Food Friday: Picnics

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

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

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

Pack safely: 

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

Pack creatively: 

Consider some alternatives to traditional cuisine. 

Classic American picnic foods, as for Fourth of July 

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

French picnic foods, as for Bastille Day 

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

Italian picnic food: 

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

Swedish picnic food for Midsummer celebration:

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

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

References: 

Chow.com

Food Timeline 

Pamphlet: Pack a Family Picnic

Foodsafety.gov

Home Food Safety 

FDA

Wellness Wednesday: Generativity 101

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

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

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

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

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

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

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

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

References:

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

Kristensargsyan’s Blog

Simplepsychology.org

Foley Center for the Study of Lives at Northwestern University

Psychology.about.com

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

Medical Monday: Are there really any low risk pregnancies ?

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

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

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

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

Here are their results: 

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

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

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

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

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

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

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

Here is the link to this current research: 

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

Structure Sunday: The Structure of Grocery Shopping

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

First reflect: 

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

Inspect, tidy and make lists: 

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

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

Prepare yourself to shop: 

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

Pack for the trip: 

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

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

When to go: 

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

Where to go: 

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

 

Once you get there:

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

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

Enjoy yourself: 

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

 

 

 

For more reading : 

How to Buy Food, at Bon Appetite

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

Supermarket Psychology, by Weight Watchers 

Surviving the Psychology of Sneaky Supermarkets, at National Geographic 

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

11 Psychological Tricks of the Supermarket Trade, at Food Network

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

Food Friday: Cool Dinners for Hot Days

It’s summer and the weather is hot. It’s great to turn to festive cold dishes. But they often contain lots of simple carbohydrates, which most of us should avoid. Here are some tips to help you avoid the same old sandwiches, crackers and pasta salads. 

Some recipes, especially these which are high in protein, require a little preparation in advance. 

With advance cooking: 

• Prepare any kind of meat, chicken or fish in surplus. Use in any of the following ways: 
• Season liberally and toss into a leafy green salad for a balanced meal, e.g Taco salad. Serve with fresh corn rather than chips.
• Season liberally and toss with firm vegetables such as cubed carrots, steamed broccoli, carrots, peas, corn, peppers, tomatoes. Dress with a vinaigrette in advance to marinate, flavor and soften. Add raw nuts to any salad but be sure about allergies. 
• Make wraps and include vegetable, garnishes, salsas and condiments. Consider rice, seaweed or iceberg lettuce wraps with toothpicks. 
• Use hard boiled eggs as a protein rich garnish to leafy salads, or mix with olive oil vinegar, mustard lemon and spices to make a rich dressing. Traditional Cobb Salad and Salade Nicoise are made this way. 
• Make an egg salad with lots of vegetables like celery, pickles, relishes, peppers, etc. 
• Make “meat” balls of chicken, meat or even fish (called gefilte fish traditionally), and serve on sticks with flavorful cold sauces for dipping. Find recipes that have high flavor since flavor is more subtle in cold dishes. 
• Make chicken salads, e.g. curried chicken salad or Waldorf salad. 

With no advance cooking: 

( Remember, deli meats are not for pregnant women.) 

• Meat deli trays.  
• Cheese Deli trays. 
• Smoked fish or poultry platter. Any of these can go with all the trimmings, i.e.fruits, vegetables, condiments. Try not to resort to all the crackers. Build hor d’oevres on slices of cucumber, small tomatoes halves or slices of firm cheese.
• Toss cubes of feta, mozarella or other cheese with leafy or firm vegetable salads. Dress attractively with flavored vinaigrette or a creamy homemade dressing. 
• Make cold fruit soup with a yogurt or kefir base. 
• Use canned salmon or your favorite canned meat fish or chicken to make spreads, dips and additions to salad. Think "tuna salad” but better. 

Once you’ve got a protein rich cold main dish figured out, it’s easy to think of cold side dishes. Make any kinds of fruit or vegetable salads; try your hand at a cold Gazpacho. Those who can tolerate legumes (beans, tofu, etc) can make many more protein rich dishes, though one must bear in mind that to constitute complete protein, legumes must be combined with whole grains. 

To keep your cool dinner healthy, steer clear of soda, fruit juices and excess alcohol. Lightly sweetened herbal iced teas flavored with lemon wedges and mint leaves are always appreciated. You can also use just a splash of fruit juice with cold and very economical club soda, at a fraction of the price of commercial gourmet sodas. 

