Wellness Wednesday: How to Tell if You’re a Workaholic

Most people say they are busy. But are they ? Americans are famous for being workaholics (fully 25 % of us). How busy is too busy ? 

I would like to present my thoughts on the issue. Then I would like to present some other sources which are more authoritative.

It is important to understand what is not too busy. If you work full time, but have no time to work out or see your spouse, and yet you have time to game, watch TV or get a professional pedicure, you are not too busy. 

You are not too busy if you find that working at your desk leads to hours of randomly surfing the web or checking social media. You can only assess yourself once you have cut all the unintended time wasting from your life. If you are mindfully watching a film, or checking specific things in social media for a few minutes, that is fine and does not count as time wasting. 

So let’s say you have optimized the way you work and spend your time (a topic for another day). Let’s say you have reviewed your schedule and have decided that everything on it is important and nothing can be cut. Then you have met the “ inclusion criteria” and can ask yourself these questions: 

• Am I getting less than 7 hours of sleep on a regular basis ? 
• Do I feel a constant sense of frustration at not getting things done ? 
• Do I lack time to work out for 30 minutes per day ? 
• Do I lack time to eat three healthy meals and snacks ? 
• Am I getting sick too often ? 
• Is the quality of my work getting lower and lower ? 
• Am I neglecting important relationships ? 

If you met the inclusion criteria and you answered yes to any of these things, you should consider thinking about whether you are overcommitted. These would be the relevant endpoints for me, after 54 years of living with, working with and being an overcommitted person. 

WEBMD

http://www.webmd.com/balance/features/are-you-a-workaholic?page=2

This article places workaholism in its psychiatric context. It is a compulsion to go work, combined with discomfort when not working. So it is much more than working hard, or working a lot. They site signs like trouble delegating, thinking about work while on vacation, or neglecting one’s nonworking life. They indicate that cognitive behavioral therapy and support groups can be helpful. 

US NEWS 

http://money.usnews.com/money/careers/slideshows/17-signs-you-might-be-a-workaholic/2

This feature described signs you might be a workaholic. Noteworthy signs including having no hobbies, working through lunch every day, coming to work when sick, being accessible to work all the time, and consistently overbooking. 

The WORKAHOLICS ANONYMOUS site is a real eye opener. 

http://www.workaholics-anonymous.org/10-literature/24-twenty-questions

Surprises in their list of 20 questions include "Do you regularly underestimate how long something will take the rush to complete it ?” This is a more in depth read and I recommend it. 

FORBES 

http://www.forbes.com/sites/deborahlee/2014/10/20/5-signs-you-might-be-a-workaholic/#430847d833d1

Forbes showcases a very worthy article about work-life balance, citing some interesting statistics including the following : "Americans put in more hours than workers in other wealthy countries and are more likely to work nights and weekends.” They alsogive an introduction to Bryan Robinson’s book “ Chained to the Desk”, which is available on Amazon. 

The follow up articles in the same series 

http://www.forbes.com/sites/deborahlee/2014/10/20/6-tips-for-better-work-life-balance/#5ae8fd25dbc9

details 6 tips for a better work like balance. The two tops which appeal to me the most are “ Letting go of perfectionism” and “ Limit time wasting activities and people”. 

SCIENCE DAILY

https://www.sciencedaily.com/terms/workaholic.htm

This site highlights some more surprising aspects of workaholism including the observation that workaholics lose track of time. They also highlight some chilling aspects of workaholism including the problem in Japan, where early death related to workaholism has its own word, karoshi. We all know that workaholism takes a huge toll on mental and physical health, but death by karoshi is hard to fathom. 

I am going to strive in the next few weeks to make my posts more brief. I will feature more outside sources. It is my hope that these posts will be easier to write and easier to read. This is one step I will be taking toward a better work like balance. 

Send me your thoughts on the matter. I would love to see what you think. 

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

Zika infections in the US have taken sharp uptick of late, presumably due to the weather and mosquito activity. Zika infections in American pregnant women now number around 300, the largest number of which are located in Puerto Rico. Numbers are also up since the initially reported numbers did not reflect asymptomatic infections, which can affect fetuses as well. The CDC ( Centers for Disease Control) estimate about 80% of Zika virus infections are asymptomatic. 

The Zika virus is transmitted by mosquito bite and by sexual contact. Consumer Reports has studied the so called natural mosquito repellants and, sadly, found that they last no more than an hour. DEET is much more effective, and has been found to be safe in pregnancy. 

