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Wellness Wednesday: Post Election Stress Disorder

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Ashamed woman.jpg

PESD is not a diagnosis listed in the DSM-5, the widely used manual of psychiatric diagnoses. And yet professionals and ordinary people are seeing it. The morning after the election, I saw and heard about it everywhere, from people on both sides of the aisle. Yes, that’s right, from both sides of the aisle. 

I have heard from hither and yon that people felt that our presidential election was a choice between lesser evils. How sad and disturbing to wake up and have a lesser evil for your President elect. How sad to have members of a family or friends fighting, arguing and estranged. 

While there may not be such a thing as PESD, there certainly is PTSD, and the signs are clear: 

  • sleeplessness
  • undue tearfulness 
  • nightmares
  • intrusive memories of past traumas
  • disinterest in food or inability to eat

Women have been particularly affected. Regardless of politics, no woman has supported Trump’s vulgar and abusive treatments of women. To seat him in the highest office in the land has made many of us feel vulnerable, on an institutional and cultural level. Election is endorsement, and endorsement is usually approval, though in this election, it certainly has the feel of concession. Events of this campaign show that while our society has made great strides toward fairness and decency towards everyone including women, sexism is still alive and well. 

Today’s sexism is not as bold as it once was. Nowadays, it can be workplace bullying, or being passed up at meetings or for raises. It is unwanted subtle advances. It does not have to be “pussy” groping, though now that has officially been recategorized at the highest levels as “locker room talk”. It is being made to feel odd because you were a girl who was also a math and science nerd. 

Lucky for you, I am a math, science and numbers nerd. And I don’t feel the least bit odd. Here is what the numbers had to say, before the election even took place: 

  • 10 % of women suffer from PTSD. 
  • 31% of women suffer form an anxiety disorder
  • 12% of women suffer from depression
  • 25% of women will experience a sexual assault in their lifetime
  • 33% of women report having experienced sexual harassment in the workplace
  • 100% of women report experiencing some type of sexual harassment in their lifetime. 

reference : 

https://www.psychologytoday.com/blog/workings-well-being/201611/post-election-stress-disorder-in-women

 

Are we women really doing so well ? The number are roughly half this for men for PTSD, anxiety and depression. The election has caused us to collectively and individually revisit much of what has troubled us.

What to do ? 

First of all, this needs to be taken seriously. It needs to be taken seriously on a personal and a societal level. If you know someone who was derailed by the election, make yourself available. Practice empathy and be a good listener. Do not debate politics, or ask about the the innermost workings of their mind or heart. Suggest general stress reduction techniques like regular meals, exercise, yoga, and sleep. Suggest a visit with a counselor or physician if there is genuine disruption in health or regular life activities. Do not force a plan on them. Do not add to their overwhelm. I am guilty of constantly trying to fix people even if what they really need is space. If you try to help too much, it feels like you are trying to take control and this is disempowering, pretty much the last thing they need.  

I learned a new phrase when researching this post. It is, HOLD SPACE. This means to create a safe space for someone, a space where they will not be judged, and where no one will try to change them. It is space where they can be heard. It is unconditional support. I will be researching this gem of a concept further. 

 

Have a better week. The holidays are coming. Take some time to plan to make them low stress and lovely. 

 

Additional reading: 

http://www.huffingtonpost.com/news/election-stress/

http://www.theatlantic.com/health/archive/2016/11/how-to-cope-with-post-election-stress/507296/

https://www.wired.com/2016/11/critical-role-self-care-handling-post-election-stress/

Food Friday: Comfort Food

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I think we could all use a little comfort food after this week. 

We turn to comfort foods when we are stressed, sad or lonely. I know lots of people felt this way after this week’s presidential election, especially women. So I am here with some ideas for healthy comfort food. 

Comfort foods are traditionally loaded with simple or refined carbohydrates. Classics include baked goods like muffins and pie, heavy savory food like french fries, mashed potatoes and spaghetti and meatballs. They are filling, warm and associated with good memories. How can you make some of your own without going into a carbohydrate coma and feeling worse after you’re done ? 

I suggest starting with some hot tea, dressed nicely with lemon and and a little agave. This might be all you need. A savory alternative is a hot chicken broth, made easily from jarred organic broth mix which is readily available in standard grocery stores these days. 

If you need more, and you need it quickly, consider homemade popcorn with olive oil, salt, herbs, lemon pepper, or nutritional yeast. (The nutritional yeast is something you’ll have to get at your local organic foods store.)

If you can take the time to prepare something, be strategic. We will go with the traditional items, just tweaked for the cause of health. 

 

Muffins:

Try my fruit muffins 2.0 HERE  and use gluten free flour or whole wheat flour, depending on your tolerances. Try cutting the sugar. 

 

Pie: 

Try a Paleo nut crust with a fruit that doesn't need much sweetening. Plums come to mind. When I thaw frozen pie fruit out of season, I do so in a large nonstick frying pan, and pretty much get the water poured or boiled off, and the filling made. How about Paleo pumpkin pie made with coconut cream ? 

Here’s some recipes: 

https://elanaspantry.com/paleo-pumpkin-pie/

http://blog.paleohacks.com/pumpkin-pie-recipe/#

These recipes are for YOU. Don’t expect to serve a huge room of extended family these healthy alternative recipes and not get some comments about how they are different. They are different in that the crust is not the same and the fillings are less sweet. But they are treats you can feel good about. A brief search on Pinterest will yield dozens of Paleo pumpkin pie recipes. 

