Women's Wellness Blog

Two roads diverged in a wood, and I- I took the one less traveled
by,and that has made all the difference.
Robert Frost

It began innocently enough, but in the end would have been grounds for divorce in twenty two states! I was speaking at a conference at a beautiful lake side resort and was hoping to get in a run before my morning presentation. The hotel was magnificently situated on hundreds of wooded acres with two golf courses cut from the fabric of the landscape. My wife had accompanied me on this trip as she knew of the splendor of the location and wanted to drink it in for herself. We don't normally run together as our schedules and biorhythms rarely coincide, but on this early October morning we had both the opportunity and motivation to venture out side by side. I had measured the distance from the entrance of the property to the hotel and had mapped out a simple 5 mile route for the occasion. It was a brisk morning, enough for a long sleeve shirt and gloves, and we stretched and warmed up by the first tee. It was too early for the golfers so we speculated that a run on the golf course was not out of the question if we wanted to "live on the wild side". About that time I spotted a jogging path lying parallel to the first hole and suggested we follow that instead. Susan agreed, so I started my Garmin 405 watch and off we went.

The first few miles were surprisingly hilly and we easily broke into a cool sweat. We kept a slow pace because of the topography and enjoyed the scenery. Three deer ran across our path onto the golf course ahead and with their abundant numbers, the squirrels looked like they were having a convention of their own. I had planned our departure to allow for about an hour run to get me safely back to the hotel in time to shower and prepare for my talk.

After going about a half hour I noticed that the color coordinated trail markers had changed from their original yellow color to black. I remember taking a few turns and forks, but thinking this was a simple circular route, I didn't pay much attention to the details. I mentioned this change to Susan and she didn't seem too concerned so we ventured on. After another mile it became clear that we were not going in a circle but were in fact traveling farther and farther from our home base. I have the sense of direction of a cross eyed pelican and Susan is not much better, so we soon realized that we were lost and about 5 miles from whence we started. We were obviously in a golf course neighborhood, but at 7 AM and dressed in black tights I was not about to knock on any doors and ask directions. We did the only logical thing we could think of and started to retrace our path in hopes of rediscovering the way home.

Mistake! As I said I could get lost in a mall parking lot so depending on me to follow the bread crumbs home is like a blind person following Google Maps. At this point two concerns were percolating in my brain, first, would I make it back in time for my talk, and second, would my wife kill me for turning our 5 mile fun jog into a 10 mile juggernaut?

I tell this tale to illustrate the universal law of unintended consequences. I started out with a plan in mind and ended up with my wife asking a passing motorist for the name of a good divorce attorney. President Obama's health care debacle reeks of unintended consequences. Regardless of the moral high ground and good intentions of universal coverage, it cannot and will not arrive without unforeseen and unintended consequences. Herein lies the dilemma; we won't know many of those effects until after years into the change.

The HIPPA laws passed by congress are a perfect example. They were intended for a noble purpose, protecting the privacy of the patient; however they have morphed into regulations that make nuclear facilities look tolerant and paper work that has singlehandedly deforested the Amazon basin. Be prepared for some form of restrictions (i.e. rationing) tax hikes (there is no other way to pay for it all), lower quality care (dumbing down just like in the public schools), and more fraud (unscrupulous doctors and executives unwilling to give up the house in the Hamptons). The system is indeed in need of repair, but to strap us all with a complete overhaul is like buying a new car when all you need is a lube job. Let's look at real reform like prevention, tort reform, portability, non exclusion clauses, and free deep fried candy bars on a stick for everyone. Okay, maybe we can leave off the candy bars, but we need a heavy dose of common sense so step number one is, in the words of Shakespeare, "let's kill all the lawyers." (and politicians, I might add)

Oh by the way, I did make it back in time from the run to give my presentation and my wife has not filed for divorce, so far.

A Prevent Defense
With the health reform debate blazing forward with the speed of a pregnant turtle, it seems only right to mercilessly show the political hacks where they have fallen off the bus. I know that sounds a bit presumptuous but trust me, I’m a doctor and I don’t just play one on TV.
First, what Washington is gobbling up then spewing out is not health care reform but heath coverage and insurance reform. No sane individual debates the merit of health care for all; it’s how that is achieved that befuddles the legislators, many of whom cannot find their way out of a wet prescription bag. Having Washington revamp the health care industry is akin to having the Chemistry department at your local community college write education policy for the nation; it’s just not what they do.
The key to real health care reform is not in legislation but in prevention. And you can’t legislate prevention! True honest to goodness prevention begins with the individual, and, in the case of kids, the family. Before we explore some practical tips for family disease prevention allow me to make the distinction between prevention and early detection. Pap smears, mammograms, and colonoscopies are techniques for early detection, not prevention. The disease already exists when these tools are utilized. They are incredibly useful and important tests and I strongly recommend their use, but don’t be under the misconception that getting a regular Pap smear will prevent cervical dysplasia and that yearly mammograms will keep breast cancer at bay. True prevention is designed to prevent or delay the onset of disease, not find it earlier once it exists. If we are to truly reform health care in this country it must begin with every family taking responsibility for prevention.
Let’s examine some methods of prevention especially suited for the family.
1) Get your kids vaccinated. If you are one of those wild-eyed, Jenny McCarthy worshiping, whack jobs that thinks childhood immunizations cause autism or any other disease, then you may already be too far gone. Not only is there no credible scientific evidence that vaccines cause autism, but not vaccinating your kids leaves them, and those around them, vulnerable to known diseases that can kill them! Measles, rubella, influenza, pertussis, and encephalitis still exist and still have serious consequences.
2) Insist on at least 30-60 minutes of physical activity for your child every day. This is an absolute minimum, and you can’t rely on the school gym program to meet this need. The average teenager spends 17 minutes actively moving in an hour long physical education class! Put a lock on the computer, blow up the TV, pour molasses in the back of the Xbox, and buy your kid a nice pair of running shoes. Childhood obesity is one of the top health problems in the country and the cure for obesity is exercise.
3) Teach good dental hygiene. We don’t often think about this as a public health issue, but many good health habits are taught early and this is one that will pay lifelong dividends. Dentists report that more and more kids (and adults) are foregoing routine check ups and preventive care due to economic concerns. Have a few less Grande Mocha Latte espressos and get your child’s teeth cleaned on a regular basis.

