Parenting

Wellness Wednesday: The Importance of Neighborhood

Right now I am in the middle of something big with my neighborhood. We are rallying and banding together to prevent the development of a huge water bottling plant in our agricultural and research oriented riverside neighborhood. Yeah, I know ! Outrageous isn’t it ? More on that later. 

I am learning what good people I have around me. I have truly been blessed. My neighbors are educated, considerate, flexible, and well spoken. They are from old to young. They come from a variety of economic and social backgrounds. They have a wide range of politics. But one thing’s for sure, we have some shared values. Those include feelings of stewardship for good soil and our pristine aquifer. 

It goes deeper. I have a sense of having a neighborhood of people who would help me if I had a flat tire. I have seen random busy people stop their cars to help shoo someone’s cows back into a pasture. I would never worry about my kids walking to school. But not everyone has these types of advantages. 

A Rand foundation report called “ Neighborhoods and Health”  indicates the following:

“ Just as conditions within our homes have important implications for our health, conditions in the neighborhoods surrounding our homes can have major health effects. Social and economic features of neighborhoods have been linked with mortality, general health status, disability, birth outcomes, chronic conditions, health behaviors and other risk factors for chronic disease as well as with mental health, injuries, violence and other important health indicators."

reference:

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf70450

Did you know, for example, that heath habits or disease habits are contagious ? That’s right, things like obesity, smoking, or on the other side, jogging and gardening are contagious too ? Neighborhoods can influence health in this way. 

Even the physical layout of a neighborhood can have its effects. Are there sidewalks, playgrounds and good lights ? A “ bad neighborhood” where it is not safe to walk or play outside severely constrains people’s ability to be active. It keeps people inside with the shades drawn, and bad behaviors like drinking can potentially go unchecked because there is no social accountability.  Such a lonely hostile environment greatly contributes to people’s stress, and of course stress truly contributes to many disease processes. 

Green spaces in neighborhoods turn out to be especially important. These serve as places to congregate and places to play. They also expose people to nature in places where it may be scarce, and research tells us that exposure to nature is beneficial to health in specific measurable ways. Please see my 2015 post on Nature and Health HERE. I remember being delighted with the particulars of what I unearthed when I did the research for this post. 

Here is a strange, wondrous and reproducible statistic:

An increase of ten additional trees on a city block on average, increases self reported health equivalent to a $10,000 annual increase in income or being 7 years younger. That’s right, adding ten trees to your block will add seven years to your life, at least from your perspective. The health they are talking about here is “cardiometabolic conditions” such as heart disease and diabetes. Several studies have tried to determine how this works. It seems to start by getting people outside, more active, with lower stress and lower blood pressure. More green space also seems to help reduce aggression and crime. 

What about the food environment of a neighborhood ? Is there local food ? Is food grown and sold ? Are there bars, grocery stores or convenience stores ? There is such a thing as a “ food desert” and I don’t mean dessert. A food desert is place which has nowhere to easily get healthy affordable food. The food environment has a huge obvious effect on food choices and health. 

Have you ever heard of a Ciclovia ? A Ciclovia is a open street programs that closes major roads to motor vehicles so they can be used exclusively by bicyclists and pedestrians. Ciclovias are being studied in large urban centers like Los Angeles in an effort to increase physical activity and sense of community in urban areas. 

What about sense of community ? What does that do ? This goes back to my original description of our neighborhood. It involves trust. There is trust and accountability in the continuity of these neighborhood relationships. Dan Beuttner, in his book Blue Zones, speaks of the decade-spanning friend groups of Japanese women, the “ moai” and their role in promoting the extreme healthy longevity of these women. The trust and connection of these long relationships provide a basis for the best things in life, such as celebration. 

These neighborhood relationships also uphold us when the going gets tough. I can remember nearly 27 years ago, I was between med school and residency, when I was pregnant with Forest. I had preterm labor and was put on bedrest. I was living in this same rural neighborhood, but in a tiny aging cottage which has since been torn down. I had a four year old, and my husband worked long days. Neighbors I barely knew, from newly married young women to aging matriarchs arrived with casseroles and pies. When it snowed, the drive just got plowed. These people became friends, and some have since passed. But their kindness left a permanent mark. 

In my search of Pub Med, which is the US National Library of Medicine at the National Institutes of Health, I found a fairly recent article stating “ The study of neighborhood health effects has grown exponentially over the past 15 years. “ Do not think for a minute that this is not real science nor that there are not real monetary and human resources being devoted to it. 

Neighborhoods affect the physical and mental health of their constituents. One study from the Archives of Psychiatry introduced me to some useful terminology as they highlighted the effects of neighborhoods on health. “ Concentrated disadvantage” was strongly associated with mental health problems for children. On the other hand, collective efficacy (the ability of neighbors to work together) and organizational participation mediated the effects of concentrated disadvantage on the effects of children. 

My neighborhood is demonstrating collective efficacy and organizational participation at its best. We have got our Facebook and Twitter pages for our cause and a great many of us plan to show up at the County Commissioners’ Office  to register our thoughts on the matter. I anticipate the group will bring some scientific and oratorial firepower to bear. 

It turns out that bad neighborhood environments generate their own vicious cycle and good neighborhood environments generate an even stronger virtuous cycle. Understanding this dynamic gives people a handle on how to make things better, no matter where they are starting from. 

How do you make things better ? Twenty two years ago I purchased an unconventional poster to decorate my office. It was shrink-wrapped, and backed in cardboard. When my practice got going, we had it framed and glassed. I still see its message every day. It is by an artist named Karen Kerney, and I will share it with you through an Amazon link. It is titled, “ How to Build Community”. It is for everyone who does not yet have a nice neighborhood to live in. It was ahead of its time. The folk wisdom it contained has now been largely validated by the science on neighborhoods and health.  I hope you enjoy it. 

