Wellness Wednesday: Exercise Specs

Today’s post will keep it simple, portraying just a few simple keys to successful exercise. With the books, shows and classes out there, it is easy to get confused about what you need to do to start getting fit. My simple reminders will hopefully bring it down to earth and help you get started or stay consistent with your exercise regimen. 

Accept your present state.

Back in the day, in some challenging yoga classes, I was, at once, encouraged to master harder and harder poses, but, somewhat paradoxically, I was taught be “ be where I am”. This mean I had to be real about what I could actually do properly at the present moment. I was not to fight or strain my way into a new pose. I was to practice as best I could until it came naturally. This was a very hard concept to grasp. 

At the same time, I want you to embark on exercise in a spirit of happy acceptance. Whatever you do is a plus. You should not make it hard, or certainly not painful. When beginning, it should just feel like mild exhilaration. It should not exhaust you. You are just letting your body and brain get used to the movements and the routine. It takes months to adjust. You will advance in intensity when you want to. You will want to when you are ready. 

Start easy and short.

Research I mentioned on this last Medical Monday indicated that 2.5 hours of moderate exercise a week has measurable effects on heart disease risk in women. This translates into 25 minutes a day 6 days a week. It is true that some fit people exercise for longer for fewer days per week. However I prefer beginners and the inconsistent to workout for less time more frequently since it reinforces the habit more effectively. 

Value initiation over endurance.

Woody Allen once side that 80% of life is showing up. This is certainly true of exercise. You can make things easier on yourself by observing a fairly steady routine. Remember Mr. Rogers ? On his TV program he would arrive home from work and immediately change from his work jacket to his house sweater, thereby prompting him to shift gears and relax. Me, I change into workout gear and somehow there is no going back. Next I get the glass of water, and off I go. Get yourself to start, and you will finish. 

 

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Take one break day per week.

Exercise is to transform your body so that it is healthier, more efficient, stronger and more functional. So give it some time to transform. Never skip your break day. And if you are feeling wiped out, take an extra break day or just choose a milder workout. Having said that, ordinary everyday fatigue should not prevent you from working out. Your exercise will actually help your fatigue, ten times out of ten. If you are feeling overly fatigued after what feels like a mild workout, check in with your doctor. Additionally you should make sure you are giving your body adequate hydration and nutritional support to transform. 

Stay tuned next week for more Wellness Wednesday tips.  

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

About 1.6 million pregnant women are at risk for Zika virus infection in South and Central  America. Now, health officials are concerned that local transmission of Zika virus has begun in southern Florida. This means the virus was acquired in Florida, instead of being acquired elsewhere while a person was traveling. This means that some of the mosquitos in Florida carry the virus.

In related news, the blood supply in South Florida is now considered to be potentially contaminated with Zika virus. The FDA ( Food and Drug Administration) has asked that all blood donations from South Florida halt until all donations can be screened for Zika virus.

In even more striking news, the CDC ( Centers for Disease Control)  is recommending that all pregnant women be screening for the Zika virus. 

As most of you know, Congress left for its seven week vacation without coming to an agreement on Zika funding. The President of the American College of Obstetricians and Gynecologists has written a strongly worded letter to Congress on this matter. 

http://www.acog.org/About-ACOG/News-Room/Statements/2016/ACOG-Statement-on-Congress-Failure-to-Take-Action-on-Zika

Proceedings from the National Academy of Sciences include research that indicates that women who enter menopause early age faster than other women. They were able to quantify this, saying that menopause speeds up cellular again about 6 %. They also indicated that poor sleep can trigger similar aging type changes. 

In related news, women who start menstruation late and who have menopause late compared to average are more likely to achieve 90 years of age. Information like this is useful in that it helps identify factors tied to longevity. 

Research from the Journal Circulation has indicate that only 2.5 hours of moderate exercise per week has measurable effects on heart disease risk in women. Let’s see, taking one day off per week leave six days for exercise. Divide that into 2.5 hours to get the time per day needed for exercise. Only 25 minutes per day needed to reduce cardiac risk ! 

Stay tuned next week for more breaking news from the world of Ob/Gyn and women’s health.

Food Friday: Delicious Dietary Fiber

We have all heard of the health benefits of fiber. You would be surprised by just how much fiber can do for you. But to get the benefits of fiber, you will have to learn a little about what it is and how it works. 

Fiber is a complex carbohydrate from plants. We are unable to digest it. But before you write it off as empty filler, consider how and works. Remember too, that our systems evolved to process our foods in the presence of lots of fiber. 

Fiber comes in two kinds, soluble and insoluble fiber. As the names suggest, soluble fiber mixes with or absorbs water, and insoluble fiber just passes through the system unaltered. 

What good could this possibly do? 

