Medical Monday: Breaking News from the World of Ob/Gyn

2016 brings in some good news for women’s health. Physicians are starting to weigh in on the new over the counter contraceptives available in Oregon and California, and they are overwhelmingly applauding it. 

A recent article in the Los Angeles Times also indicates physicians are also weighing in on the controversy on mammogram frequency recommendations, and many support annual screening from the age of 40. This view is supported by the American College of Obstetricians and Gynecologists, the American College of Radiology and the National Comprehensive Cancer Care Network. 

The National Public Radio Health Blog Shots has indication that 2015 was the year “ menstruation came out of the closet. They cite the care of Kiran Gandhi who finished the New York Marathon on her period,without pads, drawing publicity to the idea that #PeriodsAreNotAnInsult. They cite other instances where menstruation entered polite public conversation, thereby beginning to erode long held taboos. 

The FDA now classifies mesh for prolapse as a "high risk device". Given the complication rates, I think this is a good thing. Also good is that the FDA excluded mesh for incontinence which is a different device entirely and works rather well, without the same high complication rate. 

You may hear of a retrospective observational study has picked up an association between the use of oral fluconazole (Diflucan) in the first 6 months of pregnancy with a 50% increased risk of miscarriage. From this data, it is not at all possible to say whether the diflucan is causing these miscarriages. Think about it…. maybe it is the yeast itself, or a diet high in sugar. More study is needed to figure this out. 

A new blood test may help physicians sort out those at risk for preeclampsia. This is most welcome since it is sometimes difficult to discern preeclampsia from chronic hypertension. 

Finally, in some really fantastic news, the Journal of the American Medical Association (JAMA) has published research indicating that even “ older women” i.e. 69 or older, who get regular mammograms have a lower likelihood of dying from breast cancer during the ages of 75-84 compared to their counterparts who did not get regular mammograms. Currently we are permitted to stop screening around 70 and the US Preventive Services Task Force says mammograms should not be done after 75. This has to do with supposedly having an expectation of living less that another ten years. You know, something tells me this whole line of thinking is going to evolve as women live longer and more vital lives. I wonder what Betty White, Angela Lansbury, Sandra O’Connor, Ruth Bader Ginsburg or Dame Maggie Smith would have to say about all this. 

Food Friday: Staple Pantry Goods

As promised, here are my lists of staples for the pantry. You will notice that not everything here is a superfood. That is because there are special occasions like birthdays which require treats. Not only are these events important for family and social life, but it is important to learn how to use restraint and have a small single portion of an indulgent treat made after a healthy meal. Bon appetite ! 

Grains

• Cornmeal for Polenta
• Quinoa
• Oats for baking and hot cereal

Rices

• short or long grain brown ( preferably basmati)
• wild rice
• black forbidden rice
• sushi rice

Pasta

• whole grain and gluten free pasta, i.e. spaghetti or penne
• Oils and fats
• Canola, for higher heat cooking
• olive, extra virgin, for medium heat cooking
• olive, extra virgin, cold pressed, for dipping.
• sesame oil for flavor
• flavored oils
• coconut oil

Some basic spices and herbs

• kosher salt
• pepper, preferably whole peppercorns
• lemon pepper
• rosemary
• thyme
• basil
• sage
• chili
• cumin
• paprika
• garlic, fresh and powdered
• ginger, fresh and powdered
• cinnamon
• cloves

 Canned and jarred goods
 

• tomato sauce
• diced or stewed tomatoes
• tomato paste
• canned olives
• canned pineapple for pizza or stir fry
• various beans, like black, pinto, garbanzo
• pickles
• sauces like soy
• chilis, diced
• canned salmon
• coconut milk
• all the jams, jellies, chutneys, and pickles that you have canned : ) 
• vinegars like apple cider vinegar, balsamic, rice

Dried things

• raisins
• dried cranberries
• sun dried tomatoes in oil

Baking Ingredients

• whole wheat flour, I prefer fine grind for the most protein and the heaviest bread
• whole wheat pastry for pie crust
• unbleached flour if you must have it
• gluten free flour for those who require it
• baking powder
• baking soda
• cream of tartar
• cornstartch or tapioca powder for thickening pies
• sugar, white, brown cubed and powdered
• chocolate chips
• bakers chocolate 2 forms, blocks and powder
• expresso powder
• sweetened coconut
• molasses, agave, honey
• Nuts (see the freezer section in future posts) 

Beverages:

• a complete selection of chai and coffees, including decaffeinated versions of each
• teas: black, green, and herbal
• Soda water, or Perrier or Pellegrino to splurge

Stay tuned for the fridge and freezer sections next week on Food Friday ! 

Wellness Wednesday: Time and Goals

We each have goals. What would it be like to accomplish them ? What would it be like to accomplish a lot of them ? Some people do. These are people with good time management. 

It occurred to me that before I discuss exercise on this Wellness Wednesday blog, I should discuss the one thing my patients say they need before they can exercise: more time. We all have one lifetime of time. What matters is how we use it. Everyone knows this, so what is the problem ? 

Most people are not fully aware of how they spend their own time.

They are not as factually familiar with how they spend each hour as the think they are. I have found that everyone thinks they’re busy, and everyone thinks they're active. People are less sure if they are efficient in their day. This is the territory I suggest we explore at this point in the New Year. 

We are talking about time management. Have you ever had a class in this ? Few people have. It seems like it would be a good idea right at the beginning of high school. Or how about right now, in the blog post ? 