The CDC and Harvard Public Health have analyzed preliminary data. Women who get Zika in section in the first trimester have about a 13% chance of having a baby with microcephaly. The background incidence of microcephaly is on the order of .02 to .12% in the US. So far, it appears that infection in the second or third trimesters is not as consequential.

I wonder if Zika related brain damage is either present or not present, versus a spectrum of damage. If it is spectrum, what do the other 87% of babies have that we should know about ? 

The CDC director has made an impassioned plea to Congress. The House and Senate each have separate Zika funding plans, but they cannot agree. Meanwhile days could make the difference as summer approaches. 

A new study out of U Penn indicates that pregnant women who use marijuana increase their risk of preterm labor by five times. I am more interested in what it may be doing to the brain of both the mothers and the babies, and would be glad to see more research done on this important topic. 

The whole pelvic mesh situation is seemingly going from bad to worse. Mesh sheets are used in surgery to reinforce tissue. Various types of mesh in sheets or ribbons are used for hernias and for urinary incontinence. Johnson and Johnson developed mesh for use in pelvic prolapse patients. However, complications started arising including migration or erosion of the mesh. People were indeed injured, and lawsuits arose.  Washington and California are filing lawsuits against Johnson and Johnson, alleging that the company misrepresented the risks of its use. 

Now some of those same pelvic surgeons who installed mesh are removing it. Is is fitting and customary for a surgeon to handle any of her or his post op complications However in this instance, American Medical Systems has recently alleged that some physicians and lawyers are “ persuading” women to remove their mesh implants in order to make money and inflate damage claims. They also explain that there are now lending companies who work with physicians to fund these mesh removal cases. For shame !!! I will be following this story closely.

I have used Monarc “ ribbon” to suspend the bladder to help incontinence. It has an acceptable complication rate. However, years ago, when a fellow doctor friend of mine and I went to get trained on Monarc insertion, we were also asked if we wanted to train on mesh. I distinctly remember that moment when she and I looked at each other and made bad faces. It gave us both the creeps. We said no because our gut impression told us it seemed prone to complications. Lucky guess. Or maybe it was that the idea of having a piece of screen door sewn just under your vagina skin did not sound OK to us. 

The Republican Governor of Oklahoma Mary Fallin has ignored the party line, and vetoed the recent bill making abortion a felony. This brave politician described herself as “ the most pro-life governor in the nation” but vetoed the bill on the basis that it was “ambiguous and vague" and “ would not survive a constitutional challenge” , i.e. it would be illegal. The Governor was under great pressure from the Christian right to pass the bill. She also received information and pressure from the Oklahoma State Medical Board, the American College of Obstetricians and Gynecologists (ACOG), and the Center for Reproductive Rights.

Acting this presidential could get you a nomination. Similar bills are being put forth in South Carolina and Louisiana. 

Many of you have read my rants about various and sundry public health generated guidelines about women’s health screening tests. These would include mammograms, paps, annual exams and the like. My rants have generally been about the more lax approach seen by generalist governing bodies like the American College of Physicians, and the American Academy of Family Physicians. ACOG guidelines are more stringent, and I believe this is because we rely on more rigorous data produced by specialists in the field. Even so, generalist guidelines hit the press just the same as ACOGs, and it is difficult for a layperson let alone a community physician to understand why the recommendations are so different. 

As an example, ACOG believes the evidence supports mammograms in the 40s for women of average risk, whereas the American Preventive Services Task Force does not advise them until the 50s. In a nutshell, this is because the APSTF did not choose their study endpoints in the most meaningful way. Their harms included trivial things like fear of mammograms, and their endpoint was death rather than years of life. The public and many providers were thrown into confusion. 

Fast forward to the present for some good news.. ACOG will now be partnering with these same organizations to develop what will hopefully be an evidence based rigorous set of Women’s Preventive Services Guidelines. 

Stay tuned for more news next week on Medical Monday. 

Food Friday: Cookbooks

Todays's post is the last in a series of 4 posts about cooking inspiration. It is about cookbooks. As I survey my wide ranging cookbook collection, I can see that they sort themselves into a few key categories: 

Reference Material- These are books that encyclopedically categorize a small category of foods or ingredients, ie. The Spice Bible.  

Do it Yourself Cookbooks- These are books which have recipes and methods for making that which we commonly think of as " store bought" stuff.  These books often collect food preparing techniques which are in danger of being lost from the general population. How many of you know how to make crackers, cheese, pickles or ice cream ?   i.e The Home Creamery by Farrell Kingsley. 