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

Zika again dominates the news in Ob/Gyn. As of Friday, a storm system was approaching the subtropical state of Florida, where 43 are confirmed infected with the Zika Virus. Authorities think the storm may help spread the virus which is transmitted by mosquitos and sex. Meanwhile, the CDC (Centers for Disease Control) does not have enough Zika testing resources. I myself experienced this last week when I was told a specimen we sent to the CDC would take “weeks” to result. We Ob/Gyns are not able to effectively work in time frames like this, and so this week we will have being having some words with the powers that be. 

A new study published in Radiology has shown that Zika can cause many other brain defects besides microcephaly. They have thus far identified 8 major defects. One of the most common was ventriculomegaly, or enlarged ventricles and thinning cortex. 

Thus far the Florida outbreak has been clustered around Miami. However Thursday, an isolated case showed up some 250 miles to the north in Tampa Bay, Pinellas county. It is still unclear how this occurred. On the bright side, modeling done by researchers at the University of Florida has indicated that the total outbreak should limited to under 400 individuals or less, considering all the southern states. They also believe winter will stop the outbreak, which would then recur next summer the same way. It is estimated that 20,000 pregnant women in the Miami area are taking extreme measures such as confinement indoors or moving to avoid Zika infection. 

NewYork officials are noting that travel restrictions to Zika affected area not being properly observed by pregnant or pre conceptual women. How do they expect people to take these restrictions seriously when they gave full sanction to people traveling to the Olympics in Rio? 

Dr. Kristyn Brandi writes that Zika is spreading more rapidly than anticipated in Puerto Rico, and that resources of information and contraception are not adequately available. 

The chair of ACOG (American College of Obstetricians and Gynecologists) has written a strongly worded piece which has criticized how politics has prevented the funding of an adequate Zika response. He and co author, Dr. Didi Saint Louis of Morehouse School of Medicine have called for the full funding of comprehensive reproductive health care to allow women to avoid or delay pregnancy. They have called on Congress to reconvene to deal with this. 

In the non-Zika news, HPV virus is in the spotlight. This virus is responsible for abnormal paps, and cervical cancer, among other things. It has an effective vaccine which is meant for young people between the ages of 9 and 26. However parents remain wary to give it to their children. Research is being done regarding the prospect of putting it on the list of already mandatory vaccines which must be done before school entry. Surveys show that parents would accept this as long as there was an opt out provision. As of 2014, only 40% of girls and 20% of boys were vaccinated. It will be interesting to see if there will be those who decline the Zika vaccine once it gets developed. 

Breastfeeding is practiced by about 80% of all American women when they leave the hospital. However less than a third keep it up for the recommended time. The American Academy of Pediatrics has recommended that infants should get nothing but breast milk for six months, and that breastfeeding should continue one year. 

Co-sleeping beyond six  months has been shown to produce significant stress on women. Researchers at Penn State note this may be related to fragmented sleep and less time with partner. Perhaps this is related to the falloff in breastfeeding. 

In the everyone-already-knows-this department, researchers at UCLA have discovered that menopause accelerates aging. In all fairness, what they have determined is that methylation increases in menopause, accelerating cellular aging about 6 %.

And in the we-should-have-known department, the “ baby simulator” program in high schools designed to deter teen pregnancy may actually be encouraging it. Graduates of the program with over third more like to have a teen pregnancy. 

Stay tuned next week for more news from the amazing world of Obstetrics and Gynecology.  

Wellness Wednesday: Back to School 

Parents all over the world are experiencing one of the biggest transitions of the year: back to school. Whether you have grade schoolers, high schoolers or kids bound for the university, it is bound to have a big effects on your routines of daily life. And that in turn, has effects on your health and the health of the family. 

Summer can be a relaxing time when people are more physically active. Or it can be hectic with guests, vacations, and the routines can go out the window. Take a moment to assess your summer. Determine how you would like to capitalize on the transition back to school. 

For families with kids of any age, getting back on a good sleep wake schedule is key. Start at least a week early. Get back on a good meal and snack time schedule. You should be on that schedule anyway ! 

Sit down with kids of any age and go over their school supplies. Let kids have as much independence as possible in picking their supplies. These are important expressions of individuality. 

For university students, sit down and discuss finances. Establish a realistic budget regardless of where the money is coming from. Make sure they know how to balance a bank account and look up any card balances. Discuss expectations well in advance. 

For school clothes, don’t go crazy. Start by asking kids to tidy up their room and go through their things. Younger ones will need help with this, but let them do as much as they can by themselves. Encourage them to get rid of as much as they can, but go through it later yourself for things you might need to keep for younger children or other kids whom you know. Establish a habit of giving to Goodwill, and likewise, regardless of your finances, teach kids that it is reasonable to check second hand stores for things they might need. This should be given a air of boho environmental cachet, as well as frugality. After that, establish a budget and go shopping, but just get basics until your child reinvents themselves again for that year. 

Make it easy for kids to stay organized. Have an area such as a mudroom with hooks and cubbies for kids to put their things. Additionally, each child, whether large or small should have a desk area of their own if at all possible, even if they have to share a bed. This can be organization central for them. Consider having a family wall calendar, so everyone can see what family activities are coming. 

Teaching kids early on to have a routine will save them tons of stress. There are routines for sleep, eating, exercise, homework, after school activities, family time and play. Teach kids by example. Make sure you have good habits yourself. Then everyone will have a productive, low stress, enjoyable school year. 