Here is your mini class on time management, complete with some handouts and homework. 

• Obtain a notebook to document this process. 
• Record your present schedule, down to the hour, for one week. Include everything from housework to Facebook. Wear a watch all week so you will have realistic estimates of time. 
• Make a list of goals, for the week, month, quarter, year and five years. 
• Order the goals by priority.
• Assess your week long log and see where you are misdirecting or wasting your time. 
• Realign your schedule with your priorities. Include a spot for 30 minutes of exercise 6 days per week. 
• Record what happens the next week and repeat. 

Now this is a VERY simplified version of a time management class. It is, however, the essence of the process. It only works however, if you are absolutely truthful with yourself about how you spend you day’s time and absolutely truthful about what you really want. 

I hear so much about not “ having enough time” to exercise, or to shop for healthy food, or to prepare healthy meals, that I decided to address it head on. 

For those interested in more, there are really so many great resources on the web, from Lifehack.org, to books by Harvard Business Review. 

Here is a one page handout on the subject. Click on the title below to download. 

"Time Management" from the Stanford Center for Teaching and Learning

For extra credit, here is an awesome self assessment and time management tool from University of Kentucky. Click on the title to download. 

"The Successful Person's Guide to Time Management"

This should be be printed, filled out and used. 

Class is dismissed. Homework is due next week! I’d love to hear how you do. 

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

Good Monday and Happy New Year. ACOG (The American College of Obstetricians and Gynecologists) has once again reiterated the newer recommendations regarding cervical cancer screening. They have stated that “ Women ages 30 to 65 at "average risk" for cervical cancer should receive co-testing with cytology and HPV testing every five years or screening with cytology every three years”. ( Cytology just means sending cells with a pap and co-testing means DNA testing for HPV, Human Papilloma Virus via the same sample.) I would like to emphasize a couple of aspects of this statement: the phrase “ average risk”, and the idea that they are talking about sending specimens to the lab. 

Average risk is not precisely defined, and this is ok, since it gives clinicians room for applying clinical judgement to individual patient cases. Average risk does not certainly include those patients, who are by virtue of disease or medication, immunocompromised. It does not include those who have recently had precancerous cells in the cervix, vagina or vulva. In my opinion it does not include those who have a significant smoking habit, since smoking is tightly associated with accelerating the progress of HPV disease. I do not believe average risk includes those with alcohol or drug problems since these patients can have poor immune function and struggle with satisfying recommended follow up protocols. In my opinion, average risk also should not include those with high risk sexual habits, such as having unprotected sex or large numbers of partners. But does the media ever highlight any of these things ? I have not seen it. 

These ACOG recommendations are about the recommended sampling frequency for cells on the cervix. They are not a statement about the frequency of annual exams or even pelvic exams. Those proceed on their own schedules for their own separate indications. The media has not done a good job at highlighting this important distinction. After all, a woman is more than just her cervix. 

The Journal of the American Medical Association (JAMA) has received a request from a group of researchers to retract their own study from the Journal on the grounds that they have discovered that the lead researcher has falsified data about the usefulness of nitroglycerin for improving bone density.  Kudos to those whistleblower researchers. 

South Carolina Department of Health and Environmental Control (DHEC) will revise its regulations concerning the practices of licensed midwives, what we call lay midwives, meaning those who are not Certified Nurse Midwives. The DHEC was picketed by about 50 midwives. ACOG has said that while women deserve the right to chose where they deliver, they should be informed of the risks and benefits of the choices, including the two to threefold risk of neonatal death while delivering outside the hospital. (This data came from a study reported in the New England Journal of Medicine (NEJM) and involved a study of 80,000 pregnancies in Oregon.)

Let’s think a little more about that statistic on neonatal death. Neonatal death is defined as the baby dying in labor or in the first month after birth. Why would such a terrible thing happen in the hospital ? High risk pregnant patients come to the hospital. High risk mothers may have very early labor, ruptured membranes, or severe preeclampsia, all resulting in deliveries so early that babies are far more apt to die or have serious morbidities. This is the source of neonatal death in the hospital, not the average pregnant women who comes in for labor or induction.  On the other hand, most licensed lay midwives restrict their practice to low risk patients, with none of these aforementioned problems. And yet many more of their patients end up with dead babies, despite the fact that hospital caregivers are dealing with these sometimes insurmountable obstacles. Problems which are solved by a simple medication in the IV, or the use of forceps, or even a C Section in the hospital, result in death when the same problems occur outside the hospital.

Speaking of neonatal death being two to three times more prevalent among those who birth at home, did you ever consider that this is a group average ? What happens when you unpack that group ? It turns out that first timers delivering at home have a 14 fold increase risk of first apgar score of ZERO, which is tantamount to neonatal death. And while the multiparous patients (women with multiple prior births) may do better with labor, they are much more prone to hemorrhages and other maternal complications, which are not even addressed in this statistic. 

So beware of the medical reporting in the popular media. Don’t take those statistics at face value. Remember the actual human realities behind them. 

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

Food Friday:A New Year's Pantry

It’s time for a fresh start on your nutrition. Here’s an easy way to go beyond intentions and take a SMART (Specific Measurable Attainable Relevant and Time bound) step to better nutrition: 

Clean out your pantry. 