 

French Fries: 

This is easy: Crispy baked or broiled sweet potato fries made with coconut or olive oil. The key is in the cut. Sharpen your knife. Make them uniform. If you are brushing them with olive oil, make them thin, so high heat is not required. I recommend a large cookie pan lined with parchment. Lay the fries in a single layer brushed with oil and salted with kosher salt. The add pepper or herbs as desired. Bake at 375 in the upper half of oven until they are beginning to crisp. Dip in paleo or home made olive oil mayonnaise instead of sugary ketchup. Aioli sauce would also be nice. You may cook them in a hotter oven if you use coconut oil, but watch them carefully. 

 

Mashed "potatoes": 

 

Here you can try the now famous FAUX potatoes which are made with cauliflower. Wash and cut a whole head of cauliflower, cook until fork tender. You may steam, boil, or roast it. Then blend with a tablespoon of healthy fat like olive oil or a little butter, add salt or pepper to taste. Some people add a little garlic puree, but that is optional. Garnish with turkey bacon bits, and maybe chives. 

 

"Spaghetti" and meatballs: 

 

This gives you the chance to try Zoodles, or zucchini noodles. Use a peeler, or a special tool widely available in the kitchen gadget section of major stores. They cook quickly, so beware and do them last. Make the marinara sauce and meatballs of your dreams, the simply have them over the well drained Zoodles. 

 

I hope you have a nice comforting weekend. 

Wellness Wednesday: There and Back Again

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I have a large and closely knit family. But each and every one of us has travelled this last month. Some have travelled for work, some for play and some to reconnect with old friends. But we have all experienced a change in our usual routine, our place, and even our food. This week, we all will have returned home for the season. 

Travel is an exercise in contrasts. It is about how you feel just before you leave home, and how you feel just before you return. In those watershed moments, you learn things. 

You learn that for better or worse, you were in a routine. When you leave, you cannot help but critically appraise that usual routine. And you should critically appraise your usual routine. 

You learn how you feel about being with your spouse, and that is precisely because he is elsewhere. You may make new resolutions about what good things you will do when you get back. But beware, inertia is powerful, and there are reasons why you always did things the way you did. You must figure them out if you want your life and your relationship to move forward. 

You will learn how people change over time. My daughter marveled at the changes she saw in her 18 month old daughter after a ten day adventure. I marveled at the changes I saw in her. 

At reunion I visited with friends of 35 years duration. They are still themselves, but more so. I am glad I chose my close friends wisely so long ago. I still adore my sophomore roommate. Time loops back in a circle and we felt and acted like roomies for the span of one evening, then we went back to our alternate realities. 

Some of us like to stay curled up in our Hobbit holes smoking our figurative pipes and drinking our tea. But adventures knock on the door, annoying us at first then compelling us. As the Hobbit's tale teaches us, the journey is the only way to learn who we are and where we are at home. 

Food Friday: Autumn Squash

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Like comfort food ? Squash is a healthy choice. 

When made correctly, squash is rich, velvety and filling. it can be sweet or savory. It is low glycemic and nutrient rich. Squash keep well. I keep mine right on the stone floor of my kitchen. I think they look pretty. 

It takes some doing to safely open squash. After all, they are made to withstand winter to deliver their seeds into the spring. When you are opening harder squash, be careful. Use a sharp knife, perhaps a mallet, a stable surface and good technique. A good idea is to carefully “set" your knife into the skin, then use the mallet, perhaps over a towel, to tap the knife into hard thick rind. Oftentimes if it opens a little you can crack it the rest of the way with a little leverage. 

Squash can be baked, roasted or steamed. It depends on your constitution and your taste. 

If you have time and little motivation, simply scoop out the seeds and bake the halves as is. This would be in a medium oven ( 350 degrees F) until soft. 

If you have less time and more patience, cut the squash into smaller pieces and perhaps get rid of the skin by either carving it off or scooping the meat out. Then roast on a pan at about 425 until carmelized. 

When you bake or roast, use olive oil, coconut oil, or butter onto squash before you cook. You may also salt and pepper in the beginning. If you want to add a little brown sugar, do it after the squash is mainly cooked and turn down the temp to at least 350 or lower since sugar burns easily. Watch it carefully until the sugar is melted but not burned. I line all pans with parchment paper to make for easy clean up. 

Roasted or baked squash can then be eaten as is, or blended with toasted nuts, craisins, or other dried fruit, diced fresh fruit like apples, and then rebaked slowly. It can be made into soup or blended into a dish like mashed potatoes. 

If you have little time, cube the squash into 1-2 inch pieces and steam it until tender. It will cook quickly, but have a less roasted earthy flavor. You may then use it any way. 

All squash, regardless or size or coloration, are members of the same family, curcurbitae. This is remarkable when you consider all the different flavors. Some of the meat is bright yellow, and makes “ spaghetti squash” fit for a marinara sauce. Some is deep red and full of vitamin A, and other flesh is sweet, orange and suitable for making pie: pumpkin pie ! My favorite is the humble butternut, simply because of it’s wonderful taste. And since I have neither time nor patience, I pick the longest thinnest ones I can find and slice them into big “coins”  about 3/4 inch think. I then roast them with bittern a pan with parchment and let people peel of the skins themselves. 

Enjoy the hearty food of fall ! 

 

Food Friday: Preparing for a Halloween Party

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Halloween food can be goofy or elegant. But one thing's for sure: It should be good and not overly sweet. That's because is needs to buffer the sugar from the treats. Tomorrow we are having a Halloween birthday party, since our youngest was born on Halloween. 

Decor is dark botanical, with raven feathers, black roses and peacock feathers. Candles will be plentiful and a large illuminated spider web graces the large window. Black cheesecloth is draped over a dark green tablecloth, and mismatched silver completes the look. I always feature some little treasure on the table, and this time it is organic chocolate peanut better cups.