Soluble fiber

Soluble fiber softens the stool and helps it pass smoothly.  In this way it prevents constipation and all the complications from that. It binds cholesterol helps more it be eliminated. In this way, soluble fiber is heart healthy.

Soluble fiber buffers blood sugar spikes and may help control diabetes. And yes, it makes you feel full so you eat less. 

Good sources of soluble fiber are oatmeal, nuts, beans, apples and blueberries. 

Insoluble fiber 

Insoluble fiber is what your parent used to call roughage. It makes you feel full and helps discourage overeating. It bulks up the stool and protects against both diarrhea and constipation. 

Good sources of insoluble fiber are seeds, whole wheat, brown rice and even popcorn. 

According to the Institute of Medicine, Americans only get 15 grams of fiber per day in their diet. Men should get 38 grams and women should get 25 grams. Perhaps our lack of fiber has contributed to our many digestive complaints and the obesity epidemic.

These portions of fiber seem like a lot. However, if you eat the recommended numbers of servings of fruits vegetables and whole grains in a day, you most likely have it covered.

We have a long way to go, but thankfully high fiber foods such as fruits, vegetables and whole grains are readily available and fun to eat. 

References: 

http://www.webmd.com/diet/insoluble-soluble-fiber

http://www.healthcastle.com/fiber-solubleinsoluble.shtml

http://www.uccs.edu/Documents/healthcircle/pnc/health-topics/Soluble_Insoluble_Fiber.pdf

http://www.everydayhealth.com/ibs/soluble-vs-insoluble-fiber-for-ibs.aspx

http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fiber/art-20043983

Wellness Wednesday: Healthy Bowels

What affects our health, how we feel, and how we look, but is rarely discussed ? You guessed it: Bowel movements, or lack or them, or problems with them. Today we will give some attention to the humble colon, indeed the whole female pelvis, as we contemplate the well being of this part of the body. 

Those of us that operate on the female pelvic organs the uterus tubes and ovaries can tell you that they are in close proximity to the bladder and the colon.  In fact, they are sandwiched between the bladder in the front and the colon (large bowel) in the back. Constipation can affect the way the uterus and bladder feel and function, and visa versa. 

Definition

A common definition of constipation is bowel movements less than every three days. The American College of Gastroenterology defines constipation more completely, factoring in all sorts of problems with bowel movements, such as straining, small or hard stools, a sense of not being able to empty the bowels, or difficulty passing stool. Bloating, abdominal pain and excessive gas are also related issues.  

Risk factors

Risk factors for constipation include being a woman, being pregnant, being older, dehydration, low fiber diet, being sedentary. 

Causes

The basic cause of constipation is an unduly slow passage of stool through the bowel such that the stool becomes hard and relatively dry. This slow passage may be caused by a blockage in or near the colon such as a tumor, or a narrowing of the bowel from a stricture or a scarring of an anal fissure.

Since the colon moves stool forward using muscular contractions, poor muscle function can cause constipation. This can be from problems with the nerves that innervate the colon, such as in diseases like MS, stroke, and spinal cord injury. The colon muscles also function poorly if they do not contract and relax normally, or if the surrounding pelvic muscles are weak. Weak pelvic muscles can be caused by injury at childbirth, overweight, poor conditioning, poor posture, or all of the above. Hypothyroidism and diabetes can cause constipation. 

Constipation can also be caused by medications, most famously narcotic pain medications and sedatives. Certain high blood pressure, antidepressant antacid and allergy medications can do it as well. Diuretics like caffeine and alcohol can cause constipation. 

Poor bowel habits can start a vicious cycle of constipation. Ignoring the urge to go for reasons of convenience or modesty leads to more time for water to be extracted from stool, a harder stool, and a more difficult passage. The urge to go may even go away, compounding the problem. 

Poor dietary habits are probably one of the most common causes of constipation. A diet high in saturated fat and sugar can predispose to constipation. A diet low in fruits, vegetables and fiber will surely cause constipation. 

Complications

Untreated constipation may damage the area around the anus, either by producing sore dilated veins (hemorrhoids) or by causing small tears (anal fissures). The pressure and straining associated with constipation will worsen the condition of the pelvic muscles. It may do this to such an extent that the bladder may also start to have problems emptying, holding urine in, or both ! Constipation may even predispose a person to frequent urinary tract infections. 

Evaluation

Persons suffering from constipation should not suffer in silence. Constipation is one of the most common reasons people go to the doctor. The workup of constipation consists of a history, physical exam, and possibly some imaging procedures. 

Treatment

Treatment is determined after the workup is complete. Taking care of serious pathology is critical. But this is less common than lifestyle factors. Dietary and activity changes are front and center in the treatments for most people. Fiber, both soluble and insoluble, are key, along with ample hydration all through the day. Supplements of fiber are widely available if patients just cannot seem to get the right foods into their diet. Finally enemas and medications can be utilized. 