Now a few tips for the adults. Remember, you set the tone for the family. What you do often becomes the norm for everyone else.
4) Let’s get this out of the way right up front: eat healthy and exercise! There, I said it, you heard it, so do it! Enough said.
5) Wear seat belts. If you don’t know by now that buckling up saves more lives than Bruce Willis in Die Hard II then you have been living in a cave in Afghanistan. We all freak about the H1N1 virus that has killed 1000 people so far this year, but forget that not wearing seat belts kills an average of 5500 persons and injures 132,000 every year!
6) Join a church. Now before you write me hurtful and angry emails telling me that I am an ignorant, fundamentalist, Southern fried religious nut, hear me out. A study from Harvard (that close minded, Bible thumping bastion of evangelism) concluded that people who belonged to a religious community (i.e. church) had not only lower incidences of hypertension, diabetes, and senile dementia than their non church going brethren, but they also had longer lives on average. I am not advocating populating the pews just to live longer and healthier, but what a great side effect! In fact many studies show that people who regularly attend church tend to practice fewer risky health behaviors, are more emotionally stable, and have a greater sense of purpose.
7) Go back to school. This should convince you that I have gone completely bonkers. The reality is that people who keep their mind engaged in some meaningful activity have fewer risks for Alzheimer’s disease, senile dementia, and even some forms of cancer! Granted, this doesn’t mean you have to become a freshman at your local college, but staying mentally challenged through reading, working puzzles, journaling or a thousand other activities of the mind can be as healthy as jogging a mile a day.
You want health care reform? Start today by practicing family prevention

There is nothing like getting up in the morning and reading the latest medical pronouncements from a government bureaucrat whose greatest accomplishment in life is deciding between Lucky Charms or Coco Puffs for breakfast. That is how I felt the other morning when I read about the government's new "suggestions" regarding mammograms and Pap smears. As a service to patients and friends, I am putting out this special edition of the newsletter to address these important issues and allow me to vent so my head won't explode!
Let me say at the outset that I think these new recommendations are at best horrible and at worst dangerous. Just so there is no confusion about where I stand on this, let me reiterate my position: you can take these recommendations and make Origami giraffes out of the paper they are printed on because it will be worth more (I've heard there is quite the market for Origami giraffes) and at least you won't die from folding paper; whereas you might from these guidelines.

I could spend the next few thousand words giving you example after example of patients in my own practice who are alive today because of screening mammograms and timely Pap smears, but that would only prove my point too easily, so let me opine on a deeper level and dissect not only the recommendations but also the not so subtle reasons behind them.

First, the mammogram controversy. In a world besieged with pink ribbons and "Save the Ta Ta s" bumper stickers, you would think that anything we could do to lesson the impact of breast cancer would be a good thing. A survey a few years back listed the fear of breast cancer as the greatest health concern of women over 40. The controversy surrounding when to begin mammograms and how often to follow up has raged for years, but now the government appointed Preventive Services Task Force has said that those low risk women under 50 should simply bury their heads in the sand and not only not get mammograms but forget about doing self breast exams. Why, you ask? It's all about the money! Doing early routine mammograms are not cost effective they profess, which is a fancy way of saying the accounting wonks have determined that saving the life of 5 women per 5000 is not worth the expense of early detection. Try telling that to those 5. The arrogance of this group is astounding. Dr. Otis Brawly of the American Cancer Society said it well, "The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not. That stance is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them."

What you have here is a government controlled group of statisticians, ivory tower research doctors, and scientists who have rarely cared for patients making "recommendations" based on population statistics and cost analysis. Interestingly, this same Preventive Services Task Force is given frightful influence in the new "health care reform" legislation slithering through Congress. This is simply a blatant attempt to ration care. Essentially the government is saying that you may have this screening but your younger sister may not. Supporters clamor that these are simply suggestions and that the final decision is between you and your doctor. Whereas this is exactly where the choice should rest, the real world dictates that as soon as insurance companies adopt these guidelines as the "standard of care" (and history proves that is exactly what happens) then even if your doctor thinks a screening mammogram is a good idea, if you don't fit into one of the categories designated by this powerful task force, your insurance company may not pay for the procedure. They will quote the oft spoken diatribe, "We are not saying you can't have the test, we are just saying we are not going to pay for it."

The bottom line is that science, good medicine, and common sense dictates that low risk women get screened by age 40, every 2 years until 50, and then yearly after that. And for goodness sakes (and your sake) do your self breast exams! They actually save more lives than mammograms.

