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. 

Food Friday: Food for Healing

As most of you know, we spent the better part of the week nursing our 22 year old son after his ski accident. He sustained a badly fractured femur requiring a long surgery which entailed significant blood loss. He also had a mild concussion, pulmonary contusion, and a broken rib. He is stable and improving. But his course has illustrated several important things about nourishing those who are recovering from illness or injury. I thought we might take a moment and discuss them here, especially since it has been on my mind. 

When people come home from the hospital, most of time, their IV is removed. They will come home adequately hydrated. However, that can quickly change, since their capability to hold down food and drink is often limited. Your job as caregiver is to help minimize nausea which may be interfering with hydration, and to provide appropriate enticing liquids for them to sip. If your “ patient” did not come home with anti-nausea medication, and needs it, do not hesitate to call their doctor. Most of the time this can be prescribed over the phone, but sometimes, nausea heralds a concern, and the patient will be asked to come in for an evaluation. 

Another way to minimize nausea and maximize intake is to avoid overuse of narcotic pain pills. The most common are lortab and percocet, aka hydrocodone and oxycodone. These are necessary with early post ops, but they can cause nausea and constipation. Ask your doctor how they should be used if you are not sure. 

Sick or injured people do not always know what they need. It is up to the caregiver to encourage them in the right direction. In this regard, many patients will not want to drink as much as they ought. So you have to be clever. 

Hydration of the unwell is best accomplished gradually and continually. This way they are more apt to tolerate it. It is also best accomplished by fluids which contain some sugar and some electrolyte (like IV fluid!) . 

For starters, let’s do water. Some who cannot drink water can drink soda water, aka plain club soda. Even more can drink this with a splash of fruit juice or a wedge of lemon or lime. Some do well with dilute fruit juice. Decaf instant iced tea works well. Oftentimes having it quite cold will help, but this is suboptimal if your patient is chilled. Some do better with frozen cubes of the aforementioned drinks. 

On the other hand, many patients prefer hot drinks. Herbal tea is the go-to here. You can make it more appealing by adding honey or agave, and a little lemon. Decaf coffee is not a bad choice, but lots of caffeinated coffee is dehydrating. 

Some patients prefer savory or salty drinks. This is an advantage since it will better expand their intravascular volume. Here broth is the best solution, unless they can take something like Bloody Mary mix, or salted tomato juice. The best of all is a brothy chicken soup, just like tradition teaches us. Nowadays organic broth mix is widely available commercially in chicken, beef, and vegetable flavors. 

You can also hydrate your patient with watermelon if they like it. Most fruits will help, and a smoothie of fruit, ice, water, juice, and even plain yogurt can be very agreeable, even to one who is sick. 

When patients are doing well enough to take solid food, there are a few key nutritional points to bear in mind. Healing from illness and injury takes more resources than ordinary life - lots more resources. A man needing 70 g of protein a day will come to need over a hundred. He will need more nutrients too, though he may not necessarily need more calories. Therefore, everything a recovering person eats should be nutrient rich. Leave the top ramen, Pepsi, and white bread for another day - like NEVER. Present choices such as chicken, salmon and red meat, but prepare them in a way that is easy to eat. For the meat and chicken, cook it well, ground or in small pieces. For salmon, consider getting canned salmon and making it up like tuna fish salad with mayonnaise, relish and olives. But beware, if your patients are picking at their food or dairy containing drinks, the dishes cannot stay out too long, or they will spoil. The last thing you need is a recovering patient with food poisoning. With the same goal in mind, don’t put too much on a serving plate. Start with a small serving and get seconds if you need to. And, for best results, offer small quantities of food quite often. 

Caregiving is hard work. With a little forethought and a few tricks of the trade, your well hydrated, well nourished patient will have the best chance at an optimal recovery. 

Wellness Wednesday: Recovering from a Serious Injury

This last weekend my son Vale had a major skiing accident. He broke his femur, had a pulmonary contusion, a broken rib, and a mild concussion.  He had to have emergency surgery. We quickly travelled to attend him, and since then we have been making arrangements for his recovery care. 

Though he will be off school for a time he will stay at college and we will return home. Therefore, I have been working with a team of friends and relatives to accomplish his care. This will, of course, consist of a series of wound checks, physical therapy appointments and post op appointments. It will also consist of a calendar of people doing shopping, making meals and doing laundry. When he returns to school in two or three weeks, it will mean getting driven to campus and wheelchairing around. It will mean seeing how it goes.

It has also meant getting correspondence passed back and forth between the doctors, physical therapists and the university faculty. To coordinate all this, I have had to send no end of contact information. I have had to create shared calendars and documents in the cloud, and distribute them to all his friends and family who have stepped forward to help.

Vale has had to deal with pain, disappointment and disruption. It is taking all of us together to shore him up during this trying time. It is taking everything from favorite foods to ice packs, but it is worth it. Even though it has been only four days, we can see distinct and major improvements every day.

