women's health

Food Friday:Spring's First Fruits and Shopper’s Lists

This week the morels came out. Morels are the spirit of the forest rising up after spring mist and sun in close succession. They are hidden in plain sight. They are jewels amidst dung, a mushroom, not to be cultivated, and bringing the highest prices of anything in a northern hemisphere vendor’s stand. 

We gathered them as a seasonal rite, and to celebrate the birthday of a friend which comes at this time. They require a bit of esoteric knowledge, lest they be confused with inedible or poisonous varieties. They are not to be eaten raw. They are best cooked in butter and allowed to hold their own next to something simple like steak. 

To enjoy them, we must be sure we must of their origin and provenance. The effort we spend is in proportion to our enjoyment. By contrast, how is it that we give so little care to our everyday food ? 

Today’s post is a cautionary note about food safety. More than that, it is an invitation to experience our daily food more fully. You have probably all seen the bumper stickers “ Who’s your farmer?”. This is a valid question. It is both important and fascinating to learn about the origins of food. Once you learn about the different ways food is produced, including the conditions of the farms, factories and people involved, you will most likely care. What you will find is that the bad is really bad, and the good is really good. The obtaining, preparing, serving and eating of food becomes something greater, and something of which you can be proud. And, somewhat incidentally, the food is better. 

As a relevant side note, when you eat food of this quality, it will enhance your health. Since high quality natural food is best prepared simply, it is generally healthy. It is more expensive, and not the kind of thing one overeats. You will be too busy savoring it. You will be come interested in quality not quantity. Most likely, your weight will gravitate toward normal if it is not already there. 

I was hoping to also find some wild asparagus in the fields. Plus, strawberries and rhubarb are due soon. But I am impatient, and have been looking at strawberries in the stores, both organic and not. So, naturally, I was interested when a headline flashed onto my newsfeed: 

 

The #1 Most Contaminated Fruit You’re Buying Is...

 

I clicked on it, only to find that the answer is strawberries. The link led me to an articles about two very important lists which I want to share with you: 

 

The Dirty Dozen

and

The Clean Fifteen

 

These are lists produced by the Environmental Working Group (ewg.org), a nonprofit which is endorsed by The American Academy of Pediatrics. They strive to educate and protect the public from pesticide residue in food, and they use USDA ( US Department of Agriculture) and FDA (Food and Drug Administration) data to do it. 

The Dirty Dozen is the 12 most pesticide laden produce items in stores, in order of contamination. The Clean Fifteen lists the fifteen least contaminated non-organic produce items. Of course, the ideal is to buy organic. But if you cannot, you should avoid the items on the Dirty Dozen. If you can only buy a little bit of your produce as organic, then concentrate on the ones high on the Dirty Dozen list. Conversely, you can feel reasonably good about buying non-organic produce if you choose from the Clean Fifteen. You can download these lists for free on ewg.org. Take your hunting and gathering to the next level. 

Wellness Wednesday: Healthy Architecture

Have you you ever noticed that you just feel good in some homes ? This might be because of the people who live there, or because of some happy memories. Or it could be the architecture ! It has been definitively shown that architecture influences our health and our sense of well being. In this post we will be examining what science and architecture say about healthy living space. 

Vitruvius, a famed architect and engineer of the Roman Empire, note that three elements were required for a well designed building: health, comfort and delight.

Cleary these requirements go beyond household air and water quality, lighting, waste management, and nontoxic materials. They go beyond shelter, privacy and safety as well. 

The AIA or American Institute of Architects has utilized a set of design principles to inform architecture not only for homes, but for schools and hospitals as well. They are as follows: 

  • Safety
  • Social Connectedness 
  • Environmental Quality
  • Sensory Environments
  • Physical Activity
  • Access to Natural Systems. 

This means that besides being safe, homes need to provide a space for people to comfortably gather. They need to be designed in such a way as to foster good air and water quality in the home. They need to provide pleasant sensory experiences of sound, sight, smell and touch. They need to foster the ability to be active. Finally they need to include or be able to interface with nature. 

According to Robert Ivy, CEO of AIA, these criteria for health fostering architecture can go even further. He highlights the following design principles: 

  • Biophilia
  • Educational design strategies 
  • Light as therapy

Biophilia refers to our innate love of nature. It even alludes to the fact that exposure to the natural world has measurable effects on well being. This can mean we keep indoor plants. It could also mean we keep a small garden outside the kitchen door. Educational design, means that our physical spaces ideally foster learning. This may mean something as simple as including space for an aquarium,. Or, it may mean including bookshelves, a tool shop, or a lego table in a child’s room. Light as therapy is a proven factor. Daylight fosters recovery in the hospital and good emotions at home. Daylight is ideally part of every room in a building. 

Designing for wellness is important whether you rent, own or are building your home. Small but well informed changes in your living space can have significant effects on wellness. 

To learn more: 

http://info.aia.org/AIArchitect/2014/1121/aia-interactive/index.html?utm_source=http://info.aia.org/AIArchitect/2014/1121/aia-interactive/index.html#

http://www.ncbi.nlm.nih.gov/books/NBK44199/

http://www.webmd.com/women/features/25-ways-create-green-healthy-home

 

 

 

 

 

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

As per recent precedent, we will be starting with Zika virus news.

NIAID ( National Institute of Allergy and Infectious Disease) chair Dr. Anthony Fauci has reported that Zika virus has yet another disease manifestation in non pregnant adults. Besides producing microcephaly in the unborn, and Guillaine Barre partial paralysis in a certain number of adults, it also produces significant neurological damage to what appears to be a small percentage of adults. More information will doubtless be forthcoming. 

Many have wondered why the virus, which was identified many years ago, had not caused problems on this scale, before. The answer is most likely lies in the fact that it has mutated since it was a harmless strain in Africa. It is interesting to note that this information comes to us through a collaboration between UCLA and the Chinese Academy of Medical Sciences and Peking Union Medical College. 

CDC ( Centers for Disease Control) had recommended that men with symptoms who have been in a Zika infected area abstain or use condoms for 1 least 6 months. Men without symptoms must take these precautions for 2 months. That said, it is also true that 4 out of 5 people with Zika do NOT show symptoms. Hmmmm….

It is becoming more appreciated that Zika related changes in the fetal brain may require sophisticated imaging like antenatal MRI to diagnose. In other words, a woman may not find out until late in pregnancy that her baby is affected. It is important to keep in mind the big picture that most pregnant women with Zika give birth to what now appear to be normal babies. However, there has not been enough time to determine what percent are born normal, or how long or intensively one needs to observe the child before the child is declared normal. 

In other, but ultimately related news,CMS, the Centers for Medicare and Medicaid Services, has warned officials in all 50 states that ending Medicaid funding of Planned Parenthood may be out of compliance with federal law. Ten states, Alabama, Arizona, Louisiana, Kansas, Missouri, Oklahoma, Texas, and Wisconsin have already cut off funding or have passed legislation to do so. CMS has sent letters to each state to “ ensure they have a clear understanding of their obligation to follow longstanding Medicaid law guaranteeing that beneficiaries have the right to receive covered services, including family planning services…” Failure to comply with result in another warning, then penalties ($). 

With weather experts predicating a hotter than average spring and summer, Zika carrying mosquitos are expected to expand their territory in the southern states. Legislators and activists in these states had better think hard about taking away family planning clinics which are principal access points for contraceptives. Ready access to contraceptives may become very important if Zika outbreaks develop in these southern states, which doubtless they will.  To put it very plainly, less access to contraception means more unplanned pregnancy, and in the setting of a Zika outbreak, more potential for Zika affected pregnancy, and thus more potential for seriously affected fetuses, and more demand for abortion. 