Cookbook travel- These books explore a region dish by dish. They are often noteworthy for their fabulous photography.  i.e. My Paris Kitchen by David Lebovitz

Health related cookbooks- These are focused on foods, dishes and menus which have health benefits. There are many such books claiming this feature, but not all actually have it. I have included a few which I think have genuine health benefits.  i.e. The Autoimmune Paleo cookbook by Mickey Trescott, NTP. 

Coffee Table Cookbooks-  These books are typically large format, and magnificently photographed. They are sumptuous tomes which are meant to be works of art in and of themselves. Example: Culinaria, eds. Andre Domine, and Michael Ditter

Chef Based Cookbooks- These feature one famous chef who gives presents their unique recipes but also their versions of the classics, i.e. Mastering the Art of French Cooking, by Julia Childs. 

Category Cookbooks- These are cookbooks which focus on a particular category of cooking, i.e. The Essentials of Roasting by Williams Sonoma. 

Comprehensive Cookbooks- These are cookbooks which aspire to cover everything comprehensively, ie. The Best Recipe, by Cooks Illustrated. 

Here are some homegrown photos of my cookbook shelves as they are tonight. 

My personal favorites shift every few months. Right now, I am biased toward the health related cookbooks since I believe more and more that one can make healthy food delicious. We understand more than we ever have about food science and human nutrition, and many well educated and creative writers are producing excellent cookbooks by marrying this information with their skill and taste in cuisine. 

I also believe that once you taste healthy food from well written recipes, that you will not be able to go back to ordinary unhealthy food. 

With this in mind, I am going to plug one cookbook series and two particular books by different authors as my top choices at this time: 

The Jonny Bowden series on The Healthiest Foods

Paleo Takeout by Ross Crandall

Nom Nom Paleo Food for Humans, by Michelle Tam and Henry Fong 

I love all the online recipes and sites. But sometimes, the large glossy photos and thoughtful prose in a traditional paper cookbook is uniquely satisfying. Paper cookbooks also permit annotation. I can tell you all of mine are written in, with dates, who I made the recipe with, and any modifications I saw fit to make. 

Take a walk on the culinary wild side, and read a good cookbook. Better food is pleasant step toward better health. 

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

Zika Virus was front and center at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG) this last week. Hospital protocols are being developed to handle Zika affected births. Additionally, research continues into the the way that the virus affects babies, some utilizing the placenta. 

The annual ACOG meeting also presented a medical legal panel which presented evidence that latest cluster of TRAP (targeted regulation of abortion providers) laws were not based on medical indications. Many such laws are introduced under the auspices of medical necessity, where the available medical literature does not indicate such. It seems to me that abortion opponents should be truthful about promoting pieces of legislation based on their moral and religious views, and not medical science, for which there is none. 

In Brazil, where Zika virus is rampant, abortion is illegal, even for anomalies. Recently, evangelical politicians there have introduced stricter penalties there for those who illegally are found to have aborted a baby with microcephaly. There are nearly one million illegal abortions in Brazil each year. The number of women who are hospitalized for complications from these illegal abortions is ten times the number of women who are not. 

Oklahoma just passed a law making it illegal to have an abortion. It is a felony there, punishable by up to three years in prison. Physicians performing abortions would have their medical license revoked. 

And no matter where you stand on the issue of abortion, it comes as good news that abortions in the US and other developed countries have significantly declined since the 1990s. In my experience, abortion is a tough decision for people and is fairly hard on women. 

Also in the good news department, new research in JAMA (Journal of the American Medical Association) indicated that exercise wards of a variety of different types of cancer, even in those who smoke or are obese. There is a 20 % risk reduction for about 13 different types of cancers including esophagus, lung, kidney, stomach, endometrium and others. 

And in some news which I consider to be outstandingly good news, a panel at ACOG has generated a strong statement of consensus that 39 weeks is the optimal time to delivery a baby.  They have stated that there is little to gain and considerable to lose thereafter. We Ob/Gyns are committed to practicing evidence based medicine, and so I have managed patients according to the existing algorithms of the day supported by the best available evidence at the time. But, as my 22 years of practice have ticked by, I have had a stronger and stronger hunch about this 39 week point. Now there is finally a high level consensus about it. The presentation was so strong the the 63% opposed to the consensus before the talk turned into a 81% for the consensus by the end of the meeting. Inductions at 39 weeks had a lower complication rate than previously appreciated, and the C section rate did not increase. 