 I am in awe of his caregivers. The surgeon and anesthesiologist spent significant time on the phone with me both before and after the case. It was easy to tell they were top notch, but they were also genuinely invested in my son, and empathized with me having to be so far away during the surgery.  I will be forever grateful for the time and energy they spent. I later leaned that that they spent this kind of energy during the entire weekend, since Vale's hip fracture was one of five such cases. The winds in the mountains had been high, and had swept the ski slopes to a hard shiny gloss. It took its toll.

Vale's physical therapist was a ray of hope. She came from both academic and clinical practice backgrounds, and was deeply invested in her field. She was immediately able to put us at ease and to identify all kinds of helpful strategies. Vale felt 100 percent better after one appointment, from a combination of the physical treatments, but also the encouragement of knowing his prognosis.

All this touched me as a mother and as a physician. It sheds renewed light on what I do.

Food Friday: Setting the Table

When I was growing up, my parents had a sit down dinner since that’s how they had been raised. My mother had nice china and table linens, but we rarely saw them since she used them only for special occasions. Instead we had everyday plates and cups, often plastic. The margarine was set out in its own tub. (Remember that this was the 70s, when margarine was thought to be healthier than butter. )

My father had business contacts from all over the world and they would come to visit us. In one case, a German guest showed me a photo of his daughter. She was sitting at their table. I would never have thought to take such a picture of a person at a table since our table was nothing special to look at. But their table was beautiful even though they had already finished their meal. Each plate was white glass, and crowded round each plate were clear glasses of various deep jewel tone colors and shapes, some cylindrical and thin, some globular, and yet others like cones. A light went on in my mind, and ever since then I started to see table settings differently. I began to notice the beautiful dishes and table settings in my friends' houses. 

Fast forward to college, when freshman year and dorm food banished all thoughts of table settings. Then came second year, when I moved into a campus co-op named Synergy. The house was organic and vegetarian way back in 1981. We had a big hippie kitchen in a huge hippie house right on campus. Since we were a co-op we cooked all our own food in a big kitchen in rotating teams. There would be no chefs or housekeepers for us.

The ethic of this house also required a communal sit down dinner as a deliberate act of culture. However the table settings in Synergy were like none I had ever seen. Since we were all about conservation, with reuse happening before recycling, our cups, plates, and serving utensils were a motley collection of all that had come through the kitchen. We drank from a selection of old jars, such as those from sauces or jam. Our plates were all completely mismatched. Bowls were just old plastic containers from things like bulk peanut butter. Most wonderfully, the center of the table held as many as a dozen great steaming loaves of bread: home made whole wheat bread. It was the signature of the house. We would cut slices or tear chunks, and slather it with butter, jam, hummus, or whatever mystery stew the cooks happened to create. Kids from other dorms would come by just for the bread. There is a reason for the expression, “breaking of bread”. It seems to bring people together.

Greg and I bonded while making this bread since it literally took all four of our hands to knead it. We had met while cleaning the kitchen at Synergy. We took it upon ourselves to clean this hippie kitchen, since he and I seemed to be the only ones who noticed how dirty it was. We met over a filthy sink, and there was something about me turning on the garbage disposal at the wrong time. No one was hurt, but he did have to take a shower after the incident. 

Greg sometimes ate a couple of houses down the row where there was a clean kitchen, a chef, and of course, meat. His sister lived there and she had made friends with the chef. I think they had an arrangement since not uncommonly Greg would go there and use their massive Hobart mixer which would hold a 16 batch of his mother’s chocolate chip cookies. As you could smell the bread of Synergy wafting down the row, you could smell the chocolate chip cookies coming from the other direction. From then on, our collective memory would be infused with the aroma of bread and cookies. 

After graduation, we married and lived in a little farmhouse far away from University life. It was a bit run down, so we repaired and decorated it. Happily, among our wedding gifts were many table linens and pretty dishes, so it followed that the table got set very nicely. The cutting boards were set with bread and platters filled with cookies. When our daughter and the boys came along, they helped with all of this. Ever since then we have set the table and had a sit down dinner. 

Today I believe in the power of the sit down dinner more than ever, to promote communication, coordination and peace in the family. And for me, all my best dishware is out all the time. I think it sets a festive mood and makes people feel valued.

What would I do if I were just starting out, of modest means, and wanted to bring some inspiration to meals ? There are two possibilities. First, I could go minimalist and get all clear glass dinnerware from the dollar store. Everything would match, and design interest would come from the food itself, the table, or the table linens.

A more colorful and more ecological choice would be to thrift. I would have a fantastic set of non matching antique plates. I would shoot for a reasonably common size, and perhaps a common theme, say a color scheme or a design element like birds. A physician friend of mine did it complete with mismatched silverware, and mismatched but coordinating goblets. It was nothing short of magnificent. It was all thrifted, very inexpensive, and truly delightful.

And that is the point: to delight. Making the food and setting the table is a gift to others, and a joy for you. 