Enemas and suppositories can be used for serious cases. Other classes of medications can be useful, but one must be aware of how they work. 

1. Stool softeners like Colace do just that. 
2. Bulking agents like Citracel or Metamucil hold additional water. 
3. Osmotic agents like Milk of Magnesium chemically hold water in the colon. 
4. Stimulant laxatives like senna or bisacodyl stimulate the colon muscles to contract more. 

The first two are generally safe for everyone, but the last two should be used with the supervision of a doctor, since there can be medical consequences. Laxatives should be used with great caution, since they can even be addictive like narcotics, with more and more being required to get the desired effect. 

Those with pelvic floor dysfunction can be treated with pelvic floor physical therapy. More and more medical communities are incorporating this treatment modality into their centers. This is key since these issue disproportionately affect women. These women have often curtailed their work, social lives, or exercise because of problems with bowel and bladder, and this is a significant loss, especially when treatment is available. 

Stay tuned for this week’s Food Friday, when we will explore the dietary remedies for constipation in more detail. 

References:

http://www.mayoclinic.org/diseases-conditions/constipation/basics/definition/con-20032773

http://www.emedicinehealth.com/constipation_in_adults/article_em.htm

https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/constipation/Pages/overview.aspx

http://patients.gi.org/topics/constipation-and-defection-problems/

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

The news this week is dominated by virus science.

The first United States baby with Zika related microcephaly has been born in New York City. While this is not surprising, the fact that many women are ignoring Zika related travel warnings is. This summer, over 2000 pregnant women traveled to Zika affected areas and have com back requesting testing. In many cases, they are traveling to the Dominican Republic. AS f the present, cases from the Dominican Republic account for more than a fifth of all US cases. The CDC(Centers fro Disesase Control) and the American Academy of Pediatrics are grappling with how to develop protocols to care for infants who will be born with microcephaly. These infants have serious mental and physical disabilities since the higher portions of the brain are underdeveloped. 

Florida is one of the most vulnerable states in the Union to the Zika virus. Authorities estimates over a quarter of a million women are at risk in Florida. Various research indicates that a Medicaid expansion there would help reduce the risk of pregnancy women to Zika. There is also a push to require employers to take measures to limit their pregnant employees exposure to mosquitos. 

As of mid July the CDC is tracking around 1300 cases of pregnant women with Zika. Fourteen were sexually transmitted, and the rest acquired through travel. 

There is also a Utah case on record this week of a man who acquired Zika through close family contact. He was taking care of an elderly man who had acquired Zika due to travel. 

Hepatitis C is on the rise, both in women of reproductive age, and not surprisingly, in their children under 2. There is no vaccine yet for Hepatitis C, but very recently, a very good treatment has been released. 

In other viral news, work has been done showing that certain vaginal flora (Prevotella BIVIA) make it easier to transmit HIV. However, a silicone ring imbued with antiviral drug may help reduce the risk of transmission. Pregnant women with HIV have now been shown to do better if their therapy is continued postpartum. 

Finally, in some other good news pertaining to viruses, the American Cancer Society has endorse the vaccination of all preteens, boys and girls against HPV (Human papilloma virus.). 

Say tuned for more riveting news from the word of Ob/Gyn next week on Medical Monday. 

Food Fridays: Summer Eating Digest

Summer cooking and eating is a special case. Here is a handy review post for you to access all of your summer tips I have written so far in one convenient place. Some are for safety, and some are for taste. You’ll be glad you looked at this quick review. Click on the links to see more. 

The Picnic Post:

http://drginanelson.com/drginablogs/2015/6/26/food-friday-picnics?rq=food%20safety

This has the most explicit information on food safety in the site, plus some helpful links. 

The Healthy Barbecue Post:

This is right on time for your next outing. There’s a fair amount here about how not to burn the house down or end up in the emergency room. 

http://drginanelson.com/drginablogs/2015/6/11/food-friday-healthy-barbecue-grilling-and-picnics?rq=barbecue

The Summer Drinks Post:

 You not find beer or sugary soda in this eclectic list. 

http://drginanelson.com/drginablogs/2015/7/10/food-friday-drink-?rq=cold%20drinks

The Cold Food Post:

This is a recent post here in case you missed it: 

http://drginanelson.com/drginablogs/2016/7/1/food-friday-hot-weather-cold-food?rq=cold%20food

The Salsa Post:

This is one of my favorite older posts I really enjoyed making: 

http://drginanelson.com/drginablogs/2015/9/10/food-friday-the-healthy-junk-food?rq=salsa

The Cold Dessert Post:

http://drginanelson.com/drginablogs/2015/8/28/food-friday-cold-desserts?rq=cold%20desserts

Anybody hungry yet ?