This is a way of taking stock of your eating habits as they really are. I suggest the following plan for success in this endeavor: 

• Put your family on notice so they can prepare.
• Have a simple plan for your healthy meal while you get all this done
• Take everything out of the pantry and sort it into
  • Keep 
  • Donate 
  • Compost 
  • Trash 
• Be ruthless and keep only what fits into the plan of healthy eating. If you are unsure, then review our section on Nutrition. 
• Clean the whole pantry. 
• Replace the good stuff which made the cut.
• Now that you have a detailed overview of what you have and what you lack, make an excellent list of your healthy pantry staples. Keep the list on your phone and make a couple laminated copies for the pantry itself and for your wallet. 

You will feel such a great sense of satisfaction, and you will be on your way to dietary honesty. Stay tuned next week for my preferred list of staple pantry goods. 

Wellness Wednesday: New Year’s Resolutions

I have always been skeptical of the idea of  New Year’s resolutions. Did you know that only 8% of them succeed ? I am more in favor of a New Year’s PLAN. Plans can change things. 

I am all for establishing intentions and all for making lists. A resolution however, is more like wishing for something and expecting that the strength of your wish will make it come true. Research shows the desire or willpower alone is insufficient. If you are ready and willing to make changes, bring out the power tools. They are called SMART goals. 

SMART is an acronym for Specific, Measurable, Attainable, Relevant, and Time bound.

See more at:

Structure Sunday: Three Ways to Get Ready for the Week

So make a New Year’s list of the goals you would like to achieve, but apply this metric to each one. 

Here is more on exactly how this works : 

The Importance of Inspiration

For example, if you want to exercise daily, you must know what exercise you will do, and where. You should make a record of what you do. It should be something that is realistic at the present moment. You should know exactly when in the day and week it will take place and give yourself a date to reassess your progress. If you do not do these things for your exercise plan, then you are not serious about this goal. If you actually set yourself up this way, you will almost certainly be successful. It’s like Dorothy and the ruby slippers. You had the power all along. 

Meanwhile here is some additional fun and illuminating reading on New Year’s Resolutions : 

LIfehack: 50 New Year's Resolutions and How to Achieve Each of Them

Happy New Year ! 

Wellness Wednesday: Holiday Wellness Collection

Here is a little collection of holiday wellness quick reads from my past blog posts. I hope they help the next week or two be merry and bright. 

Holidays, the Happy Disruption

Holiday Wellness

Gratitude is at the Center of Wellness

Look forward to more post collections during the holiday week while I take a little time off from writing and just highlight the “ need to know “ stuff. 

Merry Christmas and Happy New Year. 

May the light of the season be within you. 

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

This weeks news is all about the facts and figures. Statistics is like pie. It is all about how you cut it. That is to say, the real meaning of raw data is challenging to correctly interpret. A great deal of the message from a study depends on how the data is presented. Be wary about drawing conclusions from studies where none can be drawn. 

The CDC report indicates that the number of abortions in the United States has hit a record low compared to 1990. This is true for all ethnic groups.

A new study has hit the press indicating that use of SSRIs, common antidepressants, in the first trimester is NOT associated with increased risk of autism spectrum disorders. Nonetheless the study also showed babies whose mother’s took SSRIs were 75% more likely to get autism than than their peers. Whether this is related to the mom’s condition, the medication or something else is totally unknown and cannot be known from this study. 

In the strange, counterintuitive and questionable department, a new observational study published in the Journal of the American Medical Association shows more complications among those with a planned C section compared to those with an emergency C section done after labor. This is against what has been show before, and against common sense. Authors at the NYT Blog Well speculate that somehow the labor is “ good” for babies. You just as well might speculate that people who chose elective C sections are less healthy to begin with. No conclusions can be drawn, although many will be. 

New findings in the Journal Cancer Epidemiology show that while cancer rates are declining in developed countries, they are increasing in the developing parts of the world. With development comes smoking, and more obesity, which increase the risk for certain cancers. 

The now ancient Women’s Health Initiative, which gathered data on a great many things, has been mined once again. This time it has revealed an association between smoking and infertility. No surprises there. 

I guess I am not the only one who doubts the work of the USPTSF on the issue of breast cancer screening and mammograms. Over 60 lawmakers, headed by Representative Debbie Schultz of Florida, have included a provision in the new budget requiring that the US government officially recommends breast cancer screenings at age 40 rather than 50 as the UPTSF does. Looks like they feel American women are willing to undergo some increased anxiety and discomfort in exchange for earlier detection, longer life, and less mortality. 

A new study out of Britain once again raises the question as to whether the use of the Ca 125 blood test can help detect ovary cancer and save lives. The results are by no means conclusive, but they will provide an impetus for much needed additional study. 

Back to pie. This week I hope you have several kinds, pumpkin, cherry and whatever is your favorite. Merry Christmas week ! 

Food Friday: Holiday Menu Planning

I don't know about you, but right now I am trying to figure out the menu for not one but several holiday dinners to come in the fairly near future. To try and minimize stress with these events which are supposed to be fun, I've decided to do a little advance planning and let you in on it too.

Sometimes it's best to stick to tradition, and include menu items you know are family favorites. But particularly when you have more than one meal to present during the holiday season, you can afford to be a little bit creative. Let's take a quick look at four different cuisines which you might consider. Christmas is really big in each of the five countries which I will present, but you can probably think of many more countries that cherish the holiday as well. You can explore their cuisines too. Suddenly there is no shortage of menu ideas when you consider it in this framework. The challenge will be choosing what to leave out ! 