Wellness Wednesday: Holiday Wellness

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

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

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

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

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

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

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

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

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

Happy Holidays from Dr. Gina 

A very nice reference for more reading : 

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

Food Friday: Trick or Alternative Treats

Ever wonder what you could give out instead of just candy ? I have worked on this challenge before at Easter when filling eggs, but have not until now considered what alternatives I could do at Halloween. 

First of all your Halloween alternative offerings should not break the bank. Secondly they should be age specific. In my family and group of friends, everyone from young children to old adults go out for the holiday, usually in costume. Halloween has always been a big holiday for our family, but especially since our youngest child was born on that day 22 years ago. When he was tiny he used to think the whole town came out for his birthday. 

I am for a strategy where you actually hand out the treat rather than have people take it from an unattended bowl on your porch. You will see why when you see my list of alternatives. Some are definitely age specific. Plus you ought to get to know your neighbors.

I think it is important to have some candy at Halloween. Always choose something that is wrapped so that the parent or child can be sure that has not been handled. You might think that the candy would get cherry picked out. This will not be the case if you were the one doing the handing out. Moreover, at Easter, I have found that some of the other non-food items are actually more popular than the candy.

Here's the list:

• Tiny boxes of raisins
• Trinkets you've purchased for cheap at the thrift store
• Interesting buttons purchased by the jar at garage sales or thrift stores
• Tiny spools of thread purchased by the bag at the fabric store
• Craft items such as decorative pipe cleaners or pom-poms
• Glass “Jewels”, meaning the pretty glass rocks you put in the bottom of a vase of flowers, Usually available at the dollar store in a selection of sizes and colors.
• Stickers
• Glow bracelets usually available at the dollar store.
• Poems quotes or sayings written decoratively and in tiny envelopes
• My favorite: beads, especially large ones.
• Tiny rolls of ribbon
• Tiny toy soldiers or animals 
• Office supplies such as decorative clips, rubber bands, tip erasers, or pencils
• Tea light candles

Basically I pick things I would like to get. Speaking of me, as you can see from the picture, I am still working hard on my costume. Guess who I am going to be.  

Have a safe happy Halloween. 

Food Friday: Setting the Halloween Table

It's two weeks before Halloween. Make the holiday your own with a party. It can be a pre-trick-or treat party, a children's party to keep them off the street, or an elegant adult soiree. 

Tonight I write to make some different sorts of suggestions about Halloween parties and Halloween food. My different perspective comes from the historical roots of Halloween which is witches' brew of an ancient Celtic festival Samhain (pronounced Sow-in), the later Roman holidays of Feralia and Pomona, and finally the Catholic Feast of All Martyrs/All Saints/All Hallows day. The name " All Hallow's"  literally says, " all that is holy".These are beautiful holidays are full of respect for the harvest, the circle of life, ancestors, saints, and the turn of the seasons. They all included feasts, and outdoors activities late in the night complete with festive fires. Accordingly, " Halloween" is of course a contraction of the words " Hallowed" and " Evening".

I have a soft spot in my heart for All Hallows' Eve as I like to call it, since our youngest child was born on that day. As a result, it has always been a big family celebration for us, and so we have always had a party. 

Accordingly, I have never gone in for the typical commercial Halloween decoration and imagery. True, I like a very dark and mysterious Halloween. Particularly after I had children, though, I never saw fit to incorporate what I feel are images of violence into the holiday. For example, I am totally not into the blood, gore and mutilation thing. 

Instead, Halloween to me is about the beauty and magic of the night and the natural world. For example I have incorporated themes of stars, the moon, planets and comets. People consider these magical motifs, but to me they evoke the magical math and science which can describe their movements. 

I also incorporate anything botanical. At this time of year the leaves are getting crinkled and brown, and the branches are bare. Some are dried all but the berries, But there is beauty even in this. You can make them even more evocative with paint, glitter, or interesting low lighting. 

I incorporate the creatures of the night in my All Hallows' decorating. From mice, rats, bats, spiders, beatles, wolves, and owls to moths chasing a flame, these are all interesting and beautiful creatures who are worthy of our attention. Instead of vilifying them or presenting them in caricature, I try to present them as they are, almost like museum specimens. If I could have live ravens with their glossy black feather, I would. For children I might do a faux insect display, with a little parchment note about the creature, and how they fit into the ecosystem. 

And fire. Of course fire, since fire hearkens to the primordial processes in the heart of our sun which make life on this earth possible. Did you ever think about the fact that when you watch a flame you are watching matter being turned into energy ?

To bring fire into the home or patio, you must first be safe. I like metal tea lights since they burn safely set inside a beautiful container. These are easy to clean up as well. I use lots of candles, and keep the regular lights down low. For fire outside, make a traditional bonfire. Check your local fire regulations and use common sense for this, especially with children. 

So use branches, bugs, bats in mobiles, candles, faux spider webs done carefully, with dark elegant colors, or moonlight white. But whatever you do, make your party beautiful enough to transport your guest to a different holiday " Hallowed" frame of mind. 