For the menu, the main dish will be traditional. he side dishes will be more exotic. Accordingly, I will do roasted chickens with multicolored potatoes. Side dishes may include an exotic vegetable mix with mushrooms, asparagus, eggplant and anything else interesting and provocative. I will try to get some heirloom black tomatoes for a salad of dark greens. 

Dessert will be cherry pie and a six layer chocolate cake. Drinks will be Pellegrino and a " cauldron" of fruit punch with dry ice. 

So at this point I will share the prep work and the decorations, and tomorrow some actual food shots. 

 

Wellness Wednesday: Halloween

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This is our last Wellness Wednesday post before Halloween, one of my favorite Holidays. It has been our family tradition to have a grand Halloween party and this year is no exception. In preparation, I would like to share with you how my view of Halloween does indeed bear on wellness, especially for children. Before I share my philosophy on Halloween and how that translates into our gatherings, I would like to go over some basic Halloween safety tips. 

  1. Go out with your children if possible. Cloak yourself and hang back near the street while they practice their confidence and their manners. If they are older and you feel it is safe, let them to go in groups or pairs. Older kids should take their cell phone and turn on tracking. On iPhone that is through an app called “ find friends.” Pushback ? Who pays for that anyway ? 

  2. For kids going without an adult, review a map in advance and agree on a route. 

  3. Set time limits beforehand. 

  4. Feed kids a healthy festive and favorite meal before nightfall, so they are not tempted to feast on Halloween candy as they walk. 

  5. Ask kids to refrain from eating candy until it can be inspected under good light. Discard anything opened or tampered with. 

  6. Discard anything that is not commercially prepared, unless you know the source. 

  7. Ensure that costumes are safe for the weather, and the dark. Use reflective tape if need be. 

  8. Make sure that decorations are safe. Be especially wary of open flames or electrical installations. 

  9. Give kids flashlights and or glow sticks for visibility. 

  10. Forbid children from entering the homes or cars of strangers. 

  11. Remind them to observe traffic laws as there will be lots of cars as well as pedestrians. 

  12. Remind them that some people drink and drive on Halloween. 

  13. Remember sometimes kids get creeped out by creepy costumes. Make it comfortable for kids to come home if they do not like it. 

 

Here is an except from my Halloween post last year which I would like to share again.

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

I have a soft spot in my heart for All Hallow's Eve as I like to call it, since our youngest child was born on that day. As a result, it has always been a big family celebration for us, and so we have always had a party. Accordingly I have never gone in for the typical commercial Halloween decoration and imagery. True, I like a very dark and mysterious Halloween. Particularly after I had children, though, I haver saw fit to incorporate images of violence into the holiday. For example, I am totally not into the blood gore and mutilation thing. Instead, Halloween is to me about the beauty and magic of the night and the natural world. For example, I have incorporated themes of stars, the moon, planets and comets. People consider these magical motifs but to me they evoke magical math and science which can describe their movements. I also incorporate anything botanical. At this time of the year the leaves are getting crinkled and brown, and the branches are bare. Some are dried all but the berries, but there is beauty even in this. You can make them even more evocative with paint, glitter, or interesting low lighting.

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

And fire, of course fire, since fire harkens to the primordial processes in the heart of our sun which make life on this earth possible. Did you ever think about the fact that when you watch the flame you are watching matter being turned into energy? To bring fire to the home and patio in first must be safe. I like metal tea lights since they turned safely sat inside a beautiful container. These are easy to clean up as well. I use lots of candles and keep the regular lights down low. For fire outside, make a traditional bonfire. Check your local fire regulations and use common sense of this, especially with children.

So use branches, bugs, bats in mobiles, candles, and faux spiderwebs is done carefully, with dark elegant colors, or moonlit white. But whatever you do, make your party beautiful enough to transport your guests to different holiday "Hallowed" frame of mind.

Reference: 

http://drginanelson.com/drginablogs/2015/10/15/food-friday-food-for-halloween-party?rq=halloween

Halloween can involve a healthy dose of fantasy. People of all ages love costumes and stories. There are so many fantastical costumes to try, there's no need to resort to the grotesque or sinister. Here's my Pinterest album of costumes and cosplay for your inspiration.

https://www.pinterest.com/drginanelson/costume-and-cosplay/ 

You might also like my collection of steam punk fashion which celebrates the popularization of science and engineering in Victorian age.

https://www.pinterest.com/drginanelson/steampunk-fashion/

Halloween should not be about fear and horror. Quite the contrary. It should inspire. Its historical roots lay in the efforts common people trying to encounter the wondrous. It recalls village life and the collective joy of the good harvest. It celebrates the interplay of chaos and order, day and night, summer and winter. This is the wellness of the holiday: that we gather together to express respect for the harvest, community, ancestors, Saints, the cycles of life, science, nature and hints of the divine.

 

Food Friday: Grocery Store Reverie

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I am back in Palo Alto, California for reunion and I hardly have time to think about food. But, in the course of my travels, I have come across some of the most beautiful grocery stores ever. 

I have never been to Italy. But I have been to France. In these places, people care deeply about food in a way most Americans don't seem to. However, here in Palo Alto, these are my people. I watched in the stores how twenty something men would converse over the quality of fruit. Or how professorial types moved about with one meal's carefully chosen foods in a basket. I saw others asking questions about cheese, and the butcher explaining a fine point or two to some prospective buyers. I saw bakers, hatted in white,  displaying desserts for the evening's customers. Even the checkers would comment on the items in my basket, like a Sommelier complementing my choice of wines. 