A Mexican inspired Christmas “ Navidad” 

• Virgin Margaritas
• Quesadillas with fresh salsa for starters 
• Ponche - a hot fruit and cider punch 
• Mexican Christmas Eve Salad _ this is colorful salad mixture of lettuce, beets, apple carrot, pineapple, jicama, pecans and pomegranate seeds. 
• Tamales with a chocolate chili mole sauce. 
• Rosca dee Reyes- A sweet spicy fruity bread containing assorted dried  or candied fruits. 

A French Inspired Christmas “Noel” 

• Champagne, Perrier
• Amuse bouche ( hor d’oeuvres) - olives, seasoned nuts, vegetable platters with dips etc. 
• Boeuf (beef) Bourguignon ( A thick stew made all day with red wine and meat cooked until fork tender eaten with crusty baguettes. ) 
• Haricots Verts ( green beans roasted with olive oil) served with lemon 
• Salade Nicoise - Tomatoes, boiled eggs, and tuna on a bed of greens 
• Diverse fruit and cheese platter 
• Buche de Noel- An amazing rolled chocolate sponge cake filled with mocha cream, frosted with chocolate buttercream to look like a log and garnished with meringue mushrooms
• Sorbet 

An Italian Christmas “ Natale” 

• Pellegrino 
• Antipasti- tuna, fresh salmon, cured meats, olives, cheeses, bruschetta, crostini, Caprese salad- with fresh mozzarella, basil and tomatoes
• Pasta, such as ravioli filled with extravagant fillings, such as meat, spinach, ricotta, figs, and even chocolate and candied citron. 
• Parmesan chicken in red sauce 
• Lemon tart 
• Gelati

 

Scandinavian Christmas recipes “ Yul” 

Glogg- spiced mulled wine 

• A “ julbord” , meaning a smorgasbord especially for Christmas
• Cold foods like Gravlax ( salmon cured in sugar, salt and dill), cured meats, cheeses, pickles, beet salad, breads and butters
• Warm foods like meatballs in berry sauce, potato dishes and cabbage dishes. 
• Desserts like Pepparkakor ( gingerbread cookies) and saffransbullar ( sweet buns)

One traditional Christmas in America, with some twists

• Turkey
• Mash potatoes
• Cranberry sauce
• Green salad 
• Asparagus
• Pie À la mode

Turkeys is front and center at Christmas time as well as at Thanksgiving. But this time give it a little twist. Consider encrusting the bird with herbs, or having it smoked. For the stuffing, go beyond simple breadcrumbs and try wild rice stuffing. Try a twist on traditional cranberry sauce and add orange. For your salad, add every favorite salad ingredient you can think of from olives to capers, dried cranberries, two colors of tomatoes, and even candied nuts. For the mashed potatoes, consider the very exotic purple potato, or for a very healthy twist, sweet potatoes. If you really want some color on your table try all three. And whatever you do with the potatoes, flavor them well with olive oil, butter, sour cream, salt, pepper and even herbs, garlic, or cheese. Regarding your traditional pie, consider one two fruits not one. Great combinations are apple raspberry, or rhubarb strawberry.

Warning: Each of these menus require several days preparation and several people to accomplish. But, as I read through all my material about holiday and meal traditions the world over, I realized that the affectionate time and extra effort spent preparing these magnificent celebratory meals together is the essence of the holiday. 

Merry Christmas all week long to all the cooks ! 

Wellness Wednesday: Body image

Hello Angels. Did everybody watch the Victoria’s Secret Fashion show last week ? I did. It is a provocative female fest of the first order and boy does it provoke a lot of conversation. So thank you VS for stimulating conversation around the world. 

I am a doctor and am first and foremost interested in health: physical health and mental health. So that is my filter. And through that filter, this is what I see, and it isn’t all pretty. 

I see that many women of all types and sizes have poor body image. I have seen umpteen conversations in the blogosphere running along the following lines: “ The VS show made me feel bad about myself.” I wonder if these women feel the same way after watching the Olympics or the Cirque du Soleil ? I wonder if they are aware that these models train like professional athletes, boosting their calorie and protein intake way up to build muscle and compensate for the long hard workouts that they must do. Many women are 5’10 or more and have pretty faces, but few can achieve this level of discipline and training.

I am not so unsophisticated that I do not realize that the VS show is essentially marketing and that it sends mixed messages to and about women. Yet, it would be nice if we could all watch Olympics, gymnastics, or even the VS show and be inspired to be our best selves. 

I am certain this chronic problem with poor body image is something we inherit from our culture, and that we are retaught every generation. Historically, we women have been property, and most generally utilized for our physical attributes. Is it any wonder this is still how we define ourselves ? Although the problem of our self worth came from without, the problem is now within us. Likewise,the solution can only come from within each of us. It is for each of us take a hard look at ourselves and count our own strengths. We need to learn to define ourselves in our own terms, and value ourselves as whole people. We all know none of us is perfect, mentally or physically. However, we must learn to celebrate what we are and to learn to enjoy the process of making ourselves better all the time.

Through my filter, I see that women of all descriptions hurt one another with fat shaming and thin shaming. Women already have to deal with objectification, abuse, unequal pay, glass ceilings, and sexism. The last thing they need to be doing is undermining each other.

I see people outside the health profession mistake all sorts of things: slim for anorexic, obese for “ big boned”, obese for "womanly" and muscular for unfeminine. I even hear some of these things from people in the health sciences. None of these analyses are helpful to the cause of the physical or mental health of women.  None of these critiques allows for the fact that there are many body types. None of them asks the right questions about fat percent, muscle mass, bone density, strength, nutritional status, menstrual health and other truly relevant parameters. 