 

Wellness Wednesday: Couples Wellness

This last weekend our adult kids cross examined us about when we had last done something with just the two of us as a couple. As a result we ended up taking our own hike in Glacier Park, something we had not done in years. This got me thinking about the ever increasing amount of evidence demonstrating how critical relationships are to health. I put two and two together. 

More attention should be given to relationships in the context of health. Primary care physicians including Ob/Gyns should include relationship assessment in their broader health history. They should be able identify serious problems and refer patients for couple’s counseling or whatever it is they need to correct the problems. 

All this can happen in the context of the doctor’s visit. But discussion about the health of our relationships should be a common one, because it is important. We talk about kale, yoga, cardio and even mindfulness. Why shouldn’t the conversation extend to interpersonal skills and healthy relationships ? 

I have spent the last few days reviewing material on the subject of relationships and what can be done to make them healthier. This extends beyond partner relationships to friendships and family relationships. The core skill set in all cases is the same, with variations depending on the relationship. 

Two particular sources were the most helpful. 

The first is an article in Psychology Today which pointed me toward a sweeping review out of UCLA on the effectiveness of couples' therapy. The conventional wisdom in the lay press seems to be that couple's therapy does not work well. This research study served to shed light on this question. It was a major review of the past 40 years of research on couples therapy. It turns out that certain therapy worked, and certain therapy did not. The conclusion of the study was that couple's therapy does demonstrably work IF it follows 5 particular principles : 

  1. The therapist must be willing to ask both partners to step back and look more objectively at the facts and patterns of the relationship and actually be willing to change how they each think of the relationship. (The individual partner’s views are not sacrosanct.) 
  2. To be effective, a therapist must be wiling and able to change actual behavior in the individuals. They must be able to take concrete steps to prevent one partner from harming the other. This includes psychological services, anger management, or substance abuse treatment. (The therapist must have teeth.) 
  3. Effective therapists must bring out the emotions of each partner. 
  4. Effective therapy must include the teaching of good communication skills. This includes active listening and responsible “I statements”. 
  5. Effective therapy must focus on strength and build resilience. 

In brief, therapy can be effective if it

  1. Fosters objectivity
  2. Changes behavior
  3. Handles emotions
  4. Teaches communication
  5. Enhances strengths

My second source led me to the famous Gottman Institute founders John and Julie Gottman. They provided a piece in the recently published " Time Special Edition, The Science of Relationships" . As lay reading goes, it is superb. I picked mine up in Costco. In it, they discussed their work and the “ Seattle Love Lab” where they evaluate and treat couples. They also referred to their most recent book, "The Seven Principles of Making Marriage Work”. In this book they present the distilled result of their observations of hundreds of successful “ emotionally intelligent” marriages. They too identified the common patterns in these relationships and have presented them for our consideration. 

They seven principals at work in successful marriages are as follows: 

  1. Enhance Your Love Maps
  2. Nurture Your Fondness and Admiration
  3. Turn Toward Each Other Instead of Away
  4. Let Your Partner Influence You
  5. Solve Your Solvable Problems
  6. Overcome Gridlock
  7. Create Shared Meaning 

You could map each of these lists uno the other and find that they line up pretty well. I find it interesting that both research groups chose to study what worked, and that the features held true over large numbers of couples and long periods of time. Finally, it seems that the social sciences are catching up to the medical sciences in prescribing evidence based treatments. 

I encourage you to delve into this literature, regardless of the type or the state of your relationships.

Check these valuable resources out at your local library, your local booksellers, Amazon.com, or even Costco.

 

Wellness Wednesday: Sleep Hygiene with Sketches

It is summer in the far north and the days are long...so long they stretch into the night. Farmers work until 11 pm and dinner is at about 9pm in broad daylight. Then the evening comes, and by 11 pm you feel the evening is just getting started. A movie is chosen and whoops, you are up way too late, especially since the sun comes blazing in shortly after 5:30am. 

So I though I would take this opportunity to share with you some sketches I did for my wellness reminder cards that pertained to the importance of good sleep hygiene. Each card will hopefully remind the user of a key principle, with the image on one side, and the reminder on the other. 

1. Adequate Restorative Sleep 

With few exceptions, adults need 7-8 hours of sleep. You should wake, almost spontaneously, and feel rested. That is the meaning of restorative sleep. 

 

 

2. Consistent Wake Time

Having a consistent wake time actually helps you fall asleep properly at bedtime. 

 

 

 

 

3. Consistent Sleep Time

Once you get in a routine, you will start to get sleepy at the right time. 

 

 

 

 

4. Correct Sleep Environment

The room should be dark, quiet and cool, without electronics or snoring people. 

 

 

 

 

 

5. Medical Evaluation of Necessary

Most major hospitals have a Sleep Center or Department of Sleep Medicine. There is now the recognition that sleep health underscores all health. Rigorous studies can be done to assess sleep problems, and treatments are available. 

 

 

To learn more see our webpage on sleep HERE

Next week on wellness Wednesday we will continue with more wellness reminders. 

Nighty Night !

 

 

Wellness Wednesday: Healthy Habit Formation 

Healthy habits are the basis of peak wellness. Heathy habits are something we can develop. Whether the healthy habit is taking vitamins, being grateful, exercising, or eating fiber, the practice only works if it is done over and over for extended periods of time. This repetition is achieved through habit formation. 

What does science say about how habits are developed ? 

The brain is designed to form habits.  New behaviors or tasks can be challenging. Over time, the brain “chunks” small possibly difficult behaviors into automatic routines which becomes easy or even effortless. This is a habit. Habits are adaptive and have helped us survive. Habit formation is our brain’s way of automating certain key behaviors, so more conscious attention can be paid to novel situations.  If we understand how this works we can form new habits at will. 

What do we need to form new habits ? 