As many states are developing legislations to make abortion procedures more restrictive, other groups are promoting the use of abortion medication, which in many cases of early pregnancy, would make abortion procedures unnecessary. At the same time others are promoting “ Perinatal Hospice Care” as another way to avoid abortion, even of babies with fatal anomalies. These facilities would provide end of life care for babies born with conditions not compatible with long term survival. This would include babies with severe chromosome anomalies, severe brain defects, and other abnormalities like the congenital absence of kidneys. The appearance of these facilites coincides with the appearance of legislation in 6 states which requires physicians to counsel expectant parents with an unborn baby with a fatal condition about Perinatal Hospice as an alternative to abortion. In other words, they are advising the parents that they MAY continue to carry the pregnancy, give birth and then place their child in a hospice until it dies. I speculate that facilites of this type are bound to arise in South America where abortion is neither widely accepted nor available, and where there will soon be thousands of severely brain damaged babies due to the Zika virus. 

Now for more virus related news. Polio vaccine has been revised. There have only been 12 cases worldwide, and this latest step should eradicate it once and for all. It is important to note that the world once feared polio as we now fear Zika. 

Gardisil,  the quadrivalent vaccine against HPV (Human Papilloma Virus) has been extremely helpful to curtail HPV disease. It reduces the onset of cervical cancer by 63% and death by 43 %. However, Gardisil 9, which covers 9 HPV subtypes rather than 4, would decrease the same by 73% and 49%, respectively. This vaccine upgrade is estimated to be worth $27 billion in health care savings over the next 35 years, not to speak of the reduction in human suffering. 

Finally, in the awesome news department, women who work out while pregnant seem to confer significant lasting benefits to the cardiovascular and brain function of their unborn children. ACOG (American College of Obstetricians and Gynecologists) continues to recommend that women with uncomplicated pregnancies do MODERATE exercise before, during and after pregnancy to benefit themselves and their children. 

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

Wellness Wednesday: Household Water Quality

Water has to be one of my favorite things. I love to drink it, bathe in in, swim in it, and just look at it.  I am lucky to live at the headwaters of the Rocky Mountains where the water in the rivers, lakes and ground supply is pure and drinkable. I have become aware of the issue of water quality simply because I have enjoyed this pristine resource, and realize it is not this way in many other places.  What can you do to make sure the water you drink and use is of the highest quality ? 

Make sure you know where your water comes from. It can come from a pubic water system, a well, or bottled water. Public water systems in the States are highly regulated and reliable systems. The EPA (Environmental Protection Agency) is responsible for regulating these. Most people in the US (86%) receive their water from a public water system. 

Private well systems that draw groundwater can either serve one household or a group of households. Fourteen percent of households in the US use private wells. EPA regulations DO NOT apply to privately owned wells or other private water systems such as rainwater collecting systems. Therefore, private well owners are responsible for making sure their water is safe to drink. 

What do private well owners have to be concerned about ? The first point is to hire a reputable ( licensed and insured) contractor to drill a well. Water testing can be done at that time. Obvious concerns have to do with keeping wells an appropriate distance from septic drain fields. Of the top 7 causes of well contamination, the first 6 are infectious organisms. Beyond that are chemicals like arsenic, gasoline and nitrates, which comes from fertilizers. The US EPA recommends that all water be tested for quality once every three years. This analysis should include fluoride, since naturally occurring fluoride levels can be more or less than recommended values for children in the home. Your local Health Department can advise you about getting your water tested. 

Bottled water would seem to be an appropriate substitute for questionable drinking water. However, there have been many cases of contaminated bottled water. Read the label to see how a particular brand is treated. If you are immunocompromised, be aware you are looking for treatments such as reverse osmosis, distillation and 1 micron filtration. The FDA (food and drug administration) regulates the production of bottled water. Unless your home water supply is questionable, there is little need to buy bottled water. You can save packaging, and fill up your own reusable water bottle from home. 

Safe water use during camping or travel is a special case by case issue. Water use concerns while camping can be addressed with a little research through the Park Service or Forest Service in the area where you plan to be. Travel concerns outside the US can be addressed through the US State Department website where you can find country specific information. The WHO (World Health Organization) is also a great resource. 

Perhaps the greatest purpose this post can serve is that of raising water awareness. Clean water is one of our most precious resources. Worldwide, clean water is an endangered species. Become aware of water issues, and become active for the cause of clean water in your community. 

 

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

Good Monday.

First the Zika news. Dr. Anne Schuchat, the principal deputy director of the CDC (Centers for Disease Control) has stated that "everything we look at with this virus seems to be a bit scarier than we initially thought”, noting that "the virus has been linked to a broader array of birth defects throughout a longer period of pregnancy, including premature birth and blindness in addition to the smaller brain size caused by microcephaly”. Additionally, she announced that "the mosquito that carries the Zika virus is present in 30 states, more than twice what officials originally thought. The maps at right indicated the territory of these mosquitos. Click on the image to take you to the CDC site on the subject. 

The White House has shifted nearly $589 million or over half a billion dollars in leftover Ebola funds in order to fight the Zika virus. This comes well short of the $1.9 billion that has been requested by the National Institute on Allergy and Infectious Diseases. Dr. Anthony Fauci, the Director of this organization has announced that he will also be diverting funds from other areas in order to close the gap on funding what he views as critical efforts.

Florida leads the nation in number of Zika cases which last week totaled 84. Zika cases in Florida account for 23% of all cases in the states. Mosquito activity is of course greater in warm climates. It is expected that when the rest of the southern part of the country achieves these temperatures that Zika transmission will increase. The CDC has reiterated that insect repellent containing DEET are safe to use at any stage of pregnancy.

Zika is now associated a third clearcut disease entity. We already know a fair amount about microcephaly which is incurred by the fetus when a pregnant woman acquires a Zika infection during pregnancy. We also know about Guillain-Barré syndrome, post viral paralysis, which can effect of minority of people after a Zika infection. Researchers in Brazil are now reporting that the virus may be linked to "an autoimmune disorder known as acute disseminated encephalomyelitis or ADEM. In this syndrome neurological symptoms could start right away or as long as two weeks later. 

New research from the CDC indicates that white women between the ages of 30s and 50s are dying at increasing rates. This is been attributed to poor access to healthcare in rural America. In related news, a new study from Delaware has indicated that women enrollees in their state Medicaid program outnumber men to 2 to 1. State officials are interpreting this as an indication of increased poverty among women.

California has expanded the care that pharmacists are able to give. Perhaps most significantly, they are now able to prescribe contraceptives without the patient having to visit to another caregiver. While three quarters of physicians in one poll do not support the dispensing of birth control by a pharmacist, the American Congress of Obstetricians and Gynecologists support this legislation wholeheartedly.

Delaware has modified its Medicaid policy to require that contraceptive costs be bundled with the hospital’s charge for obstetric care. The Governor of the state, Jack Markell, recently wrote an op-ed for the New York Times describing this change and indicating his belief that it would allow for better family planning. He also went on to argue that contraception is vital to prosperity. 

The Guttmacher Institute recently released a study showing that teen abortion and pregnancy rates have dropped to historic lows. Teen pregnancy rates in particular have been cut in half between the years 1990 and 2011. The teen pregnancy rate in 2011 was 52.4 per thousand and, also of interest, is nearly 25% lower than the rate in 2008.

 

That seems like plenty to think about this week. Stay tuned next week for more news from the amazing world of Ob/Gyn. 

 

 

Wellness Wednesday: Household Wellness: Indoor Air Quality 

Can a house be sick or healthy ? I think it can. Where we live can have a significant influence on our health. Here are are some tips on how to play doctor for your house. 

Consider house “physiology” and house “anatomy”. You must evaluate the air quality, the water quality, the surfaces, the organization and the light. This week we will focus on indoor air quality.