It is embarrassing as a member of the American College of Ob-Gyn to hear of their latest dictates surrounding Pap smear frequency. As a clinician for the past 21 years, I have treated numerous young women with pre-cancer changes of the cervix that, if they had abided by the new Pap guidelines, would have been subjected to hysterectomies, radiation and even death from missed cervical cancer. We are living in a time of epidemic infections of the Human Papilloma Virus (HPV) the causative agent of cervical cancer. We have never seen the volume of infections nor the mass of girls under 21 infected with the virus as we are documenting now, and we have no clue as to the long term impact of these infections. The rate of cervical cancer has plummeted over the past several decades due solely to early detection ( by means of regular Paps) of changes that are easily and completely curable. To revert back to a time when women walked into my office with large cancer lesions on their cervix from neglect and a lack of detection seems ludicrous. What the American College of Ob-Gyn won't say is that the biggest risks for these infections are early onset sexual activity and multiple sexual partners. The liberal leaning political hacks that make up the leadership of this organization will support your 15 year old getting an abortion but will never promote an abstinence program, and they now say young women don't need the "stigma" of being labeled as having a sexually transmitted infection. It is hard for me to take the advice of a group that is supposedly championing women's health when I see them making recommendations that hurt women.

The bottom line for Paps: get them yearly and begin when you become sexually active (not like the woman who answered my question, "Are you sexually active? with, "No, I just usually lie there!").

Folks, if you want a taste of what government run health care will be like, check out the rationing in these guidelines. After all, they did such a great job in getting plenty of H1N1 vaccines distributed, didn't they!

Blessings,
Ron

P.S. address hate mail and dissenting opinions to obamacare@stayoutofmyhealthcare.com

We are all students, whether we are returning to high school or taking an adult education course in the evenings. Of course not all learning is in a formal setting like the classroom. Most of us continue to soak up knowledge from life experience, smart friends, or good books. I have recently come across several manuscripts that are not only interesting reading but also provide excellent medical advice. Specifically I want to recommend three books that directly and practically address the broad topic of healthy aging.
It is a misnomer to talk of anti-aging concoctions or secrets because everyone and everything ages. In spite of late night infomercial’s claims, we all are going to get older. Time travel has yet to be perfected and that would truly be the only way to thwart the aging process. Between you and me I wouldn’t want to go back to the seventies even if it was possible. Disco gave me headaches and Puka beads clashed with my acne. The point is that aging is an unalterable law of physiology. What we really crave are tools for slowing the process or aging in such a way that minimizes morbidity. I think an admirable and achievable goal is to live as long as possible, but live it well. It is in that spirit that I offer three books that capture this philosophy, each specific to their own concentration, but unified in that they all agree that living a long life is valuable if it can be done in a way that allows for physical and emotional independence and productivity.
In 2008 Dr.John Ratey published Spark: The Revolutionary Science of Exercise and the Brain. I know, it sounds like some science fiction account of monkey brain experiments, but it is a masterful explanation of why those of us who exercise feel the way we do, and more importantly why those who don’t exercise, should! Ratey embarks upon a fascinating and entertaining journey through the mind-body connection, presenting startling research to prove that exercise is truly our best defense against everything from depression to Alzheimer's disease. “Spark is the first book to explore comprehensively the connection between exercise and the brain. It will change forever the way you think about your morning run---or, for that matter, simply the way you think”, states a review from Amazon.com. It is chock full of case histories from real persons who have transformed their lives by incorporating exercise as part of both prevention and treatment of disease. It will motivate you to get off “the couch of doom”, throw away your bag of Cheesie Poofs, and get moving…literally.
The China Study by world renown epidemiologist T.Colin Campbell,PhD, is a groundbreaking description of the findings of one of the largest studies ever done on nutrition, disease and longevity. This should be distinguished from The China Syndrome which was a very bad movie with Jane Fonda that watching can actually shorten your life…but I digress. This study examines more than 350 variables of health and nutrition with surveys from 6,500 adults in more than 2,500 counties across China and Taiwan, and conclusively demonstrates the link between nutrition and heart disease, diabetes, and cancer. While revealing that proper nutrition can have a dramatic effect on reducing and reversing these ailments as well as curbing obesity, this text calls into question the practices of many of the current dietary programs, such as the Atkins diet, that are widely popular in the West. The bottom line in this book (not to spoil it for you I hope) is that a whole-food, vegetarian based diet is unquestionably the most healthy and, along with overall calorie restriction, associated with longevity. Finally some validation that my tofu casserole surprise is the master food!
The final must read to ruin your family’s dinnertime is The Blue Zones by Dan Buettner. This is the most recent book by National Geographic explorer (and husband of Cheryl Tiegs) that focuses on several areas in the world that have an unusually high number of people over 100 years old. What I found fascinating is that even in diverse cultures, the basic principles of longevity are congruent. Exercise, stress control, dietary discipline, and having a sense of purpose all headline ways to age well. The strength of this book lies in the vigorous and voluminous data collection and the personal approach to telling the story. Translated: it’s a fun read that leaves you with some important insights.
So pack a lunch of bean sprouts and cabbage, hop on your bike, and merrily peddle off into longevity and don’t forget to tote these three books along with you as your guides to living well for a long, long time.