The food should do the same. This means, of course, that the food should be a little unusual, yet very good, and very showy. Do always consider the comfort of your guests and make sure that there is something for the very young and the food sensitive to eat. For example, I have done an herbed roast turkey in the past, with a wild rice stuffing with dried fruit. I always do a dark carbonated fruit punch with floating berries and dry ice. I like lots of fall fruit strewn on the table. Desserts are numerous, and seasonal. 

Needlework by Anne Nickerson RN

Table centerpieces should look like a Dutch master painting, tumbling over with black grapes, gnarly nuts, an errant butterfly, dried branches and perhaps exotic flowers. Make sure you have covered all the senses, from sight and taste, to smell and hearing. Arrange for some aroma therapy from atomizers or candles. Just make sure to use only natural scents like essential oils  since many people are quite sensitive to artificial fragrances. Finally pick some beautiful, different and transporting music and keep it low in the background. The Harry Potter Soundtracks are a good place to start. 

For more ideas on your Halloween party, click the image at right to see my Pinterest album on the Holiday. 

Structures Sunday: the Structure of Studying

I'm a perpetual student. You may not realize it but in certain circles this was considered an insult. I now realize it is good thing. Indeed life long learning is the only way to go.

I have already blogged about the importance of reading and creativity. Those of you who know me realize I have a number of serious creative pursuits, Since we are approaching Halloween, I am deep in preparation to sew a detailed costume. For these sorts of things as well as my work, I have to study. That's right, study.

For my costume I have had to research everything from specialized sewing machine feet to the thermal properties of craft foam. For my amateur photography I have had to research telescope eyepieces and how to connect a old school serial port to a USB port.

Tonight for example I am deep into my annual board review preparation. Every year we have to review research articles and take tests, But every 10 years or so we have to take a big test and that is what I am preparing for this week.

Additionally, I am aware of many of my friends and their adjustment to the new school year. Bottom line: all parents home school, even those parents whose kids go to public or private school. That's how I felt anyway when my kids were in grade school and high school. Every day when I would come home from work I would simply change hats and I would turn from OB/GYN to homeschool teacher. I would check in with each of my kids to see what they had to do for homework and upcoming tests. I would check in on how their classes were going. I might take a some time and give them a little supplemental information on a topic if I happened to know something about it. Finally I would monitor their study habits. As much as I think they found it irksome, I think even they would admit it has served them well. 

So what are good study habits? There are numerous books written on the subject which are beyond the scope of this blog post and well worth reading. I just want to emphasize that you should stay intellectually and creatively active as a part of your overall good health. I also want to empower you to get involved in your children's academic life. So here are a few basic tips for studying that will serve you as a parent coaching children, a student, or simply as an adult keeping her intellectual and creative life healthy.

• Get an overview of the task at hand. Even grade school children should know that school goes in semesters or quarters. They should know when the tests and quizzes are given, and when their assignments are due. Both children and adults should have a simple clear system for writing this down. It can be either digital or paper. Their should be a daily and weekly routine for referring back to this schedule. That makes for no surprises and less procrastination. 
• Prepare. It does not matter whether you are preparing for a book report in seventh grade or a board exam when you are a doctor, preparation is key. Learn to channel your anxiety and concern into an early jump start on your project. This is imperative because it alleviates stress and gets the job done.
• Know how to study. Here is a general method for low stress, effective preparation. 

1. Scan the material for an overview.
2. Read the material thoroughly.
3. Highlight the material thoroughly.
4. Make your own handwritten notes from your highlights.
5. Make index cards from your handwritten notes, using a brief description on one side and more complete details on the other.
6. Quiz yourself on your index cards. Do it out loud. When you do, put the ones you know well in one pile and the ones you need to review in another pile. Repeat your index card quiz, this time only with the pile that you need to review. Again, put the ones you fully understand in the good pile and the ones you need to review in the bad pile. Repeat the process until there is nothing in your bad pile.

It turns out that getting as many senses involved in your learning helps. The technique described above involves several senses, sight, touch, and hearing. Reading, writing with your own hand, and seeing what your own hand has written or hearing yourself read what you're own hand has written reinforces the learning of information on multiple levels, indeed in multiple areas of brain.

This is all well and good if you simply need to learn facts. However, if you need to know how to work problems, that comes next. Work on all the problems you can two or three days before they are due. That way you have a chance to go in and ask questions well before the problems need to be turned in. If you are a parent supervising children with homework like this, be sure that they do their assignments at least two days before they are due. You will ingrain this kind of habit in them for the rest of their life, and that will serve them well. And don't forget to lead by example.

If you're working with older children who will be taking tests, coach them a little bit in test preparation. Emphasize early and repeated contact with material as well as working of every problem that the teacher has handed out. Encourage students to use practice tests that have been provided to them and that are available on the Internet. Encourage them to fill in their understanding with information they find on reputable Internet sites such as Khan Academy. Have them try finishing the test preparation the day before the test is given so that they can spend that day asking the remaining questions. Tell them not to be afraid of being like Hermione Granger and having their hand in the air all the time. 