 

Indicators of poor quality: 

  • smelly or stuffy air (step outside first then back in to check) 
  • dirty central healing or cooling equipment 
  • areas storing moldy items like books, shoes

 

Particular concerns about air quality: 

 

Radon

The federal government recommends that you measure radon in your home. It is odorless, colorless, radioactive gas which can cause lung cancer. It can be in any house of any construction, and there are ways to correct it. The link below is a useful pamphlet on radon: 

 

A Citizens’s Guide to Radon

 

Weatherizing

Weatherizing is important for energy conservation. However, it can lead to inadequate ventilation, moisture buildup and mold, which produces allergens. 

 

Asbestos

Asbestos is a natural fibrous material that causes cancer. It was once used in many building supplies. In place and undisturbed, it does not cause problems. However, when it is disturbed during processes like remodeling, it can enter the air microscopically and be inhaled into the lungs. If you think there is a chance of this happening in your home, obtain a licensed professional to evaluate and deal with the situation.  

 

Carpets

Carpets trap dirt and dust mites which produced allergens which end up suspended in the air. When carpets are installed they release VOCs ( volatile organic compounds) which are toxic . 

 

Carbon Monoxide 

This colorless odorless and deadly gas can be produced as a by product of incorrectly installed or maintained furnaces, fireplaces or wood stoves. It can also enter the home from stoves that have no dedicated outdoor air supply.

 

 

Ways to prevent bad indoor air quality:

 

  • Ensure proper ventilation of stovetops and bathrooms.
  • Forbid any smoking indoors.
  • Check for and remedy any leaks or standing water anywhere including basement and attics.
  • Do not store paints or solvents in an attached garage.
  • Do not use odor- masking chemicals or “air freshening” devices.
  • Do not use pesticides or herbicides around the home. Your county extension agent can advise you on safe alternative for around the home. 
  • Test for and remedy any radon problems.
  • Avoid disturbing old building materials which may contain asbestos. 
  • Chose hard surfaced flooring instead of carpeting and use cleanable area rugs where softness is desired. As everyone to remove shoes before entering. 
  • When carpeting is chosen ask installers to unroll it for at least 72 hours at the warehouse to off gas before installing at the home. Then allow another 72 hours before occupying the space. Make sure the carpet can be removed without the use of toxic chemicals. 
  • Vacuum any carpet frequently with a HEPA filter vacuum. 
  • Damp mop floors and wash bedding in hot water weekly to prevent dust mites and their airborne allergens. 
  • Ensure heating stoves are properly designed, installed and maintained. Ensure they are vented to the outdoors. 
  • Avoid toxic household cleaning products and craft supplies. Many natural cleaning alternatives are available. Please see this post on that subject: 

Wellness Wednesday: Natural Home Cleaning

 

There is a lot more to this than I anticipated. I’ll confess, I learned a lot in preparing this post. Stay tuned for Wellness Wednesday next week when we will explore water quality. 

 

References: 

Epa.gov on indoor air quality

American Lung Association

United States Consumer Product Safety Division

 

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

The first US  “Zika Summit” happened a week ago Friday. Much of what was discussed was how to fund the crisis. While it is expected that there will be a few cases of Zika clustered around the country, it is not believed that Zika will affect the United States the same way it has affected Brazil. Special attention was paid to Puerto Rico where hundreds of thousands of Zika cases are expected and therefore thousands of pregnant women anticipated to acquire the infection. 

Congress has not approved the current administration's request for $1.9 billion in funding to fight the ZIka virus. For this reason NIAID (National Institute of Allergy and Infectious Diseases) director Dr. Anthony Fauci has decided to divert funds from the study of Ebola for preventing and fighting the ZIka virus. Transfer of funds from other sources is being contemplated.

It is now accepted that Zika is the cause of post Zika fetal microcephaly. However there seems to be more to the story. This which was hinted at earlier has now been confirmed: Zika virus has spread throughout South America and Latin America. However according to the World Health Organization,“… a surge in microcephaly has been reported only in Brazil.” This remains to be explained, but when it is, it will doubtless provide clues to how the virus causes microcephaly.

Generally it is believed that infections of all kinds are most threatening to pregnancy when they are incurred in the first and second semester. However in the case of Zika, it appears that this is not necessarily true. A recent study published in the New England Journal of Medicine indicates that complications connected with the virus carry over into the third trimester. They note that it is unclear whether “...there is a point in pregnancy where contracting the illness isn't potentially serious”. 

During this period, while public health officials have been recommending mosquito control precautions in countries vulnerable to Zika, I have been wondering about the safety of DEET. Most experts agree it is safe for use by pregnant women as long as they use it as intended. There is one study of 900 women in Thailand published some years ago in 2001 which provides reasonable evidence that daily use of DEET causes no discernible problems.

An interesting law in Tennessee makes it a criminal offense to give birth while addicted to drugs. These women face jail. Naturally this law was designed to deter pregnant women from using. However physicians in the state have declared that the experiment backfired, noting that women who are pregnant and using simply avoid obtaining prenatal care.

In the "practicing medicine without a license" department, Arizona's Republican Governor Doug Ducey signed a billto require abortion clinics to utilize Mifeprex according to an outdated FDA protocol and not the current evidence-based protocol. The new protocol provides that the medication can be used for a significantly longer time in pregnancy then the old protocol. The change in protocol was approved by the American College of Obstetricians and Gynecologist who noted that it aligned with "current available scientific evidence and best practices”. 

New research indicates that pregnant women who use marijuana are 77% more likely to give birth to a low birth weight baby. These babies are also more likely to end up in newborn ICU. Authors of this study note that it is important that we determine the effects of marijuana in pregnancy since so many states have legalized its use.

It would seem a threatening world out there. However, I can see a faint silver lining in all this. It seems the world is finally focusing on the reproductive health of women and children as a foundation for a healthy society and the future for us all.  

A Belated Food Friday: Probiotics, Prebiotics and Synbiotics

What are they ? 

Probiotics are live bacteria and yeast which are good for health. The most common is lactobacillus - found in yogurt and fermented foods like kefir, and sauerkraut. Bifodobaceterium is another and is found in some dairy. 

Prebiotics non digestible carbohydrates that act as food for probiotics. Probiotics are dietary substances that favor the growth of beneficial bacteria rather than harmful ones. 

Synbiotics are products that combine probiotics and probiotics. Foods like yogurt have both the organisms and the carbohydrate and so are symbiotic. 

The FDA regulates all these like foods rather than drugs, and has not certified them for treatment of any medical condition. however research suggests some helpful effects. 

 

What do they do ? 

Probiotics and probiotics help us digest and move food though our gut. Undigested or poorly absorbed food can cause problems such as inflammation, gas and cramps. By helping to normalize digestions, research suggests probiotics and probiotics can help the following: 

  • ease IBS
  • ease inflammatory bowel disease 
  • slow infectious diarrhea 
  • slow antibiotic related diarrhea 
  • help eczema 
  • prevent vaginal infections 
  • prevent allergies 
  • foster mouth health 

 

Should you use them ? 

People who are healthy can use probiotics and probiotics without problems. They have few side effects except gas. On the other hand, those that have serious medical problems should consult their doctor before using them. No one should substitute complementary therapies such as these for prescribed conventional therapies. 

Their exact mechanism of action is unclear. What is clear is that we live colonized with organisms. It is also clear that some populations of organisms are healthier for us that others. Probiotics, probiotics and synbiotics move us back towards a spectrum of organisms which foster better health. 

You can get probiotics as tablets or “ shots” i.e. tiny concentrated drinks. However, my favorites are plain homemade yogurt, kefir, and all kinds of sauerkraut. Smoothies made with plain yogurt or kefir with whole fruit have a delicious tanginess. I like to enjoy my probiotics. 