In simple terms there are three steps: 

  1. Cue
  2. Routine
  3. Reward

This is called a habit loop. These are well explained in Charle’s Duhigg’s book "The Power of Habit”.  The cue triggers the routine, and the routine triggers anticipation of the reward. For example, my exercise routine is cued by changing into exercise clothes. From there, I go downstairs to workout, and the reward is the endorphins and the satisfaction. There is no doubt that at first, it is hard to link the steps. But it becomes easier with each cycle. To be realistic, it takes somewhere between 6 weeks and 3 months to form a new habit. 

What about bad habits ? They too have cues, routines and rewards. Basically, they have to be understood in terms of their rewards, namely, what you get out of it. In many cases, smokers smoke to get a moment of peace in a busy day. This is obviously legitimate. However, the cigarette is unhealthy and chemically addictive in addition to being behaviorally addictive. It turns out we should not exactly delete bad habits since this leaves a void. Instead we are better off to overwrite them with good ones. To illustrate, a smoker could use patches to wean down on the addictive nicotine, while overwriting her smoking habit with a healthful tea drinking habit. Perhaps to make it more engaging, she would brew the tea from loose leaves. Her reward would be the moment of peace, the taste, smell, and mental clarity that followed. 

My subject in this post are the cues. In simple terms, they are reminders of health habits. I decided to expand my set of reminder cards to include not only the subject of nutrition, but also the subjects of sleep, exercise, communication, and creativity. I believe these are some of the elements in total peak wellness. Here are my cue phrases so far. 

Sleep 

  •      Adequate restorative sleep 
  •      Consistent wake time 
  •      Consistent sleep time 
  •      Correct sleep environment 
  •      Medical evaluation if necessary 

     Exercise 

  •      Start easy and short 
  •      Warm up
  •      Cool down 
  •      Value initiation over endurance 
  •      Good gear 
  •      Eat for exercise 
  •      Hydrate for exercise 
  •      Tunes for exercise 
  •      Podcasts for exercise 
  •      Exercise daily 
  •      One break day per week 
  •      Stretch after exercise 
  •      Buddy exercise 
  •      Track your exercise 
  •      Explore HIT 
  •      Include yoga 
  •      Mix it up 
  •      Use good form 
  •      Consult professionals 

Creativity 

  •      Get inspired through people travel and media 
  •      Find your styles 
  •      Express creativity in your personal space 
  •      Make a space for your creativity
  •      Take time for hobbies 
  •      Take time for Travel
  •      Take time for recreational reading 
  •      Pick a hobby and learn it well
  •      Share your creative work

Work 

  •      Always work
  •      Honor work in and out of the home 
  •      Chose meaningful work 
  •      Become expert at your work
  •      Give work boundaries in time, space, and thought
  •      Do you best at work 
  •      Communicate effectively at work
  •      Reach out often at work
  •      Play as a team 
  •      Ask for appropriate compensation

Communication 

  •      Breathe and think before speaking 
  •      Use Honesty 
  •      Use courtesy
  •      I statements
  •      Precision of speech
  •      Closed loop communication
  •      Listen more than speak 
  •      Listen actively
  •      Repeat back clarification 
  •      Acknowledge others’ point of view
  •      Build common ground

 

You can find nutrition reminders HERE discussed in a prior post. I plan to devote a few wellness Wednesday’s to the development of these reminders or cues. 

For more reading : 

http://jamesclear.com/three-steps-habit-change

https://www.psychologytoday.com/basics/habit-formation

https://www.sciencedaily.com/releases/2014/08/140808111931.htm

http://www.scientificamerican.com/article/power-of-habit-excerpt/

Food Friday: Family Dinner

It’s summer and the kids are home. Why not take advantage of their company and get serious about some awesome family dinners ? Sounds like fun, right ? But it’s much more. According to a considerable body of research on the subject, family dinners are important to well being. (Reference: thefamilydinnerproject.org)

Family dinners are associates with the following findings: 

  • Better academic performance 
  • Higher self esteem
  • Greater sense of resilience 
  • Lower risk of substance abuse 
  • Lower risk of teen pregnancy 
  • Lower Risk of depression 
  • Lower likelihood of developing an eating disorder 
  • Lower rates of obesity 

Let’s think about why. 

 

The family dinner is a testing ground for the performance of a family group as a team. And yet, pulling it together to make a family dinner is not all that hard. It is within most every person's or every family's reach. Engineering the family dinner is an exercise destined for success. Most people are grateful when someone makes them something to eat, no matter how simple. It is a primal act of caring, usually free of strings, that one person does for others. Thus a dinner is easy to produce and easy to accept. 

Children and teens can and should help prepare the dinner, even if is just setting the table. They learn preparation and cooking skills, and they learn to pitch in. They also learn that if they don’t pitch in, they will stand out. 

The family dinner is a time when most families put aside conflict, since conflict at the dinner table just doesn’t work. The ritual and the food cause us to make a deliberate change in our behavior for the better. We cease to be isolated individuals and come together to make something more, a family or a even a social group. Thus, it is very hard for someone to be lonely at the table. At the table, it is graphically obvious that you come from somewhere, and that you have a place. 

Our family table has extended into the adulthoods of our children and to the younger cousins and their friends. We are very lucky in that regard. Most of them have gone off to college and have come back, bringing spouses, girlfriends, friends and grandchildren in tow. They have each developed family table specialty skills. Echo bakes and is an award winning amateur chocolatier. Forest is lately enamored of our Instant Pot, a cool pressure cooker, which enables you to make impressive meals with little planning or tending. Geri does veggies and my son in law does smoked meats and salads. Vale is smoothie man. Hanna my niece is a cake decorating expert. They are all serious students and professionals, but they have all come to be serious foodies too.