I am very concerned about eating disorders in young women. However, I see them very rarely. But, numbers wise, prevalence wise, I am profoundly more concerned about the obesity epidemic. This will end up causing no end of disease related suffering as women of this generation come into middle age and older. We as women have to come to terms with the need for good nutrition and regular fitness. We need to get back in touch with strong female physicality.  If we cannot get in touch with our physicality, we become oblivious to our bodies and avoid them outright and they get less and less healthy with each passing year. 

Strong healthy physicality in women, and I mean mature adult women as well as young women, lends confidence to the mind as well as the body. What does physicality mean ? To me it means, being in touch with your body. This means being able to honestly assess your bodies strengths and weaknesses with the help of your doctor and maybe even a trainer. It means standing in front of a mirror without clothes. It means getting on a scale and doing a waistline measurement. It means accepting where you are at the present moment and knowing you have the power to better yourself.

Physicality means having the courage to try new things with your body, new exercises, new sports. Sports ! Yes… I believe all women need sports and competition in their life. It builds confidence in all things, because sports teaches you how to try and try again. Sports teaches you how to practice, even how to train, however modestly. 

Your physicality extends to other people. It asks you to acknowledge your own sexuality, and to ask whether it is in a reasonable state. 

Physicality bears on how you present yourself to the world. You may not wish to become a materialistic fashion slave. But….. do you neglect your own appearance and present yourself poorly to the world ? Do you neglect your hygiene ? Do you dress down or to be invisible ? Is your posture poor ? Think about these things and take responsibility for yourself. Love what is, shower it, brush it, put some cream on it, then dress it up to show your best self. 

Physicality extends to the natural world. It asks that you get out in it and feel it with all your senses. When learn to use your body in the natural world, the natural world will, in return, sculpt you into a better adapted creature. 

It is good to embrace health and beauty in all forms. True beauty is health. You have the power to make some of your own. 

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

There is some sobering news in this week's collection. 

Findings from Sweden published in the Lancet indicate that babies from women who gained a large amount of weight in pregnancy are at increased risk of stillbirth and infant death compared to others. This work is an impetus to study the issue in more depth, since there is no clear indication of why this is it the case. 

A study presented at the World Diabetic Congress has shown that about 10 % of teens with type 2 diabetes in the study got pregnant over at 6.5 year period. Any women with diabetes in pregnancy are at high risk for complications. Pregnant teens with diabetes are at especially high risk. It was noted that these pregnancies frequently have poor outcomes. 

A study published in the Journal of Clinical Electrophysiology has indicated that women who were overweight at age 18 have a greater risk of sudden cardiac death. This persists irrespective of later weight loss. Those with a body mass index (BMI) in the high 20s have a 33% greater risk.. Those with  BMI over 35 quadruple their risk. 

New research indicated that 62% of all Ob/Gyns are now women ! That even counts the old ones : )  

Speaking of doctors, new research published in JAMA, the Journal of the American Medical Association indicates that about 29 % of all medical residents have depressive symptoms or depression during their training. The general population comes innate about 6.7 %. Of course this is all about long stressful work, sleep deprivation but also about hierarchical structures and bullying. In my opinion, a lot would have to change for this to be different. 

Omigosh this post is so dismal it is sounding like a parody but I kid you not, researchers from Oxford, namely statisticians and medical epidemiologists, have now asserted that happiness has no direct effect on mortality. They say the idea that unhappiness causes illness is a really a case of illness causing unhappiness. 

Data crunching at the CDC has concluded for 2010 and from 1976 until 2010 pregnancy and abortion rates have fallen to record lows. 

Dame Sally Davies (Yes, ladies she is a Knight of the British Empire ), the Chief Medical Officer in England, has declared obesity the greatest threat to women’s health and to that of future generations. She has declared it a national priority. 

Finally, in a bit of progress, the FDA has updated the required pregnancy and breastfeeding labelling for prescription medications. 

Maybe the world's researchers wanted to get all the bad news out of the way before the holidays. I can't wait for next week. Stay tuned. You can't make this stuff up. 

Food Friday: Special Holiday Food

Holiday food is not just the food on the holiday table. It is two weeks from Christmas and in many families and in many workplaces it is like one long holiday. Food is front and central in many places at this time of year. Make yours special. 

Here are are some categories of holiday food to think about: 

• Office food
• Cookie exchanges 
• Food Gifts
• Hospitality Gifts to bring to a party
• Potluck food to bring to a party 
• Foods for the stocking 
• Foods for the holiday table. 

Office Food

Office food at the holidays can be overwhelming. From deli and cheese plates to commercial thank you baskets to homemade confections and baked goods, it can really pack on the pounds. The best thing to do is to make sure to keep a good list to write thank you notes, have a small sample of one or two treats, then cover the rest up and put it in the office fridge until the end of the day when the food can be taken home to someone’s hungry adolescent horde. 

Cookie exchanges

These take the advance planning of someone with an MBA. The key is a good freezer. The other key is a source of good freezer friendly cookie recipes. For example, anything based in shortbread is good, whereas meringue cookies are right out, unless they are baked same day and carefully transported. Remember that there is good gluten free flour that is widely available that will bake up just like regular wheat flour. You may not know who you are feeding, and you want to be inclusive.

The idea is this: You bake a good sized batch of cookies every couple days starting a couple weeks before Christmas. You freeze each batch. You do at least 3 types of cookies but 5 is better. You make sure to vary the flavors and form factors, so they will look interesting on a gift platter. On the day before the exchange, or whatever activity demands batches of festive cookies, you bring them out and arrange assorted cookies on said gift platter, making sure to package and decorate them well. Voila, now you know you could run at least a small company. 

