women's health

Food Friday: Summer Guests

Summer should be full of guests. Where there are guests there should be great food and drink. And yet, it is important that the work of food preparation not get in the way of entertaining. Here are simple, easy ideas for summer entertaining. 

 

 

1. Give at least a week of notice, so the gathering is informal but not too informal. Be open to drop ins. 

2. Be aware of any food intolerances or limitations. Have at least three dishes everyone can eat. 

3. Incorporate the out of doors somehow. 

4. Invite guests to contribute a dish but let them know to come even if they are too busy to prepare something. You may also simply ask them to bring soda water if you suspect they are busy. It is a good idea to invite guests to bring what they are good at cooking, within the constraints of your theme. 

5. Favor foods which can be prepared in advance, especially the main dish. An example would be meatballs in a slow cooker. 

6. Favor food which are presented, more than actually prepared, i.e. fruit and vegetable platters with dips. Similarly, favor foods which are assembled by the guest, i.e. a taco or fajita bar. 

7. Serve buffet style. 

8. Have a great selection of drinks, especially in hot weather. People love a big punch bowl. We make ours with 2 parts club soda with one part 100% fruit juice such as apple raspberry juice from frozen concentrate. We cool it with ice, but also frozen berry mix. We may also float some citrus slices. The variations on this punch can be endless, and it the flavors can morph as the bowl needs refilling. 

9. Don’t be afraid to decorate a little. You can be fun, festive or sophisticated at your whim. 

10. Finally, don’t forget the most important part of entertaining: Making your guests feel welcome. 

Wellness Wednesday: Healthy Communication Skills

Communication skills are intrinsic to our wellness. They are central to our relationships and our effectiveness in life. I have distilled a list of six main steps in healthy communication. I discovered I have lots of room for improvement. Hopefully you will find something helpful too. 

1. Attitude adjust.

  • Consider your purpose in the conversation. 
  • Assume the best intentions in everyone. 
  • Stay positive - honest, patient, optimistic,  sincere. 
  • Value everyone equally. 

2. Check physical factors.

  • Put away distractions like phones. 
  • Make comfortable eye contact.
  • Watch your body language.  
  • Watch your tone. 

3. Listen actively.

  • Listen first.
  • Ask open ended questions.
  • Set aside judgement while listening. 
  • Listen actively -  Don’t interrupt; read back, aka clarify and reflect. 

4. Guide your reaction. 

  • Use empathy; Try to see the other person’s point of view.
  • Practice self awareness -recognize emotions and stresses as they arise and rather than react to them, handle them appropriately. 

5. Say your piece. 

  • Pause and ponder. Think before making a point.
  • Understand how your message might be received.
  • Tailor your message to your listener.
  • Use empathetic assertiveness. 
  • State needs, express feelings; Value your own point of view as well. 
  • Be direct; Be BRIEF - Give the "b"ackround, "r"eason,"i"nformation, "e"nd, and "f"ollow-up.

6. Connect and conclude. 

  • Connect personally.
  • Encourage the other.
  • Focus on the result.
  • Ask for input and feedback. 
  • Follow up with a plan. Close the loop. 
  • Show appreciation for the person and the conversation.  

 

Awesome references that expand on these tips: 

http://lifehacker.com/top-10-ways-to-improve-your-communication-skills-1590488550

http://www.lifehack.org/articles/communication/9-tips-to-improve-communication-skills.html

http://www.wikihow.com/Develop-Good-Communication-Skills

http://www.skillsyouneed.com/ips/improving-communication.html

http://www.skillsyouneed.com/general/emotional-intelligence.html

http://www.skillsyouneed.com/ips/improving-communication.html

http://www.inc.com/kevin-daum/8-ways-to-improve-your-communication-right-now.html

http://www.citehr.com/11334-6-good-tips-increase-your-communication-skills.html

http://advancedlifeskills.com/blog/14-very-effective-communication-skills/

http://www.wfm.noaa.gov/workplace/Comp_Conf_Handout_1.pdf

http://www.helpguide.org/articles/relationships/effective-communication.htm

Structure Sunday: What I do to stay healthy

I am 53 and I have lupus. But I am pretty darn healthy, thank goodness. People often ask me what I do to stay healthy. It's really no mystery. So today's structure Sunday is about the structure of my week. 