( My apologies to those in the Southern hemisphere who are in the middle of their winter.) 

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 !

Food Friday: Cooked Vegetables

In my quest to help people enjoy good nutrition and attain a healthy weight, I have discovered several challenges. Some particular challenges are processed food high in processed carbohydrates, bad fats, sugar and salt, drinks like soda. People consume these, though almost everyone knows they’re bad for you. On the other hand, everyone knows veggies are good for you. And yet, they are seldom eaten by those who really need them.

People don’t use vegetables because they don’t know how to obtain and prepare them. I call this poor vegetable literacy. The exception is of course simple salads. Everyone in America knows salads are healthy, but most salads are so small and plain that they are hardly nutrient dense. I have posted before about hard salads and also about salsas. Our post today is about cooked vegetables. 

Cooked vegetables are easy to prepare. As with other foods, they can be steamed, sautéed, broiled, baked, and grilled. There are only a few vegetables that I do not serve cooked. They include lettuces, radishes, and cucumbers. Otherwise, vegetables can be divided into the following categories: 

• Cooking greens
• Root vegetables
• Squashes
• Nightshades 

Cooking Greens

These include collard greens, spinach, kale and chard. How you prepare then depends on whether they are hard or soft. If they are soft like spinach or chard, then you can simply sauté them. If they are hard, lightly steam them first, them saute in butter, or olive oil. Do not salt or pepper them until they are wilted or you will overdo it. Dress lightly with seasoned rice vinegar or a squeeze of lemon. You may also prepare them with other things like bits of prepared meats, red pepper, or tomatoes. Warning: they cook down dramatically. 

Root Vegetables

These include carrots, beets, parsnips, turnips, and rutabaga. Some would include kohlrabi. They are best roasted or sautéed.  They can also be steamed to reduce saute time. Most of the work is in the cleaning. All but the smallest and most tender need be peeled. Once sliced, they can be roasted in a hot oven (425) with olive oil salt and pepper. You can roast them in foil with butter or oil or roast them on a shallow pan to get them almost crispy. They can be steamed and then sautéed in a pan with olive oil or butter and flavoring. They then benefit from a sauce. My favorite sauce for root vegetables is herbs, butter, orange and a little honey or agave. The orange is conferred with a tablespoon of frozen orange juice concentrate. I like them cooked until fork tender. 

Squash

Here are some healthy carbs. They are vitamin rich too. Since I am impatient and like shorter cooking times, I often peel and cut up my squash. They can be steamed or roasted, then dressed like root vegetables. They can also be made into soup when blended with broth, milk, sour cream or even parmesan cheese. Acorn squash make little bowls when cut in half and the seeds scooped out. For those, I fill them with slivered almonds, dried fruit soaked in wine, mushrooms, onions, and fresh fruit like apples. Then I bake them in moderate heat (350) until soft, which takes the better part of hour. Softer squash like zucchini can be grilled, sautéed quickly in a pain with other vegetables, or tossed into a spaghetti sauce or soup. 

Nightshades

These include tomatoes and eggplant. Eggplant is underutilized. When roasted it has significant umami, that meaty satisfying savory-ness. Tomatoes have to be one of my favorite foods. I like them fresh, roasted or dried. They are full of vitamin C and lycopene. They enhance the flavor of other vegetables almost universally. They are good alone.

Learn to love cooked vegetables. Eat them by the plateful. They will love you right back.  

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 

The Power of Habit: Why We Do What We Do in Life and Business

$9.18

By Charles Duhigg

Buy on Amazon

•      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/

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

Women in Latin American are more likely to get Zika than men. We presume they are exposed equally to Zika carrying mosquitos. This difference appears once girls become sexually active. How do you put it together ? Here is what doctors and researchers think. They believe sex may spread Zika more than was previously believed. Furthermore, getting Zika though sex is easier for a woman than for a man. Other sexually transmitted infections follow this pattern and in their case, it is because sex in women causes undetected micro abrasions which allow greater access to the bloodstream. 

President Obama has come out and said that Congress should not recess for summer until Zika funding is secured. With this funding, a vaccine will be produced sooner. Some speculate that the issue of Zika calls to mind issues of contraception and abortion, and that is why Congress is unable to deal effectively with it. Zika is bringing reproductive rights into focus. ACOG ( American College of Obstetricians and Gynecologists) representatives have noted that the southern states likely to have the most Zika are the same ones which have high unintended pregnancy rates and poor access to family planning resources. But Texas is taking a different angle anyway. They are trying to scratch up enough funds on its own to provide mosquito repellant to it’s poor women, budgeting 2 bottles per month per women.  

In other news, US maternal mortality rates have doubled in the last 25 years. Black women fare the worst, with mortality rates quadruple that of white women. 