I enjoyed this throng of like minded people. The beautiful displays of foods engendered conversations all around the store. Many people had phones to their ears, checking with companions elsewhere about what to purchase. These were not just grocery lists. They were menus that were being executed. Several were doing what I had been doing earlier in the day, holding a phone out in front sending a live video to another who would look over the wares and voice their preferences. 

There were thoughtful conversations here and there, but at the same time, the group had a bit of hustle and bustle as if they all had somewhere to get to. People were expecting them. Within the hour, so many well considered tables would be set. 

This would be my wish for every one on this evening of travel. The food you buy and the place you buy it should mean something. Moreover your dinners should be special in some way.  Finally, do what you can to have special dinners with special people, in a special place.  

Wellness Wednesday: Being Proactive

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I found myself a little out of my comfort zone this week. I was working on a little app for the App Store, and I am new to developing. I had done my due diligence, reading, and going through the tutorials. And yet, things were just not working out how they were supposed to. I got a little down about it. I got a little mad about it. Tech support sent me a lame email back not really addressing the questions I had clearly asked. I put the project aside for a couple days. I thought, maybe this is just not my thing. Then Monday morning rolled around, and thought, I am going to wend my way through the phone networks of Apple Computer and find someone who can help me. Three layers deep, I did. The person I reached was amazing. She agreed that I had done all that I should have; She took on my cause and bumped it up the chain of command. Ultimately the advice she gave me worked. I looked back on the incident and realized how silly I was to have gotten discouraged. Only when I got proactive and reached out, did things get better. 

Proactive is the opposite of reactive. To be proactive is to be psychologically healthy. It means being the one who takes the steps to make your life what it is. It means to be responsible for one’s self, one’s thoughts, actions and circumstances. It means to be self-determined. 

To be reactive, on the other hand, is to be a victim of life. You life is determined by other people and other factors. What you do is a reaction to other factors which have happened “to” you. You may feel out of control or like a victim. 

Wouldn’t anyone want to be proactive ? You may want to become a proactive person. And yet, until you adopt the mindset and behaviors of being proactive, it would be very difficult. 

How do you become a proactive person ?

 

Responsibility

The first step is to realize that you are responsible your own well being and success.  Life hands people circumstances which range from good, to bad to ugly, and yet, mindset is the main determinant of how people feel and how they do in life. Remind yourself you are empowered in your life. Pin a pin, put up a poster, or do what you need to do to train yourself to remember this. 

 

Honesty

Also central to the process of being proactive is to understand your starting point. This requires honesty with one’s self about one’s present state. It is like talking a good hard look at the balance sheet of your life. What are the assets, and what are the liabilities ? Only then can you realistically plan for going forward. Train yourself to honesty. 

 

Accountability

To be responsible is to be accountable for yourself. In literal terms, you are the accountant of your life. You have the ability to set a budget, or a goal, and work backward to meet it. You are more than dreams and talk. You have real steps to realize your plans. You may even use the so-called SMART goals. (Click HERE to learn more.)You are reliable to others and to yourself. Train yourself to take regular inventory or your life. Train yourself to use SMART goals. 

 

Action

When you use SMART goals, you will get used to the idea that big goals are achieved with small steps. Furthermore, you will get used to taking small steps. Many people who haven’t realized their goals are simply not used to taking steps outside their normal routine. Being proactive means training yourself to get used to taking new and different steps as part of a larger, realistic plan. It also means training yourself to get used to the fact that meeting goals proactively takes time.  

 

Resilience 

When you become proactive in your life and start to take steps toward realizing your life goals, you usually encounter obstacles. These may derail or discourage you temporarily. This is natural. However, the proactive person must have resilience. This is the trait which embodies the best response to adversity. With resilience, the problem is acknowledged, analyzed and the steps of the plan are reworked. They are iterated, and reiterated.  With resilience, one has to train oneself to keep a flexible positive attitude, along with the idea that continual reiteration is part of the process. 

 

Communication 

In everyday life, being proactive is easier said than done. Everyone feels pressured, angry or frustrated at times. These are small everyday examples of being reactive. Sometimes even bigger situations like peoples' jobs or relationships are the result of being reactive rather than proactive.  Learning the emotional and communication skills associated with being proactive is no easy task. 

During challenging encounters, the natural reaction is fight or flight. Proactive communication requires acknowledgement of these reactive feelings, but not acting on them. Simply pausing, and breathing is an essential first start. In that moment, the feelings of anger, frustration or sadness are acknowledged and set on the back burner. Then a constructive response can be proactively made in accordance with the speakers highest and best ideas.

A proactive person also knows she has the right to defer. She can take time to think about things, calm down, or gather more information. She knows how to say these things the right way. She uses responsible closed loop communication. Responsible communication uses "I statements”, i.e.“ I think”, ,”I feel”, or “I need” or “ I want”.  In this way, you speak for yourself. You may not be listened to, but at least you have spoken up for your self, and your statement has the weight of authenticity which may well continue to sink in after the conversation. 

Closed loop communication has to do with listening well. When you speak, you are obliged to listen. Listen with full attention until the speaker is finished. Then use another “ I statement” , which is “ I heard….” then repeat back a nutshell version of what you thought you heard the speaker say. This is especially useful for challenging or complex conversations. It honors both the speaker and the listener and greatly reduces the chances of misunderstanding. 

Train yourself to breathe, pause, use "I statements", and closed loop communication. 

So you see that being proactive is a training process. Nobody has a charmed life. But everyone can use the methods of responsibility, honesty, accountability, action, resilience and communication to be more proactive and move toward the life they want. 