Sunday- the beginning of my week

  • Breakfast with family
  • Team clean - ( Housecleaning) especially laundry
  • Clean desk, pay bills ( which I have recently mostly automated yay ! ) a big stress reducer
  • Grocery shopping 
  • small scale recreation 
  • longer workout 
  • family dinner 
  • Prep for the workday per usual routine- down to packing lunch and snacks, and picking morning outfit ! ( a stress reducer and time saver ) 

 

Monday -workday

  • The usual routine of am protein drink, midmorning snack, second breakfast, lunch and midafternoon snack. Daytime intake must include one large glass of water, one large bowl of ground green tea, and one small cup of kefir, a probiotic.
  • pm- break from workout 
  • family dinner per usual routine 

Tuesday- workday 

  • usual routine 
  • longer workout 

Wednesday - surgery and chores

  • grocery shopping 
  • shorter workout 
  • entertain if possible 

Thursday workday 

  • longer workout 

Friday - workday 

  • shorter workout 
  • special family dinner
  • evening outing 

Saturday - 

  • family breakfast 
  • longer workout 
  • larger scale recreation 
  • entertain 

 

Everyone thrives on routine, from adults to children.  It gives your system signals of peace and plenty. With a reasonable routine, stress hormones decrease and everything from thinking to healing improves. 

You can also use routine help with taking medications and supplements, and to regulate your sleep schedule. If you are having a tough time meeting your health goals, just build a routine. Routine can make hard things easy. 

People say they do not have the willpower to eat well and exercise regularly. Here's the newsflash: It's not so much a matter of willpower as it is engineering. You simply schedule your healthy habits and stick to the schedule, no questions asked. 

Food Friday: Fast Food

Woman pouring smoothie looking.jpg

I am loathe to miss a meal and can hardly tolerate missing a snack. My patients know they aren't supposed to either. Metabolism, energy, a bright outlook, ability to exercise, blood sugar control, weight management and sharp thinking all depend on it. So often my patients say they don't have time to eat, especially breakfast. These are the same folks who are struggling with their weight. So instead of repeating this point, I am going to give you my down to earth, personal go to suggestions when you really have next to no time to make and eat food. 

First, however you have to shop correctly. Remember super basic is key, and one real cooking episode is needed: dinner. Most people don't struggle with dinner. Cook extra at dinner so you will have leftover protein rich foods and cooked vegetables. 

Here is my basic grocery shopping list for fast food, by section.

Freezer: 

  • Lean meat, chicken, turkey, fish, shredded cheese
  • frozen fruits for smoothies: mixed berry, mango, blueberry etc 

Fridge: 

  • Milk, cottage cheese, plain yogurt, sour cream, cheese, kefir, eggs
  • salsa, condiments like pickles 
  • whole grain low carb wraps
  • nuts like walnuts and almonds 
  • healthy broth mix 

 

Pantry: 

  • whole grain bread, corn tortilla chips, oat bran cereal, healthy cold cereal like muesli 
  • canned salmon, canned tomato products, sauce and stewed
  • your favorite complete protein powder
  • dried fruits like craisins 
  • oils - olive and canola 

Produce: 

  • cooking greens like chard, kale and spinach
  • Salad greens like spinach and lettuces 
  • cucumbers, tomatoes, broccoli, green beans, zucchini, carrots, colored peppers, avocados
  • Strawberries, watermelon 
  • apples, bananas, oranges  
  • red and green grapes 
  • stone fruits in season 

 

"Recipes"

 

Breakfast : 

  • bowl of cottage cheese or plain yogurt with any fresh or frozen fruit. optional : nuts, craisins
  • healthy cold or hot cereal with dollop of yogurt, and some fruit
  • chopped fresh or leftover veggies with a couple scrambled eggs with or without cheese. Dress with salsa, sour cream or avocado. 
  • wrap with leftovers 
  • 2 cups milk with protein powder 

Snacks: 

  • hardboiled egg, cheese, dairy, fish chicken or meat with fruit or veggies like carrot sticks

Lunch: 

  • Salad greens with  hardboiled egg, cheese, dairy, fish chicken or meat. Try mixing canned salmon with mayo olives and pickles for a great spread. On a cold day, make soup with broth and leftovers. Make it the blender to speed up the process. 

Dinner: 

  • Main protein rich dish, green salad, cooked vegetable and fruit for dessert. Cook extra for wraps later.

Note:

  • A hefty blended smoothy with yogurt and protein powder, fruit and even vegetables can substitute for any meal. 

 

Give some of these fast foods a try. Bon appetite. 

 

 

 

Wellness Wednesday: Curing Procrastination

Is procrastination an illness ? No. But it can affect your health. Let’s take a look at what it is, why it happens, and how to cure it. 

What is procrastination? 

Procrastination is putting off things that need to be done. How big is the problem ? About 20 % of people are chronic procrastinators and these percentages increase significantly during college. People who are chronic procrastinators perform more poorly in their family, in high school, in college, in jobs, and in relationships. This sounds like an unfortunate nuisance, but it is actually a health problem. According to many sources, procrastination creates stress which interferes with sleep, weakens the immune system and makes heart disease more likely. It is also very hard on mental health. 

To understand why procrastination happens, we have to look deeply into issues like self control, self image, inner honesty, fear of failure and distress tolerance. 

1. Procrastination may start as a form of silent rebellion against parents. This becomes a vicious cycle as adolescents avoid parents in favor of friends, who do not hold them accountable as parents would. 