Make sure you and your children have a good night’s rest before any tests. I realize this is easier said than done but it is sound advice. In fact, make sure they are well rested before any school day. This will maximize their ability to learn. Equally important is a good protein rich breakfast, especially before tests.

It is important that if you are parents supervising children in their studying or their homework that you be supportive not harsh. Regardless of what you may think of their teachers, encourage courtesy toward the teacher. To do otherwise is a disservice to your child. 

Is very important to remember that if you are helping someone with their work, you're principally helping them to understand how to do the work themself. Under no circumstances do you do the work for them. You may work a similar problem for them to see, since that is different.

A healthy creative and intellectual life has been proven to benefit health. This is true for both adults and children. I hope these tips help make your studies easy and fun.

Food Friday: Soup is Soul Food

Every cook should know how to make homemade soup, especially those on a budget and those interested in eating healthy.

Two weeks ago I wrote an unusual post about how to make soup stock. It might seem like an unusual post for blog on Obstetrics, Gynecology, and healthy lifestyle, but not when you take a closer look.

One pillar of healthy lifestyle is healthy eating and another pillar is a healthy home life. Home cooked food can help with both. Soup is one of the most comforting and potentially healthy home cooked foods. It is also one of the easiest, of course once you know how. Homemade soup is also one of the thriftiest things to make since you can utilize leftovers and assorted ingredients from the refrigerator, garden, or pantry.

How to start? As always, start by cleaning up any stray dishes in the kitchen, organizing, and assembling your ingredients. Thaw any broth you have frozen. If you have not made frozen broth you can obtain good organic broth in three different flavors at any natural food store. You can also get a jarred  broth concentrate, also organic, at most grocery stores and at Costco as well.

Determine the vegetables you want to include. I'm a fan of great variety, But you can also make a vegetable flavored soup and emphasize one or two flavors such as red pepper. Prepare all of the vegetables by washing trimming and cutting them to the appropriate size.

I try to ask my patients to emphasize the protein in their diet. Decide what the protein in your soup will be. Consider chicken, red meat, fish, seafood,or even eggs. Cut your choice into bite-size pieces.  If you can tolerate legumes like beans and peas and can handle the carbohydrate that they bring, those can be included as well. Prepare all these ingredients so that they are ready to put in the pot.

I like to try to make my soup with only one pot. Choose your pot based on the volume that you want to make. Make sure it is extra large so that when you stir it with a long wooden spoon nothing will spill out.

Use a good cooking olive oil to sauté your first ingredients.These would include garlic, onions, or chilies if they are in your recipe. You will do them first so that they will flavor the oil. Make sure to use enough olive oil on the bottom of the pan. After this, Add your meat, chicken, or fish. Sauté until golden brown, but not fully done. I like to add fairly heavy spices to the cooking meat at this point since the flavor seems to penetrate better than adding it later. Then add your vegetables one by one and cook them until partially done, going from the hardest such as carrots to the softest such as spinach at the last.

When everything seems partially and evenly done, add liquid. I usually add a a half a cup of either red or white wine first. This adds to the depth of flavor. Then I add my broth, at least enough to cover all the hard ingredients, and usually more. I may or may not add a can of diced or stewed tomatoes, depending on the flavor I want to achieve. All you have to do at that point is bring it to a boil briefly, then simmer until the hardest vegetables are fork tender. If you intend for your meats to get very tender, they will have to simmer at least a couple hours. 

This is a good general recipe for a variety of different kinds of soup. You can make it with a large variety of different vegetables and if you add beans and a little pasta it turns out like a minestrone. If you add only a few vegetables and a lot of beans, tomato paste as well as onions and chilies, you have chili. You can pick a vegetable theme such as green vegetables and limit yourself to just a few onions, leeks, spinach, and kale. If you make a broth-y chicken soup with napa cabbage, ginger and green onions, you can drop whisked eggs into it and have egg drop soup. You can do the classic pumpkin soup especially at this time of year. Or you can go with the popular roasted red pepper soup.

If you have athletes, children or adolescents in the home, you can afford to serve this soup with a good whole-grain bread. Otherwise, it should stand on its own. You can always add a side salad and cold glasses of milk, to round it out.

Have fun with your soup and add some garnish. Garnishes can be anything from grated cheese or sour cream to minced green onions, parsley, crumbled hard-boiled eggs, sliced almonds or Siracha sauce. 

You will find that people tend to gather around a kitchen table with a good homemade soup. Having a sitdown family dinner with soup is good for health and good for the soul. 

Structure Sunday: The Structure of Family

What is family and what does it do for us ? I have had a family focused type of weekend and I wanted to share some numbers and thoughts about the issue of family. 

• The nuclear family: Two parents and their children.
• The blended family: which is remarried or re-partnered parents each with their own children under one roof.
• The extended family: such as sisters, uncles, grandparents, and non relatives either living in the home or elsewhere.
• The single parent family
• The childless family.

Consider all these and more. Add in non married partners, good friends and neighbors. All these people bear on how we live, our health and our happiness. 