 

References: 

http://www.webmd.com/digestive-disorders/features/what-are-probiotics

http://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/probiotics/faq-20058065

https://nccih.nih.gov/health/probiotics/introduction.htm

Wellness Wednesday: The Art of Preparation 

Why discuss preparation in a health blog ? Preparation is an antidote to what ails us. 

Preparation is key to overcoming health challenges like obesity, poor nutrition, lack of fitness, chronic disease, and bad habits.

Tax day is April 15th and tax season has prompted my focus on preparation. There is a lot of stress going around associated with tax preparation, and not just because money needs to be paid. There is stress because some people leave their preparations for taxes for the last minute. 

The opposite of preparation is procrastination. Check out this older post on procrastination: 

Curing Procrastination

Procrastination increases stress, undermines self - confidence, and undermines relationships at home and work. 

It decreases performance and effectiveness at completing any goals, including those associated with health. 

There is a common misconception that preparation and goal meeting is about will power and discipline. On the contrary, preparation is about the realization that goal meeting is hard. Because goal meeting is hard, we need preparation which is easy. Said better, preparation is what makes it manageable. Preparation, not will power, is the key to success. 

Let’s dissect or “ unpack" preparation, so you can see what it really is:

  • Having optimism that your goal can be achieved.
  • Taking the time to fully define your goal. 
  • Frankly assessing where you are at the present moment, so that you can see how far you have to go.  
  • Breaking down your goal down into parts. These subsections of the main goal, and not the whole goal, get divided according to the SMART goal criteria. Each of these subgoals must be: 
    • specific 
    • measurable
    • attainable
    • relevant 
    • and time bound. 

 

That is what will make them, if not easy, then attainable.

To learn more about SMART goals, read here : 

New Years Resolutions

Three Ways to get Ready for the Week

The Importance of Inspiration

 

Sometimes preparation itself is daunting. However, when the ask of preparation itself is broken down into segments, it is easier to face. And, crucially, starting with plenty of time ahead will take enable you to spread the segments out so you don’t have to do too much at one time. With preparation the hard becomes easy and the stressful becomes empowering. Try some today !  

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

The CDC has finally given some time bound recommendations to prevent the spread of Zika virus. In particular, they are advising women to wait 8 weeks after Zika infection to attempt pregnancy. Men are advised to wait 6 months before having unprotected sex. Imagine, there is nearly an entire continent of people who are being asked to strictly observe these rules. 

Knowledge about Zika is diffusing northward. Nonetheless, about 1 in 3 people in the US think Zika is spread like a cold. Furthermore, 42% do not realize it is sexually transmitted, and 29% do not realize it can be spread through blood transfusions. Seventy five precent do not know of its association with Guillaine Barre syndrome, post viral paralysis. They have obviously not been reading this blog. You know that it can be acquired through a bite from the Aedes Aegyptae mosquito, from sexual contact with an infected person, vertically from mother to child, and also in any manner that is blood borne. 

The CDC is working hard to get sources of contraception to Puerto Rico, which is under dire threat from the Zika virus. The CDC has recently ramped up their presence on the island and estimates that 138,000 women there do NOT wish to become pregnant but do NOT have access to birth control. 

Democrats in the Colorado House have moved to take away copays for birth control in their state. It still has to pass the House where the GOP holds a one seat majority. 

The Governor of Virginia Terry McAuliffe has vetoed a bill which would have blocked Planned Parenthood Funding in his state. Apparently the bill as written would not affect the ability to provide abortions but would have blocked small state grants for health services like cancer screening and sexually transmitted infections. 

The FDA is altering the labelling for the use of “ Mifeprex” the so called abortion pill. It can now be used for up to 70 days after a missed period rather than 49. The new criteria have been approved by the WHO ( World Health Organization), the AMA ( American Medical Association) and ACOG ( American College of Obstetricians and Gynecologists.) These governing bodies have all cited the need to bring legislative practice into line with available scientific evidence, and this meets this requirement.

I can not help but wonder if this change was hastened by the Zika crisis plaguing the Americas. Because of the specter of the complication of microcephaly in babies born to Zika infected mothers, abortion is under more consideration there than ever before. 

Smoking is has been a scourge to all, but it is arguably harder on women than it is on men. Many people do not realize it’s role in fostering cervical cancer. The reason for this is that HPV ( human papilloma Virus) causes cervical cancer by inserting its DNA into the DNA of our cervical cells. Chemicals from smoking makes DNA fragile so that it breaks ( and admits the virus) easily and makes more errors in replication. That is one of the main ways it causes disease including cancer all over the body. A shocking new report has found that smoking while pregnant produces the same DNA mutations in babies as it does in adult smokers. This study was large and considered very authoritative. 

New research published in the Journal Circulation has indicated an association between endometriosis and cardiovascular disease. This was an observational study with large numbers, so it does not speak to causality or mechanism. It is nonetheless useful information in that it may prompt more investigation, and even at this early junction, prompt more targeted screening of possibly at risk patients. 

Wow this week’s news is rather sobering and somehow all connected. Here’s hoping the week will bring some good news to the world of Women’s Health. 

 

 

 

 

Food Friday: Skin Food- Cocoa Butter and Coconut Oil Body Cream

You all know how I love chocolate. What if you could indulge in chocolate without a single calorie ? That wonderful smell of cocoa butter is the answer. I make my own body cream out of cocoa butter and coconut oil. I have very dry and very sensitive skin due to my lupus. I have found this is well tolerated and very helpful. 

The internet abounds with recipes for homemade cream such as this. I will provide a no frills version PLUS some extra tips to ensure the process is hassle free. 

Prepare all your supplies first:

  • Cocoa butter and coconut oil in 1:1 ratio
  • powerful mixer with whisk attachment 
  • glass bowl for microwave
  • spatula and ladle
  • final containers such as mason jars with lids 
  • roll of paper towels for covering the work surface, covering the mixer and for cleanup
  • a handy garbage bag
  • Stovetop with good ventilation
  • shallow metal pan or bowl for cooling 

Steps: 

Place equal volumes of each fat in a microwave bowl. Warm as little as possible to get it all completely melted and mixed. You can do the same on a stovetop with a double boiler or simply a bowl over a pot of hot water. Stir. Ensure good ventilation. 

Cool in metal pan until solids are just beginning to reform. While still mostly liquid beat mixture in powerful mixer, covering mixer with paper towel to avoid spray. Stop at the yellow slightly thickened stage for a product that is like butter. Whip to stiffer white peaks for a creamy body spread. Work quickly at this stage since it will harden on your utensils. 

Spoon or pour into mason jars or other decorative containers and place lids. 

Clean up all thick material with the paper towels. Hot water will dissolve this stuff, but when it gets cool again in your drain, it will clog it. Get as much off with your paper towels and then wash up the faint residue with hot soapy water. 

This stuff smells wonderful and would be great for pregnant bellies, healing scars, or dry winter skin. I hope you like it. 

 

Wellness Wednesday: The Common Cold

 

What is a cold ?  

A cold is an upper respiratory infection caused by one of hundreds of viruses. According to mayoclinic.org, they normally last 1-2 weeks. They normally occur a few times each year even in healthy adults. Children have them more frequently than adults, and there are usually sicker than adults with it. 

Cold symptoms:

It is important that you can distinguish a garden variety common cold from something more serious. Here are the most common cold symptoms.

  • Runny or stuffy nose 
  • Itchy or sore throat 
  • Cough 
  • Congestion 
  • Slight body aches or a mild headache 
  • Sneezing 
  • Watery eyes 
  • Low-grade fever 
  • Mild fatigue

 

Cold symptoms are caused my the immune system’s response to the virus. These responses can cause their own problems, such as excess secretions and swelling of the passageways. This combination of increased secretions and narrowed passageways can  in turn can foster secondary bacterial infections in the sinuses, ear or throat. These complications require treatment. 