2. Certain necessary tasks or even the idea of the tasks make people uncomfortable (distressed) , either because they dislike doing them or they are perceived as difficult or overwhelming. Those who cope with their feeling of dread or discomfort (distress) by avoidance may procrastinate, only making matters worse. Those who have poor coping skills or distress tolerance are likely to do other dysfunctional things to cope with life’s daily challenges and discomforts, such as abuse substances. 

3. When people do not want to risk failure, they will subconsciously "arrange" to have insufficient time for a task, thereby providing themselves with a ready excuse for their suboptimal performance.

4. Procrastination is self sabotage. People procrastinate to fail in order to show others they have been mistreated, to “get back at them” or to acquire victim status. ( This is, by the way, passive aggressive behavior.) 

5. Some people who procrastinate simply want others to pull up the slack in whatever it is that needs doing. 

6. Some people who really want to succeed procrastinate. They deceive themselves about several things: 

  •      They will be more motivated tomorrow.
  •      They have plenty of time left. 
  •      Their task will not be that challenging nor take that much time. 
  •      They will do better when they are feeing more motivated or inspired. 
  •      They think they do better under pressure. 
  •      They are talented enough to pull it off. 

     These are white lies we tell ourselves. 

 

What can be done about procrastination ? 

 

1. Procrastination is hard to overcome but it requires honesty with oneself and usually firm persistent guidance from others. 

2. Strong feelings of interpersonal conflict should be evaluated by a qualified counselor. 

3. Problems with procrastination in the setting of substance abuse should also be evaluated by a qualified counselor. 

4. Simple methods to beat procrastination are as follows: 

  •      Fortify your will power and your distress tolerance with adequate sleep, healthy meals, snacks and regular exercise.      
  •      Become a list maker. Get a system which is either digital, paper or both and include reminders such as sticky notes or alarms. 
  •      Use SMART goals criteria for your list items. See more about SMART goals HERE. Nutshell version: SMART goals are specific,measurable,attainable, relevant and time-bound.
  •      Overestimate the time it will take you to get something done. 
  •      Ditch perfection as a goal. It gets in the way of progress and accomplishment. 
  •      Divide large tasks into a series of small manageable tasks. 
  •      Practice mental “ time travel” to see how you will really feel tomorrow. 

5. All of this requires self regulation. Practicing self regulation with small tasks has been proven to improve self regulation with big tasks. 

  •      Realize that self regulation is critical to healthy relationships and success in life. That should be plenty of motivation. 
  •      Pick several easy small tasks, and stick to them. Larger tasks WILL get easier as a result. 
  •       Yoga or meditation is especially good training for the nervous system where self regulation is concerned. 
  •      Be easy on yourself for lapses. 
  •      Pat yourself on the back for all successes. 

   

References: 

 

Cal Poly’s Procrastination PDF - WOW amazing document ! http://sas.calpoly.edu/asc/ssl/procrastination.html

Psychology Today: 

https://www.psychologytoday.com/blog/dont-delay/200903/self-regulation-failure-part-4-8-tips-strengthen-willpower

https://www.psychologytoday.com/articles/200308/procrastination-ten-things-know

https://www.psychologytoday.com/articles/200909/ending-procrastination-right-now

https://www.psychologytoday.com/articles/201109/procrastination-oops-where-did-the-day-go

https://www.psychologytoday.com/articles/200308/procrastination-ten-things-know

 

Mindtools: 

http://www.mindtools.com/pages/article/newHTE_96.htm

 

The Procrastination DOOM LOOP 

http://www.theatlantic.com/business/archive/2014/08/the-procrastination-loop-and-how-to-break-it/379142/

 

Procrastination and the great Stanford Marshmallow experiment 

http://youarenotsosmart.com/2010/10/27/procrastination/

 

University of Cambridge 

http://www.counselling.cam.ac.uk/selfhelp/leaflets/procrastination

 

Princeton

http://www.princeton.edu/mcgraw/library/for-students/avoiding-procrastination/procrastination.pdf

 

Procrastination and Your Heart

http://nymag.com/scienceofus/2015/03/procrastination-is-not-great-for-your-heart.html

 

 

 

 

Medical Monday: ACOG weekly news

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 ! 

 


Food Friday: Food Joy and Fat ?

Food joy. Does all this enthusiasm about food contribute to the obesity epidemic ? Consider everything hot now in food : food magazines, the food channel, food trucks, street food, farmer's markets and local food ! Vegan, Paleo, Pegan, organic. 

I say a resounding NO. All this food joy is a great step in the right direction. It does not contribute to the obesity epidemic. I have no data here. I only have 30 years in medicine, most of which is focused on women’s health. 