Finally, cool desserts are easy. Try fresh berries, melon or pitted fruit with cow’s milk or coconut cream. If you are feeing ambitious, prepare an exotic sorbet. Simple reliable ice cream makers are commonly available these days at any big box store, and make your recipe into ice cream in 45 minute or less. Just remember to freeze the cylinder well in advance of using it. 

Wellness Wednesday: Creativity and Health

Yes! There is substantial connection between creativity and health. I started thinking about it today when my creative son Vale said he needs different parts in his day: some hardworking, others restful, and then finally, a creative time. The creative time is when he really recharges. I feel the same way. I crave that creative time almost as one would crave food or drink. 

What is the science behind this? To answer this, we need to remember that, on one level, we live in our nervous system. Our nervous system has two main parts: electrical and chemical. Chemical messengers called neurotransmitters convey information between neurons, long nerve cells, which then conduct electrical signals down their lengths. All our sensory input and thought output occurs this way. When we are creative, the brain is utilized in broad new ways, in a process that is both effort-requiring and pleasant. New neural networks are formed and older ones are kept healthy. More neurotransmitters are released. In fact, a Yale study (1) found that older "creatives"  have measurably more robust white matter of the brain, and tend to live substantially longer than non-creatives. Ok, so creativity seems to keep brain tissue healthy, which seems to be associated with longevity. 

It turns out that creativity also seems to impact the immune system. This was suggested in a small study of HIV patients, wherein writing was utilized as a therapy. Emotional writing versus non emotional writing was associated with a significant rise in CD4+ white cell counts. (2)

All form of creativity seem to be associated with positive health outcomes, from music, movement, to the graphic arts.

"There is evidence that engagement with artistic activities, either as an observer of the creative efforts of others or as an initiator of one's own creative efforts, can enhance one's moods, emotions, to other physiological states as well as have a salient impact on important physiologic parameters. " (3) 

Music has even been shown to help control pain. (3) 

Both being creative and experiencing the creative efforts of others improves measures of well being. On this basis, 

"... the arts are also being used to create safer hospital environments, introduce nature into medical settings and enhance aesthetics through hanging art on previously sterile space. And guess what? Patient/caregiver stress is measurably reduced, quality of care is increased, and costs of treatment go down. (4)

Numerous observational studies have shown associations between being creative  and the following outcomes: 

• increased happiness/enhanced mood
• less anxiety
• increased resilience
• better problem solving and mental acuity
• improved self confidence
• decreased tendency toward dementia
• increased longevity

What of the person who says they are not creative? First of all I think this is misconception. Creativity may be something you are, but it is also some thing you do, and something you can develop. Though I cannot tell you exactly how to be creative, I can give you a few hints. Creativity involves the following two traits/practices: 

1. openness- meaning mental flexibility and willingness to entertain new ideas

2. conscientiousness - which means carefulness and perseverance. Malcolm Galdwell has postulated that 10,000 hours at something is required to achieve mastery, and of course mastery is associated with that pinnacle of creative states, FLOW, but that is a topic for another day. 

Meanwhile have a look at my latest creative endeavor: 

References: 

http://www.ncbi.nlm.nih.gov/pubmed/21840401

 http://www.ncbi.nlm.nih.gov/pubmed/22807062

(1) http://www.jneurosci.org/content/29/16/5319.full

(2) Psychosom Med. 2004 Mar-Apr;66(2):272-5. 37 pts 

(3) Am J Public Health. 2010 February; 100(2):254-263. 

(4)https://www.psychologytoday.com/blog/arts-and-health/201004/arts-in-healthcare-creativity-the-health-it

Medical Monday: For the Autoimmune Among Us

Chances are, you know someone with an autoimmune condition. This might be Lupus, Rheumatoid Arthritis, inflammatory bowel disease, Multiple Sclerosis, or many others. I decided to post about this on my site since autoimmune disease affects so many women. 

I received a diagnosis of autoimmune disease (Lupus) in 1995, but probably had it long before that. And yet, I am fit and healthy. I believe my health habits have helped with this.

If you have received a diagnosis of autoimmune disease, be encouraged. How you do will depend on your unique disease process, but will also depend tremendously on how well you take care of yourself. Those with autoimmune disease and those that care about them can learn more HERE. 