When adults should contact the doctor:

  • Fever of 103 F (39.4 C) or higher 
  • Fever accompanied by sweating, chills and a cough with colored phlegm 
  • Significantly swollen glands 
  • Severe sinus pain

 

When the doctor should be called for children: 

  • Fever of 100.4 F (38 C) in newborns up to 12 weeks 
  • Fever that rises repeatedly above 104 F (40 C) in a child of any age 
  • Signs of dehydration, such as urinating less often than usual 
  • Not drinking adequate fluids 
  • Fever that lasts more than 24 hours in a child younger than 2 
  • Fever that lasts more than three days in a child older than 2 
  • Vomiting or abdominal pain 
  • Unusual sleepiness 
  • Severe headache 
  • Stiff neck 
  • Difficulty breathing 
  • Persistent crying 
  • Ear pain 
  • Persistent cough
  • Pregnant women should call for any illness, just to make their caregivers aware and to discuss pregnancy safe management options. 

High fever, severe sore throat or body aches may indicate a special pathogen like influenza or strep which requires a specific treatment.  Without a doubt, there is little downside to calling your doctor and asking if they think you or your chlld needs to be examined or tested. 

 

Prevention of Colds

Cold viruses are spread by touch or particles in the air. We probably encounter them much more often than we get sick. Sometimes the immune system deals with them easily and we don’t really get sick. Getting sick happens when we encounter a particularly virulent (strong) virus, or when we are run down, or both. 

Prevention is a matter of not getting run down ( easier and than done) avoiding contact with sick people or viruses. Hand washing with soap and keeping surfaces with clean with antimicrobial cleaner is critical. When my kids were growing up, we established a tradition of washing hands whenever we arrived home from elsewhere. 

I also believe good oral hygiene is key to preventing upper respiratory infections. This means keeping up on the toothbrushing, flossing and dental repairs. A peroxide based mouthwash before bed is very helpful too. 

 

Treatment of Colds

Treatment is largely supportive. This means we try to ensure that patients hydrate well and rest. We also like them to keep their nasal passages clear and cough down so they do not get secondary bacterial infections from all the congestion. This can be accomplished with over the counter decongestants and cough suppressants. (Though it is important to note that aspirin is not given to children and cough syrup is not given to children under 4. )  Better yet decongesting is accomplished with frequent steamy showers and lots of herb tea, to keep the passages clear. Good oral hygiene probably hastens healing too.

Did you know that chicken soup is actually ideal for the cold sufferer ? There is actually an old research study showing it has anti-inflammatory effects, and certainly we know it helps to hydrate and nourish. While it is hydration that is often emphasized, people recovering from a cold need at least as many calories as normal. While one should feed a cold, one should NOT “ starve a fever”. 

I generally make my soup stock and my chicken soup from scratch. However that is not a quick proposition. For this reason, I like to keep some high quality canned chicken soup on hand just in case I am pressed for time and someone is under the weather. There, that is the ONE time I will recommend a “store bought, pre-made”  food. 

So in this case as in many, an ounce of prevention is worth a pound of cure. Stay in your exercise routine, sleep adequately, eat well, and practice good hygiene. Those things are a lot more fun than getting sick. If you do get sick, follow these measures. Treat yourself to some good soup, a steamy bath or shower, and a first rate Netflix binge. 

 

 

 

 

 

 

 

 

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

Research on Zika continues at an accelerated pace. This last week Zika news includes the release of a new three-in-one test to test for Zika, Chickengunya and Dengue. Researchers say this cannot keep up though without an emergency spending bill from Congress. 

Puerto Rico has become a strong cause for concern. The director of the CDC has visited recently and expects “ hundreds of thousands” to be infected by Zika, among whom are thousands of pregnant women. Puerto Rico is believed to be an important route of infection to the United States. 

In Brazil, newest numbers show 29 % of Ultrasounds on babies born to Zika infected mothers show fetal anomalies with “ grave outcomes”. The newest research shows the prevalence much publicized defect called misrocephaly, but it is also becoming clear that other kinds of problems are likely Zika-related. These would include: lack of amniotic fluid, other forms of fetal brain damage, blindness,and stillbirth. 

There are 273 cases of Zika in the US States and 282 cases in the US territories including Puerto Rico. 

A small randomized controlled trial published in March of this year studied 78 first time mothers and their second stage of labor. The second stage is the time from becoming completely dilated to pushing the baby out. The old guidelines allow first timers pushing well to take 2 hours without epidural or three hours with epidural. Study subjects were allowed to push for one hour greater than current guidelines. In this study, when they did, C sections rates were cut in half without any other adverse effects noted  in either mother or baby. The authors remarked that the study was underpowered to detect small but clinically important differences. It does however, suggest that first timers were being “cut” as we say, too soon. 

As an Obstetrician, I would note that I have seen this study reported in the press. Many assumed that this meant that caregivers should now let patients push longer. Finally I got at look at the study itself. Nowhere in the press did it mention that all of the women in this study have epidurals. This makes it more difficult for many people to push effectively. Now it makes sense to me that more time made for more safe vaginal births. Certainly in many cases,  second stages with low quality epidural-influenced pushing should not be expected to make as much progress as second stages in women with strong epidural-free pushing. More time should be given for these patients. Normally, in a real labor population, some people have epidurals and some do not. Labor length averages are going to be influenced by his. However, If every single patient in a small study has an epidural, result swill skew toward the effect of the epidural-ized labor. Obviously. 

The old labor guidelines were made in the days before epidurals. In those cases, the women were probably unmedicated and thus pushing for all they were worth. In such cases, the old time allowances were probably appropriate. The idea is that, if your patient was going to deliver vaginally  safely, she should be able to do so within the old time allotments. Furthermore, if you persist in pushing her longer, you set yourself up for a variety of bad situations like stuck shoulders, a traumatized baby, or a traumatized mother, or a very late and thus risky C section. Hard coordinated pushing should result in continued progress of some degree. If it does not, the safety of vaginal birth should be questioned.

There are various signs we watch for during labor to tell if the baby can safely be delivered vaginally. It is so much more than the time duration of pushing. We watch the fetal heart tones, the evolving shape of the baby's head, the movement of the baby in response to the mother’s particular push in whatever particular position she is in. We factor all this in. I may know someone is stuck after only one hour, and I may let someone else safely go for four. It is a matter of not only knowing the labor guidelines, but but knowing the reasons behind them and knowing your particular patient very well. 

In the way cool department, researchers are using an iPhone app to begin a study of postpartum depression. They will be looking at a possible genetic predisposition for PPD. Using the iPhone will allow them to more easily get the enormous numbers (100K) they need to produce quality conclusions. 

In the good news department, Vox report that several more states, Missouri, Hawaii, Washington, South Carolina and Tennessee are considering bills to allow pharmacists to prescribe birth control pills. Ob/gyns support these bills because of the well established safety of these medications. 

The Supreme Court is hearing arguments about the ACA’s (Affordable Care Act) contraception mandate. A religious group called “ Little Sisters of the Poor”, one of the plaintiffs, are nuns, and they argue “ the birth control provision violates the laws of God.”

Governor Mike Pence of Indiana has signed a bill prohibiting abortions even for birth defects. He did this despite opposition from several of his female pro-life Republican colleagues in the House. Has he heard of the Zika virus ?

 

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

 

 

Food Friday: Easter Lunch Planning 

Sorry, for some reason this did not go out as planned.... so here it is ! 

Every year we have a sizable party for friends and family. Every year I try to include some traditional dishes, but also some things to surprise and delight. Right now I am letting you in on the menu planning process. 

This year, Passover does not coincide with Easter. Most years, it seems like it does. Since I am Jewish we do not have leavened bread on those years. However, this year, we will be able to. 