Those with poor nutrition and problems with obesity are most often those who have not discovered the joys of food. Many times they are those that eat whatever food they can get. This ends up being the stereotypical top ramen, soda pop and boxed mac and cheese, or the iconic white bread. I remember unkind comments from adults I knew as I was growing up, as they wondered how people with so little money could get so much food to get so big. This reflects a profound misunderstanding of nutrition poverty and obesity.

Many times overweight people do not eat very much. They have little and eat little. What they do have is cheap carbohydrate, and they need to eat it as their whole meal since protein sources and fruits and vegetables are or are perceived as less available. Because of this diet, these folks suffer from chronically low metabolism and have low energy. They therefore become less active. Their extra weight compounds their insulin resistance, which results in more fat deposition. It is very hard to get out of this vicious cycle.

Many times I see young women in this predicament while they are pregnant. In this instance they have access to better resources such as food stamps as well as nutrition teaching. I have found that they are as eager and able as anyone else to learn. Once they do learn about the correct composition of meals, as well as the correct timing and quantity, they are astounded about several things. First, they are astounded about how much they enjoy their new diet. The are almost universally shocked at what large quantities they are supposed to eat. And, given this, they are amazed that their pregnancy weight gain levels out appropriately. Finally, they begin to enjoy food preparation, but note that it is a time commitment that they did not have before.

Some have odd reactions from significant others, and find themselves isolated. The partners may not want to change the way they eat. Sometimes partners even make fun of the one trying to be healthy and tease or taunt them back down to their level of poor nutrition. 

Most of the time this change toward nutrition awareness, and eventually toward food joy, is life altering. They never want to go back. Sometimes it becomes a source of pride and accomplishment in the family, and mealtimes become social in a way that they had not been. 

To me, the final stage of food joy is the social and cultural aspect. I took a walk down my own Main Street. I was amazed at what our little town had to offer. We had artisanal breads, real sushi, Thai food, genuine French macarons, and handmade watermelon chili sorbet all on one block. Granted, most of these delicacies were treats. But they were foods that made people appreciate food, other people, and other places. I saw people clustered in cafes, and out on the sidewalls. I saw people working on laptops, socializing, and flirting, all the while over special foods and drinks. They all seemed rather vibrant. 

It appears that people who take the time to walk about to find beautiful food like this are not apt to “ waste” their calories or carbs on junk. They become conoisseurs who are interested in the best for themselves. 

It is always a step in the right direction when people start to focus on quality, in nutrition, food, or even cuisine. When people focus on quality in one dimension of their lives, it tends to spread to others. My favorite part of this whole process is watching patients start to embody quality and enthusiastically take good care of themselves. 

 

Wellness Wednesday: Exercise Statistics

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

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. 

 



Structure Sunday: The Structure of Your Home Office

Today's women have to do it all. Homemakers and professionals alike need a home office to do all that they need to do. Here are my tips for what goes into a home office, and what should take place there. 

I have also included some great resources about home offices. 

 

Three setups tailored to your budget:

The Essentials:

  • A place to write and store your life management things. 
  • Day runner with addresses, calendar, and notes or smartphone with same features. 
  • Backup for your smartphone if you have one. ( ? cloud) 
  • Writing implements, pens, pencils, highlighters, markers 
  • Spiral notebook to centralize and keep notes ( instead of sticky notes everywhere)
  • A few sticky notes even so 
  • Filing box and files 

Nice to have: 

  • Laptop with internet access 
  • Software 
  • Spreadsheet like Excel for Windows or Numbers for Apple  
  • Word processor like Word for Window
  • Photo storage and processing software. 
  • Bulletin or marker board for ideas, art and planning 
  • Bookshelves 
  • File cabinet 
  • A decent camera

Deluxe: 

  • Printer/fax/scanner
  • Nice speakers
  • Nice headphones 
  • IOS device like ipad 
  • an extra monitor 
  • A good camera

 

Ideas for your home office schedule

 

At the beginning of your day...

  • Leave your home office alone. Get your health related things done first, like working out, bathing, and eating a healthy breakfast. 

 

 In your home office work time… 

  • Check your email twice per day. Don’t do it reflexively. 
  • Leave social media closed until tasks are finished. 
  • Add every new contact into your address book AS THEY COME IN.
  • Keep a spread sheet of your budget. 
  • Use accounting software like Mint, which is free, ibank, which is cheap, or Quicken, to keep your bank, loan and credit card accounts in order. 
  • Set up bills to pay automatically or put reminder notices in your calendar program. 
  • Store your photos digitally, and backup those and your other documents two ways, the cloud, and a cheap external hard drive. 
  • Work on your projects in sessions about 45-90 minutes long. Then get up and stretch and drink some fluids. 
  • Develop a system of file keeping. You may like Evernote which is free. You can organize anything into albums. In side the albums are notes where you can put text, documents, picture, sound, movies, links, or anything. 

 

At the end of the day

  • Review your calendar and plans for the next day. 
  • Chart any nutrition or fitness data that you are working with on a daily basis. Make sure the method is simple and fast. 