Stepping back, I see that no matter what their fancy, the whole thing is one big shared hobby, and when we do food, everyone is pretty happy. A happy hobby. Moreover, while it was simple and easy when they were little, they have, on their own, leveled up, as the gamers say. They relish the acquisition of skills needed for their culinary hobbies, and that gives them social confidence. Finally, they relish the presentation of their dishes to others. The “ breaking of bread” has always been a bonding experience and in a family this is nothing but good. 

Think about all this this summer, when your kids are around more, and hopefully you have a little more time. All you have to do is start something fun in the kitchen. Put your heart into and it and invite others to join in the process of creation. It will take on a life of it’s own.  

Wellness Wednesday: Five Steps to Mosquito Protection

Mosquito season is here. This has taken on a critical importance in many states in the south and eastern parts of the United States and in all of Central and South America. This is because mosquitos can carry, among other things, the Zika virus, which has been shown to produce serious brain damage in the unborn, and potentially serious disease in adults. Mosquitos also carry other serious diseases, including some which affect dogs and horses. Examples include West Nile virus, Heartworm, Dengue fever, Malaria, and even Ebola.  It is high time to discuss mosquito bite prevention. 

First one must note that mosquitos need standing water to reproduce, and even a tiny amount will do. Natural bodies of water such as ponds, puddles, and sloughs can breed mosquitos. Manmade water collections such as buckets, tarps which have collected rainwater, birdbaths and the like will provide very suitable breeding ground as well. 

Step One:

Eliminate standing water around your home. Get rid of any debris in your yard or patio (e.g. toys, wheelbarrows, pots etc.) which could harbor mosquito larvae. Change the water in your birdbaths at least once per week. Fill in any low spots in the yard. 

For larger bodies of water such as a pond or fountain, purchase “ Mosquito Bits “ or “Mosquito Dunks”. These are pellets or pucks of biological agents which interfere with mosquito reproduction. Once example is Bacillus Thuringiensis, which does not harm the environment. 

Step two: 

Install replace or repair your screens. You will want to enjoy the summer breeze without worrying about the mosquitos. 

Step three: 

Invest in some lightweight cool summer clothes. White gauze shirts with long skirts or lightweight palazzo pants are a pretty option. Most outdoor clothing companies such as North Face or Patagonia offer mosquito resistant shirt which are also usually sun protective as well. 

Step four: 

Buy some DEET based mosquito repellant. This is the only mosquito repellant which has been proven to work. Moreover, it has been shown to be safe in pregnancy. Use your insect repellent correctly. 

  • Read the instructions and precautions of your product. 
  • Only use on exposed skin and clothing. 
  • Do not use near eyes and mouth.
  • Apply to face by spraying hands or cloth, the wiping on. 
  • Never use on injured skin. 
  • Do not breathe it. 
  • Do not use near food. 
  • Do not use it on animals. 
  • Keep out of reach of children. 
  • Do not apply to children’s hands. 
  • When returning indoors, wash treated skin and clothes with soap and water. 

Step five: 

Stay indoors during the twilight hours when mosquitos are most active. 

 

Stay tuned next week for more summer health tips on Wellness Wednesday. 

Wellness Wednesday: Reclaim your Summer ! 

Setting Summer Goals 

I write this post as the beginning of summer approaches. I look forward to each summer as though I were a school child with a summer break instead of a physician with a steady job. All the same it is a special time, when children are more available, and when people are happily vacationing. We get an especially big dose of this spirit since we host guests in a vacation rental. They remind us of what summer is all about: excitement family, relaxation and adventure. 

To make sure you get all you can out of the summer, I suggest you plan. I suggest this since I am doing the same thing for myself right now. 

No matter your job, no matter your income, you should make sure to refresh yourself in this most sparkling of seasons. 

 

 

 

 

Here’s how.

1. Make a list of your summer goals. Make sure to include your goals in the following areas:

  • Fitness- Set realistic SMART goals for fitness. Make sure to incorporate active summer sports into these goals. Likewise, plan ahead to get fit before that big hike, so you can enjoy it best. 
  • Nutrition and Culinary- Make dishes you want to cook, eat and share, especially with fresh summer produce.
  • People goals- Who do you want to see this summer ? Make time for reconnecting. 
  • Project goals

Home improvement, garden, artistic- Take a summer themed classes, like water colors. Do some gardening. I believe everyone should garden, even if it is a nice tomato pot on the porch. 

Activities- Take advantage of the out of doors and the company of your kids. 

Staycations and Vacations - You can make time special right where you live, or strike out on the trail, for all day or all month as your circumstances allow. 

2. Consider making use of a wall calendar that comprises the whole summer. Block out the time so your goals are realistic.  Leverage your available technology to communicate and coordinate with others in your group of family and friends. 

3. Document your summer so you can best enjoy your memories later. Use photo, video, journalling, paper and mixed media scrapbooking or even digital scrapbooking. 

 

No matter your job or responsibilities,

summer is not just for kids.

Reclaim your adult summer !

The first day of summer is June 21st.

Make it your best yet.

Wellness Wednesday: Healthy Boundaries

Boundaries are essential to our physical and mental health. And yet, they are rarely discussed in everyday conversation. This post is to put the concept of boundaries on your radar, and into your vocabulary and to encourage you to learn as much as you can about them. 

Boundaries can be physical, mental, emotional, or even functional. At essence, a boundary is the line between you and everything else. To have good boundaries means that you maintain a truthful view of yourself. You know how you are distinct from others and honor that. Additionally, you take responsibility for all that is yours, from the state of your body, to your thoughts, your emotions, your skill sets, and the way you perform in life. 