Last week’s Food Friday went over many of the traditional foods from around the world. Because Easter occurs so early in the spring, it is before crops are really coming in. Thus even the festive menus include foods made from preserved things, like cured meats and fish. But, when you think about it, dried wheat ground into flour is a preserved thing, and so breads are among the traditional dishes, especially if they contain dried fruits and candied citrus peel.

For our bread this year, I am looking forward to a traditional Russian Easter Bread made by one of my Russian friends. My mother in law usually brings lamb, which is herb encrusted. My daughter is quite the chocolatiere, and I am going to try to persuade her to make a batch of handmade chocolates in fanciful shapes on Saturday. We like to make bugs and butterflies from molds. Her husband is the salad expert and produces an extraordinary spinach salad with candied walnuts and sliced strawberries. I will handle the new potatoes, smoked salmon with cream cheese and pickles, and new asparagus. Also I cannot resist making a meringue cookie in honor of one of the great grandmothers in the family. For them I will use only the whites of the egg, and so will liberate numerous yolks. To utilize these, I will make lemon curd. I have discovered that just about everyone in my family loves it. Few here in the states eat it. It is more popular in Britain. It is a rich lemony spread made with butter, sugar, yolks and lemon juice. You can even make it with lime juice. People use it like jam. It is a beautiful sunny color. 

And that is quite enough for the cooked sweets, since there will be the egg hunt in the nearby forest. There will be lots of treasures, such as spools of thread, coins, buttons, ribbon and more, but there will also be candy. Some of the eggs will be wooden and painted, and some will even be stone. In the past I found some that rang like bells. They went to the permanent egg collection. 

Make no mistake these gatherings are for more than fun and food. They forge the social bonds we need to be happy and healthy. So regardless of your religious , political, familial or cultural affiliations,  get together and make something nice. Renew old bonds and forge new friendships. 

Welcome to my spring holiday table. I would love to hear about yours. 

 

 

 

 

 

Wellness Wednesday: Wellness While Gardening

Gardening does not strike anyone as a particularly dangerous pastime. However there are a few tips and one critical point I’d like to share on the subject. 

I have been a committed gardener ever since I got married 33 years ago. It has been a soul feeding pastime for me. Gardening has gone hand in hand with family time, from the hands on science education for our kids to our present day culinary pursuits. 

I have gotten sunburns, rashes, cuts, scrapes, slivers and mosquito bites.  I have gotten dirty and dehydrated. I have lifted too much. I have risked heat stroke and frostbite. Thank goodness I have not gotten any ticks. But these are the concerns at hand. If you check the CDC (Centers for disease control ,they cover the list of precautions that would have prevented all these ills, and I will recoup them dutifully here. But there are a couple surprises, and at the end, one BIG POINT. 

  • Your clothing and hat should protect against weather, insects, chemicals (even organic ones) sun and yes, dirt. Dirt is full of pathogens like various fungi, tetanus and toxoplasmosis. This is of special concern to those who are pregnant or have compromised immunity. Play in the dirt with gloves.  
  • Make sure your every ten year tetanus shot is up to date. 
  • Your skin should be protected by sunscreen or insect repellant as indicated. 
  • Your hands should be gloved no matter what. Did I mention the gloves ? 
  • Your eyes should be protected from flying debris and dirt. You are not pulling enough weeds if you do not have dirt flying toward your face. 
  • Have water with you and hydrate throughout the day. Dehydration happens faster than you think. 
  • Know the fertilizers and supplements you are dealing with. Read all labels and follow all directions. 
  • Know your equipment, and make sure it is in good working order. If you are using sharp objects or powered equipment, keep your attention on what you are doing and keep small children out of harm's way. 

Here is the BIG POINT, and I will plead with you on this. Use organic methods. Please. The whole point of gardening is to get closer to nature and to produce something wholesome you can eat. Please do a little reading, and welcome yourself into the immensely gratifying world of organic gardening. If there is one thing that will save the world, it might be this. 

I am not even going to begin to address all the safety concerns of gardening any other way, such as with conventional herbicides, pesticides, or fertilizers. It would take too long and it would be depressing. So, get yourself one of the many excellent organic gardening resources, like maybe a book, the internet, or maybe your grandmother.  It doesn’t matter if you do container gardening in the middle of a cityscape, or if you have a farm. Chose this life affirming hobby, and do it in a life affirming way. 

 

Stay tuned next week for another Wellness Wednesday. 

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

The CDC (Centers for Disease Control) predicts Zika will spread along the Gulf States of the US this Summer. The CDC has also said that since mosquito control in Florida is good, the risk there should be relatively low. As with regard to South America, and in particular Mexico, the CDC has noted that the Aedes mosquito, vector for the virus, is rarely seen above 6500 feet. 

Researchers studying a Zika outbreak in French Polynesia have identified a 1% risk of microcephaly among children born to mothers infected in the first trimester. Observers of the Brasil outbreak think the figure is too low given what they are seeing. It will take several more months to draw any conclusions.

As of Friday, there are 450 people in the United States who are infected by Zika. This does include Puerto Rico, where the Puerto Rican section of ACOG ( American College of Obstetricians and Gynecologists) are providing IUDS free of charge. (So proud of my brothers and sisters in ACOG ! )

In other news, concerns have been raised in an opinion piece in the journal Obstetrics and Gynecology that media coverage of controversial medical technologies may prevent certain women from getting the best treatment for their particular needs. They site the recent reluctance of doctors to use mesh implants, morcellators, or Essure sterilization even in patients for whom they are well suited. 

In the no-good-reason department, new research shows that sexually active teens with LARCs ( Long acting reversible contraceptives such as IUDs) are 60 percent less likely to use condoms that similar girls taking the pill. Birth control use in teens is distributed as follows: 2% use LARCs, 6% use Depo Provera injection, patch or ring. 22% use the pill. 

Also in the no-good-reason department, new research indicated 50% of pregnant women who quit smoking start again after childbirth. What percent of smokers quit during pregnancy ? 13 %. 

What about smoking pot in pregnancy ? One thing’s for sure, Ob care givers are not consistently counseling patients about it. These are the findings of new research published in the journal Obstetrics and Gynecology. I will say that as a caregiver, It is challenging to counsel against something that is so widely used, and for which people will rally. Neither the popular media and the research community  give us much in the way of support here. In fact, the facts on MJ use in pregnancy are not encouraging. If you are interested you can read the definitive information HERE, which is a summary document from the American College of Obstetricians and Gynecologists to its members. This is an area needing further attention. That is, if we value the brain power of the next generation. 

Steroids are given to mothers at high risk for preterm delivery. At this time, we give them from 24-34 weeks of gestation. However, new evidence indicates they may be helpful given even as early as 22 weeks. Hopefully the demand for this will be small. 

A new study published in JAMA ( Journal of the American Medical Association) reveals that vaccine aversion may be beginning to manifest in increasingly rates s measles and pertussis (whooping cough) in the United States.  No surprise here. 

Also In the vaccine department, there is good news. Chicken pox, also called Varicella, is now nearly 100% preventable. Think that’s no big deal ? Try telling that to someone like me who got it at the age of 24 ( and got seriously ill) or someone with a terrible case of shingles, which is reactivated chicken pox. New data says getting two shots instead one, one at age one, and the second around 4-6 years of age, confers near 100% protection. 

Stay tuned for more breaking news from the world of Obstetrics and Gynecology, here, (or hopefully in your inbox) next week, on Medical Mondays. 

 

 

Wellness Wednesday: Natural Home Cleaning 

There are many cleaning products on the market now which are safe, effective and appealing. But they sure can be expensive. In this post, we will go over the general concerns with conventional cleaning methods, the basic principles of healthy cleaning, and finally the “ ingredients” you will need to make your own cleaning supplies for a fraction of the cost. 