At the end of the week

  • Review your calendar and plans for the next week. 

 

Home offices can be a lot of fun. They are ground zero for domestic creativity. Think recipes, projects with kids, projects for the house, tracking that workout and budgeting for that vacation. Knowledge is power and organization will put it to work. 

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Food Friday: Healthy Substitutions

Eating well is not about dieting or deprivation. It is about understanding food and physiology. It is also about taking a little extra time to obtain and prepare great tasting and healthy food. Some people worry about all the things they would have to give up to eat healthfully. But I’d rather think about all the substitutions that both taste better and are better for you. 

Here are some specific examples to make this easier: 

Drinks: 

  • Instead of cheap caffeinated coffee, use water process decaf made strong in a french press. Or, for lower cost, try decaf Earl Grey tea. 
  • Instead of sugary or artificially sweetened soda, use club soda, plain Pellegrino or Perrier with a light splash of pure fruit juice and citrus wedges. 
  • Instead of a milkshake, have a smoothie with real fruits, plain yogurt, and ice. 

 

Snacks: 

  • Instead of forgetting snacks for work, bring a week’s worth on Mondays. Include easy things, like raw nuts, cheese, and long lasting vegetables. 
  • Ditch the granola bars in favor of sweets like fruits with plain yogurt or cheese. 
  • Steer clear of office sweets by having your own vegetables, dips and nuts. 


Breakfasts: 

  • Instead of an Egg McMuffin, saute mixed veggies like peppers, onion and tomato then cook with a couple eggs and a little cheese. 
  • Instead of a sugary cereal, have a low sugar whole grain high fiber cereal with skim milk and piled with fresh berries or even slivered almond. 
  • Instead of no breakfast have the very quick banana and a glass of milk. 


Lunches: 

  • Have a breadless sandwich. We call it a salad with meat. 
  • Keep things like salad dressing at work so your lunch salads are more appealing. 
  • Watch cafeteria soup… it is full of fillers like starch and sugar. Make a big batch from scratch and bring it all week long.


Dinners: 

  • Instead of main dish, salad and starch, have main dish, salad and cooked vegetable. 
  • Instead of pasta or rice, have Zoodles, meaning noodles made from vegetables such as zucchini. 
  • Broil, grill or bake rather than fry. These methods require less tending and cleanup anyway. 

 

Desserts: 

  • Make a crustless or nut crust pie and reduce the sugar. 
  • Have plain yogurt or cheese with fruit for dinner. 
  • Make a conventional dessert but halve the portion size and make it beautiful. 

 

To learn more about the principles behind these modifications, see the following sections on our website: 

Wellness Wednesday: Beyond Relaxation to Renewal 

Most of us are familiar with the recommendation to relax on a regular basis. We are all familiar with the ravages of stress and the problems associated with insufficient sleep. We generally think of relaxation as the antidote. To most people this means to physically rest or sleep , and to be quiet and still. There is no doubt that some of this kind of time is good on a daily basis, especially if it is done in a mindful fashion such as in meditation.

But sometimes we need more than relaxation. We need renewal. Renewal goes beyond relaxation. It is similar to relaxation in that it is a break from the usual work routine. However, after that, the similarities end. Renewal is more planned. It may involve physical activity, such as exercise, or an outdoor adventure. It may even involve a challenge. It often involves other people, especially people who are new to you. It involves unfamiliarity, learning and even getting outside of one’s comfort zone. 

Productivity experts are extolling such “ strategic renewal” as the newest productivity tool in the success toolbox. This concept can be utilized on different time schedules: daily, weekly , monthly, quarterly. 

Daily Renewals 

  • exercise 
  • meditation 
  • reading 
  • connect with close family and friends 

Weekend Renewals: 

  • connect with farther flung family and friends, socialize and entertain
  • patronizing the arts 
  • sports 
  • spiritual observance
  • volunteer
  • outdoors 
  • reading 
  • exercise 
  • creative pursuits outside of work 

Monthly or Quarterly renewal: 

  • adventures 
  • conferences 
  • different kinds of work projects 
  • travel

See to the basics first: adequate sleep, regular exercise, and good nutrition. Ensure some relaxation on a daily basis. But go beyond all this and try to start thinking about renewal as well. 

To learn more :

See our sections on Sleep Yoga and Meditation 

LIfehacker

Huffington Post 

New York Times 

Stanford University Cafe Science

What Most Successful People Do On the Weekend, by Lauren Vanderkam 


Food Friday: Drink !

I am absolutely compelled to write again about hydration in this, our week of three digit temperatures. I had one reasonable and well intentioned patient who came in with symptoms and was FIVE LITERS short on her hydration ! 