Structure Sunday: The Structure of a Weekend

Did you know the the weekend as we know it is only about 100 years old ? I can't imagine life without the weekend. There is no natural correlate to the 7 day week. It is entirely man made and was probably designed in ancient Babylon. From there it was exported to the ancient Israelites and continued through the Jewish people through the idea of the Sabbath. 

However, it wasn't until 1908 in a car factory owned by Henry Ford, that Jewish and Christian cultures combined to give us the weekend. Before that time, workers would labor untold hours. Early labor rights were established after the French revolution, but even then their workweek was ten days on with one day off. Meanwhile in England, Sunday had evolved into the " Lord's Day" for rest and worship. 

In the late 1800s Europe was becoming more and more hostile to Jews. Immigration of Jews to America increased, and they entered the work force. Accordingly, the work force in Henry Ford's factory was composed of both Christians and Jews. The Christians took Sunday off, and the Jews observed Saturday as the Sabbath. To make everyone happy, the clever and diplomatic Mr. Ford created the two day weekend. Not only that, Mr. Ford popularized the weekend road trip... driving what ? You guessed it, his Model T. 

How did fewer working days effect commerce and productivity ? Somewhat paradoxically, research on the subject consistently shows that fewer work hours lead to greater productivity overall. Some say the sweet spot is a four day 8 hour work week, but that remains to be demonstrated. 

References: 

The Atlantic

American Public Media

Here is a rough version of what has been our ideal weekend routine: 

Friday evening: Dinner with family (with reference to the Jewish Sabbath)  something fun afterwards

Saturday morning: Catch up on sleep, brunch with family, outings, projects

Saturday evening: entertain 

Sunday Morning: brunch with family, clean house,  projects

Sunday evening: family dinner and get ready for the week

Here are some fantastic resources on having a great weekend: 

Lifehack

Reader's Digest

The Muse

Fast Company

Forbes

Entrepreneur

Pinterest 

Food Friday: Healthy Barbecue, Grilling, and Picnics.

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

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

Grilling: 

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

Food Handling: 

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

Poultry 165 degrees

Ground red meat 160 degrees

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

Reheat cooked meat like hot dogs to 165 degrees. 

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

Healthy Grilling recipes: 

Cooking Light 

Food Network

Eating Well

Fitness Magazine

Food and Wine 

Health

ENJOY ! 

References:

FDA Barbecue Basics

UDSA on food safety

National Fire Protection Safety Association 

Wellness Wednesday: Weathering the heat

Do you know how hot you are ? Do you even know how hot is too hot ? Find out here before things get too hot to handle. 

One of the body's main tasks is to maintain a constant internal temperature. Our physiologic functions depend on it. There may be fairly wide fluctuations in our external temperature, but our core temperature must stay quite steady, near 98.6 degrees F. If it does not, we can suffer heat exhaustion and heat stroke.  Per Outside Magazine (reference)" On average, nearly 700 people die each year from extreme heat. ". 

When are people at risk ? 

• During heat index of 90 degrees or more 
• During relative humidity of 60% or more 
• When working in contact with hot objects, or wearing bulky protective clothing 
• When in places of direct sun with little air movement 
• When they are very young, very old or unhealthy

Heat exhaustion

• Caused by loss of body water through excessive sweating
• Symptoms of heavy sweating, weakness dizziness, visual disturbances, thirst, vomiting, diarrhea, shortness of breath, palpitations, tingling of hands and feet and collapse
• Treatment- cool and hydrate the person by any means possible as quickly as possible

Heat stroke

• Results when the body can no longer cool itself though sweating or other means and the core temperature rises to 104 or higher. 
• Symptoms are confusion, agitation, irritability, seizures, coma and brain and other organ damage. 
• Heat stroke victims usually do not recognize their own symptoms. 
• Skin will be dry if heat stroke is caused by hot weather, but moist if caused by vigorous exercise. 
• Skin is flushed, breathing is rapid and shallow. 
• Heat stroke comes on quickly.
• If heat stroke is suspected, it is imperative to call 911 to get immediate medical attention
• Treatment- Cool and hydrate the person by any means possible as quickly as possible while waiting for the ambulance. 

