. There is a need. So it makes sense that Big Pharma  would submit some candidate drugs.

 In three different studies on Flibanserin, two primary endpoints were studied: sexual desire, and satisfying sexual endpoints (SSEs). 

Study results in summary: 

  1. SSEs increase from a baseline of 2-3 per month by 0.5-1, meaning on average, there was half to one more SSE per month when flibanserin was taken, compared to controls. 
  2. Desire increased minimally. 
  3. Distress regarding sexual dysfunction decreased minimally. 

Concerns and side effects that surfaced:

  1. hypotension (abnormally low blood pressure) 
  2. syncope (fainting) 

The FDA states that concomitant use with alcohol was especially risky: 

"Hypotension anad syncope can occur with Flibanserin alone and the risk is amplified by drug interactions and concomitant alcohol intake. " (reference) 

So...Flibanserin does not seem like an ideal solution, but may be, like many medications, one tool in the toolbox to treat a given disorder. 

Sexual function is complex and sexual dysfunction is most generally multifactorial. It may involve physical, psychological and interpersonal factors. Check with your Ob Gyn if you have challenges in this sensitive area.