Let us review. Normally, a non pregnant woman needs 2 liters of fluid per day. A pregnant woman needs three. Add another liter for temperatures over 85 degrees, and yet another liter for activity such as hiking. So if you are pregnant and hiking on a hot day, your fluid requirement is easily 5 liters, and that is assuming you are coming to the day adequately hydrated in the first place. 

The human body is about 60 % water. Let's say you weigh 154#. That means you weigh 70 kg. That means you contain 42 kg of liquid or 4.2 liters. Getting short on fluid percentage wise is easier than you think. 

How can you lose so much fluid ? Well there are the obvious ways, but then there is also respiration, sweat, and something short of sweat which is still fluid loss through your skin called insensible loss. It all adds up. Heat and activity increase insensible losses like crazy. 

Here is the interesting stuff: 

" ...fluid loss of 1% impairs thermoregulation (the ability to regulate your temperature), and thirst occurs at this level of dehydration......Vague discomfort and lack of appetite appear at 2 % . Dry mouth appears at 3%. At 4% work capacity is decreased. Difficulty concentrating, headache, and sleepiness are observed at 5%. Tingling and numbness of extremities can be seen at 6%, and collapse can occur at 7% dehydration. " ( reference from the World Health organization

Here is the fun stuff: 

Summer is a great time for cold drinks. Try to take the traditional summer cooler and put a healthy spin on it. Here are some examples that will provide you with much needed electrolytes as well as fluid and taste. 

  • Club soda with a splash of 100% fruit juice. 
  • Mocktails like Virgin Mary, Virgin Daquiris
  • Herbal iced tea or sun tea on ice with lemon and mint leaves, sweetened with a little fruit juice 
  • Healthy fruit frappes made with fresh fruit, ice, and plain yogurt or kefir. 
  • Decaf mocha frappes made with ice, one pump of chocolate, and your milk of choice. 
  • Stay hydrated and enjoy ! 

For more information see : 

Drinks in Nutrition 

Weathering the Heat 




Wellness Wednesday: Bathing

Did you know the in the Middle Ages, bathing was considered unhealthy? Indeed, they were not called the Dark Ages for nothing. 

Bathing has had a long history, dating back to ancient India, where it was done more than once per day for ritual reasons.  Elsewhere in the ancient world, Greece developed the ritual of bathing into a way of life, where it was integrated with the tradition of athletics and the life of the the gymnasium. Roman baths are famous as a social institution, where gossip and politics took place amidst the steam and the towels. Later as Christianity took hold, public baths went out of favor as being immoral, since they were associated with debauchery and hedonism. Bathing itself fell out of favor during the time of the plagues, as Medieval physicians felt it opened the pores and let in disease. Farther north, the Nordic people maintained a tradition of saunas, and unlike the other public bathing environments around the world, theirs bore no association with immorality or disease. 

During these dark times others kept the practice of bathing alive. European explorers marveled at the cleanliness of the Mesoamerican people. Across the sea, Japan had a rich bathing culture, using rock pools, furnace baths, and heated rocks with seawater to make steam. In later years the Japanese would refine the art of the public and the private bath, requiring separate cleansing beforehand, then a clean soak to establish tranquility before family dinner time. 

Today we use baths for cleanliness, relaxation and therapy. It is a simple intervention with pleasant results. With only a few precautions, baths are a great strategy. The precautions are these: 

Pregnant women in the first trimester should not take hot baths. This is because there is an association between elevation of core body temperature with failure of the neural tube to close, and conditions like spina bifida. 

No bath should be very hot, since this increases risk of heart attack and fainting in the susceptible. Very hot baths also dry the skin and can precipitate headaches. 

Bathing in warm plain water is best. However a tiny bit of scented essential oil or salt may be used. Bubble baths are hard on our tissues as is the use of soap, which should be restricted to the shower only for truly dirty or greasy skin, and never the perineum. The face should be cleansed twice a day with cleanser, not soap, and should be moisturized before fully dry. 

Enjoy bathing as a stress reliever. As Sylvia Path once said, 

"There must be quite a few things that a hot bath won't cure, but I don't know many of them."

 

References: 

http://www.history.org/foundation/journal/autumn00/bathe.cfm

http://www.brainyquote.com/quotes/quotes/s/sylviaplat107968.html

https://www.aad.org/dermatology-a-to-z/for-kids/about-skin/taking-care-of-your-skin/washing

 

Medical Monday: Dramatic Results with Long Acting Birth Control

Did you know that fully half of all pregnancies are unplanned?  Something pretty dramatic would have to happen to slash the rate of abortions and the rate of unplanned pregnancies, right? Actually not.

Hot off the press:

Researchers at Children's Hospital Colorado, through a grant from the Susan Thompson Buffet Foundation, devised a study to see the effect of freely providing long acting reversible contraceptives (LARCS) to teens and women who could not afford them. They did this over a 6 year period. The birth rate for teenagers fell 40% percent! The rate of abortions in that group fell by 42% as well. The pregnancy rate for unmarried women under 25 fell similarly. 