Food gifts

These have been addressed previously HERE.

Hospitality Gifts

When you are choosing your party outfit, chose your party gift. Some people call them hostess gifts. Think of it as an accessory to your outfit. It’s good form, breaks the ice, and makes everybody feel good right away at the front door.

If you are attending a potluck and are bringing a dish, it does NOT count as your hostess gift. Classic gifts are a wrapped bottle of wine or champagne, but can just as easily be Pellegrino, Perrier, or sparkling cider. Another route is cut flowers, but I myself prefer a live plant such as an orchid. 

Potluck food 

First rule is to ask the host what they would like you to bring, smile, say yes and do it. Second rule, is make an extra special version of whatever it is. Third rule: try to steer clear of common dietary intolerances. Fourth rule: make enough. Fifth rule: present it well. Sixth rule: observe standard food safety practices. 

Foods for the stocking

Filling stockings is one of my favorite things to do. I bet if you thought about it, you could list the favorite treats of everyone in your family, and maybe a few of your friends. Think a bit more broadly and cover spices and condiments; then consider food related items like pretty toothpicks, and soon your “ foodie “ stockings will be overflowing. Here are some ideas: Hard candy in pretty small tins, actual high end natural cough drops, favorite gum, of course chocolates, but make sure they are not crushed, candy canes or licorice (but only if people actually like them), bottles of culinary extracts for cooking like vanilla or lemon, exotics like pomegranates, star fruit, cumquats, fancy nuts, and their nutcrackers. Capers, tiny jars of indian chili paste, colored peppercorns, teas, tea infusers, jams, and hot sauces. You get the idea. Just troll through a nice organic store and santa’s little helper will find lots of stocking sized treasures. 

Foods for the holiday table

I have covered this a bit before, but the essence is this: Bring people together in a spirit of wonder, gratefulness and congeniality. If your cherry pie can help with this, by all means make it. As far as healthfulness is concerned, yes, there is a healthy hack to every traditional recipe. I would like to write a bit more about this, and so this will be my topic for next’s week’s Food Friday. 

My best wishes to all the busy elves. 

Wellness Wednesday: Wellness Gifts

Still searching for that perfect gift ? Why not give something that promotes health and wellness ? I propose considering a “ wellness gift”. Here are some useful categories: 

1. Books on health and wellness. These could be books on mental or physical health. 

The Seven Habits books by Stephen Covey are some of my favorites. 

2. DVDs for exercise, yoga or meditation- Try those by Gaiam or Jillian Michaels. 

3. Basket of healthy drinks: herb teas, decaf coffees, matcha, or chai

4. Basket of healthy foods 

5. Healthy cookbooks ! - Try the Mayo clinic cookbooks, as well as the series by Jonny Bowden PhD, CNS. 

6. Tuition for a series of health classes, but only if you are sure they want them. 

7. Cool workout gear, or a gift certificate for it. 

8. Certificates for spa treatments, massage, or even a personal trainer session.

Spread cheer this season with some of these worthwhile wellness gifts. 

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

Until recently, the only treatment for preeclampsia is delivery. However, a new study is underway to test Recombinant Human Antithrombin to manage early onset ( 23-30 weeks) preeclampsia. As the same suggests, this medication acts by inhibiting abnormal blood clotting and inflammation, two components of preeclampsia. If this helps, this will be the first medication to directly address this common and serious disease. 

In the unbelievable department, The Government Accountability Department (GAO) has discovered something concerning at the National Institute of Health (NIH) . They have discovered that the NIH does not, in their research, always keep data on sex, thereby making it impossible to determine whether or not an intervention or exposure affects men and women differently. Those of us from the world of Ob/Gyn can tell you that rather often, the same factor will affect men quite differently than it will affect women. 

Here’s your reference http://www.gao.gov/products/GAO-16-13

The Radiologic Society of North America heard research results indicating that the recent Medicaid Expansion has boosted rates of breast cancer screening in low income women. Assuming these and other women do not pay too much attention to the USPSTF ( US Preventive Services Task Force) recommendations of later and less frequent mammograms, we may soon see increased rates of early detection and eventually, longer survival. 

ACOG (The American College of Obstetricians and Gynecologists) has made its strongest statement yet on pregnancy, stating not only that it is safe, but that it is recommended on a daily basis and should be the norm. 

OB/GYNS all over the world are nodding on this one. The Journal of the American Medical association has indicated the WHO's (World Health Organization) optimal rate of C section at 10% is too low. As C section rates rise to 15%, the study shows maternal and infant deaths decrease. In fact, maternal and infant deaths continue to decline through about 19%. This is the sweet spot, meaning where maternal and infant well being are at their highest. In the US about 33% of births happen by C section. This probably has to do with many things, including our culture, patient preference, doctor’s risk tolerance, the medico-legal climate, and the obesity epidemic. We can improve. 

Sobering : False positive mammograms may be linked to a higher risk of breast cancer later in life. The group in question is those whose mammograms indicate the need for a biopsy but then whose biopsies are negative. These women, despite negative biopsies, have a 39 % higher risk of breast cancer in their future that women who didn’t require a biopsy. I wonder how this finding will factor in to the recommended frequency of mammograms. So many authorities are weighing in on how frequently they should be done. ACOG still says every 1-2 years after 40. 