The vaccine rate for HPV (Human papilloma virus) has been low in this country. However, it is more than it has been in last years, and the rates of high risk HPV disease are decreasing. To really stamp out cervical cancer, we need to achieve the so-called “herd immunity” conferred by near universal vaccination. 

More good news…. In 2010, 16 % of Americans were uninsured. In 2015 this dropped to 9.1 % of Americans. Of course this is related to the ACA, the Affordable Care Act. Of course this has a cost. But, as a physician, I would like to remind the non-medical public that it is much cheaper for the taxpayer to pay for early prevention of illness and pregnancy than to pay for delayed treatment of illness and unintended pregnancy. 

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

Belated Medical Monday : Breaking News form the World of Obstetrics and Gynecology

A new inexpensive paper based rapid test for Zika has been introduced. This represents progress, but it’s accuracy remains to be determined. More recently, it has been discovered that testing urine for Zika is even more sensitive than blood. Good news for low cost testing ! 

Researchers are endeavoring to discover how the Zika virus does its damage. As in the case of many disease processes, the immune system seems to be mediating. Zika first affects the placenta by limiting the growth of placental blood vessels. It then moves to the fetal brain where, the immune response to the virus turns off a gene needed for fetal brain cells to specialize. 

Also of interest: there are pairs of twins who are unequally affected by Zika. In some cases, one twin develops microcephaly and one twin does not. Findings like this might lead to clues about how to test for, prevent or treat the condition. 

The United Nations has set up their own fund to combat Zika. Sixty -one countries are now affected by the virus. The National Governors Association in the United States has calling on Congress to strike a deal on emergency funding for Zika. It has been 2 months since President Obama initially requested the $1.9 billion though to be necessary to fight the virus. 

The safety of the widely used anti-nausea drug Zofran was questioned last year after a piece of research was released. A newer study from the Journal Reproductive Toxicology has found no connection to birth defects. In fact, it has also found that women who used Zofran were less likely to have a miscarriage or stillbirth. 

Outspoken Ob/Gyn and former clinical instructor at Harvard, Dr. Amy Tuteur has pointed out how the natural birth industry has fostered guilt and shame among those who have required or who chose medical interventions for labor and delivery. These interventions include pain relief, hospital birth and C sections. Most of these interventions are done in the service of the health and well being of the mother and baby. Dr. Tuteur points out that some may have lost sight of these fundamental goals. Anyone wishing to hear more of her opinions (which are as sharp as her scalpel) should go to http://www.skepticalob.com. 

The chair of Illinois ACOG Dr. Maura Quinlin is trying to address the rise in home birth by bringing parties together to craft regulations to guide the practice. Chief among them is the need to restrict the practice to “ low risk women”. My position on this is that this is a first step; but that many women with complications start as low risk, and that they go from complicated to uncomplicated in the blink of an eye.

Most home birth midwives in the US are not Certified Nurse Midwives, who have years of graduate level education and hospital training. Most home birth midwives in other developed countries are. This is one reason behind the disparities in safety data between the US and other countries. The president of the American College of Nurse-Midwives and the president of the American College of Obstetricians and Gynecologists are working to establish educational competencies for midwives practicing in the US in order to bring them up to the standards in the rest of the world. 

Findings recently presented at the annual meeting of the American College of Obstetricians and Gynecologists have shown some alarming facts associated with home birth. Women with prior C section who opted for home birth, even those attended by Certified Nurse Midwives, had a greatly increased risk (10X) of infants with serious medial conditions including seizures and neurological dysfunction (brain damage). Additionally, home birth VBACS ( vaginal births after C sections)  attended by midwives have a much higher risk of Apgar scores of 0—5. Earlier data referenced on my site has shown a greatly increased incidence of first Apgar of 0 for first deliveries at home. 

Maryland is moving forward with the “ Contraceptive Equity Act” , prohibiting copays and preauthorization requirements for contraceptives. Insurers have until 1-1-18 to comply. Hopefully more states and countries will follow suit. 

The chair of the Michigan section of the American College of Obstetricians and Gynecologists has noted that numerous pieces of legislation have been introduced in recent years that aim to govern the practice of medicine for women. These have had to do with everything from reproductive and contraceptive care, to breast surveillance and even ultrasounds. She is encouraging the public to be wary about this. I would say it like this: Be wary of politicians who want to practice medicine without a license, especially if they only seem to want to do so on women’s bodies. 