 

Scary clean

Scary can come about in several ways: if you use toxic cleaning products, if you mix cleaning products, if you use standard cleaning products incorrectly, or, if you let something become so soiled over time that only the most powerful solvents will get it clean. 

Medline Plus, a resource of the National Institute for Health (NIH), has produced a page on household cleaning products which is worth bookmarking: 

 

Medline Plus Household Products

(click to view)

 

They start by explaining that many common household substances are potentially toxic enough to cause illness, birth defects, or even death.

 

 

You might think safe natural cleaning is all about what you clean with; but there is much more to it. 

 

 

 

 

Principles of Safe Cleaning 

  • Keep up on your cleaning so things do not get really difficult to clean. 
  • Read the label of any cleaner, natural or otherwise. Make sure you know what it is made of. They all should be powerful chemicals; that’s why they can get things clean. 
  • Keep cleaning materials in their original container, with their labels on, so they can be identified. This holds true for homemade cleaning solutions, whose labels should include all their ingredients. 
  • Store all cleaning materials, natural or otherwise, away from children and pets. 
  • Never mix cleaning solutions. Bleach and ammonia for example, may react, ignite or explode. 
  • Volatile hydrocarbons, even from naturals like mineral oil, can be combustible so they may not be used near open flame. 
  • Before cleaning, prepare. 
  • Assemble your supplies and materials. 
  • Assemble your outfit ! Yes, in many cases, you need to wear protective clothes, put your hair up, wear some gloves, and have some eye protection. It won’t hurt either to have some music, TED talks, or audiobooks set up for easy listening. 
  • Do one area at a time. 
  • Turn the lights on, and clear away as many items and furniture as are practical. Open the windows or otherwise secure good ventilation. 

Then and only then, you can clean easily and safely. 

 

There are many “ recipes” on the internet for home made natural or less toxic cleaning solutions, all complete with tableaux style photos which invariably include bundles of lavender and the obligatory lemon wedge.  The very best resource I found was a link from the National Institute of Health to this page : 

Twelve Home Cleaning Recipes

( Lemon and Lavender not included.) 

Click on the title link to view precise recipes AND instructions to get the most out of these solutions. They have all been tested for both performance and safety at the Toxic Use Reduction Institute (TURI) at University of Massachusetts, Lowell. Very rigorous ! 

Their ingredients list

Their ingredients list

These are all available at standard grocery stores ( even Murphys’ oil) , as are jars and spray bottles. Labels can be obtained at an office supply store. I recommend writing down the recipes somewhere, i.e. in a note taking app, or even into your family cookbook. The labels do get drizzled on in the course of cleaning, and may run even with sharpie pen labelling. You will not want to lose the recipes. 

Cleaning is a chore, but it should not be unsafe or miserable. I recommend being well prepared, and using products that you like, whether homemade or purchased. If you make your own, you may also consider adding a few drops of your favorite essential oil to your solutions, to make your task smell as good as possible. I also am a big fan of taking the time to set up a pleasant listening experience. Happy cleaning. 

 

 

Next week we will explore safe gardening, as the gardening season approaches.

Food Friday: Chocolate 

I’m devoting a whole post to chocolate. That’s how strongly I feel about it. The great Spring celebrations of Passover and Easter are coming up and it is time to think about festive foods. 

In our house we take our chocolate seriously. You might even say we are chocolate snobs. Our snobbery has been fostered by two things: our affinity for France, and our pursuit of fine organic foods. 

For my daughter’s graduation from high school, I took her to France. We wanted economical flights and lodging, and so we went during the drizzly spring break. We arrived shortly before Easter Sunday only to find the southern French countryside greened, blooming and decorated.

It turns out that in France, Easter is a bigger communal holiday than Christmas. Every storefront was beautifully decorated. The bakeries, pastry shops and chocolate shops were full of dazzling creations - figures of every sort, made in bread or chocolate, then festooned with sugar formations and woven ribbons. Chocolate was absolutely central to the Easter celebrations, and we saw chocolate like we had never seen before. 

Now we make our own creations at home. We feel fortunate if we just get it tempered correctly. To make our own, we have had to learn all about it. We have learned about the equatorial, often war torn regions where it  grows, and we have learned about the farming and labor practices entailed in chocolate production. We have learned that to get organic chocolate, we pay more, but that the workers involved get a better wage, and the land is left unpolluted. 

It turns out that these days, westerners like us have come to recognize the value of country specific cocoa beans. When I attended one chocolate tasting demonstration, even I could tell the difference in the tastes. 

But what about health ? Could all the health claims about chocolate be true ? As always, the devil is in the details. Healthfulness is compromised when lots of milk fat and sugar are added and when the chocolate is overly processed, (i.e. Dutch or alkali processed). It turns out chocolate needs to be appreciated almost like coffee beans, in its dark, somewhat bitter form, and certainly with its own fat, cocoa butter, which has its own health benefits. 

According to the clevelandclinic.org, cocoa beans confer healthfulness via the following compounds they contain: flavonoids, antioxidants, and flavanols. These potent compounds combat oxidative stress. This means they neutralize damaging compounds called free radicals which may accumulate the body. They can also, by various mechanisms, favorably impact lipids, lower blood pressure, and improve blood flow. 

Current recommendations provide for taking about 1 ounce of dark chocolate a few times per week. At my office, we always keep some on hand, “ for medicinal purposes only” : ) . 

 

Stay tuned for more holiday food info next week on Food Friday. 

 

 more reading : 

Metro UK

Medical News Today

 

 

 

 

Wellness Wednesday: Safe Cosmetics 

We think of cosmetics as luxurious little compounds we use externally to improve our appearance. But they are mixtures of chemicals of which we should be aware. We place them on our skin, eyes and near our mouths, and may not realize that they could have potential health impacts. We also store them in our homes where they could be obtained by little ones who may use them in unsafe ways. 

This week’s post deals with these concerns. To explore this complicated area, I have researched on two main site, fda.gov, i.e. the Food and Drug Administration, and breastcancerfund.org. They both make the following strong recommendation: To read the labels of any products you buy. They advise us to know what these ingredients are, and to look them up on FDA.gov if there are any concerns. They also state that products with unlisted ingredients should not be used. 

FDA site 

http://www.fda.gov/Cosmetics/default.htm

The FDA site is rather comprehensive so I will not attempt to reconstruct or summarize it here. Instead, I will highlight some points that I felt were noteworthy. 

FDA.GOV states that “ FDA regulates products that we think of as “makeup” –such as lipstick, blush, foundation, face powder, eye shadow eye liner, and mascara--as cosmetics under the Federal Food, Drug, and Cosmetic Act.” The FDA pays particular attention to color dyes used in cosmetics. Coal-tar based dyes are common in hair dye. They are known to cause eye injuries or allergic reactions. However, the FDA cannot take action against them since the package insert provides instructions and discloses this risk. 

Hair straighteners are also a concern. Some can release formaldehyde.The FDA advise avoiding exposure to formalin, methylene glycol or formaldehyde. 

“ Progressive dyes” are hair dyes which produce the desired color change after repeated use. They contain lead acetate - made for external use only and are unsafe to have around children due to the risk of lead poisoning. 

Mascara is associated with a significant number of complications. Apparently eye injuries are a common result of mascara application while moving, i.e. while one is in the car. Mascara can also cause infection or irritation. It should be thrown out after three months or if the eyes get infected or inflamed. Mascara is not to be shared, even with friends or relatives. Bacteria which may be friendly to you may cause problems in someone else. 

Do not use Kohl, aka al-kajal, kajal, or summa. Kohl is a traditional dark black eye decoration in many areas of the world but is not approved for use in the US. It consists of salt and heavy metals (! ) such as lead. It is linked to lead poisoning. I remember when this was in vogue in the 70s. 