It turns out that giving flu vaccine to pregnant women in the second and third trimester benefits not only the mom but at least have of the unborn babies as well. Bonus ! 

Stay tuned next week for more breaking news from the world of Ob/Gyn ! 

Wellness Wednesday: Cold Weather Workouts

Now that the temperatures are dropping and the outdoors is frosty, there are a few cold weather tips you need for working out outside. 

• Chose safe routes. Avoid iced over rivers of uncertain stability. Winter roads can be icy. One winter run of mine a few years ago landed me in a CT scanner, since I slipped, fell and hit my head on the ice. All was well, but it was no fun and showcased my imprudence to all my friends in the emergency room. Plowed roads or snowpack can work well, but you still have to be on your guard for black ice. Despite your best efforts, you may fall and injure yourself, so always carry your cell phone or go with a buddy. Some have suggested a loop close to home so you are are never far if you have to limp back. 
• In your first excursions of the cold season, go for less time than you usually do, to see how you adapt. You can always work up gradually later. This is especially good advice if you have asthma or other medical conditions. 
• Don’t forget sunscreen, especially in bright snow white conditions. Likewise wear appropriate eye protection for sun, snow and ice .
• Warm up and cool down as always. However, in the case of cold weather, do it inside. 
• Dress in layers, so you can stay warm but not overheat and sweat too much. Start with a wicking layer, followed by insulation, and then a shell. Always include a hat, which adds warmth without bulk and can help prevent frostbitten ears if it has earflaps. Consider a neck gaiter to keep the mouth and nose warm. Absolutely wear gloves to prevent frostbite. 
• Check the forecast before you go, factoring in not only temperature but precipitation and windchill. Tell someone where you are going and when. 
• Have an indoors workout alternative if it is just too challenging out of doors, preferably an indoor alternative at home, such as a workout DVD you can do in your living room or basement. 
• Do not mix alcohol with any workout. Be aware that alcohol degrades decision making, and masks symptoms of hypothermia. 
• Know and recognize the symptoms of frostbite, whiteness, tingling and pain. Know, recognize and heed the signs and symptoms of hypothermia: shivering, confusion, fatigue and slurred speech. Hypothermia is medical emergency and must be corrected right away. 
• Avoid cold weather exercise in the face of dehydration, inadequate calories or sleep deprivation. These can limit your bodies ability to thermoregulate. 

Working out outdoors in the winter requires extra preparation and mindfulness. However, there are some major benefits: Winter workouts produces a bigger endorphin boost than working out in warm weather. You burn more calories in the winter and train a bit harder. And it is invigorating to be out in the weather, and the landscape is often stunningly beautiful. Getting outside in the winter is important for fitness, but it also improves attitude and mood as well. All in all, is it something you should add to this season’s workout mix. 

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

California and Oregon will soon allow pharmacists to screen patients and prescribed birth control pills. While the American College of Obstetricians and Gynecologists considers this a step in right direction, they believe they should be available over-the-counter, plain and simple. While it is true that low dose combination birth control pills can have medical complications in a very small percent of people, by and large their health benefits far outweigh their risks.

As most of you probably are already aware, hepatitis C has a new medical treatment which provides a cure in a very high percentage of people. However, hepatitis B has remained a challenge, and in particular, we have had to deal with the problem of vertical passage of the virus from mother to baby during pregnancy, labor and delivery. However recently at the meetings of the American Association for the Study of Liver Diseases, new research was presented. In the course of a randomized controlled trial, a drug called Tenofovir was shown to be able to reduce vertical transmission. 

Yet another encouraging recommendation about exercise in pregnancy has been released. According to the American College of Obstetricians and Gynecologists, nearly half of US women gain too much weight while they're pregnant. We all know that women who gain too much weight in pregnancy are very uncomfortable. However they also have higher rates of miscarriage, premature birth, stillbirth, and babies with birth defects. They’re also more likely to have heart problems, sleep apnea, gestational or pregnancy associated diabetes, preeclampsia also known as toxemia, and abnormal blood clots. They are at higher risk for cesarean section. So there are ample reasons to find ways to control this weight gain. 

The new memo released by ACOG advises pregnant women to exercise regularly and more often than they currently do. The memo states that while walking is the best exercise, jogging, Pilates, yoga, cycling, swimming, and other forms of exercise are perfectly acceptable. ACOG cautions against contact sports such as skiing, and other specialized sports such as scuba diving.

More good news: it appears that breast-feeding for two months or more reduces a gestational diabetic’s risk of developing type II diabetes later in life by 50 %. Moreover, the risk of diabetes lessens as the patients breast-fed longer.

Finally, here is some good news that initially sounds a lot like bad news. Since 2010, there has been a significant increase in the number of women under age 26 who have received a diagnosis of early-stage cervical cancer. In the next age group, 26-34, the numbers were unchanged. What changed for the younger age group? The answer is the availability of insurance. One of the features of the ACA, The affordable care act, was to allow children to stay on their parents insurance plans through the age of 26. Most likely the increase in diagnoses came from increased compliance with recommended screening, i.e. pap smears. Once again, we are reminded that appropriate screening leads to early diagnosis, which leads to less invasive treatments, fewer complications, and higher rates of cure. 

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

Food Friday: After Thanksgiving

How was your thanksgiving ? Not flawless ? That's ok. Take this time to decide how to make the rest of this weekend worthwhile. 

Our family and friend group has a leftover party every Thanksgiving Friday. Pies are featured as well. Turkey soup and turkey pot pie are great options. 