The Missouri house last week debated a bill that would assign the fetus full personhood. Further south of Missouri, past the Mason Dixon line, mosquitos capable of carrying the Zika virus are plentiful. This is where the virus will have its greatest effect in the US. However, it is also the part of the US where reproductive services are harder to procure. The southern states, especially Florida and Texas have had some of the largest funding cuts to contraceptive services of any states in the union. They also have some of the higher rates of unintended pregnancy. In what should be a source of statewide embarrassment,  Florida cut Planned Parenthood clinics out of Medicaid funding, but now is crying for more Federal Aid (your tax dollars) to combat Zika. That’s some nerve.  

Belated Food Friday: Food Movies

We are one day behind, both today and tomorrow. Thursday night I attended an unexpected emergency, and through much ado, all is well. However between that and the birthday parties, family slideshows, and wedding showers this weekend, we are a bit behind. So I am going to release a fun "Food Friday" now, and Tuesday the belated Medical Monday. The rest of the week I will be devoted to by niece's wedding, which will be held at our farm. I may send out some more fun posts. 

Why watch movies about food ? Food is something we must deal with everyday. It can be a chore, but it needn’t be. Movies about food tell the stories of how food came to be as it is today. Food movies remind us about what and who it takes to put it on our table. They also serve to inspire us to make better and healthier food for our families. 

There is a dark side to food in the developed world. There are numerous documentaries which go into this. Here is a site which catalogs and reviews them. 

First we Feast

I would like to focus on a celebration of food, and the people who make it.  Here is a great “beginner’s”  collection of food movies which I have seen. I have tried to provide a little introduction so you can chose mindfully. I have also included viewing source options. Do not be put off by other languages. The subtitles are easy to get used to and it is fascinating to hear the other languages in the setting of what is happening. 

• Haute Cuisine - (French with subtitles) (Netflix)- chronicles the career of one of the personal chef’s of the president of France. 
• Chocolat- (English) (Apple movies) Art House film with a all star cast including Johnny Depp and Juliette Binoche- set in France - about a newcomer whose beautiful bakery inspires the villagers to enjoy life. 
• Chef- (Netflix)- unmissable sweet story about a single dad who is a chef, his young son and their transition to a food truck business
• Like Water for Chocolate - (Netflix) (Spanish with subtitles) - fanciful earthy tale about a family with a daughter who can infuse her feelings into the food she cooks. Great fun. 
• Babette’s Feast (Apple Movies) (Danish and French with English Subtitles)- Period piece movie about a French housekeeper and cook who moves to Denmark two live with two old  puritanical sisters. Her cooking is transformative. 
• Julie and Julia - Delightful account of a New York woman who blogs about cooking every dish is Julia child’s cookbook “Mastering the Art of French Cooking”. 
• Ratatouille- Charming Pixar film about a rat who wants to become a 5 star chef. 
• The Hundred Foot Journey - Must see culture clash tale of an Indian family, their restaurant, and a french chef.  A visual feast. 
• Burnt (Apple Movies) - Drama/Comedy about a narcissistic two star Michelin chef who has to grow up to get his third star. Stars Bradley Cooper. 
• JIRO Dreams of Sushi - (Japanese with English Subtitles) Documentary about the greatest sushi chef in Japan 
• The Ramen Girl- (Amazon video) ( English and Japanese with subtitles) Heartwarming comedy about an young American Woman in Japan who is determined to learn the art of making traditional ramen. 

Series: 

• Giada DiLaurentis (Food Network) glossy production, pretty Giada and simple Italian dishes 
• The Barefoot Contessa, Ina Garten (Food Network) - Beautiful streamlined classic recipes 
• Tastemade - Sourced-(internet and Apple TV) engaging series of shorts by Aussie hostGuy Turland about classic ingredients and how they are sourced. 
• Chef’s Table - series of different chefs and their unique contributions. (Netflix) 
• Cooked - MIchael Pollan - unparalleled photography, food science and delicious food (Netflix) 
• The Mind of a Chef - David Chang; origins of classic dishes and travel to their geographic and cultural origins (Netflix) 

Some of these series are complete and some are ongoing. These are generally much shorter than full length movies and are great to watch if you don’t have much time. 

So I recommend tucking in to these food movies. Just make sure you get out of the theater and into the kitchen yourself, even if your dishes don’t look exactly like the ones on the screen.  

Wellness Wednesday: Healthy Stuff

Wellness includes how you feel as you function in everyday life. How you function greatly influences how well you are. How you handle your material belongings in your home and workspace influences all of this. Today’s post is devoted to introducing the topic of  healthy relationship with your material belongings. 