Permanent tints and dyes for eyebrow and lashes have caused serious injuries. Those containing coal tar colors are not safe for use. Makeup experts advise against eyebrow pencils anyway, saying that they appear too severe. Additional definition is best achieve with a subtly applied dark eye shadow.

Parabens have been in the news as a suspected undesirable chemical. Parabens are preservatives to guard against microbiological growth. Studies show they are safe at levels up to 25 %. In cosmetics, they are typically used at levels up to 0.3 %. Parabens do have weak estrogen like activity and for this reason a public concern has been raised. However, they are 10,000 to 100,000 less potent than natural estrogen produced in our own body. In the small quantities in which they are used, they are believed to be unlikely to contribute to any cancer risk. 

Phthalates are a group of chemicals used in many materials from floor covering to food packaging. They are also used in numerous cosmetics. Their primary use in cosmetics is in hairspray, nail polish and synthetic fragrances. They too are endocrine disruptors, meaning they interact with hormone receptors. The FDA states “ It’s not clear what effect, if any, phthalates have on human health”.They continue to follow this question, but to date “ FDA does not have evidence that phthalates used in cosmetics pose a safety risk. “ However, some people prefer to avoid phthalates until there is more proof of safety. The particular compounds to look for are dibutylphthalate (DBP), dimethylphthalate (DMP) and diethyl phthalate (DEP). DEP is the only phthalate still commonly used in cosmetics. 

Talc is a common substance which shows up in baby powder and blush. It is a mined mineral and contains magnesium and silicon. Certain talc has been known to be contaminated with asbestos, which is a known carcinogen. For this reason, since the 1970s, it is purified before use. Pure talc has not been linked conclusively to any cancer, though in the 1970s it was rumored to be linked to ovarian and breast cancer. The IARC ( International Agency for Research on Cancer), which is part of the World Health Organization, has made the following statements about talc: 

  • IARC classifies talc that contains asbestos as “carcinogenic to humans.”

  • Based on the lack of data from human studies and on limited data in lab animal studies, IARC classifies inhaled talc not containing asbestos as “not classifiable as to carcinogenicity in humans.” 

  • Based on limited evidence from human studies of a link to ovarian cancer, IARC classifies the perineal (genital) use of talc-based body powder as “possibly carcinogenic to humans.”

Breast Cancer Fund

breastcancerfund.org

This organization takes a more conservative point of view than the FDA. They advise avoiding any substance where there is doubt, or a lack of data, and advises reducing the total number of cosmetics altogether. They also advocate for making your own products with nontoxic ingredients from your kitchen. 

Their first piece of advice is to avoid synthetic fragrance, as it often contains Phthalates. Additionally many people are sensitive to it. Several people on my staff get an instant headache when they smell strong synthetic perfume. 

They urge caution about a products with unsubstantiated claims of being natural or organic. Only a USDA organic seal guarantees 95% or more or organic ingredients. "All natural" or organic does not mean hypoallergenic and does not determine safety. Anyone can be sensitive or allergic to anything. For example, many essential oils are fine when aerosolized, but irritating when applied directly to skin. 

Breast Cancer Fund advises caution when getting the nails done. In particular they suggest steering clear of shops with use polishes with formaldehyde, toluene, and dibutylphthalate, the so called "toxic trio” . There are many brands that are now “ three free”. Ask your salon to carry these. 

I support the advice to use minimal cosmetic products. I also support the idea of making your own. I will conclude this post by sharing what I use. Bear in mind that I am 54 with dry skin and long curly dry hair. For face, I rely on what my Dermatologist has told me. I shower twice a day with plain water. I exfoliate gently with an apricot pit scrub, and in the day use a Retinol ( vitamin A based) cream with sunscreen. In the evening after I wash with water only, I use a home made mixture of a stronger Retinol cream, a richer moisturizer and a concentrated vitamin C serum. On the body I take it easy since I have sensitive skin from Lupus. I use a waterproof electric shaver in the shower, so I need no shaving cream or razors. After the shower, I use a home made 1:1 mix of cocoa butter and coconut oil, both organically produced. ( It is actually a chore to melt, blend and re-temper.) For hair, I use only conditioner, no shampoo. I use a light mineral based moisturizing foundation with sunscreen, and mascara with a brush that I clean and replace every 2 months. Finally I use Burts Bees lipgloss for face color and lips. That’s it. 

Oh yes, that photo of me was a joke but I guess it fits in here. 

Next week on Wellness Wednesday we’ll expand on this theme and go over natural home cleaning solutions. Thanks for reading. 

 

 

 

 

 

 

 

 

 

 

 

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

Good Monday.

The CDC continues to study the relationship of the Zika virus to a severe brain anomaly called microcephaly. No one really doubts the association; The goal in documenting the association scientifically it to understand the mechanism of how the virus dose the damage and therefore how, ultimately to prevent or interrupt it. Similarly, new research this week provides stronger links between Zika infection and Guillaine Barre syndrome, or post viral partial paralysis. 

Zika virus has been seen as far north as Washington DC. Aedes Egyptae mosquitos have been identified there as well, and it is speculated that they survive the winter by staying indoors or in subways. Apparently the mosquito maps in the US are “not complete”. 

Preterm labor and delivery has vexed Obstetricians for decades. We have little to prevent it. We did feel were making inroads into predicting it using two specific tests: ultrasound measurement of the cervical length and a swab for a chemical called fetal fibronectin. However, according to new research these may not be as useful as previously thought. Risk factors for preterm birth are young age, low pre pregnancy maternal birthweight, smoking, short inter conceptual interval, urinary tract infections, and periodontal (gum) disease. 12% of all births in the US are preterm. Preterm delivery is the leading cause of neonatal mortality in the US. For more information, see our section HERE on preterm labor. 

A study reported in the Journal of Adolescent Health has shown that only about 42% of men have heard of emergency contraception, aka the morning after pill. This is a safe effective solution to prevent unplanned pregnancy. It is available over the counter. 

Essure is a device placed in the fallopian tubes for sterilization. It turns out to have a far higher complication rate than was previously believed or advertised. A powerful social media campaign brought this to the attention of the FDA who has now studied the matter and given its recommendations. Essure will not be pulled off the market. Instead, Bayer AG will be required to perform new studies on the implant. The FDA will also require a boxed warning and supply a checklist for physicians to review with patients. The FDA is currently seeking public input on the packaging. 

From the chickens and eggs department, a recently released study in the Journals of Gerontology showed that “ higher education, positive wellbeing, overall good health, and higher physical functioning all contribute to women maintaining good memory health after age 80.”  This data comes from a study initiated in 1991 and is a subset of the huge Women’s Health Initiative Study famous for its revelations about postmenopausal hormone replacement therapy. 

A recent study in older first time pregnant women shows that induction at or after 39 weeks is NOT associated with a bad birth experience or a higher risk of C section. This is contrary to the prevailing wisdom. 

This last week, the US Supreme Court has heard arguments over the matter of abortion facilities. At issue is whether they must meet hospital grade surgical standards. Proponents state this will make the facilities safer. Opponents say that this is a ruse, cost prohibitive and simply a legal way to close down all but a few facilities (75% of them according to ACOG, the American College of Obstetricians and Gynecologists. Medical experts say this level of facility is not medically necessary for these procedures.

Meanwhile statistics in the US now indicate an 18 % drop in unplanned pregnancies between 2008 and 2011. One third of these pregnancies were averted though legal abortion. Further south, the staunchly Catholic South American countries grapple with the devastation of Zika induced microcephaly and the question of abortion should it be identified. 

 

Stay tuned next week for more breaking news from the world of Obstetrics, Gynecology and Women’s Health.