Here are some illuminating data from census.gov.

About 50 years ago, 80 % of households included a married couple. Now this is down to 50 %. Some households are made up of non family members, and these are up from 10 % to about 33% in the same last 50 years. 

Two parents households with children have decreased about 15%in the last 50 years to 70% of all households with children. About 25% of all household with children only have a mother. Father only households are up to about 4% of all households with children. 

Among all households with or without children, a steady 30 % are childless. 10% of all households are single parent households with children. Households which are traditional, meaning married with children are half of what they were over about the last 50 years, going from 40 to 20 % . 

Everyone knows the saying “ It takes a village.” I would like to point out that this is not just for kids. Adults, married, single or partnered, are happier and healthier if they have strong familial and friendship ties.

Through history, we have developed families, clans and tribes for surviving and thriving. We are wired for it. But in modern times, we are more likely to reach out to friends or coworkers. People sometimes forget to reach out to those closest to them, even those with whom they live. 

I am writing to suggest that people look around and renew ties to those most near. I suggest that this include spouses and partners, children and others in the household, as well as old friends and even neighbors. These relations may not have the cachet of accomplished coworkers, but keeping these relationships healthy has deep benefits. 

It helps us with continuity, and to know our personal history. It helps with feelings of stability, especially for children. Getting along with those closest to us is not really glamourous. But it make us flexible and empathetic. It grounds us. 

Try starting with a phone call, email, or a card in the mail. Then, by all means, plan some sort of get together. The most important thing to remember is that it doesn’t have to be perfect. You don’t have to be perfect, and they don’t have to be perfect. The most important thing to do it to connect. 

Food Friday: Healthy School Lunches

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

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

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

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

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

Structure Sunday: The Structure of Childhood Memories

Childhood memories are an important part of who we are. It is up to parents to engineer varied and happy memories into their children's lives. This weekend we went down memory lane by virtue of hosting a wedding reception for the son of some of our closet friends. You would not think a wedding would focus a great deal on childhood memories. And yet, this weekend, it was a veritable memory fest. Of course there was the requisite slideshow of the childhood pictures of both bride and groom. But more than that, at the reception, clusters of conversations ensued, conversations between people who had done much together as children but little recently as adults. 

My extended family is large and we ourselves have three grown children. But, and this is one major point of this post, we have so many friends who are like family. These are families we have known for 20 to 30 years, and whose children have grown up with ours. Back in the day, we gravitated toward them because they were good and interesting people. More than that, they were creative and adventurous, and despite the fact that we were college students of modest means, we had adventures: us, our kids, our friends and their kids. These people have stayed our good friends all this long while. It feels like a tribe, or the proverbial village, the village it takes to raise a child. 

These adventures we had took time, planning and some wherewithal, but it all paid off in ways which we did not then entirely anticipate. Today we have grown kids who sit around the table and marvel at all they got to do as children. We look at old pictures and tell tales of glory. They know their experiences have shaped them. These children have grown to be inventive and resilient from their experiences. These are two of the greatest gifts a child can have. And now they are taking their kids out too.

It is fewer and fewer kids who have these experiences of rafting, camping, hiking or traveling for the sake of seeing a new place. I am writing to encourage you to find good people for your village. Find them and set off on adventures. You will have to take time off work, plan, get some gear, and maybe even learn a few new things. But that's all part of it. Go make some great memories for yourself and your children. You will get more out of it than you realize. 

Structure Sunday: The Structure of Education- Preschool

Education has been of foremost importance to our family. Most of my life has included  receiving education or supervising the education of my children. After all of this I have some definite ideas about education and I would like to share them with you.

I've been thinking about education because it is, of course, back to school time. As you know from my last post on school related matters, I'm a parent who believes that parents should be involved in their children's education. 

To me a child's education involves not only their scholastic pursuits. It also involves their sports, extracurricular activities and even the home schedule and enrichment activities the parents plan with family. This particular blog post will focus on a child's education before the school years even start. 

In the years before school there is a lot you can do for your child to enrich them. First and foremost, have a loving and orderly household. For example, try to have a peaceful sit down family dinner every night. 

Make sure your child is included in as many of the family activities as possible according to their stage of development. Once you reconcile yourself with the fact that doing things with the child takes more time and preparation, you will simply be more relaxed and so will the child. 

Here is a controversial and challenging recommendation: get rid of your TV. Those who know me well know that I am a big fan of certain forms of media such as music, internet and film. However, I believe in mindful consumption. TV decides your content for you, whereas if you have a screen connected to some sort of input device and parental controls you decide. I think it is critically important for children that mainstream commercial television not become their default activity or God forbid, their default reality. Where video content for children is concerned, I am a big fan of high-quality nature and science oriented programming. It doesn't matter if kids understand every scientific word; they learn very quickly to put it all together. 

When you have no TV, it behooves you to put many wonderful things in its place. Children before the age of school have a limitless sense of wonder and can be enthusiastic about anything good. Make plans to expose them safely and comfortably to all aspects of the natural environment, such as mountains, lakes, rivers and ponds. This may mean something as simple as going to the neighborhood park.