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

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It turns out that Dr. Peter Hotez, the Dean of that National School for Tropical Medicine has been thinking about the interplay between Hurricane Matthew and the Aedes mosquito which spreads Zika. His informed speculations were that the Hurricane could provide an initial respite from the mosquitos, being essentially blown away by the tremendous winds. However, the enormous amount of standing water afterwards would provide ideal breeding ground for the virus carrying mosquitos. 

Though the Federal government has passed a limited Zika funding measure, the bulk of the costs have fallen on States. The 1.1 billion dollars recently approved requires the development of a spending plan which the Department of Health and Human Services are required to complete by the end of the month. One hundred and fifty two million will go toward vaccine development. The rest will go to local labs to speed up testing, as well as for prevention efforts like mosquito control, and education campaigns. 

Much of the press about Zika focuses rightly on its effects on pregnant women, namely microcephaly and other severe effects on the fetal and neonatal brain and nervous system. However, Zika virus effects non- pregnant women and men by increasing their chances of Guillain Barre Syndrome, post viral paralysis. In the recent new wave of such patients, 97% of these patients had symptoms of Zika 4 weeks prior, further cinching the relationship of the virus to the syndrome even further. 

At least 808 pregnant American women have Zika. It is likely that there are many more since the infection can be asymptomatic, and testing results are much delayed. Physicians and Institutions are trying to ready themselves for the increase in special needs children which will come as a result of the Zika epidemic. 

New Zika recommendations indicate that both men and women wait six months to get pregnant after Zika exposure. 

In other virus related news, studies have shown that parents are more likely to ask for HPV ( Human Papilloma Virus) vaccine to be given to their children if their child’s caregiver discusses it with them in a certain way. In particular, if caregivers highlight the parent’s role in preventing HPV infection, parents are more likely to agree to the administration of the vaccine. HPV vaccine is grossly underutilized. Researchers and physicians are trying to increase HPV vaccine utilization rates by funding the vaccine with others and by giving it in school based programs. HPV is a virus which causes serious and sometimes fatal disease processes ( cervical cancer)  for which there is an effective vaccine. Yet many will not utilize it. Once we are fortunate enough to have a Zika vaccine, I wonder if some will decline that too. 

Speaking of inadequate utilization of vaccine, over half of millennials do NOT plan to get the flu vaccine this year. Half of these people do not believe it is effective and 29% think it will give them the flu. The data do not bear out these concerns. 

Here is some bad news that is, at the same time, interesting and useful. First, people in most modern countries gain weight during the holidays. The amount and time frame varies by country. In the US, our weight is at its lowest in October, right after summer, and increases in the ten days preceding the holidays. It appears that holiday related weight gain, regardless of country, takes about FIVE months to lose. That’s right people, gain it in ten days, lose it over five months. 

In other bad but fascinating and hopefully helpful news, stress contributes to aging in a very particular and profound way. A large human DNA study has demonstrated that “ adverse events in childhood ...hasten …telomere tear down." I once read telomeres are the protective shoelace tips to our DNA shoelaces. Telomeres keep DNA from fraying as it were, and this prevents premature aging. They were able to determine that each significant stressful event in a person’s life increases the risk of shorter telomeres by 11 percent. DNA codes for what we are… in a very immediate tissue sense of the word. Damaged DNA leads to all kinds of diseases including cancer, and basically the failure to heal and renew properly. We have to start taking the prevention of childhood stress much more seriously. 

State Medicaid expansions are most costly than previously anticipated. This is because more qualifying patients have signed up, and they are sicker than had been anticipated. This should be cause for increasing the funding to the expansions, says this fiscal conservative. Why ? It is because preventive care and treatment that is earlier rather than later ALWAYS is cheaper in the long run. Never mind that it is more humane and the ethical thing to do. 

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

Food Friday: Disaster Relief Food

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If you do not know about Hurricane Matthew and what it is doing, then stop reading this blog post right now and check out this link on the weather channel: 

https://weather.com

This is one of the most devastating storms our nation has ever faced. Hurricane Matthew is a Category 4 of 5 hurricane. This ratings are done by the wind speeds observed in the storm and these are currently at 130 miles per hour, enough to tear the roof off a house. It is not terribly uncommon for a hurricane to achieve this category. What makes the potential for damage so great in this case is the path that this hurricane is likely to take. It will travel straight up the populated Florida coast, passing over Cape Canaveral and onto the southern part of the Eastern Seaboard. These are low lying populated areas.

We are told the main hazards are wind, as wind, but also as a fringe of tornados at the edge of the hurricane. Other hazards are the sheer volume of rain and flooding, powerful waves at the coast battering the shoreline, but even more so the so called storm surge, which is like a monstrous high tide coming far higher and more inland than it should, amidst everything else, complicating the task of dealing with buildings compromised by wind and falling debris. 

Power will be lost, and food likely spoiled. Tap water may not necessarily be safe. Food will be a challenge. In the aftermath, people may eat the spoiled food and get sick. Water born illness may spread, as may common maladies like pneumonia, since people will either be without shelter, or in crowded shelter where illness is easily acquired.

The Red Cross is the preeminent organization for disaster relief in this country. For this reason I have devoted food Friday to a link to direct you to their donation page. I was going to talk about Kombucha, a delicious probiotic drink, but I cannot get my mind off the hurricane and its victims. 

When I was a little girl, ages 6-12, I lived in St. Petersburg, Florida. I lived through hurricanes Agnes and Camille. Camille was class 5, though it merely sidelined us. I have many vivid memories of being in a hurricane. Oddly, all of them are pleasant. 