Men make horrible patients. Men doctors make even worse patients. Men doctors who are wimpy about pain make inexcusably, embarrassingly horrible patients. I can say this with both authority and confidence as I am all of those things. Case in point: I turned fifty not so very long ago and my perpetually helpful wife reminded me that a stroll down colonoscopy lane was in my near future. I realize this is an absolutely essential screening exam as there are more curable cases of colon cancer picked up early through this test than there are crooks in Congress, but to say I am somewhat hesitant goes beyond an understatement. Let’s just call it what it is; unbridled terror! The thought of some long flexible tube traveling up unchartered territory gives me goose bumps on top of my goose bumps. Now I don’t want to get any angry emails accusing me of advocating avoiding this helpful and necessary exam. I am all about prevention…as long as it’s you that’s doing the prevention. I don’t have any trouble wallowing in someone else’s bowels and body fluids in surgery, but if I cut myself shaving I contemplate calling 911. I actually think this is a man thing, sort of like asking for directions, making your own sandwich, and lifting the lid. For most guys having a lighted camera charting territory never before mapped is about as manly as Liberace in full bloom. Actually I’ve heard the procedure itself is not that bad (mainly from sadistic so-called friends who want you to share their misery) but the prep before the scope receives universal disdain. There is nothing like drinking four gallons of lightly sweetened motor oil while all the time knowing that it is designed to sand blast your colon. And that it does, so I’ve been told. One sarcastic soul simply advised me to have a good book and a Sam’s card to bulk buy your TP.
Let me reiterate, this diatribe is in no way meant to dissuade you from having your intestines surveyed and projected on a screen like some National Geographic special. It needs to be done. So as the fine folks at Nike say… Just Do It! I would, however, make a few requests before the procedure. Ask the gastroenterologist to refrain from a play by play of what he sees. “And over there is what looks to be a hyperplastic polyp. If we come in real slow and close we won’t scare it and you can see it feeding!” Also, I would pick a place that does not employ everyone you normally see at Sunday school. There is nothing more distracting than getting an enema from the woman you were having a spirited discussion about “women being silent in the church” just the week before. Remember, she chooses how much and how hot that water is! Finally, I would not have your wife drive you home afterwards. If your household is anything like mine you would go straight from the colon cleanse to the carpool line and have to explain to four eighth grade girls why you were sitting on a doughnut and were the color of a three day old carp. Find someone to bring you home that doesn’t have to make thirteen stops and has at least a smidgen of sympathy.
I know this may all sound chauvinistic hearing a gynecologist speak about not having uncomfortable procedures done after what we routinely do to women. Believe me I understand that Pap smears and pelvic exams are not exactly a stroll in the garden. As the Pap-er and not the Pap-ee I realize I have no grounds to complain about invasion of privacy, but I also recognize that women are the master race. They are strong in mind and spirit whereas men generally have the pain threshold of a grasshopper. Childbirth is a perfect example. If men had babies there would only be single child families. If men carried a baby for nine months performance anxiety in the bedroom would shoot to new heights as men would constantly be reminded of the cause and effect of pregnancy. “If I do this, I might get that, and I don’t want to do that again, so that’s that.” Now some of you guys may be defensive and attempt to counter this with the old “what about the prostate exam” diversion. You have got to be kidding! One finger for ten seconds verses a bivalved metal prong and a spiked brush rubbing the skin from the cervix! That’s like comparing a Tonka Toy to a Hummer SUV.
One final point. Colon cancer is one of the leading causes of death for both men and women, and it is largely preventable. There is no excuse for not having this done and done soon if you are over fifty. I am preaching to myself here as I will soon make the call to set up my dance through the diverticuli. Life is full of uncomfortable challenges but to live long enough to face your share, get your Pap (not you, John) your colonoscopy, your mammogram and your cholesterol checked. You know what they call someone who practices good prevention? Old!
Now has anybody seen my fiber?