Engineer shade, breaks and ample hydration into your summer activities to keep everyone safe and comfortable in the heat. 

References: 

http://www.mayoclinic.org/diseases-conditions/heat-stroke/basics/definition/con-20032814

http://www.webmd.com/a-to-z-guides/heat-stroke-symptoms-and-treatment

https://www.osha.gov/SLTC/heatstress/

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

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

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

DSM IV, the Diagnostic and Statistical Manual of Mental Disorders 

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

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

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

Study results in summary: 

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

Concerns and side effects that surfaced:

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

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

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

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

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

Structure Sunday: The Structure of Summer

Do you ever feel that summer comes and goes too quickly ? If you take some time and think about how you would like your summer to be, you could prevent this from happening again. You might actually make a summer wish list. Just make sure the things on your list are SMART. That is: 

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

I remember thinking of summer as a vast expanse of relaxation, without the structure of the school year. I do think it is wonderful to have time set aside for doing absolutely nothing. But that is not a good way to knock things off your list. 

Need ideas for your list ? 

Create a summer reading list which must have some fiction and non-fiction. Check your local bookstore, Amazon.com, or Audible.com. Check you local library or the New York Times Bestsellers list. Check the Newberry and Caldecott award winners online for children's books. Check for the Hugo and Nebula awards for the best in science fiction. 

Get out of doors with the family at least once per week. 

Keep a garden. You must grow something edible. 

Take a trip to the city. You must visit at least one museum. 

Take a trip to the countryside. You must visit one body of water. 

Make something, i.e. a table, or a pair of earrings. 

Learn something new, like French, gymnastics, or coding. 

Have friends over for dinner and board games. 

Summer is coming ! Don't miss it. 

Food Friday: Cooking With Family

You can't have enough cooks in the kitchen. 

I reflect back on having kids, now that all mine are grown and I have become a grandmother. One of the most gratifying family times for me has been cooking with my kids and their friends. I think I stumbled upon this as an awesome parenting strategy. It turns out that it gives you time to talk. Because it also keeps you occupied, it helps to keeps the tone light.

Cooking a meal teaches everyone tolerance, though slowly. It promotes cooperation, planning, safety skills... the list goes on. It settles people's energy back on the home life and shows how much fun you can have together. I cannot recommend it enough. 

Start early and be relaxed about messes. Having said that, don't be afraid to teach kids to tidy up before beginning to cook; The French call it  "Mise en Place", or to put in place. Likewise, don't be afraid to teach them enthusiasm in cleaning up. And in this matter, lead by example. And to help yourself, have a great collection of cookbooks or Pinterest Pins at the ready for inspiration. 

For a great guide on age appropriate cooking activities, click HERE. This is from Rutger's, entitled "Cooking Brings Kids and Families Together".

Cornell Cooperative Extension has a great article HERE, titled "Cooking Together as a Family has Multiple Rewards". 

And from WebMD, "Cooking With Your Children" HERE. 

Here are some books on the subject: 

"Cooking Time Is Family Time: Cooking Together, Eating Together, and Spending Time Together", by Lynn Fredericks 

"The Table Comes First, Family, France and the Meaning of Food", by Adam Gopnik

And here are some fun blog posts on the subject: 

The Kitchn

Playground Dad

Toca Boca

It's fun to start in the kitchen with small children. But the good news is, it's even more fun when your kids have grown.

Bon Appetite!

Wellness Wednesday: Workplace Bullying

All the data I could find indicates that the vast majority of people, have at one time or another, experienced workplace bullying. As I have become a more careful observer of the years, I have learned to ask my patients questions about their work environment. 

What are the tip offs? When I notice increasing blood pressure, more frequent illnesses, less self confidence, more digestive problems, and hear about increasing stress, depression, anxiety and work problems, I suspect workplace bullying. 

When I ask about work, and get into the particular details, I often hear about a situation which would qualify as workplace bullying. But the surprise is this: Much of the time, the patient doesn't even realize that bullying is what is going on. 

What is bullying ? 

Workplace bullying is a systematic pattern of behavior that harms, intimidates, shames, undermines, offends, degrades or humiliates an employee, possibly in front of other employees, clients or customers. It is an abuse of power and a form of emotional abuse. It is a threat to health, livelihood and relationships. 