Bad boundaries allow numerous problems to occur. For example, weak boundaries allow one person to tolerate mistreatment from another. Another kind of weak boundary allows one person to blame others for their problems. Bad boundaries produce abuse, resentment, chronic victims, pleasers, controllers, bullies, the overcommitted, enablers, entitled freeloaders, martyrs and guilt trippers… The list is endless. 

Boundaries are established as we grow up and have life experiences. We may learn from experience that standing up to a bully causes them to leave us alone. Or we may learn that it makes the situation worse. We may learn from parents that misbehavior has clear consequences, or we may learn that we can get away with anything. We may learn that when we apologize, it is accepted and life goes on. Or, we may get a never ending stream of resentment. All these types of things can affect the integrity of our boundaries. 

Those who have suffered abuse have particularly damaged boundaries. They tend to tolerate much more mistreatment than they should. In fact they may not even know to classify mistreatment as mistreatment since they do not even know what healthy relationships look like.  To them, an abusive relationship is sadly normative. And since boundaries are like fences in that they have gates, abused people have trouble with gates as well. Is particular,  abused people often shut out those trying to help. 

Few people have perfectly healthy boundaries. To have healthy boundaries, one has to be aware they even exist, if only on an intuitive level. To really understand them requires examples. Having healthy boundaries is about setting limits for oneself. While it is not about setting limits for others, it is about setting limits on what one will tolerate from others. Likewise, it is not about reacting to others. Rather, it is about communicating clearly specifically directly and honestly from a first person point of view ( "I statements") and giving responsible feedback to others. 

We all need to be aware of our personal boundaries and how to keep them healthy.

 

  • First is to realize boundaries exist.
  • Second, we must realize we have an innate right to maintain our boundaries.
  • Third we must become self aware of our own thoughts and feelings regarding what we are comfortable or uncomfortable with in ourselves and others.
  • Fourth, we must be honest and realistic about our needs, and employ self care to meet them.
  • Fifth we must be willing to enforce our boundaries if they are violated. This is done for the long term good, but we must realize that in the short term it may cause conflict.
  • Sixth, we must reach out for support and knowledge as we strive for healthy boundaries. This is because we are trying to learn that which, by definition, we did not know before. It is also because we may encounter resistance from those who encroached on our boundaries before. Sometimes, this requires professional counseling or a supervised support group. 

 

Healthy boundaries are critical to our self respect, integrity and optimal functioning. Here is some great reading to learn more:

 

http://psychcentral.com/lib/10-way-to-build-and-preserve-better-boundaries/

http://tinybuddha.com/blog/how-to-set-healthy-boundaries-3-crucial-first-steps/

http://www.essentiallifeskills.net/personalboundaries.html

https://www.ipfw.edu/affiliates/assistance/selfhelp/relationship-settingboundaries.html

https://www.psychologytoday.com/blog/prescriptions-life/201311/7-ways-protect-your-energy-enforce-healthy-boundaries

http://www.loveisrespect.org/healthy-relationships/setting-boundaries/

http://www.huffingtonpost.com/jennifer-twardowski/6-steps-to-setting-boundaries-in-relationships_b_6142248.html

http://greatist.com/happiness/how-to-set-boundaries-in-relationship  

Food Friday: Food in Literature

This is the third in a series of four posts about food inspiration. The first was on food websites, and the second on food movies. This one is about food in literature. 

The body of food literature out there is astounding. It is generally nonfiction, however some fiction does food so well the I shall include a sample of it here. In my research for this piece, I discovered not only new food writing to complement what older material I have unearthed throughout the years, but books about writing food writing. I also discovered food writing collections, and “best of” food writing collections. That’s how popular it is getting. 

We will start with a selection from fiction: children’s fiction. If you have not read Little House on the Prairie, by Laura Ingalls Wilder, you should. It is a classic children’s book despite the unfortunate TV series from the 70s. The descriptions of prairie meals or the maple syrup collection have stayed with me to this day. 

In college I was a vegetarian for two years. I was interested in this from an environmental standpoint. By some calculations the energy and water needed to produce a feedlot beef gram of protein was much greater than that to produce a gram of plant based protein. Also I lived in Synergy, a vegetarian row house at college where they knew how to combine foods to make complete proteins. At that time, the culinary bible in my life was Diet for a Small Planet by Frances Moore Lappe. This book connected the dots between bringing food to our table and the environmental consequences to soil, water, air and people along the way. Fast forward to the present and you can read very well written, researched and photographed books on the same subject, chief among which are books by the wonderful Michael Pollan. You cannot go without reading these. 

My soon to be husband lived in Synergy with me. We married after my fourth year and moved to the north woods, where he became a professional outfitter. There we got our cake and ate it too in the form of sustainably produced wild game, mostly elk and deer. To this day, we eat it almost exclusively, except for salmon and organic chicken. 

I became a young mother, and like all young mothers, read books to my children. Among them were the lovely Brambly Hedge Series books by Jill Barklem. I don’t know who was more fascinated, me or my daughter Echo. The illustrations and prose were exquisite, and conjured little mouse size kitchens full of flour sacks, jams, preserves, drying herbs and wheels of cheese. The author went beyond that and described the elaborate country picnics of the mice, with their fruity gelatin molds, pies, tarts, and syllabubs. 

Upon my arrival to the countryside, I had to learn a number new skill sets beyond parenting. Chief among them were gardening and cooking. I had come to the marriage with one Good Housekeeping cookbook from my mother. It was no nonsense with good illustrations, and from this I learned that I could hardly abide a cookbook without illustrations.