We hear a great deal today about health care reform. The pundits and politicians are bantering about like hens in a hen house clucking about this plan and that reform. It is politically and philosophically prudent to be on the side of some type of change in the health care system. No one disagrees that the system is unsustainable in its present configuration. I concur that the situation is dire, the patient is in cardiac arrest and something has to be done. However, I differ from many in believing that the solution is one that is simpler yet more impractical than a government take over. I realize that sounds somewhat contradictory, simpler yet impractical, so let me explain.
We will never cure this country’s ills without a strong dose of personal responsibility. The government, politicians, insurance magnates and even doctors are not only inadequate to change the system, but incapable of effectively bringing about change, because the change has to begin from within. It has to come from the individual, the man in the mirror. The biggest healthcare crisis in this country is not cancer, AIDS, heart disease or funding, it is people not making healthy lifestyle decisions. Until we as individuals start doing the things we know to do to stay healthy, we will be a nation of sick care delivery not health care. Part of the problem is one of education. For example many feel that getting regular mammograms and doing self breast exams are excellent preventive tools for breast cancer. They are not! They are simply tools of early detection. The cancer already exists when the utility of mammograms and self breast exams is realized. These tools prevent nothing other than higher morbidity and mortality, which is a good thing. But we have to move back one level if we are to truly prevent breast cancer. For example, decreasing your body mass index (BMI) a simple measurement that assesses your amount of body fat can reduce the occurrence of breast cancer 40%! Reducing obesity, stopping smoking, increasing your intake of fruits and vegetables, limiting alcohol intake; these are behaviors that all substantially reduce the likelihood that you will develop a breast cancer. Are mammograms and self breast exams important? Of course they are. They have been shown time and time again to increase survival rates in breast cancer victims, but our focus should be not only on early detection but absolute prevention. If the government wants to have an impact on breast cancer, focus more on exercise programs and dietary instruction rather than new and expensive imaging technology. With breast cancer or any illness, it goes back to decisions and actions that an individual takes. That is not to say that someone who is thin and a vegetarian will not get breast cancer. There are multiple factors that go into disease development, many of which we don’t understand. My point is that, in general, the skinny vegetarian has a lower incidence of breast cancer than the fat, couch potato, and when you expand that to whole populations you begin to see how individual decisions can have a massive collective effect.
Another example from my field of women’s health care is cervical cancer. The PAP smear revolutionized the care and treatment of cervical cancer in the 50’s as it allowed for the detection of the disease in it earliest stages when it is 100% curable. As time went by and research progressed it became apparent that a major cause of cervical cancer is infection with the Human Papilloma Virus. PAP smears can pick up changes in the cervical cells long before they develop as a cancer, but the PAP only detects the changes once they are there. There is nothing about the PA tat prevents cervical cancer. One of the only things that does prevent infection with HPV is minimalizing sexual partners. Having multiple sexual contacts dramatically increases your risk of infection with HPV and thus greatly increases your risk of cervical dysplasia and cancer. Again, prevention is different from early detection. If you want to prevent cervical cancer, develop effective programs supporting abstinence or monogamy. How many politicians are willing to handle that hot potato?
These are but two examples illustrating that the answer to our health care crises begins and ends at home. Simply providing health insurance to everyone will only reduce the number of uninsured, a rather obvious conclusion, but it will do nothing to solve the real problem; that of preventing disease. 48 million uninsured sick folks will become 48 million insured sick folks which will further bankrupt and already bankrupt system. Each and every individual has to take responsibility for making healthy choices if we are to resolve this sick care crisis. At the beginning of this piece I stated that the answer was simple, personal responsibility. I also said it was more impractical. I am no pie in the sky optimist that expects Billy Bob to give up his PBR and Twinkies. I understand that Suzie Sweatbelly will stay hermetically sealed to her couch of doom and not exercise. My point is that what we as a society have to decide is how to convince Billy Bob and Sally that they are killing themselves and their kids by living an unhealthy lifestyle. I realize the contradiction in this line of thinking. In individual has every right to live the life they choose. I agree. I as a fellow citizen have no moral authority to tell Billy Bob that he must lose 50 pounds. He chooses his lifestyle, but he also takes responsibility for his actions. Here is where the problem arises. We clamor for personal rights but we cower from accepting personal responsibility. Do we as a society have a moral imperative to take care of the sick and affirmed, yes, but that is paralleled by a moral responsibility of the individual to make decisions that improve their health. I am my brother’s keeper, but in turn it is my brother’s responsibility to not embrace behaviors that jeopardize his health and my good will.
Will we ever be a society of both free will and moral accountability? We must if we are to survive this health crisis.

A Day in the Life of a Mom (with a few of my own embellishments)

6:30 AM Get up to the alarm clock playing Bachman Turner Overdrive’s “Taking Care
of Business”.

6:50 Wake up teenage children; wear thick skin to deflect complaints.

7:00 Eat breakfast, Pop Tart for me, anything they will accept that has less than 500 calories for them.

7:30 Drive car pool, consider home schooling as carpool line is like traffic at O’Hare airport.

9:00 Shower.

9:05 Run out of hot water for shower.

9:30 Get dressed. Discover that dog has chewed only shoes that match outfit.

10:15 Arrive at church to help in distributing poinsettias as fundraiser.

10:16 Ask if anyone wants a dog.

11:30 Get call from youngest offspring; lunch crises! Food at school not fit to feed Guantanamo prisoners. Must bring edible lunch stat.

12:00 Arrive at school with Chick-fil-A value pack for child, pack of crackers for me.

12:30 Free time.

12:31 Busy body friend calls cell phone; just wanted to chat.

1:30 Chat concludes, arrange for second mortgage to pay cell phone bill.

2:20 Get in carpool line for youngest child, wonder if all mothers trained in demolition derby.

3:00 Youngest daughter arrives to car.
“How was your day?”
“Fine.”
“Learn anything?”
“Yes.”
“What?”
“Nothing.”

3:45 Call home to make sure older daughter made it there safely.
“How was your day?”
“Fine.”
“Learn anything?”
“Yes.”
“What?”
“Nothing.”

3:47 Debate merits of private school tuition.

4:00 Get home. Argue with oldest daughter about …everything.

4:30 Start 16 loads of laundry, sand blast kitchen, rake up dog hair from living room(plan to donate to Locks of Love).

5:00 Loving husband arrives with flowers and offer to take out to dinner.

5:01 Day dream over. Husband comes home stressed about credit card bill.

5:30 Begin dinner preparation.

5:32 Give up on Rachel Ray recipe and throw Betty Crocker Boil in a bag dinner in
microwave.

6:00 Family dinner. Discussion of why piercing and tattoos in a 15 year old sends wrong message to college placement advisors.

7:05 Help oldest daughter on calculus homework.

7:10 Remember why you hated calculus.

8:00 Relax with husband.

8:01 Make phone calls for school volleyball team fundraiser.

10:00 Kids to bed (theoretically).

10:15 Fold 16 loads of laundry, wonder how husband can go through 12 pairs of
underwear in one week.

11:00 Go to bed. Dream blissfully of waking up in the morning and doing it all again.