For kids, a hurricane was all excitement. There was no school. It was 1967, and everyone gathered around the TV to watch Meteorologist Roy Leep track the storm. He was kindly but authoritative, with the air of a scientist. Where the colorful and dynamic realtime satellite images are now, there was a large very much analog wall map full of symbols, isobars and moveable pieces. Almost all children had a hurricane preparedness booklet. I  even had a felt map of Florida, and had cut out the official symbols for tropical depressions and hurricanes so I could move them along the map.  I was familiar with the tracking terminology. I tried to predict time and place of landfall. 

Once during a hurricane my mother made me sit on the couch in the middle of the house with her and would not permit me to get near the windows as I wished.  In that same incident, large lightning strikes caused sparks to come out of the wall outlets. Eventually the power went out and we lit candles, which I though was wonderful. We got to eat snack foods, which were normally not allowed. 

Once, when I lived on a small residential island on a bayou, we had a tremendous hurricane related storm surge. I slept through it, and the next morning it was bright sunshine. I, together with all the other children in the neighborhood took to the streets... in boats. There were also pool toys like floating seats. Everyone got out and had a grand day, and were all the happier when we learned that the one bridge had washed out. We all swam like fishes in the first place, living there. We all had pools, and seawalls, and boats. But now, our boats banged awkwardly against their pylons whose lines had been slacked, and our pools had all become contiguous with the ocean waters which had come over the seawall and across the lawn. 

Somehow I think the adults did not have the same experience. As I got older, more toward two digits, I didn't either. I learned in retrospect, that during Camille, two states away, many had lost life. Our Florida houses were made of concrete and screened porches, but in the old south, they were made of wood. Homes and lives had been lost, and would be again and again. 

I got to where I could readily discern that strange green light in the sky which precedes the hurricane and occupies the eye. I could literally feel the lightness of the fall in barometric pressure. Once here in Montana my daughter and I were taking our groceries to the car during a bad windstorm.  Though it had been over 40 years, I remembered that green light in the sky, so beautiful. I told her if I didn't know better, I could feel the lift of the whole atmosphere. I told her about the funnel clouds I'd seen over the Gulf of Mexico, and how they started as a dark grey V shaped little buds off a big cloud. We looked around and thought maybe we saw one. As we got home, ten minutes away, we passed by what had been a stand of massive old cottonwood trees. Now there was just a giant pile of sawdust and twisted roots. The three homes in proximity including ours were untouched, though people in the neighborhood said the wind had been a deafening roar. We later learned that two small tornadoes had been believed to touch down. I was heartbroken for the magnificent trees, but then ashamed of my sentiment compared to what victims of violent storms must feel. 

By morning, the Red Cross will be badly stretched for resources of all kinds. We all need to do what we can to help. Here is their link. 

 

Wellness Wednesday: Wellness in Dying

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I generally shy away from this topic. But a few things have happened recently causing me to realize that there are some issues that can make the process better. 

I did say process. I have observed a range of situations, from a young person with a couple of years to plan, to a middle aged person who died suddenly and unexpectedly, to an elderly person whose passing was entirely anticipated. In all cases it was a process. They were all hard, and they were all different. As an inexperienced observer, I did notice that several things had a big impact on how the whole process went, for the patient and the friends and family. 

Wellness in dying comes from wellness in living. It comes from the most basic of things.

  • Get along with those around you. Resolve your issues and express all your affection. 
  • Stay out of debt.
  • Obtain life insurance to cover any debt that you have and to provide for spouse and children through college.
  • Clear out your household clutter so your family and friends will not have to do it.
  • Have a clear paperwork system.
  • Have computer backup and passwords entrusted to someone.  
  • Establish a will if you have assets and or children. This can prevent bad feelings after you are gone.
  • Establish a living will (advance medical directives)  including instructions for any organ donation with your primary caregiver. 
  • Arrange your life and work so you are not always postposing special experiences. 
  • Arrange your everyday life and work so you have good experiences routinely. 

These are the Days of Return and Repentance in the Jewish Calendar, a time of self examination. It is the week between Rosh Hashanah and Yom Kippur, the High Holy Days. The liturgy refers to the Book of Life. It refers to those whose names will be inscribed for the coming year and those that will not. The traditional blessing reflects this imagery. The whole service is very much a contemplation of mortality and the need to be mindfully present in the time we have. 

May you be inscribed in the Book of Life for the coming year. May you have a good year and a sweet year. 

Food Friday: Feeding the Recovering 

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Last week on Food Friday we looked at "Feeding the Unwell". We talked about patients who were quite ill or in the early post op phases. This week we will go on to pleasanter things and talk about the time frame when patients are feeling better, but still are unable to cook healthy attractive food for themselves. 

Nutritional requirements are increased while recovering. In particular, nutrients and protein needs are particularly increased, similar to that for pregnancy. There are other special needs. For example, the need to avoid constipation is key. Those recovering from surgery or whose mobility has been limited are prone to constipation, and this can be a significant source of discomfort. Strategic food choices can help avoid this. 

Those who are recovering may have had antibiotics. They may benefit from probiotics such as yoghurt, kefir, sauerkraut, and kombucha. 

Appetite is often diminished in the recovery period. Foods need to be especially appealing and tailored to the patient’s preferences. It also is best to foster a small frequent meals type schedule. 

Between all this, you as the caregiver or helpful friend have several options: 

  • Bring freshly made food which can be portioned out over time.
  • Bring frozen food which can be heated up.
  • Bring ziplock freezer bag “ Kits” of food for use in slow cookers or fast cookers ( pressure cookers like InstantPot) which the patient might have. 
  • Make sure the patient has enough healthy handy beverages. Consider herb tea, probiotic Kombucha, milk if tolerated and lightly sweetened drinks. 
  • Bring frozen “smoothie kits” containing yogurt or kefir, fruits, and veggies. 
  • Use the secret weapon of some wholesome sweets, .i.e. dark chocolate, or a slice of fruit pie to kickstart a recovering person’s appetite. 
  • Use the secret weapon of salty foods like pickles, salsa or sauerkraut to induce someone to drink more water. 