The president of ACOG has come out stating that we should have a much more critical attitude toward chemicals in the environment which may cause birth defects. Project TENDR has been created from a variety of expert disciplines to advocate for greater government oversight on the chemicals. TENDR stands for Targeting Environmental Neurodevelopmental Risks. 

Newborns get about two months of flu protections from a shot given to mom during pregnancy. 

Despite the demonstrates efficacy of the HPV vaccine, it is still woefully underutilized. Moreover, HPV related cancers are on the rise. Between 2008 and 2012, they have increased about  17 %. HPV cancers are not just cervical cancer in women. They also include head and neck cancers in both men and women. 

Finally, in the good news department, an eight study meta-analysis out of Europe has shown that obese infertile women who have trouble ovulating do better with lifestyle intervention than fertility drugs. Six months of interventions resulting in weight loss were four times more likely to conceive than their counterparts who used fertility drugs alone.  

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: Summer Safety Kit

Here is a convenient comprehensive kit to keep you safe this summer. It recaps some posts from the recent and more distant past, all in one convenient place and on the theme of having a safe and happy summer. 

Reclaim your Summer

This deals with the importance of time off and the concept of summer vacation for adults. 

Weathering the Heat

Contains some amazing facts and figures about heat stroke.

Five Steps to Mosquito Protection

This is especially important to review in this season of the Zika Virus.

Wellness While Gardening

Tells of the little known perils of playing in the dirt. 

Hydration 101

This critical post has concrete information to help you stay out of trouble this summer. 

Stay tuned for next week on Wellness Wednesday, when we will talk about the Summer of the Mind.  

Medical MondayL Breaking News from the World of Obstetrics and Gynecology

In Zika news, it has become clear that we do not yet know the length of time that Zika stays in the reproductive tract of a man. Thus, we do not now how long he may be able to transmit it sexually. 

In a recent poll, 73% of Americans feel Congress should pass the funding to fight the Zika virus as recommended by the Obama administration. However, reflecting a poor grasp of the situation, only 46% feel they need to pass it immediately. 

In the we already knew this department, ACOG ( American College of Obstetricians and Gynecologists) has issued new evidence based guidelines to help prevent perineal lacerations. These include using episiotomy selectively, and well as using warm compresses before birth. 

SCOTUS ( Supreme Court of the United States) has struck down a restrictive Texas abortion law. This law would have required that abortions be provided at an ambulatory surgical center by a physician with hospital privileges. There is no scientific data saying that either of these elements is necessary for safety of the procedure, which is normally done in an office by a midlevel provider such as a nurse practitioner. Many abortion clinics would have had to close had this law stayed o the books. The Court ruled by a 5-3 vote largely along gender lines that these laws placed an undue burden to women seeking legal forms of health care. 

In other SCOTUS news, the Court has refused to hear a legal challenge to the Washington State rule that pharmacies must deliver all prescribed medications, even emergency contraception. This ends a nine year legal battle in which some pharmacists and a pharmacy refused to stock or fill the morning after pills. The Court voted 5 to 3 not to accept the case. Four Justices must agree to accept a case if it is to be heard. 

In the pendulum swings department, there are two items. First, Obs are giving serious consideration to the optimal time for delivery. In the past, 42 weeks was considered a reasonable time for induction. In my tenure, this has become 41 weeks. Now 39 weeks is under consideration. 

Secondly, women with a statistical risk of ovary cancer of 4% or more who is over 40 may be better off with her ovaries and tubes removed. When I finished residency in 1994, we encouraged women facing a hysterectomy to have the ovaries out as well if they were over 45. In recent years, this has become more of a patient choice. Now, we are refining this judgment to include family history and other risk factors in a statistical model to determine the best course, and it may favor removal of the ovaries earlier than previously recommended. 

Once again the USPTF (US Preventive Services Task Force) has cited the lack of evidence supporting the annual pelvic exam, and how it should be done only when symptoms are present. And yet, when examining their published statements, one sees that they do not highlight the fact that there has been nothing done to prove or disprove the utility of the exam either way. This is because doctors the world over have taken it as common sense to do the exam, thus no study has been done. The public should know that saying that there is no proof that something is not useful is NOT the same as saying that something has been proven TO BE not useful. Personally I find important things every week if not every day I do a pelvic exam, and that includes both speculum and bimanual exams. Furthermore, nobody is traumatized by their exam. Children and those with disabilities who need exams and who might be traumatized are examined with the aid of anesthesia supervision. 

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

Wellness Wednesday: Hydration 101

Summer has finally arrived in the northern hemisphere.

Our part of the planet is pointed much more directly at the sun and you can feel it. Sun protection and hydration become critical. Last Wednesday we covered mosquito protection and this week we will recap hydration. 