The achievement of the American dream is predicated by a culture of work, work, and more work. Daily we are bombarded with the virtues of busyness. We live in a time where relaxation and rest is equated with slothfulness. We have to stop the madness! I realize it is heretical in this McFrenzied world, but stopping to smell the French fries is okay, and at times preferable to filling every minute of every day with activity. More important, it is not healthy to always be busy.
Numerous studies have elucidated that busyness (defined as a perception of being over-schedued or suffering time pressure) puts you at risk for a diversity of disease states. Diabetes, hypertension, some forms of cancer, gastrointestinal problems, obesity, premature labor, heart attacks, and strokes are lust a few of the medical problems that list emotional and physical fatigue as a risk factor.
You cannot achieve wellness when you are not rested. Balance is the key. The problem in 21st century American culture is that rest is not a priority. Understand that this is a decision. There are no laws that dictate workaholism is a requirement for success. This applies to both those who get paid for their work and the significant part of the population that constitute stay at home spouses. To be healthy in mind, body and spirit, you have to achieve a healthy balance of structured activity and rest.
Dr. Richard Swensen is a leading authority on the benefits of rest. His book, Margin, (NavPress 1992) takes examples from his own medical practice and combines this with studies from the world literature to provide insight into ways of restoring emotional, physical, and time reserves to overloaded lives. He uses the term “margin” to describe something that is held in reserve for contingencies or unanticipated situations. In other words, it’s the physical and emotional cushion we have to soften the landing of inevitable stresses, disease, conflict and turmoil. If we lack margin then any disturbance, big or small, puts us over the edge and creates the conditions for physical and emotional deterioration. He asserts that rest is one of the greatest tools for gaining and sustaining margin in your life.
Swensen recognizes that you need rest in three specific areas of your life; physical, emotional, and spiritual. Each area is unique, yet they are all intertwined in the complex fabric of who you are. At any given time you may need to focus on physical rest, as when you have had a particular strenuous exercise session, whereas another day may necessitate dumping emotional baggage to “rest the brain.” This is a dynamic process that, once you understand the principal, can restore, revive and renew

Ten Commandments of Good Health
Many years ago a desert dweller climbed a mountain and talked to a bush on fire. What resulted was a set of laws that was to revolutionize mankind’s behavior. These were not ten suggestions formulated by a long range planning committee nor were they ten proposals put forth by a strategic consultant, they were commandments from a Holy God. These laws have become almost universally accepted, even by divergent religions, as wise and worthy of adopting.
With all humility and a sincere desire to be unpretentious (I am not even worthy enough to scrape the grasshoppers from Moses’ designer goat skin sandals), I propose the Ten Commandments of good health to serve as a lamppost for your journey down fitness lane. It seems unfair to hurry through these guidelines, so I will opine in the next posting on the second five.

Commandment One
You Shall Exercise:
Live Longer, Reduce Stress, and Grow Your Brain
Exercise is the elusive fountain of youth. If you are heavy, harried or hormonal, moving with purpose is a critical part of the solution. Everyone knows exercise is good for you, but few of us follow through. Exercise begins above the neck with a commitment to self and family. Part of this motivation lies in the hidden benefits of exercise that are not common knowledge such as the prevention of breast and prostate cancer, reduction in the onset and progression of Alzheimer’s disease, and as a cure for clinical depression. Start with a simple walking program and free yourself from the “couch of doom”.

Commandment Two
You Shall Rest:
A Nap a Day May Keep the Doctor Away
We live in a hurry-up culture where “Just Do It” supplants “Let It Be”. Busyness has be¬come a virtue that is without merit. Idle hands are the devil’s playthings only in those who haven’t learned the discipline of relaxation. Certainly there is a place for goal setting and industrious behavior, but there is also a purpose in rest and play. Relaxing on purpose is healthier than just doing something aimlessly. A major area of our lives that is most affected by this culture of chaos is sleep. The average adult requires eight hours of restful sleep a night to function best the next day. The average adult actually gets around six hours of sleep a night. This obvious disconnect leads to chronic fatigue and foggy thinking. 40% of Americans (100 million people) are moderately to severely sleep-deprived!

Commandment Three
You Shall Not Worry:
Make Stress Work For You
Stress is the little yapping dog biting at the heels of our health. It is generally an annoyance, but, if it goes on long enough, can become a festering wound. There are a number of books and counselors that provide a wealth of guidance on effective stress management in a world that oozes anxiety. Studies indicate that up to 75% of visits to doctors are related to anxiety. Stress is simply a perception of an internal or external event and thereby can be influenced by our thoughts. One person’s stress is another person’s opportunity. You will never be without stress, but you can control and minimize the adverse effects.

Commandment Four
You Shall Get Checkups:
Prevention Pays Lifelong Dividends
A healthy mind and body is dependent on action and education, not passivity and ignorance. You must be an advocate for you and your family’s well-being by embracing prevention. Men are especially negligent in this arena, and often decisions regarding family health are delegated (by default) to women in the household. Seventy percent of health decisions involving the family are made by mom, which includes checkups, vaccines, nutrition, and screening tests. Most importantly, the woman, by her actions and decisions, sets the tone for current and future health decisions. A major health care crisis today is not cancer, AIDs, or heart disease, but people not making healthy, proactive lifestyle decisions. We have to transform a system based on sick care to one that truly embraces well care, and that can only be achieved by practicing individual, responsible prevention.

Commandment Five
You Shall Not Be Gluttonous:
Eat Your Way to Good Health

We are often called a society of consumption. The talking heads are referring to consumerism; however, the real consumption issue is what we eat. Our diet has more of an impact on our health and longevity than almost any other activity. Content and quantity are the evil twins of gluttony. There are four simple guidelines that, if followed consistently, will provide a foundation of healthy nutrition that will build a legacy of wellness. Simply stated, eat balanced, low fat, low sugar, and high fiber meals. It is possible to alter the health inheritance of our kids and grandkids by changing how we think about food. You can spring the family from the prison of poor nutrition and not be held captive by your genetics through a simple and doable eating plan. We truly are what we eat.