I read about cooking. I also read about gardening. I discovered you could read about gardening and cooking at the same time if you read about kitchen gardens, or potagers, as the French call them. I acquired a divine volume entitled The Art of French Vegetable Gardening, by Louisa Jones et alia. I pored over its pages and tried, with no money, to make my garden look the same as the potagers within the walls of ancient french castles, a noble effort indeed. 

I discovered food writing in earnest. I discovered there was such a thing as a food writer, and read Ruth Reichl’s Comfort Me with Apples. Ms. Reichl was the last editor in chief of Gourmet magazine, and now makes food shows at PBS. She introduced me and all her readers to a world of food writing. 

Meanwhile,our sons were born, and their literary mice were warriors, not bakers. They loved the Redwall series. This series caught on with all my kids, and as they worked their way through over twenty volumes, they often made mention of the magnificent feasts within those pages. Indeed, our son Forest and I wrote to the British publishing company for the Redwall series offering to develop recipes for a Redwall cookbook. They wrote us a very warm but formal letter back indicating plans for such were already underway. A couple years later, one appeared in bookstores. You can still find it on Amazon as the Redwall Cookbook. 

Our family meals became very important to us. The idea of a family meal was very old. However it came into popular modern focus again with the advent of the Slow Food Movement. A book of the same name appeared by an Italian author Carlo Petrini, and I devoured it. It was a counterpoint to the fast food culture that American had become. 

Food was very international for us. It was a form of armchair travel. We were very busy with young children, med school and residency and we did not vacation much. Learning about food and making it from my own garden gave me some of the same satisfaction. Accordingly, I fed this interest with some of the most famous food writing, Pater Mayle’s A Year in Provence. 

I have always been a lover of all things French. This is because my French teacher in high school was very dear to me. She was an important figure in my life, and I keep in touch with her to this day. Somehow, magically, she was able to teach me discipline with affection. Not surprisingly, she was very strict in class, and made us learn the language and culture very well. So naturally I gravitated toward books about french food.

This brings me up to the present day. On my active shelf I have several books about French food, the voluminous Julia Child volumes, Mastering the Art of French Cooking, French Women Don’t Get Fat, by Mireille Giuliano and The Sweet Life in Paris, by David Leibowitz. Of course a couple of these are books by Americans about French Cooking. To read a French book in French about French cooking is another matter for another day. 

I will leave you with something sweet to finish. I love to read about cooking. I also love to give books about cooking. Regular readers will also recall that l adore chocolate. Naturally therefore I love to read books about chocolate, its origins, production, etc. I once gave all my children a great coffee table book about chocolate, called The Ultimate Encyclopedia of Chocolate, by Christine Macfadden and Christine France. The next Christmas, I forgot and gave it again. Would you believe the next Christmas I gave the eldest the same book once more ? Such is the nature of adoration. 

Until next week, happy reading. 

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.  

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. 

 

 

 

Wellness Wednesday: Family and Social Support and Health

I have a pretty healthy family, and a pretty healthy group of friends. However, sometimes someone get sick or needs a surgery. I am always grateful and amazed at how people rally to help. At the same time, I think of my many patients who have to go it alone, even though they are not doing well. 

What is the relationship of social support to health ? It’s huge. I decided that if I write a blog post highlighting this interesting connection, that more people would connect with others in times of need. 

The most common form of social connection is marriage. Marriage is clearly associated with health. But there are some interesting particulars. Numerous studies over the last 150 years have noted this association. In more recent years, the association was questioned, on the hypothesis that perhaps healthier people marry. This turned out not to be true. In fact, unhealthier men were more likely to marry. 

If you parse the date further, the “ marriage effect “ is seen to be stronger as couples age. Moreover the effect is stronger for men than it is for women. Non married stable partners also have greater health than singles, however not as much as married people. There is not yet enough data to comment on whether same sex married couples share this health benefit of marriage. 

What are the particular mental and physical advantages associated with marriage and social support ? 

  • decreased depressive symptoms
  • better recovery from episodes of depression
  • lower heart rate and blood pressure 
  • lower serum cholesterol 
  • higher immune function 
  • reduced risk of Alzheimers 
  • better outcomes for hospitalized patients
  • decreased likelihood of chronic disease, disability, mental illness, and death

How do marriage and social support confer this improve effect on both mental and physical health ? There are several observations about those who are married, partnered or have good social support that seem likely to hold the answers : 

  • better social connectons
  • presence of companionship 
  • better emotional support 
  • better economic well being and more likely to be insured
  • more likely to keep medical appointments and get recommended screenings
  • more likely to take prescribed medications 
  • safer behaviors 
  • better nutrition 
  • more likely to get regular exercise

Dan Buettner in Blue Zones, identified social support as a principal correlate of extreme  longevity. He was focusing on groups of people around the world who lived healthy until past the age of 100. Regardless of place or culture, social support was key.

I think this is a powerful reminder for all of us to assess our our family and social connections. Are our relationships in good working order ? Those relationships may be more important than we realized. 

 

References: 

http://www.uniteforsight.org/gender-power/module1

http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-to-eliminate-cardiovascular-health-disparities/about/influences_on_health/family_social_support.html

http://www.economist.com/blogs/economist-explains/2015/01/economist-explains-0

http://www.webmd.com/sex-relationships/guide/relationships-marriage-and-health

http://www.health.harvard.edu/newsletter_article/marriage-and-mens-health

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/

https://www.bluezones.com/2014/03/blue-zones-history/

 

 

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. 

Food Friday: Our Passover 2016 Menu

Friday night is the beginning of the 8 day holiday of Passover. It commemorates the journey of the Hebrew slaves out of Egypt and into freedom. This passage can be seen on many levels: geographic, cultural, religious,  psychological, and, concerning our topic today, culinary. 