The developed world has an unhealthy relationship with stuff. Many of us have more than we need. Our collective patterns of consumption strain the environment.  Our individual patterns of consumption strain our personal finances. Excessive objects clutter our spaces andmakes us miserable. 

How can all this be stopped ? Two fairly recent books have addressed this challenge. The first was written by two friends of mine, Joshua Millburn and Ryan Nicodemus. It is titled, “Everything that Remains”.  I met these two fine fellows at TEDxWhitefish where they gave a beautiful and clever presentation on Minimalism, or the art of mindfully curating one’s things and one's life down to that which is necessary and desirable. You can access their work HERE: 

http://www.theminimalists.com

and their TEDx HERE: 

http://www.theminimalists.com/tedx/

The second is a really trendy and fascinating set of books by a Japanese women named Marie Kondo. She has written The Lifechanging Magic of Tidying Up and its companion volume, Spark Joy. These books go into the concrete details of tidying up. However it is not done for its own sake. She makes it clear that it is to enhance quality of life and effectiveness in life. Ms. Kondo draws a clear connection from this tidying practice to clarity of mind and clarity of purpose. She speaks of improving relationships and clarifying life goals as by products of removing one’s clutter, and systematically determining which of one’s possessions “ spark’s joy”. Sparking joy is, in fact, her inclusion criteria. One should only keep an item if it “ sparks joy". Granted, joy is broadly defined to include traits like beauty or utility. She states quite plainly that curating and decluttering your space is a prerequisite to clarifying what is one’s own unique ideal lifestyle. 

I am no minimalist. In fact I derive great joy from textiles, colors, and various materials. I continually acquire new books. But I have come to understand that I should go through my things periodically, and that if I do there will be things which I can let go. Thus the quality of my items increases as their quantity decreases. 

I have also come to utilize alternatives to “ things”  more often. In particular, I am a magazine addict. My office overflows with them. I do not like the piles, even though I derive great joy from the individual issues. My solution ? I have gotten an app called Textile. For a small subscription fee, I can get many of the magazines I want in digital form. Additionally, I consume more and more material by Kindle or Audible. There are still some things, like cookbooks, which I like to have in paper, but this is the case less and less. 

I am interested in gaining mastery over my things so they are not master of me. I would like to edit and organize my things so they do not take up so much of my time. I am beginning to see time as a more tangible commodity. I am becoming more and more selective about how I spend this “ thing” called time. Your material possessions, you time, your lifestyle choices and your wellness are intimately related. Check out these two books, their insightful authors, and give a little more thought to how the space you inhabit influences the life you live. 

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

A startling report by the Pan American Health Organization has reported that Zika can be carried by the Mosquito Aedes Albopictus, also known as the Asian Tiger mosquito. This is important since before this, we only thought it could be carried by Aedes Aegyptae, which has a much more restricted range. The potential northern reach of Zika pay be much farther than previously believed. (See map.) 

Testing for a Zika virus vaccine is slated to begin in September of this year.  

In other good news, there may be another strategy toward curbing the spread of Zika by mosquitos. Apparently, infecting a mosquito with a bacteria called Wolbachia makes it less likely to get Zika. It is hoped that Wolbachia colonized mosquitos will infect the entire population of mosquitos, displacing Zika.  

Hypertensive disorders of pregnancy such as preeclampsia, also known as toxemia, appear to have some modifiable risk factors. These would include diabetes, obesity, cholesterol levels, pre-pregnancy blood pressure levels, and the incidence of binge drinking. These factors should be targeted and improved before pregnancy to minimize the chance of preeclampsia. 

A retrospective study published in the journal Pediatrics has revealed that women who get flu vaccine in pregnancy protect their babies as well. Those babies whose mother received flu vaccine turned out to be 70% less likely to get the flu. Among those babies whose mothers had received the flu vaccine who did get the flu, they were 80% less likely to require hospitalization. 

An English study from the Journal of Adolescent Health has revealed that 3/4 of girls from ages 11-18 have listed breast related concerns as reasons for dropping out of sports. Other data has showed that 72 % of women have experienced exercise related breast pain. And yet only 10% of girls in the survey were wearing a sports bra prevent this. The study also queried girls about their knowledge about breast heath and development. 90% said they wanted to know more.The survey showed that the favored solution was a females only health class with a female teacher sometime around age 11. 