Get them involved in sports and other athletic pursuits. Before you do however, make sure you know what the sporting lifestyle entails. Getting young children involved in soccer, ballet, martial arts, equestrian pursuits, or skiing are all very different undertakings. In an ideal world, we would simply cater to the tastes and talents of our children. For the time being, we have to simply say, "where there's a will there's a way." I am a particular fan of ballet and a martial arts since they are available in most towns and are relatively reasonable in cost as sports go; Plus they give children great physical poise for the rest of their lives.

The great indoors also holds many fascinations. Teach children to play board games with other.  Give them access to all kinds of art and science materials. Absolutely every child should have a box of paints and a bug jar.

Consult with your local music teachers to find out what age their music education should begin. Consider taking lessons alongside them. 

Key among my recommendation is this: read to your child until he or she can read. Then, keep reading to them until they are absolutely fluent. Try using your fingers or their finger to track the words. All along the way provide them with a wealth of reading material. Take them with you when you go to the library or to the bookstore and consult with the staff about the best in children's literature.

Young children should be exposed to live theater, live music, museums and outdoor festivals such as county fairs, horse shows, farmers markets, and Renaissance fairs. 

All of these activities for children will stand them in good stead socially, intellectually and physically for the future. Each of these activities, if done in an appropriate and supportive way, will enhance your child's skills and confidence. These traits will transfer over into all the other areas of his or her life. 

Food Friday: On the Glories of Summer Fruit

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

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

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

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

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

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

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

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

Canning for a New Generation: Bold, Fresh Flavors for the Modern Pantry

$16.63

By Liana Krissoff

Buy on Amazon

Ball Complete Book of Home Preserving

$15.30

By Judi Kingry, Lauren Devine

Buy on Amazon

Ball Blue Book Guide to Home Cannin, Freezing & Dehydration (Volume 1)

Alltrista

Buy on Amazon

Structure Sunday:The Structure of Back to School Preparation

I loved school. But I always hated those back to school signs in the stores. I still do. It always made summer seem shorter than it really was. And yet, now that I am a seasoned parent, I think there are real benefits to preparing for back to school. 

Just about now, it’s time to check in with your kids about any summer assignments they might have had. Don’t be that parent who declines to ask since they want their child to “ do it on their own”. Ask and get involved. Yes, it is nice when kids are self starters, but each kid is different, and you should at least know what is going on. 

It’s time to get together with your munchkin and deep clean their room. Give them some advance notice so that it is not a shock and so it does not interfere with their remaining summer plans. Let them know you might be willing to make some improvements if a good job gets done. Great examples would be a new bulletin or marker board, or perhaps a cool shelf.

Make sure that once their room is clean that everything truly has a place. Sometimes kid get blamed for having messy rooms when in fact there really is nowhere to put anything. Make sure there are enough hangers, shelves, baskets, boxes, or whatever it takes to fulfill the maxim “ A place for everything and everything in its place. “ And of course, most importantly, set a good example and keep your house clean, tidy and organized. People, especially kids, get used to whatever they’re in. You do your kids a big favor to model organization to them in this way. Being spatially organized does so much to lower stress in the house. 

Make sure to supply what they need for school. Make sure the basics are there, but also try to show you value education by going the extra mile for them with their school supplies. Make sure they have an excellent backpack to carry it all. Allow them to express their personal style. 

Make sure you know about the lunch and PE situation to come. Consider a well done home made packed lunch if school lunch quality is marginal. You can even teach your child to make her lunch eventually. Food is a great place to show kids values in action. Make sure your child has a chance to choose how they carry their lunch. 

Attend any orientations or registrations with your child, all the way through twelfth grade if you ask me. 

Finally, survey the back to school clothing situation. Assuming the room cleanup went well, ill fitting, damaged, or unwanted clothing has been given, donated, or recycled. Introduce the idea of starting your school shopping at a good thrift store such as Goodwill. Offer to take some of your child’s friends along. It is a truly fun treasure hunt. It is hip, green, and cheap.Then after that, check online for any swaps or sales, then get what you must new. 

You are the parent and you have a lot of influence. You can have this influence better by what you do, compared to what you say. Your day to day choices about how you interact with your kids convey your values. These back to school  tips will help you your convey your interest in their education, life habits, and health. They help you convey that you care about them. 

Wellness Wednesday: Healthy Communication Skills

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

1. Attitude adjust.

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

2. Check physical factors.

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

3. Listen actively.

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

4. Guide your reaction. 

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

5. Say your piece. 

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

6. Connect and conclude. 

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

Awesome references that expand on these tips: 

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

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

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

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

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

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

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

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

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

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

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

Wellness Wednesday: Curing Procrastination

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

What is procrastination? 

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

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

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

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

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

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

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

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

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

     These are white lies we tell ourselves. 

What can be done about procrastination ? 