It is an archetypal story that the Jewish people have seen fit to memorialize and celebrate with the Passover Holiday. And, more than every other Jewish Holiday, it is celebrated with food. True, the Seder, or Passover celebration service has a beautiful and music-laden liturgy in a volume called the Haggadah, but the special food items eaten are written right into the text.

The ceremony begins with blessings over wine and candle lighting. The narrative proceeds to bring us into a desert land, into the fold of an impoverished and weakened people. Moses, with divine inspiration, invokes the plagues upon Egypt to persuade Pharaoh to let his people go. Finally the tenth plague, the death of the firstborn of Egypt breaks him, but he reneges, and the people are pursued by Pharaoh's chariots through the Red Sea, where they are delivered to freedom and the soldiers drowned. 

As the story proceeds, we at the table are permitted meager portions. We must wait patiently and hear the story unfold. We may dip bitter green herbs in salt water symbolizing the bitterness of slavery and the tears the people. Of course, everyone at the table is quite hungry by now, and we are reminded to remember the suffering of people everywhere, and even into the present. Fairly soon we can have a sip of wine. At last we are given the Matzah. It is a flat tasteless cracker made of flour and water. It is the closest thing to cardboard that you can actually eat. It has its appeals, but I think mainly from association to the festive family gatherings. It depicts a “ poor bread”, a bread made in haste, the bread of slaves on the run, the bread of people who can afford nothing else. Everyone eats some in ceremonial fashion, and often with a spread. But no ! It is a spread of pungent horseradish called Maror, again to symbolize suffering. It is traditional to see who can take the biggest bite and wince the worst. 

The rabbis must have known about being hangry, since right about then we are permitted also to spread Charoset on the matzah. Charoset is strange compared to typical American foods, one the hearkens to other lands and other times. . It is a paste made of fresh and dried fruit, perhaps citrus, spices and various nuts. It is mulled with sweet red wine. It can be made chunky or smooth, and can be delicious. It symbolizes the mortar for the bricks with which the slaves built. People make a sandwich of Matzah, Charoset, and Maror, as did the famous Rabbi Hillel centuries ago, since he taught that the bitter went with the sweet. 

Finally the meal is announced, and it is ritually begun with an elaborate blessing and a boiled or roasted egg. The egg is, of course, a symbol of new life. The entire “ Seder plate “ is presented. The plate is often very large and ornate, with special spots and labels for each of the ceremonial foods, including lamb and the ones already mentioned. As the meal unfolds in many courses, we are encouraged to recline and take our time, and to use pillows to highlight our status as free people.

Modern Seders make mention of various forms of oppression in modern times. In that spirit, the Seder is for passing on wisdom as well as celebrating, and elders at the table are meant to tell the young people what they have seen in their day. I can remember one Seder I attended with a friend as a young high school student. It was in Los Angeles in the 1970s. After the meal was largely finished, the elders started telling stories. I was brought to a table where several very old people had pulled up their sleeves. I could see numbers tattooed on their arms. I realized in silent horror that they were survivors of the concentration camps of World War 2. They spoke at length about what they had seen, and admonished us to never forget. These stories were tragic, but they encouraged us by saying, “Look at us now !” .

Indeed they were filled with joy and pride, in a grand ballroom filled with family and friends, dressed to the nines, and sitting before a splendid table with a spread fit for royalty. I will never forget it. 

So Friday when I make our small family Seder, I will think of them. Friday afternoon, however, I will think of all the things I have to prepare. To conclude, I would like to share with you my planned menu. For a Passover menu, it is one part traditional and one part eclectic, just like our family. I hope whatever your tradition, whatever your religion or lack of it, that you can celebrate with us in your heart. 

 

Passover Menu 2016 

 

The Wine: organic grape juice of course. 

 

Bitter herbs: Mixed greens to include arugula, mizuna, mustard greens spinach and kale for the sweet and bitter (with a citrus vinaigrette for later in the meal) 

 

Roasted eggs, deviled by my son in law if he has time. 

 

My own Charoset, featuring dried mango, golden raisins, dates, dried cranberries, almonds, orange juice and champagne, and spices. 

 

Home made matzah- very rustic and hot out of the oven. 

 

Horseradish - straight up no embellishment. 

 

Halibut and salmon terrine - My substitute for the traditional gefilte fish. 

 

Roasted carrot fries - yum 

 

Matzoh ball soup - A family favorite - essentially a chicken soup variation with these amazing smooth light dumplings called matzoh balls. Mix the matzoh meal (wheat crumbs essentially) with eggs and oil and let them sit in the fridge. You will drop them in broth later. Then you roast a couple chickens (done ! ) reserve the meat, make broth, then prepare a mirepoix. A mirepoix is a mixture of finely chopped carrots, onion, and celery, which together give wonderful aroma and taste to soup. Sauté the mirepoix in olive oiling a big pot, add the meat as well, with herbes de provence and pepper. Add broth over all of it, garnish with white wine, bring to a low boil, then drop in your formed Matzoh balls. It won’t take long until they are ready and rise to the top. Serve with matzah. 

 

Fresh fruit- I cannot serve a meal without fresh fruit. Any will do. Strawberries, watermelon, mango and blueberries tomorrow. 

 

Desserts: 

 

Always more than one. 

 

Coconut macaroons- some dipped in chocolate - Love ! 

 

Flourless or fallen chocolate cake - Need I say more ? 

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

 

Wellness Wednesday: The Art of Preparation 

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

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

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

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

Curing Procrastination

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

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

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

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

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

 

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

To learn more about SMART goals, read here : 

New Years Resolutions

Three Ways to get Ready for the Week

The Importance of Inspiration

 

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

Food Friday: Easter Lunch Planning 

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

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

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

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

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

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

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

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