Once a patient realizes what it is, and a name has been put to it, she can begin to take steps to deal with it. But bullying is a complex human behavior and it is challenging to counteract. It is best to get outside help to deal with it. Most of the time it involves not only the one bully, but an overall workplace environment that is permissive of it. This is because it is difficult for bystanders to call out the bully, lest they become a target themselves. It is also difficult since bullies are generally highly ranking in organizations. Targets often fear for their jobs. Employers, when informed, are in a hard place, since they have not usually witnessed the behavior and moreover, they have an interest in keeping their more highly ranked employees. 

Nonetheless, bullying takes a toll on people and organizations. While bullies are more highly ranked, targets are often up and coming, and they pose a threat or perceived threat to the bully. Targets are often very productive likable workers. Organizations with bullies often start losing their best people. 

As a physician it is very important to me that my patients know about workplace bullying. I would like all of them to be in supportive home and work environments. Failing that, I would like them to have the tools to speak up against this form of abuse, whether it is done to them or to their co-workers. 

The references in this blog post are especially informative. Please take a few minutes to have a look at the resources on this very important topic. 

Stop Workplace Bullying 

Workplace Bullying 

What Workplace Bullying Looks Like in 2014--And How To Intervene

Workplace Bullying Institute

Medial Monday: A joke of a research study

I think we can all agree that the following three things are good : 1. Chocolate 2. Humor, and 3. Getting the bad guys in a sting operation. This story I am going to feature for you today has all three. 

Science Journalist John Bohannon and his well educated friends created a bogus study on the health benefits of chocolate. To do so, he created a bogus health institute, and a bogus study wherein he enrolled 18 unsuspecting individuals. They followed through with the study protocol and a statistician ran the results. Lo and behold, those in the chocolate group lost weight faster. He then goes on to explain how this is obviously a falsely significant result, otherwise known as a " false positive". A study designed this way is bound to have numerous false positives. This is related to the very low number of people in the study and the high number of effects tested for. Any person educated in the basics of research could see this. 

He and his colleagues "wrote up" their paper on their "research", generated a catchy press release, then began submitting the paper to a variety of journals for publication. He included journals of borderline credibility, and those which are "pay to play" meaning you have to PAY THEM to get your article published! (I didn't even know these existed!) He had alarming rate of acceptance of this ludicrously flawed paper. Once it was published and picked up by all kinds of news services and magazines, he fessed up to the prank. I am sorry to say it was picked up by the likes of Huffington Post, and Shape magazine. Have a look at their glossy reporting of the bogus story in his article linked below. 

All this goes to illustrate what I have cautioned readers about all along: The need to critically evaluate what you read on the internet and elsewhere on the subject of health and medicine. So much misinformation is out there. Much of it is done by groups who know better, but who are in it for the profit. 

And yet, at the same time, so many promising things are happening in medical research. Please take a few minutes to review our section on Information and Learning. It will give you some basic tools with which to safely navigate the internet. 

And then for some real entertainment and information, check out John Bohannon's article exposing himself HERE. His interview on NPR about his elaborate ruse is featured HERE. Finally, here is a fun and scientifically solid site about health reporting in the media: HEALTH NEWS REVIEW, where they look at the the good, the bad, and the ugly. 

Have fun and be careful about there. 

Structure Sunday: The Structure of Family

So much has changed in six weeks. Grandpa passed. His memorial brought a tide of family and friends together. And now our daughter  has delivered a baby girl named Emery Helena. 

Those tasks once reserved for adults have passed to those who still to my eye look like children. Our roles have changed and our titles have too. This morning I heard a call for grandpa, which sounded out of place, on account of his passing,  until I realized they were calling my husband. Mom, which was reserved for me, has passed to my daughter and I am becoming grandma. 

My exact title is still under discussion. I've been working a lot on labor and delivery lately, and the nurses are trying out different versions of grandma,  seeing which ones fit, and which ones will stick. 

I would like to think this is because I do not seem exactly like a grandma.   I think this is true for many women in my situation. Our culture has evolved in such a way as to allow women of my age to continue very active lifestyles. Many fifty something's are much healthier than their counterparts from decades past. The way we can live and the roles we can play at any given age are not nearly as limited as in the past. Perhaps we live less by convention or stereotype than in days gone by. 