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

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

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

4. Simple methods to beat procrastination are as follows: 

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

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

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

References: 

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

Psychology Today: 

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

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

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

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

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

Mindtools: 

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

The Procrastination DOOM LOOP 

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

Procrastination and the great Stanford Marshmallow experiment 

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

University of Cambridge 

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

Princeton

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

Procrastination and Your Heart

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

Eat That Frog!: 21 Great Ways to Stop Procrastinating and Get More Done in Less Time

$8.74

By Brian Tracy

Buy on Amazon

Procrastination: Why You Do It, What to Do About It Now

$13.47

By Jane B. Burka, Lenora M. Yuen

Buy on Amazon

Structure Sunday: The Structure of a Hobby

Who could have imagined that the love of horses could lead to so many good things. 

When I was a child, I was enamored of horses. I always asked my parents to let me have a pony ride at the fair. When my family moved into the beautiful Palos Verdes Peninsula in Southern California, horses became a major part of my world. You see, all the homes were situated around a network of riding trails and riding rings that were maintained by the city. Every house had a stable, and every family a rider or two. I got some riding lessons locally and really liked it. My parents and I decided this would be my sport and that we would pursue it as a family. 

I was accepted by an established trainer and he obtained a proper quarter horse. We trained until we were ready to show. It required about an hour and half drive out of town each way, and we did it at least four days per week. I did my homework in the car. When I arrived, I would train for several hours each time. It was dusty, intense and stressful, but I liked it nonetheless. Eventually I showed with my stable, all up and down the Pacific Coast in what was then called the Pacific Coast Hunter Jumper Stock Horse Association circuit.  It required a lot of time away from school which was hard. 

Riding has a way of building you up, no matter how hard it is. You learn tolerance: tolerance for your trainer, tolerance for your parents, and tolerance for your horse. You learn tolerance for the invariably bad weather, like intractable rain making muddy arenas, or broiling dusty heat in the Indio sun. You learn to control your fear and steel yourself as you wait to enter the competitors ring. Nowadays we call this distress tolerance. 

You learn to win, and you learn to lose. You are being trained, but at the same time you are training yourself. You have a chance to meet a great goal by meeting lesser ones along the way and you learn right away the winning takes a long long time and more work than you imagined.

I truly believe everybody should have a chance to pursue something seriously. I think all children especially should be raised knowing that they will be taught many things, and that when they find one that is special to them that they will be encouraged and even expected to learn it well. When young children attend classes for hobbies like ballet, music, riding or marital arts, or when they play sports like soccer or football, they learn that success requires practice over time. 

These traits of distress tolerance, perseverance, courage, and ability to work on a goal are key for success in life. I believe hobbies right from childhood foster these priceless traits. 

When I attended the horse show at Rebecca Farm today, I thought a lot about my horse show days. I was full of pride for all the riders and all they had accomplished. I hope you will go out and attend such sporting and arts events in your community. More than that, I hope parents will introduce their children to something inspiring they can pursue. 

For more information, see rebeccafarm.org. 

Medical Monday: Dramatic Results with Long Acting Birth Control

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

Hot off the press:

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

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

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

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

To learn more: 

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

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

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

Food Friday: Fruit Stands and Farmer's Markets

My dad and I didn't always get along. He was an old school businessman from the midwest and I was a California city girl. So much was off base. Nonetheless, I recall our trips to fruit stands with affection.

Whenever we drove out to the countryside in search of fruit stands with beautiful produce, everything became right. My dad had a childlike enthusiasm for such things. He would inspect everything that was set out, checking color and smell, and then speak earnestly to the farmers about the season and their particular varieties and cultivars. He would direct me to examine each astounding thing.

 He was particularly concerned with tomatoes. He could remember all their names, and was thrilled to see the varieties with unusual colors and dense sweet flesh. He liked nothing better than to slice the finest deep red ones onto a plate with a little salt. 

All this is brought back to me at this time of year, as I look forward to the farmer's market each week. I would encourage you to pack up and go. Bring some cash, some bags, a camera and the family.

Here are several great reasons to get out to the farmer's market: 

• You will see what is being produced in your area. 
• You will get the best tasting fruits and vegetables. 
• You can get large quantities for "putting up" ,i.e. canning, freezing, and drying. These projects can be simple like applesauce, pickles or jam, or complicated like salsa, relish or chutney. They can be for your families' delight or for use as coveted gifts at the holidays. 
• You can meet new people and see ones you already know. 
• You can get gardening tips. 
• You can find some unique gifts or get inspired to make your own. 
• You can use your fancy stroller and wear a big hat. 

My dad made the acquaintance of an old Japanese man who sold a particularly fine dense large red tomato. He had brought it from afar, and developed it. It had no name. Late in my dad's life, he saved some seeds from this tomato and put them in an envelope scrawled with the following, " Gina, Hope these seeds produce. If so save some for me. " 

Many years later, after his passing, I found the envelope. I did not trust myself to grow them out, so I gave them to a neighbor who is very careful gardener. To our surprise they germinated and produced the lovely tomato.