A July post from last year has some facts that bear repeating: 

• 2 Liters = the amount of fluid a non pregnant woman needs per day
• 3 Liters= the amount of fluid a pregnant woman needs per day
• Add 1 Liter for temps over 85 degrees
• Add 1 more Liter for activity like hiking. 

So… the fluid requirement for a pregnant woman hiking on a hot day is 5 Liters !!! 

And to recap…

Consider a woman weighing 154#=70kg

• 60% of the body=water =42 kg or 4.2 Liters for our 70 kg woman
• 1% loss of fluid = 42 ml impairs thermoregulation and causes thirst. 
• 2% loss of fluid - discomfort and loss of appetite 
• 3% loss of fluid - dry mouth appear
• 4% loss of fluid- work capacity decreased 
• 5% loss of fluid- reduced concentration, headache, and sleeping 
• 6% loss of fluid-tingling and numbness of extremities 
• 7% loss of fluid-collapse 

Taken from the World Health Association (WHO) website 

Hydration does a number of great things

Firstly, it protects you from harms: 

• Urinary tract infection
• Kidney Stones 
• Preterm labor 
• Headache 
• Helps prevent heat stroke 

see Weathering the Heat 

Finally, hydration makes you feel good and look good. 

It’s fun to get creative with your healthy drinks.

Break out of the old routine of sodas and beer which do nothing but dehydrate and put fat on the belly. 

Try these instead : 

• Plain Club Soda with a little splash of 100% fruit juice and twists of citrus 
• Mocktails like a Virgin Mary or a not so sweet Virgin Daquiri
• Herbal iced tea or Sun tea, sweetened with a little fruit juice 
• Healthier frappes made with ice, one pump of chocolate, and your milk of choice 
• Green smoothies 

Drinking a tall cold glass of something healthy and fun is good for you both physically and mentally. It gives you a little creative outlet, and a chance to sit down and take a micro break. 

Be sure to catch all of our blog posts at 

www.drginanelson.com/drginablogs  

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

Good Monday. This week the news is again dominated by the specter of Zika. I reported earlier that the Puerto Rican chapter of ACOG (American College of Obstetricians and Gynecologists)  is working hard to deliver donated contraceptives to women in this vulnerable population. However, IUDS are not common there due to cost, and as a result, few doctors know how to insert them. Approximately 60,000 IUDS and 80,000 packs of birth control pill packs have been donated by Bayer, Allergen and Medicines 360. The donor companies have also started training physicians to use and presumably teach the use of IUDS. However, their dispensation is held up since the CDC has yet to line up a licensed distributor in Puerto Rico.

This sounds like a problem that can be solved. IUDs are not that hard to put in. I cannot help but think that telemedicine, i.e. videoconferencing, could not help train doctors to put in IUDs. By some accounts there are about 150 Ob/Gyns in Puerto Rico, and about 138,000 women there who are vulnerable to pregnancy.

A little more Googling on my part indicated that the Puerto Rico Obstetrics and Gynecology is holding a “ Sunshine Seminar”  August 4-7 this year at the Wyndham Grande Rio Mar Beach Resort and Spa. Really ? Instead of studying morcellators and bioidentical hormones, maybe conference attendees should put some gloves on and start seeing as many patients as they can. 

I am going to contact the chair of the Department of Obstetrics and Gynecology Dr. Sharee Umpierre at the University of Puerto Rico and see what she has to say about the situation. 

The New England Journal of Medicine reports an increase in abortion medication in Zika affected South American countries. 

In some good news, the FDA has given the go ahead on human clinical trials on a Zika vaccine known as GLS-5700. The safety and immune response will be studied in about 40 subjects. Thank you very much you brave souls. 

In more good news, the NIH ( National Institute of Health) have started a massive study on Zika in affected countries. 

The House has approved $1.1 B to fight Zika. This would come from $750M in savings, $107M unused Ebola funds, $100M in cuts to the Department of Health and Human Services (Medicaid and Medicare) and $534M from Obamacare in the US territories. This does not add up. And, it will not pass the Senate or the President’s Desk. 

Ten cases of Zika were confirmed in Dallas County, Texas as of Friday. So it begins. 

In other breaking research news, there is quite a bit of what we already knew or suspected: Cranberry juice may help prevent UTI (urinary tract infection). Physical inactivity increases risk of ovary cancer and healthy lifestyle reduces cancer risk. Leading oncologists push for greater use of the HPV (Human Papilloma Virus) vaccine. Healthcare is more affordable since Obamacare. Age of puberty for girls is going down. Soy isoflavones reduces menopause symptoms. Women who work long hours face more chronic disease. 

Why are studies done on matters that already seem established ? One reason is that prior studies may have been done to get a rough indication of a cause or pattern. Later, better designed studies can establish something closer to proof. However, some of these things are just common sense. If we took full advantage of the knowledge we already have and actually put it into clinical use with our patients, there would be so much more health and so much less disease. Case in point: HPV vaccines usage. 