Next time…what else but six through ten!

The first time I heard the word I almost tripped over the narcoleptic dog passed out in my hallway (a story for another day). My running partner and accountability Nazi just arrived having inhaled two Grande Expresso Lattee Mocha whatevers, and he was ready to run.
“Today we are going to do a fartlek!” he babbled shaking uncontrollably from a caffeine blood level that would kill a moose. I paused, trying to comprehend through a haze of diet coke and Bagel Bites what in the heck he was talking about. Suppressing even my most vile middle school tendencies, I repeated what I had thought I had heard him say.
“A fart who?”
“ No, it’s not a who, it is a what. A fartlek. Speed play. Come on, any runner knows what a fartlek is.” I had to admit that if knowledge of distorted bathroom words was the singular qualification to be labeled a runner, I had failed miserably. There is no doubt that runners have a unique jargon, much like any obsession such as miniature car collecting and online war games, but obviously my education was seriously lacking. I had mastered VO2 max, lactate threshold, glycogen depletion, and carbo loading, but fartlek…no. Even writing it makes me giggle. Admit it. Try and say it three times in a row without laughing out loud. Any experienced runner can tell you there are times when, well, let’s say things emote unintended, yet I couldn’t imagine that they could build a whole workout around this unfortunate event.
Indeed fartlek is a legitimate term in the running lingo and it does mean speed play. It is Swedish (there’s the problem) and has been a mainstay of training for distance runners for years. Fartlek training was developed in the 1930s by Swedish coach Gösta Holmér (1891-1983) and has been adopted by many track aficionados since. It was designed for the downtrodden Swedish cross-country teams, which had been thrashed throughout the 1920s by Paavo Nurmi and the Finns. Holmér's plan used a faster-than-race pace and concentrated on both speed and endurance training I can only imagine that first day of practice for the hapless Swedes.
“Okee doakee Sven, today were going to fartlek past those fiendish Finns with explosive intensity!”
The idea is to use short bursts of speed to improve fitness and endurance. It also incorporates hills and rough terrain as it was originally designed for cross-country athletes. There is even a Fartlek Hill in Quantico, Virginia used by the Marine Corp to whip its officers into shape.
“Sound Off, One, Two Three, Four. I don’t know but I can see. Fartlek Hill makes a man out of me. Sound Off”
I do gravitate to the idea of speed play. We don’t often think of exercise and workouts as play, but I am convinced that the more we see this kind of activity as enjoyable and playful, the greater the benefits. There are not many studies about attitude and exercise, but I can tell you from my own experience that when I am running and just letting it flow, problems seem to melt away. I find that I look forward to my next run as I know I will feel better, look better, act better and avoid seeing Paris Hilton on TV for another day. If it is fun, your consistency and benefits skyrocket. Now it may be that you are just too tired to do anything else, but whatever works!
Speed play tricks the body into better fitness. It literally stresses the muscles and as they adapt, they strengthen. Our lives also sometimes need to be stressed for us to adapt and grow. It is hard to accept this in a culture where failure is equated with leprosy. I know personally that I learn the most from my failures. I don’t like this somewhat backward appearing logic. I would much rather learn voraciously from success after success, but the reality of my life is that successes often only follow failure. Rarely do they precede them. I don’t mean to imply that failure is to be embraced like a warm puppy on a frigid day. Fight it, avoid it, hate it, but understand that when it comes, and it will, learn from it.
After a strenuous fartlek session, my legs feel like rubber linguine, but I know all those little magic mitochondria are constructing new and stronger muscle cells like a Mexican building crew on a deadline. I will come back stronger from the stress.
We really don’t play enough. Years ago Robert Fulgham wrote a wonderful little tome in which he claimed that everything he needed to know in life he learned in kindergarten. I think he was right. One of those things was to play more. We are programmed to stop playing early in our upbringing, often at the bequest of a harried parent who just wants us to sit still and finish our summer reading book assignment. Some adults however never lose their lust for play. They are called adult attention deficit disorder patients! Seriously, if we all just played more and worried less we would live longer to have more time to devote to the important things in life like is the American Idol voting rigged and is Lindsay Lohan going to her fifth or sixth rehab? Play doesn’t have to be a pick up game of kick the can in the backyard, it is anything that actively engages the mind and the body and is intrinsically fun. Those of us who have kids understand the importance of play. We see it everyday.
Speaking of kids, if you ever want to completely embarrass your 10 year old daughter, proudly announce to her and her group of friends that you are going out for a short fartlek. Believe me, they will talk about that one for years.