New research presented at the annual meeting go the Pediatric Academic Societies shows that HPV is associated with a twofold increased risk of self destructive escape behaviors such as cigarette smoking, marijuana, and use of alcohol. I wonder if this means we should begin pap and HPV screening on young women with these behaviors sooner than the recommended 21 years of age ? 

Normal weight people who ate 25 % less than they wanted were studied for two years. Research published in Journal of the American Medical Association Internal Medicine has shown that after two years, they were happier, less stressed, slept better, and had better sex drives that their counterparts who ate all they wanted. My guess is that this habit generated a sense of mastery, which transferred over to other areas of the test subject's lives. The study also showed that test subjects lost weight, from what had to be the high range of normal to about 22.6, the lower side of normal in Body Mass Index (BMI) 

Ever hear the term “ reproductive coercion “? Neither had I. However, I have heard of a phenomenon where men pressure women to get pregnant against their wishes. It can involve the sabotage of birth control and is highly associated with physical abuse. A recent study among sexually active high school girls in New York has shown that gives as young as 14 report reproductive coercion.  This problem is just coming to light. 

In related news, women serving in the military have been noted to have trouble obtaining their prescribed birth control. Perhaps related to this is the higher rate of unplanned pregnancy in the military compared to the general population. Is this reproductive coercion? Not exactly. 

In the “ I had no idea “ department, it appears that 1 in 6 hospital beds in the US are in Catholic affiliated hospitals. This percentage has increased in recent years. In these hospitals, there are, of course, no abortions performed. However, health care staff are also advised not to promote contraception, and not to perform sterilizations. Is this reproductive coercion ? 

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

Food Friday: Food Inspiration, Part 1 of 4

I love food. I love healthy food. But sometimes I need food inspiration. I would like to turn to my four big sources of food inspiration: 

• food websites
• cookbooks
• food in literature 
• food movies 

This week we will touch on food websites. 

First and foremost, there is Pinterest. This is a free online general pinboard where you can create your own page full of albums and “pin” items from anywhere in the internet or from Pinterest itself. It is your all purpose infinite online scrapbook collection. More often than not, it is my first stop when searching for a specific recipe. Sometimes I just need inspiration and will just scroll through my own extensively curated food albums. It takes about 5 minutes for me to go from unmotivated to excited when I check Pinterest. 

Other general resources are food.com, foodnetwork.com, and epicurious.com. Of these, epicurious is my favorite. That is because it is a knowledge rich site. Sure, it has gorgeous  graphic design and photography. Additionally, it is well organized and is geared to someone who truly wants to learn to cook well. There are numerous tips, tricks and educational resources. There is also a free membership, and this enables readers to collect their favorite recipes on the site. Epicurious is a site I have used for years, but apparently it won a Webby award in 2015 for best site in the food and drink category.

AmericasTestKitchen.com and CooksIllustrated.com get the highest marks for being instructional, but they lack the high style and visual appeal of epicurious.com. If you want to understand technique, or the science behind cooking, go here. 

Saveur.com deserves mention as an old and fascinating resource. The magazine has been one of my favorites for many years. Saveur is distinguished by its philosophy of setting food into it’s cultural and geographic context. Reading Saveur is a good bit of culinary armchair travel. To introduce you, check out their page on the best culinary blogs of 2015: 

http://www.saveur.com/saveur-blog-awards-2015-voting-closed

I should say that there are many beautiful websites and blogs out there which I will not showcase. That is because I am going to try to highlight sites which feature healthier cuisine. Many of these are vegetarian or vegan. I will include them, since current evidence based guidelines recommend we consume more plant based foods. However, I will also feature Paleo sites, which I believe are even better. 

The Paleo movement is amusingly misnamed since it has little to do with what Paleolithic people (cavemen) ate. The Paleo diet is devoid of grains and legumes (beans, soy and the like) , as well as modern processed foods and sometimes even dairy. There are many versions of the Paleo diet. At its worst, it is trendy nonsense. At its best, it is allergen free, and rich in healthy animal proteins, healthy fats, and  nutrients and fiber from fruits and vegetables. 

A new favorite for me is Paleo Magazine. A good place to start is their list of the top 10 Paleo Blogs on the Web: 

https://paleomagonline.com/top-10-paleo-blogs-on-the-web-2014/

My favorite on the list is Nom Nom Paleo.