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

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. 

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

The CDC( Centers for Disease Control has revealed that there are 6 cases of Zika related birth defects in the mainland US. These  are those that have delivered so far. Overall, there are 234 cases of confirmed Zika in pregnancy women in the US. All of these Zika infections were acquired elsewhere and brought here. Accordingly, New York has the most cases of Zikaa in the US, being a port of entry. So far there have been no cases of Zika infections transmitted by mosquitos in the US, though Aedes mosquitos are due to being bitting in the Southern states this week. 

Another preliminary study has come out suggesting that contracting Zika later in pregnancy confers less risk of perinatal malformations. This study was done in Columbia where there are over 12000 pregnant women who have the virus. It is interesting to note that about 80% of Zika infections are asymptomatic. These asymptomatic cases cause microcephaly all the same. 

The WHO (World Health Organization) has come out stating that there is little risk that the Olympics will case Zika to spread around the world. I personally question this, but hope they are correct. 

In other news, California Governor Jerry Brown has signed a bill potentially allowing illegal immigrants to buy insurance coverage on the state’s exchange. This seemingly radical idea is interesting to consider, since these people do come in for care. Without this coverage this care goes unreimbursed but still costs the taxpayer money. With the coverage, these people would presumably come in for preventive care or at least for earlier treatment which would mean a savings in both money and human suffering. 

A study released this last week predicts that if the next president repeals the ACA (Affordable Care Act) the  24 million Americans will lose health insurance coverage. Most doctors feel this would cost us more than the insurance in the long run. Speaking of the ACA, premiums may rise as much as 10% next year. 

CMS(Center for Medicaid Services) has adopted a policy encouraging the use of LARCs (Long Acting Reversible Contraceptives). They have concluding that this is good way to reduce the incidence and cost of unintended pregnancy. An article this week in the Atlantic has highlighted how many communities in the south the so-called “ Bible Belt” discourage discussion of contraceptives, especially IUDs, preferring instead “ abstinence curriculums” .

New research published in Obstetrics and Gynecology has indicated that most websites and apps for fertility are inaccurate in predicting fertility window. Really ? This is not rocket science. 

In the good news department, there may finally be some help to prevent vertical ( mother to child) transmission of Hepatitis B. When Tenofevir is used before birth, infant’s viral load and 7 month infections rates are lower than those who did not get the treatment. 

Stay tuned next week for more news from the world of Obstetrics and Gynecology. And don’t forget…. DEET is safe in pregnancy !! 

Food Friday: Portion Sizes

For something so critical to nutrition and well being, I am surprised I haven’t written about this yet. We talk about what to eat, and when to eat. But this discussion is nowhere near complete unless we talk about how much to eat. And how much can be very subjective. Estimates of portion size can be critically flawed. Sometimes when I listen to patients recount dietary history, it sounds correct, and yet they are not losing weight as one might expect. I think in many cases this is because portion size may be underestimated, sabotaging their efforts. 

It’s no secret that portion sizes in restaurants and grocery stores have purposely catered to our gluttonous tendencies. Portions have grown to more than twice of those in the 1980s. Even our plates and cups are bigger. This keeps us coming back for more and allows them to charge us more. A win win right ? Not for us. Obesity is a huge public health problem, and one that has both physical and psychological consequences. 

Let’s examine various methods of portion size management, and you can see what can work for you.

1. Know your calorie requirements. Use the handy calculator in the link. 

http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/calorie-calculator/itt-20084939

2. Have a general sense of your nutrition proportions: ( These are from the US FDA, the Food and Drug Administration.)

3. Check reference or for labels to check the size and specifications of a serving size. Compare this to what you need for your meal or snack. Serving size on the container does not necessarily equal recommended size .

4. Have a set of measuring cups and spoons. Have a small kitchen scale. Until your are familiar with common units of measure, measure and weight things. Here are some common measures of volume: 

2 Tablespoons = ping pong ball

1/2 cup =tennis ball

1c = baseball 

5. Avoid eating out. If you do, order small portions and just eat part of it. 

6. Buy in bulk but repackage in smaller quantities and do not eat from the bag. 

7. Don’t skip meals 

8. Do eat in between meal snacks which pair protein with produce. 

9. Use smaller plates and make sure your plate is at least half filled with green vegetables before you take other dishes. 

10. Avoid doing other things while eating. 

11. Eat slowly. Your brain takes at least 15 minutes to register that you are full. 

12. Stop eating when you feel 80% full. 

Part of the pleasure of eating is the taste and the company you eat with. But I would like to point out that the pleasure of eating also involves knowing that what you are eating is good for your body. Finally part of the pleasure of eating is knowing you have not eaten too much. Watch portions sizes, and your meals with will be better than ever. 