What are LARCs? They are the subdermal (under the skin) implants like Nexplanon, or the IUDs (intrauterine devices) such as Skyla, Mirena and Paraguard. These are well established, well understood devices which have excellent safety profiles. For more information, check our section HERE

These LARCs are fairly expensive. This study showed the effects of eliminating expense as a factor. Interestingly, for every dollar of cost of the contraceptive, nearly $6 was saved in Colorado's Medicaid program.

Perhaps more importantly, there are as yet, unmeasured consequences. We know from global data that there is an inverse relationship between education and number of children. We know that women who have children early may postpone or forego their education. We also know that women who are educated have better access to contraception and choose to delay childbearing. Not surprisingly, as a women's number of children rises, her financial dependence increases. On a population basis, as numbers of children rise, so do income disparities between men and women. Finally, as number of children rise, standard of living goes down and rates of poverty go up. It will be interesting to see whether, in Colorado, rates of educational attainment and income go up among young women in this cohort. 

To learn more: 

http://www.nytimes.com/2014/10/02/science/teenage-pregnancy-and-abortion-rates-plummet-with-long-acting-female-contraception-study-says.html

http://www.nejm.org/doi/full/10.1056/NEJMoa1400506

http://www.brookings.edu/research/reports2/2014/09/generation-unbound

Wellness Wednesday: Music and Health

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. 

 

 

Medical Monday: Insulin resistance

This is one of those chicken and egg things. It turns out that being insulin resistant makes you gain body fat. But, it also turns out that gaining body fat makes you more insulin resistant. What a vicious cycle! No wonder it is hard for people to lose weight. 

Recall that insulin is the hormone produced by the pancreas which is responsible for getting glucose from the circulation and into the cells, where it can be used for energy.

Recall that glucose is the final breakdown product of all carbohydrates (carbs) like bread, rice, pasta, potatoes, etc. If too much glucose is in the circulation, either because too much has been consumed at once, or because the insulin cannot move the glucose into the cell or both, high levels of glucose in the blood stream get turned into triglycerides and fat. Atherosclerotic plaques can form in the vessels and cardiovascular disease results. This is part of what we call metabolic syndrome

In a normal person, insulin rises in response to a meal and diminishes in-between. Moreover, it rises in proportion to need. Insulin would spike if you drank a coke, but just gently ebb if you ate some strawberries. Why? Because the sugar of coke just jets into your bloodstream, unnaturally rapidly. Your body cannot cope with it. A strawberry has structure and the sugar and nutrients release slowly. Said another way, the glycemic index of coke is high, and that of a strawberry is relatively low. 

I recommend that my patients eat low glycemic all the time. What about treats? When a person eats low glycemic consistently, their ambient insulin levels decrease. Insulin levels are related to cravings, and their cravings diminish. A "treat" will bring the cravings back, since it may cause insulin levels to spike. If you think you can have an occasional treat and then resume your healthy low glycemic diet and resist cravings, more power to you. 

How do you turn this vicious cycle into a virtuous cycle? First visit with your doctor if you have diabetes, the condition which is the mother of all insulin resistance. Visit with her if you have been told you have polycystic ovary syndrome. This also entails some degree of insulin resistance. 

Second, learn about how to keep your blood sugar low and steady, with three meals and three snacks every day. Add protein each time to buffer your carbohydrates. Add exercise everyday to boost your muscle mass, burn fat, increase your insulin SENSITIVITY and increase your metabolism. 

Here's the flip side of the coin: If you lose fat, you will become more insulin sensitive. And, if you become more insulin sensitive, you will make it easier to lose weight! 

To learn more, check our sections on 

NUTRITION 

CHRONIC ESTROGENIZED ANOVULATION

For more reading check THIS out from Live Science. 

 

Structure Sunday: The Structure of Our Practice

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. 

Food Friday: Picnics

Did you know that picnics were once only for the very wealthy? Picnics evolved from outdoor hunting parties in the 14th century in Europe. Such elegant outdoor meals were depicted in artworks and tapestries dating back to the Middle Ages. Picnics themselves became entertainment for the wealthy from the Middle Ages, through the Renaissance, and then into the Victorian era. They epitomized the virtues of the wealthy classes, which extolled sport, social life, the beauty of nature, and elegance. In the Victorian era, picnics became especially popular and extended to the emerging middle classes. 

The Oxford English dictionary defines picnics thus: “Originally, a fashionable social entertainment in which each person contributed a share of the provisions; now a pleasure party including an excursion to some spot in the country where all partake of a repast out of doors; the participants may bring with them individually the viands and means of entertainment, or the whole may be provided by some one who “gives the picnic”. 