 

Here are some of my Pinterest Boards with recipes which may inspire you. 

Instant Pot Tips and Recipes

Paleo Nutrition

 

Pick dishes with ample protein, fruit, veggies, and fiber. Include healthy fat such as avocado, nuts, olive or coconut oil. For specific information on these, see below: 

Protein

Fiber

Healthy Fat

Smoothies

 

Here are some tips to make your culinary caregiving experience more manageable and satisfying. 

  • Visit your patient first to see how she really is doing. 
  • Make sure you know her allergies, intolerances, preferences and level of hunger. 
  • Check in regarding who else will be helping, and whether someone else has organized a meal schedule. 
  • Organize a meal schedule yourself using Google Docs or another method of your choice. 

 

Your patient will not just be well fed; She will have the pleasure of seeing you and the knowledge that you care.  

Wellness Wednesday: The Importance of Neighborhood

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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. 

Wellness Wednesday: How to Visit Someone in the Hospital 

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On first glance this seems self-explanatory. However, a few tips may make things easier. 

If you are uneasy about visiting the hospital, figure out why. Are you afraid of embarrassing the patient ? Do you not like hospitals ? Do you fear illness yourself ? Figure out your reasons and decide if they are reasonable. Remember that the visit is for the benefit of the patient, and that it is an act of care. People in hospitals can very easily feel isolated, as though everyone else is out there living life to the fullest…but them. 

Call beforehand. Based on circumstances, call the patient, her significant other, or perhaps the nursing station of the ward that she is on. Find out the visiting hours, if there are any, and whether or not a visit is appropriate. When you call, ask if the patient needs anything from home or from the store. Sometimes little things can make a big difference, i.e. gum, or their iPad. 

Consider bringing a small gift of your own. However, when considering gifts of or drink, make sure you know the patient’s dietary limitations. In the hospital, dietary restrictions are common, such as during the time before and after surgery, or stroke. When considering flowers, make sure they are permitted. Some units cannot have them because of infection risk. If the patient can do things to pass the time, consider bringing activities that he or she will like, such as card games. 

When you arrive, check in at the nursing station and with the patient’s nurse. Wash your hands. Once in the patient’s room, it is important to suss things out. It may be a time for visiting and joking, but it also may be a time to just be present in silence. Either way, it is a comfort. Even without a lot of conversation, just being there is very beneficial. On the other hand, patient’s still like to hear about what is going on in their friend’s lives as they would normally. If the patient is too tired to read, they might like having the paper read to them. Do remember that hospitalized patients are almost always tired. Watch carefully so that you do not stay too long, to that there are so many guests that the patient feels overwhelmed. 

Do not ask prying or personal questions about the patient or the illness. If the patient wants to talk about them, be a good listener. Even then, do not pry. Do not ask the nurses, doctors or other staff about the patient’s condition. They are not permitted to discuss the case without the patient’s permission, and asking right then might be uncomfortable. 

When you are there, consider offering material help to the patient or to her helpers. She may need kids shuttled, dogs walked, or lawns mowed. You could even offer to set up a google doc or some equivalent to coordinate the helpers if the need is extensive. 

Consider helping your friend after they transition back to home. Getting around will not be the same even if they are stable enough for discharge. Plus, hospitalized patients get a lot of attention to help them through. To have that come to a screeching halt upon discharge would not be all that fun. Connection, not isolation, is essential to healing. 

Most major religions, certainly Judaism and Christianity, include visiting the sick as a formalized duty. It represents the best of society, and embodies compassion. The secret is, it blesses the visitor as much as the visited. 

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

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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 

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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: Unpacking the Seven Principles 

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Last week in the post entitled “ Couple’s Wellness “ I referenced the work of Julie and Stuart Gotten of the esteemed Gotten Institute and the Seattle Love Lab. I introduce their book entitled “ The Seven Principles for Making Marriage Work”. However we didn’t really go into what those principals really are. This week I will give you a thumbnail sketch of each in the hopes that you will be interested enough to pursue more study. They 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 

Enhance Your Love Maps

The love map is a term for the area of the brain which holds all the information about your partner. The Gottmans propose that having a detailed love map of your partner enables you to love better, and weather challenges more easily. This is done by concerning yourself with all the things that are important to your partner and keeping up to date with what is going on in their life. 

Nurture Your Fondness and Admiration

Fondness and admiration usually exist at the beginning of any relationship. However, as time passes and life’s difficulties are encountered, they may diminish. Expending effort to deliberately keep these past memories and present feelings of fondness and admiration alive will prevent bad feelings from developing in their place. In particular, the Gottmans state that fondness and admiration are the antidote to contempt. 

Turn Toward Each Other Instead of Away

A couple’s connection is built of many small connections throughout the course of everyday life. When one partner reaches out even slightly in speech or gesture, the Gottmans call this a bid. If the other partner turns away from (disregards) the bid, the bidder is slighted and some degree of detachment or irritation takes place. However, if the partner turns toward the bid responsively, their connection is strengthened. The Gottmans teach that a tendency to turn toward your partner’s bids build trust, goodwill and emotional connection. 

Let Your Partner Influence You

The Gottmans have found that partners who share power are more likely to have happy and long lasting marriages. Part of sharing power is allowing influence to flow back and forth. In these marriages conflict prompts a search for common ground. 

Solve Your Solvable Problems

This sounds hard at first but the Gottmans break it down as follows: 

  1. Soften your start-up. 
  2. Learn to make and receive repair attempts.
  3. Soothe yourself and each other.
  4. Compromise.
  5. Prices any grievances so they don’t linger. 