I would also like to mention an important site on Paleo food which goes into a fair amount of medical science. This is

thedomesticman.com

It’s young author Russ Crandall had a life threatening bout with autoimmune disease. The Paleo diet helped in his recovery. He is medically literate and goes to some length in his books to explain the connection, which is that in some people, the Paleo diet can help reduce intestinal hyperpermeability and inflammation. 

I am going to conclude with a couple other specific favorites. First is the “eat" section of Greatist.

greatist.com/eat

Their site is beautiful and evidence based. Finally, there is

theforestfeast.com.

For sheer beauty, you should go here.

I hope, from now on, the question “ What should we have for dinner ?" is a pleasure rather than a pain. 

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

Good Monday. The administrative wheels are beginning to turn in response to the Zika virus. In particular, the CDC(Centers for Disease Control) and OSHA( Occupational Health and Safety Administration) have issues interim guidelines for employers and workers who are in settings which increase their risk for contracting Zika virus. This includes workers in outdoor settings, travel or health care settings. Guidelines deal primarily with protective clothing and the correct use of EPA approved insect repellent. Additionally the CDC has activate the Emergency Operations Center to Level 1. This means the CDC assigns the largest number of staff possible to work 24/7 on the response. To date so far, there have only been three other Level 1 responses, to Ebola, H1N1, and Hurricane Katrina. Experts in Brazil have come to understand that the perinatal consequences ot Zika go beyond microcephaly. It has been found to " erode the fetal brain"...destroying the lobes which control vision and thought an other basic functions. Moreover, Zika appears to prevent formation of areas of the brain "not yet formed". 

Meanwhile the House and the Senate continue to debate about what is the “ right number” for money to fund the efforts to handle the Zika crisis. 

At the same time researchers at NASA and NCAR ( National Center for Atmospheric Research) have made themselves exceptionally useful and, lacking an adequately absorbing space mission, have created a month to month map model which plots risk of Zika in US cities. The map does this by taking into consideration climate and population factors and how they affect the prevalence of the carrier of Zika, the Aedes Aegyptae mosquito. These maps really brings the situation into focus. Have a look HERE. 

Beast cancer risk prediction may be about to improve. New research presented at the American Cancer Society annual research meeting suggests that adding  “ genetic risk score” together with mammography density and hormone levels to current models will improve predictions. Improved predictions are help us devise tailored screening regimens for individual patients of varying risk. Hormones will be assessed only in postmenopausal women not taking andy hormone therapy. In these women, they plan to sample estrogen, testosterone and prolactin. Adding these markers improved risk prediction somewhere between 6 and 10 fold. 

The FDA (Food and Drug Administration) has recommended that there is a possible new link between flucaonazole (Diflucan) and miscarriage. This possible link is restricted to high dose or extended therapy regimens, not the 150 mg single dose most commonly prescribed. However, in response to this warning, the CDC is recommending the use of topical products only in pregnant woman. 

All you moms know it , I know it, and now science knows it. Mom brain notwithstanding, healthy new mothers are smarter, faster and more resilient than their pre-pregnancy selves. Older research has demonstrated this. Now the journal Behavioral Neuroscience has published research using sequential MRI studies of new mothers’ brains. They have found increases in grey matter in the prefrontal cortex and the parietal lobes and others between about 2 weeks postpartum and 3 months postpartum. These are areas which have to do with emotional regulation, survival instincts and hormones. 

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

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

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

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

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

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

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

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

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

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

The Dirty Dozen

and

The Clean Fifteen

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

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

Wellness Wednesday: Healthy Architecture

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

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

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

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

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

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

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

• Biophilia
• Educational design strategies 
• Light as therapy

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

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

To learn more: 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wellness Wednesday: Household Water Quality

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

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

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

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

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

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

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

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

Good Monday.

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

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

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

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

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

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

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

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

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

Wellness Wednesday: Household Wellness: Indoor Air Quality

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

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

Indicators of poor quality: 

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

Particular concerns about air quality: 

Radon

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

A Citizens’s Guide to Radon

Weatherizing

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

Asbestos

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

Carpets

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

Carbon Monoxide 

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

Ways to prevent bad indoor air quality:

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

Wellness Wednesday: Natural Home Cleaning

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

References: 

Epa.gov on indoor air quality

American Lung Association

United States Consumer Product Safety Division

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

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

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

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

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

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

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

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

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

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

A Belated Food Friday: Probiotics, Prebiotics and Synbiotics

What are they ? 

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

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

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

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

What do they do ? 

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

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

Should you use them ? 

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

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

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

References: 

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

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

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

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

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

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

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

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

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

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

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

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

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

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