Today, picnics are far more casual, though they still retain the aspect of having a festive meal outdoors. In our country, we tend to have picnics primarily in the summer. This poses some risk, since in summer temperatures, food borne illness is more common. Here are some tips to avoid problems: 

Pack safely: 

  • Include materials to clean hands, with soap and water, sanitizer or wipes. 
  • Pack ice, clean utensils, plates, leftover containers, paper towels and trash bags. 
  • Pack cool food with ice packs to stay below 40 degrees. Open infrequently. Pack drinks in a separate cold cooler, since this drink cooler will be opened frequently. 
  • Carry coolers in an air conditioned car, not the trunk. 
  • If hot food is precooked, do not delay before finishing cooking on the grill. Any time lapse in-between is an invitation for bacterial growth. 
  • Cook hamburger and other meats to 160 degrees, and chicken to 165 degrees. 
  • Prevent cross contamination with drippings or marinades. 
  • Do not reuse marinades. 
  • Don’t serve on your prep platter.
  • Discard food if left out more than an hour at 90 degrees. 

Pack creatively: 

Consider some alternatives to traditional cuisine. 

Classic American picnic foods, as for Fourth of July 

  • fried chicken
  • hot dogs
  • macaroni, egg or potato salad
  • corn on the cob
  • iced tea, lemonade
  • apple pie 

French picnic foods, as for Bastille Day 

  • Baguettes and baguette sandwiches
  • pate foie de gras or tapenade 
  • Salade Nicoise 
  • Perrier Sparkling water 
  • macarons
  • mousse or pots de creme

Italian picnic food: 

  • salads: pasta, caprese, arugula
  • bruschetta with toast
  • limoncello soda 
  • layered torta or pizza 
  • salami, ricotta, fresh fruit 

Swedish picnic food for Midsummer celebration:

  • grilled marinated lamb
  • Gravlax
  • pickled herring with sauces 
  • seeded crispbread
  • cheesecake with berries 

 

If you don’t recognize the dishes, google them or search on Pinterest. You have some pleasant culinary surprises in store for you. 

 

References: 

Chow.com

Food Timeline 

Pamphlet: Pack a Family Picnic

Foodsafety.gov

Home Food Safety 

FDA

 

Wellness Wednesday: Generativity 101

I must have missed a day during my Psychology rotation. If I could have planned it, I would have missed the part about Freud and psychoanalysis. Give me a social or a cognitive psychologist any day and I will be much happier. These types of psychologists study the development of personality and cognition, or the thinking process throughout the lifetime. One of the great social psychologists, Erick Erickson, viewed our lifespan as occurring in stages, eight to be precise. They are depicted in the graphic taken from the pages of simplepsychology.org. ( See reference below.) 

I am writing tonight to introduce a new concept: generativity. It is the eighth stage in Erickson’s concept, and this seems to indicate it pertains only to people who are middle aged. I think it pertains to all adults, young or old, and maybe even certain adolescents. In a prior post I highlighted the evidence behind the importance of creativity to health. In this post I would like to highlight the importance of generativity to health and wellness.

Generativity is a term created by Professor Erickson to denote "a concern for establishing and guiding the next-generation." It has to do with creating something beneficial for those who come after you. It has to do with making the world a better place. In both Japanese and western culture it has to do with making your mark. Steve Jobs famously use the phrase "put a dent in the world". 

I have a hard time seeing that this kind of altruism is restricted to middle-aged people. The literature says that this personality trait does not have to be there initially to manifest itself later in life. But what if we were to hold it up as a desirable value? What if we were to make it trendy? Would more people embrace it and do so sooner in life? In Jewish thinking there is a phrase which I think relates to this. It is “Tikkun Olam”. This means to repair the world. It is something we are taught from early on.  It is one of the highest Jewish values.

In the field of psychology, there is actually a scale to measure generativity in a person. It is called the Loyola Generativity Scale or LGS. It is a point system in which the subject answers the following six questions:

  1. I tried to pass along knowledge I gained through my experiences.
  2. I have made and created things that have had an impact on other people.
  3. I have important skills that I try to teach others.
  4. If I were unable to have children of my own, I would adopt children.
  5. I have have a responsibility to improve the neighborhood in which I live.
  6. I feel that my contributions will exist after I die.

You get a zero if the statement does not apply to you, a 1 if it sometimes applies, 2 if the statement often applies, and 3 if  the statement always applies. The higher the score, the more generative you are. And not surprisingly, the happier you are. There is real research that indicates that a high score on the Loyola Generativity Scale is positively associated with life satisfaction.

Generativity is a new term for me. However it is an old and very useful concept. I am writing today to do my part to put it a little more on the map, and to encourage a conversation.

 

References:

What's generativity and why it's good for you at HuffingtonPost

Kristensargsyan’s Blog

Simplepsychology.org

Foley Center for the Study of Lives at Northwestern University

Psychology.about.com

Generativity in the Young, Midlife, and Older Adults. McAdams, et alia. Psychol Aging 1993;8(2):221-230.