Medical Monday: Breaking news From the World of Obstetrics, Gynecology, and Women’s Health

To follow recent tradition, I will give the Zika update first. The WHO (World Health Organization) has reported that the spectrum of neurological damage to babies with Zika is greater than previously appreciated. Microcephaly is certainly the most obvious problem, but others such as spasticity, seizures, and vision problems are possible. 

This week a new method of acquiring the virus was confirmed. An American lab worker working with the Zika virus has contracted it though a needle stick. 

In the US, funding is still not present to fund the fight against the virus. Nonetheless, scientists at the National Institute of Allergy and Infectious Disease (NIAID) are “aggressively pursuing" a vaccine. 

Research is also taking place regarding how to alter the genes of the Zika carrying mosquitos so that they are sterile. Wiping out an entire species through genetic engineering may have unintended consequences. Researchers are examining this important issue. 

Over thirteen hundred cases of Zika are confirmed in Puerto Rico, but there are probably many more including those who are asymptomatic. ACOG (American College of Obstetricians and Gynecologists) is leading the effort to train physicians on the island to place IUDs for contraception. The WHO this week has finally issued a recommendation to women in affected areas to delay pregnancy. 

Both ovary and breast cancer therapies are in the news this week, and the messages are promising. For starters, research presented a the annual meeting of the American Society of Clinical Oncology has highlighted 11 additional genetic mutations associated with increased risk of ovarian cancer. This may ultimately give us expanded opportunities for screening and treatment of this disease. 

On the treatment side, it turns out that a combination of IV and intraperitoneal chemotherapy is more life extending than either therapy alone, for the treatment of ovarian cancer. Also on the treatment side, it turns out that extending anti-cancer hormone therapy such as Tamoxifen for 10 instead of 5 years reduces risk of recurrence or second primary in older women with early stage breast cancer. 

Syphylis cases have more than tripled in the last decade. At the same time, the majority of sexually active women between 15-25 have NOT been screened EVER for any sexually transmitted infections since they do not believe themselves to be at risk.

The CDC ( Centers for Disease Control) has reported the “ the US obesity epidemic continues to worsen”. Fully 40% of US women are obese. Obese is defined as a body mass index (BMI) at or greater than 30. Do you know your BMI ? 

Food Friday: Nutrition Reminders

In the office, most patients show understanding of good nutrition. And yet, when at home they say they have trouble actually eating healthy. The frustrates them and mystifies me. I would like to help. Sometimes I'd like to just come home with them to show them how easy it is to make it work. But that isn’t exactly practical. Instead I’d like to come up with something tangible that would remind them of all the principles and tips they have learned, so they can put them into practice. 

Sometimes I think this could be done with an attractive nutrition art poster to be displayed in the kitchen. Sometimes, I imagine kitchen linens featuring helpful suggestions in clever graphics, e.g. “ Eat your greens ! “ For quite a while I have been imagining a deck of cards. Each card would feature one nutrition reminder. 

The reminders would have to be attractive, both visually and tangibly.The principles they conveyed would have to be simple and clear. Right now I am trying to cook up a list of catchy little reminder phrases which will help people have an enjoyable and easy time making good nutrition at home. I would like to devote this post to sharing what I have so far, and to solicit your input about what reminders you could use. 

Here’s my list so far: 

• 3m3s
• Bring your Own Bags 
• Buy in Bulk
• Buy in Season 
• Buy Local 
• Celebrate 
• Cook from Scratch 
• Cook With Kids 
• Don’t buy Junk 
• Dress the Table 
• Drink Tea
• Drink Water 
• Eat Cultured 
• Eat Fermented
• Eat Low Glycemic
• Eat Salads
• Eat the Rainbow 
• Eat While Grains 
• Explore Cooked Vegetables 
• Eat Healthy Fats 
• Eat Fresh or Frozen
• Eat with Friends
• Eat Fresh Fruit 
• Eat Organic
• Eat Sustainable Fish 
• Explore Paleo 
• Grown Your Own Food 
• Hara Hachi Bu 
• Keep Sharp Knives
• Keep Your own Recipes 
• Know Your Farmer 
• Make Extra Dinner 
• Nuts to You 
• Order Your Way 
• Pack Your Lunch 
• PPP
• Purchase Good Containers
• Read Labels 
• Read Cookbooks
• Resect Food Allergies and Intolerances 
• Prep Your Breakfast 
• Share Recipes
• Share Your Garden Surplus
• Shop Twice per Week 
• Sit Down for Meals
• Spice it Up 
• Take Food Pictures 
• Use a Kitchen Scale  

I would really appreciate any other ideas you have about what might help make good nutrition happen for you. Meanwhile, if you haven't already, check our the blog on the website and scroll back to see the last several Food Fridays for more cooking inspiration.