These are the features that an effective problem solving session needs to have. They liken good problem solving to that done between respectful professionals or esteemed guests. 

Overcome Gridlock

The Gottmans assert that gridlocked issues in a marriage touch on deeply held beliefs or wishes, or each partner’s dreams for their life. If partners sit down with each other and try to discern the real basis of the tightly held position, then perhaps a common ground can be found. 

Create Shared Meaning 

The Gottmans assert that a real marriage is more than the sum of its parts. By parts I mean living or loving each other, raising kids competently, and having sex. Instead, they argue, the couple must create a their own unique culture, which incorporates both partners' closely held beliefs and dreams. The Gottmans have identified four aspects of creating shared meaning:

  1. Rituals of connection, such as a family sit down dinner 
  2. Support for each other’s roles
  3. Shared goals 
  4. Shared values and symbols.

This will give us all a lot to think about until next week on Wellness Wednesday. 

 

 

Wellness Wednesday: Couples Wellness

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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.

 

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

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Florida has an ongoing Zika outbreak in a Miami neighborhood of Wynwood. The CDC (Centers for Disease Control) has confirmed local transmission there for several days. In response, Florida Governor Scott has pledged that Zika tests will be free for all pregnant women. Apparently there is a Zika test kit shortage and physicians' offices have waiting lists for their use. Pregnant residents in Florida are beginning to curtain their activities and travel in their home towns. Other women are delaying pregnancies, freezing eggs for later, or leaving the area when pregnant.

California has the seen the first births of Zika infected babies. These cases have been from mothers who travelled to Zika affected areas. 

Texas Medicaid has decided to cover the cost of mosquito repellant to women of reproductive age. 

President Obama has asked Congress to reconvene early to work on Zika. Meanwhile the CDC has itself provided an additional  $16,000,000 to 40 states to combat Zika. They had already given $25,000,000 in July. This comes out to and additional $400,000 per state on average and does not sound like much in the scheme of things. The money is meant for developing programs to collect and track data on both the mothers and the babies affected by Zika. I have to say that when money is short, as it is, that making the choice to fight the virus with information seems like the wisest first step. When more money comes in, which hopefully it will, it can go to bigger ticket items like better mosquito control and vaccines. Current mosquito control techniques are poor against the mosquito since it can live indoors or outdoors, can hatch in a tiny amount of water, can bite multiple people, and has eggs which can last for months. 

The CDC has clarified that all pregnant women need to be assessed for risk of Zika. They do not necessarily need to be tested, but their travel history and the travel history of their partner or partners should be assessed. 

The CDC has reviewed data which show that the use of Long Acting Reversible Contraceptives (LARCS) is low in Zika affected States. LARCS are among the most effective means of contraception and considered safe for most all women. 

Finally in encouraging Zika news, The Journal Science has reported that three different Zika vaccines have worked “to perfection” in rhesus monkeys. Each of these vaccines works by a different mechanism to stimulate the immune system to combat the virus. One vaccine uses dead virus, but the other two use two different viral DNA subunits to stimulate an effective immune response. 

In other news, the CDC has reported that adults across the board are about 15 pounds heavier than they were 20 years ago. Boys and girls weigh more as well, though boys' heights have gone up. Girls' hights have stayed the same. The average 5’4 woman weighs 168.5 pounds, which qualifies as a BMI (Body Mass Index)  of 29, nearly going from overweight to obese at a BMI of 30. Normal BMI is somewhere between 19 and 25. See the NIH (National Institute of Health) BMI calculator HERE: 

http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

Vitamin D is in the news again. Apparently Vitamin D levels decrease by 20 % after cessation of oral contraceptives (OCs). This has potential consequences not only for women but for any pregnancies that ensue. Because of his new finding, it might be appropriate to check Vitamin D levels after OCs are stopped or before pregnancy is considered. 

In the close-to-science-fiction department, we turn our attention to telomeres. What is a telomere ? Tasciences.com quotes Blackburn and Epel from the Journal Nature, saying that

“ Telomeres are the end caps at the end of each DNA strand that protect our chromosomes, like the plastic tips at the end of shoelaces. Without the coating, shoelaces become frayed until they can no longer do their job, just as without telomeres, DNA strands become damages, and our cells can’t do their job.”.

Telomere length is therefore a marker of cell aging. Cell lifespan shortens as telomeres shorten. We are born with a certain telomere length. The majority of telomere shortening occurs in the first 4 years of life. Little is known about why telomeres shorten. It turns out that early exclusive breastfeeding for just 4-6 weeks is associated with longer telomere length at age 4-5 years. This may have consequences for long term health and overall longevity. The CDC has reported that just about half of all postpartum women are breastfeeding at 6 months. Less than a third were still breastfeeding at a year. The American Academy of Pediatrics has recommended that women breastfeed for at least 6-12 months. 

The Journal Pediatrics reports that “ Breast milk give a boost to premature babies mental and physical development.” Those who received breast milk during the first 28 days of life had measurably better IQ, math, memory and motor skills at age 7 compared to those who received less breast milk. I will comment that to pump breast milk for 28 days while your premature baby is in the NICU (newborn ICU) requires a high level of dedication. Perhaps it is difficult to factor out this maternal dedication as a factor in the better outcomes of the breastfed babies in their study.  These breastfeeding mom’s of preemies either are or become some of the most dedicated and resourceful moms out there, due, at least in part, to what they have to deal with. Maybe the better outcomes are born of the mother’s overall dedication. Hat’s off to you…. dedicated NICU moms. 

 

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