Consider this time, your leftovers, your pies, friends and family and be grateful.

Wellness Wednesday: Holiday Wellness

Here are just a few tips to make this most intense part of the holiday season less stressful, more relaxing and more celebratory. 

1. Take a look at your calendar from now until New Years. Make sure you are neither overbooked, nor forgetting about events that are meaningful to you. Make sure the schedule is realistic and that your family members are all on board with the plan. 

2. Take a hard look at your budget and stick with it for your Holiday expenditures. A great source of holiday stress is financial. Reduce costs by decorating with natural elements, entertaining pot luck, and by making or baking homemade gifts. Consider also gifts of outings. For example, give a certificate good for “one Sunday afternoon walk in the park with me”. 

3. Ramp up the consistency of your workouts. You will feel better about yourself and avoid the Holiday weight gain. 

4. Be choosy about your indulgences. Eat slowly and savor your treats. Drink ample water through the day, and be sure to consume the sights and sounds of the season, not just the tastes. Consider being the amateur event photographer of the family. It takes your appreciation of the season far beyond the food. 

5. Relatives coming from out of town ? Make a sound plan for their accommodations. A little advance planing can save a lot of stress. 

6. Anticipating stressful interpersonal encounters ? Plan ahead and adjust your attitude. Try to see the good in everyone. Blessed are the peacemakers. 

7. Bon chic, bon genre - This is a French saying meaning that if you dress well, you bring your best self forward. Dress to present yourself thoughtfully, and to indicate your respect, enthusiasm and cheer. Never dress to impress. Dress to delight and to put others at ease. 

8. Consider the deeper meaning of the season. This is, of course, the best way to put the shine on the season. 

Happy Holidays from Dr. Gina 

A very nice reference for more reading : 

http://www.clevelandclinicwellness.com/Features/HealthyHolidayCelebrations/Pages/introduction.aspx#

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

Happy Monday on this short week ! This week in honor of Thanksgiving I plan to apply the filter of gratitude to the news that I feature. Let’s see how this works out. 

The LA Times recently reported on the actual C Section rate in the US ( 33%)  as compared to the theoretical ideal of 15 %. An ACOG (American College of Obstetricians and Gynecologists) spokesman indicated that this discrepancy was largely about risk tolerance of the involved parties. Gratefulness filter: Le’t be glad we live in a place where C sections are readily available to those who need them. 

Findings coming out of the African American Cancer Epidemiology Study indicate that black women with the healthiest diets were 34 % less likely to develop ovarian cancer that their counterparts who ate the most unhealthy diet. Gratefulness filter: Diet is an easy factor to modify !

Findings presented at the American College of Rheumatology indicate that Denosumab was superior to Zoledronic Acid ( Zometa) at restoring low bone density due to osteoporosis. Gratefulness filter: This is great news for all with low bone density ! 

The Supreme Court rejects the case against Planned Parenthood. Justices Scalia and Thomas dissent. Gratefulness filter: Let is be glad we live in a country that respects free speech of differing parties, that observes due process and the rule of law. 

About 10 % of all new mothers suffer from post partum depression. New York is rolling out a ambitious program which will require that all expectant and new mothers will be screened for depression. Gratefulness filter: Thank goodness awareness is increasing about this important and treatable problem. 

Rhode Island has a new state mandate requiring HPV vaccine for youngsters. Nearly three quarters of seventh graders received it by the start of the school year. Gratefulness filter: Thank goodness we have a way to prevent cervical cancer. 

Count your blessings this week and stay tuned for more news from the world of OB/Gyn next week on Medical Monday ! 

Wellness Wednesday: Nature and Health

Tonight I attended the Banff Mountain Film Festival as I have done almost every year for the last 20 years. This film festival is a celebration of mountain culture and the outdoor lifestyle.

Mountain culture means a certain thing to me, my family and my friends. Understanding what this means can shed some light on what it means to be healthy. 

I could say it means high adventure like ice climbing, parasailing, and extreme skiing. I could say it means having a community where fitness is highly valued. I could say it means being outdoorsy. I could say it means being active in the environmental community. But it is not exactly just these things. 

It is a little but of each of these things. But mostly it is this: it is connecting WITH  people IN nature. We know from the social sciences that being connected to others is critical to health and wellness. We also know that immersion in nature is critical to our well being. Numerous studies have demonstrated that exposure to or immersion in nature improves the following: 

• mental health

• immune system resistance

• reduced stress

• reduced anxiety 

• reduced anger

• reduced fear

• increased positive mood

• increased feelings of unity with others, more sense of community

• more concern over helping others 

• enhanced social interactions 

For children, exposure to nature has been associated with the following:

• reduced stress levels, increased fitness 
• reduction in ADHD symptoms 
• enhanced student performance on tests of critical thinking 

The data on the subject of nature and health are fascinating, overwhelming and encouraging. Check some out for yourself: 

University of Minnesota

Health Promotion International

National Wildlife Federation

American Public Health Association

Stanford University via Science Alert

The Lancet

University of Washington

Norwegian University of Life Sciences

No matter where you live, be it city or country, this is important for you to know. You and your family need your time in nature, no matter the season, no matter whether you live in the mountains. coast, desert or plain.

You should keep an eye out for any outdoor film festivals in your area as they are sure to inspire. Our local festival out of Banff is sponsored in part by National Geographic. I was intrigued by their stated interest which was the intersection of “science, adventure and storytelling” . Go out and get some for yourself.