That said, a grandmother is still a grandmother and she has a role to play. I and all the other members of my family, seem to have eased into our various new roles without much deliberation, just some common sense. However I would like to give my new role some thought in that I'd like to be a grandmother for the new age. I'd like to teach my granddaughter to code, and I'd  like to go to Zumba with her and my daughter. I'd like to keep what's good from grandmothers past while augmenting it for the present day. I'd like to be grandmother 2.0. 

Food Friday: My labor basket

The time has finally come for my daughter to have her labor induced. She is overdue and it is time. And, since gift giving is one of my "love languages" I was inspired to create a "labor basket" full of goodies. 

Now I know as well as any Obstetrician that one is restricted to clear liquids during induction of labor. This is because a patient under induction should, at any time, be prepared to go to C section. C sections are much safer when the mother has a virtually empty stomach, or only clear liquids on board. This is because pregnancy, labor, anesthesia, and C sections all make patients more likely to aspirate, which means to breathe in something they should have instead  swallowed. It is basically choking, and it can lead to pneumonia. The other reason is that clear liquids absorb quickly, and should the patient become nauseous, she will have an easier time getting rid of it. She will feel less badly. 

So my labor basket for my daughter contains the finest clear liquids I could find. First, I got our favorite: Perrier, in three flavors: plain, grapefruit and lime. Next I got a couple flavors of IZZEs, peach and blackberry, the ones which were truly clear and had no visible particles. To round things out, I picked up some of her favorite tea, Earl Grey decaf, and then, lest she be tired of all the sweetness, some seasoned organic chicken broth in little single serving containers. Finally I found some nice stainless insulated mugs. 

Then I considered the whole environment. We had covered taste, so I decided smell was also important. I chose some natural citrus body spray. Then I tucked in our favorite body cream called Booda Butter. No kidding it smells just like chocolate, but looks and feels like soft butter.

 Then, I covered sound. I know she has her Pandora on her phone, but I didn't think headphones would work. So I sprang for a little USB powered waterproof bluetooth speaker. And, being the veteran mom that I am, I enclosed a 12 foot USB extender cord for convenience. For sight, I put it all in a pretty green picnic bag and brought a blooming orchid along as we prefer living plants to cut flowers.  

I was tempted to overdo it since I had all kinds of other ideas. For example, you could include a cozy throw for mom, as long as its washable. You could tuck in some healthy chewing gum. The best idea I have seen was from the very cool older patient I had many years ago. She brought a bag of beautiful textiles and draped them all over her labor room, i.e.  over closet doors, etc. The room looked like a Casbah. And last week I had a lovely patient who used an aromatherapy atomizer with essential oils in her labor room. 

Your gift may not fit in a basket. You may be asked to help in the labor room, but only if she asks. Perhaps she will need help with her other children or pets while she is in the hospital. You may also be needed afterwards, helping with chores. Baskets are great, but perhaps the best gift of all is to be present.

Wellness Wednesday: Quantify Yourself

I have always said that knowledge is power. This is especially true in this digital age since we have access to so much searchable knowledge. I have also always said that one of our primary goals in our medical practice is to empower women to take charge of their own health.  It is therefore natural that I am very interested in helping women to empower themselves through the use of technology.

It turns out that one of the most powerful things we can do to take control of and change our own behaviors is to observe, record and track them. This habit is called quantification. People who do this regularly as a part of their self improvement are participating in the "quantified self’ movement. Livescience.com defines the quantified self movement as a “movement which aims to measure all aspects of our daily lives with the help with technology.” 

Quantifying ones habits such as hours of sleep, minutes of exercise, or calories eaten, does not necessarily need to be done with a high tech device. It can be done with paper and pencil. However, since smart phones are nearly ubiquitous, these records are most often kept on these small powerful personal devices.  Of course there is a proliferation of different apps for this, one for every topic and several for many parameters. Not only is there a proliferation of different software apps to help with quantification, there is a proliferation of different hardware such the Apple watch and the FitBit. 

If the patient and I decide to follow some detail of her health such as her blood sugar, we begin some sort of record keeping. The patient makes the measurements, records them and naturally evaluates them herself as she goes through the week. This alone often results in substantial improvement in her numbers, since she can begin to discern patterns and the reasons behind them. Taking measures to push the data toward better performance is gratifying day by day. It becomes like a game that the patient is determined to win. This is called ”gamification" and it too, it is powerful in behavior change.

When the patient comes in to review her data, she can get even more benefit when we analyze her data together. If we add another layer such as her diet, and superimpose it graphically on the blood sugars in her records, we can see a cause and effect relationship between what she eats and her blood sugars over time. Sometimes a third layer of data such as activity can be added into her records and we can use this variable to improve her blood sugar control even more. 

This kind of record keeping puts the facts and the control in the hands of the patient. It is much more effective than a doctor simply telling her to eat better and exercise more. It has been my consistent observation that all sorts of patients have success with this type of approach. Moreover, in reading about this "quantified self movement" it seems apparent that this technique can be used for many types of conditions, like weight, exercise, autoimmune activity, sleep problems and even mood disorders. It can also be used for broader issues of life performance, in relationships and on the job. 

I hope this introduction into the quantified self movement has inspired you to learn more. Here are some fun references which makes for very interesting reading.

The Quantified Self, a TED talk by Gary Wolf

The Quantified Self at Livescience.com

The Beginners Guide to Quantified Self, at Technori

Why You Should be tracking Your Habits ( and how to do it well) at Lifehacker.com

The Quantified Self: How Cold Hard Data Improves Lives, at Bloomberg.com

The Data Driven Life, at the New York Times 

How Self-Tracking Apps Exclude Women, at The Atlantic

Medical Monday: Skin Deep

What does it take to be beautiful ? I mean physical beauty. It it feels so awkward to even ask this since, in general, beauty is mostly a matter of the heart.

 You might be surprised to hear about my idea of physical beauty. Basically, to me, physical beauty equates with health. Every face, every age, every body type, hair type or skin color is beautiful when it is healthy. 

Skin is especially telling. It is the first thing we see. The skin of the face is vulnerable and worthy of our protection. It is sun season again, and I would love to see everyone take pride in and care of their skin. 

What are the main steps to beautiful skin ? 

• Optimize your fitness, nutrition and hydration. 
• Cleanse and moisturize twice per day. 
• Exfoliate once per week.
• Sun (UV) protect ardently. 
• Never tan. Never. 
• Be assured sunscreen is safe.
• Chose a broad spectrum sunscreen with SPF 30 or greater. 
• Chose a water resistant brand. 
• Apply 15 minutes before going out so it will soak in. 
• Reapply every 2 hours. 
• Consider a hat or SPF clothing. 
• Get a partner to "watch your back" for any suspicious moles. 
• See your dermalogist for any concerns. 
• Enjoy summer. 
• Be beautiful. 

Structure Sunday: The Structure of a Family Road Trip

Family road trips are traditionally fraught with stress. But yours doesn't have to be. The road trip season is upon us and you will want to prepare.

irst of all let the kids in on the plan. Get them involved in the preparations. It won't hurt them a bit to learn the organizational skills necessary for a small vacation. In fact you can delegate age appropriate chores to kids from 5 To 95 and that will make everyone all the more engaged. 

• Pick a destination. 
• Pick a route. 
• Research attractions along the route and at the destination. 
• Make sure everyone gets some say on the activities.
• Go over the fine art of packing light and packing layers. 
• Make sure everyone has a duffle and a backpack of their own.
• Choose some activities for traveling. Choose a mix of electronic and paper content. 
• Choose a mixture of packed food and culinary stops along the way. 
• Always plan for minor illness and inclement weather. 
• Plan your stops if there is any question of availability of lodging. 
• Encourage each traveller to document the trip in their own way, i.e. Diary, sketchbook, iPhone, camera, etc. 
• Confirm you have necessary charging and connectivity cords, batteries, etc. 
• As the trip leader, personally confirm the travel arrangements from the condition of your car to the AAA membership.  

What could go wrong? : ) We ourselves are on the road heading down to Missoula for the Lindsey Stirling concert. It is turning into a bit of a culinary tour since when I left home, I stopped by the natural food store and got a bag of healthy car foods and drinks. Then going past the lake, grandma offered us waffles with berries. In Ronan we stopped by a little red and white taco place and I just knew the tacos would be crispy and hot. They were. Our intentions were then set on a bakery further down the road whose reputation had preceded it. Alas it was closed, but it made a good picture. (See photo.)

Travelling is an important family activity when learning takes place and memories are made. Takes these steps to make sure that both are good.