I love my ManCave. If a man’s house is his castle, his ManCave is his 5 star Hilton resort. The truth is most ManCaves are dumps, but appearance is only superficial. The attraction of the ManCave goes beyond structure, it lies in function. You see, a ManCave is anywhere or any place a guy can be himself. It is a safe place where he can do the things he loves and not have to apologize, justify, or explain his actions. Before you start having “Silence of the Lambs” thoughts, let me explain.
When we bought our current house it came with a carport (Oh excuse me, a porte- cochere), a greenhouse, a pool, and a freestanding structure about the size of a small bedroom. The prior owner had used this separate building as a woodshop (his ManCave no doubt) so it was decorated in early Cro-Magnon décor. Once all the equipment was removed its true rustic nature was revealed. Let me reiterate that a ManCave is not dependent on appearance, comfort, “Trading Spaces” worthiness, or the number of roach motels per square foot. A ManCave is a state of mind. So with much pleading and gnashing of teeth I convinced my bride to let me take over this space and make it my own. I suspect that she relented only because it was separate from the house and was shielded from all smells, sounds, or embarrassments that might emanate forth.
My ManCave became my sanctuary, my holy grail of contentment, and unquestionably my responsibility. She allotted me a generous budget of $24.99 for decorating, and darn if I didn’t easily come in below budget. You enter the ManCave on elevated iron meshwork that looks dangerously like the grates that cover those exploding steam vents on the streets of New York. You are immediately struck by the unique ambiance of the building because the door tends to stick in warm weather, and the first few minutes of the tour involve a hernia generating tug of war with the demon entrance. Once inside the attraction of the ManCave is apparent as the windowless humidity of mid July slaps you full force. Luckily I had the good fortune of finding a used window unit that fit nicely into a weak area in the wall. The parallel lines of 72 inch fluorescent lights flicker into action and the room is bathed in a sickly sallow luminescence. Prehistoric size roaches scatter with haste as to not disturb my approach. Only now, in the glare of the soothing artificial lights do you see the guts of the ManCave. In the center of the room is monolithic structure that could easily be mistaken for an ancient alter to an unknown god. In reality it is my UltraBody Stack 2000 circuit weight machine. Four stations of muscle straining, gut busting, hernia aggravating love. I have actually had this machine longer than I have been married. That is not to insinuate that this machine is anywhere comparable to my wife, believe me, she is much tougher. The weights have helped me through the tough times, only asking for the occasional lube job. There are no tears in its foam pads, but its pulleys are beginning to grind a bit, much like myself.
Surrounding the weight stack is a trinity of exercise equipment: stationary bike, treadmill, and punching bag. I must admit that I don’t utilize the punching bag often, but it is great for stress relief when my daughter says she wants to date a guy with more piercings than a Aborigine warrior. My treadmill and I have bond that is totally unnatural. It is a bit creepy when my treadmill has more miles on it than my car, but it runs on electricity, not $4 a gallon gas. This is actually my third stationary running trainer (as she prefers to be called). With Summer days that rival the Sahara and a schedule as unpredictable as earthquakes in California, I have learned that a quick jaunt on the treadmill allows me to train when otherwise I would be hooked up to an IV in an ICU recovering from heat stroke. I know the running snobs (and you know who you are) cringe in their CoolMax ultra ventilating shorts when anyone mentions treadmill training, but for me it works. I have conquered the boredom factor by positioning an old TV and DVD player in front of the treadmill to pass the time on longer runs. Not long ago my wife went with me to the local video rental store to check out some DVDs and she was horrified as she exclaimed, “Ron, those clerks all knew you by name!”.
“Yea, I guess I am in here quite a bit.” I calmly replied.
“Have you ever told them why you rent so many movies?” she asked. I could see where this was heading.
“No”. I took the bait.
“Oh my gosh, they probably think you are some pervert weirdo who has no job and just sits around all day and watches movies! I am never coming here with you again!”
“Don’t worry darling.” I reassured her. “I told them they were all for my wife who is on house arrest for exhibitionism.” I spent that night enjoying the solitude of my ManCave.
We all need that place where we can unwind, scratch various body parts, and watch reruns of Walker, Texas Ranger without offending anyone. Be it a ManCave, a car, or even a backyard, it is essential for each of us to seek and find a sanctuary where you can recharge. This is not some selfish wish or desire for it makes you a better you. Time to reflect and relax is at a premium in this society and it is one commodity that is constantly on backorder. Find your ManCave. Cherish it. Protect it. Let it make you a better man, husband, father and friend.

Since Ponce de Leon traipsed through the swamps of Florida searching for the Fountain of Youth, people have been seeking for the magic elixir of longevity. Today, while not seeking the waters of a mythological spring, we scour the aisles of the health food stores snatching up the latest antioxidants in hopes of outliving our mortgages.
Aging is a cellular event. If we want to know how to live longer, we have to know what keeps our cells happy.

Over the past ten years, watershed discoveries of what keeps our cells happy have captivated the medical community. Scouring the literature reveals seven practices that have been unequivocally linked to healthy cells and long lives. The most important and exciting part in these findings is that anyone can benefit regardless of genetics, finances, current health, or age. In other words, being healthy and living longer is foremost a choice. But here's the hard part. It requires discipline and effort.

1. Eat five servings of fruits and vegetables a day.
In a study published in the Archives of Internal Medicine in 2005, consuming five fruits or vegetables per day reduced the overall mortality of the study population by 24%. Eating this number of fruits and vegetables every day is easy to accomplish as most need little preparation and can even be used as great snacks. Today's marketplace supplies fruits and vegetables year-round, and they are some of the most affordable foodstuffs in the grocery store.

2. Do in aerobic exercise for 30 to 45 minutes a day
The most exciting research on this topic relates to exercise and its relationship to neuroplasticity or the ability of the brain to regenerate damaged brain cells. This may establish exercise as both a prevention and treatment for Alzheimer's disease and other neurodegenerative diseases. Exercise is indeed the fountain of youth and can benefit any age including kids and seniors.

3. Don't smoke!
It is amazing that this even has to be on the list, but 25% of adults still smoke and smoking among teens has increased over the past few years. A recent study from Michigan State University showed that you can reduce your likelihood of premature death by 76% by stopping smoking. One of the biggest health challenges of today is to reduce or prevent teenage tobacco abuse.

4. Maintain a body mass index of 18.5 to 24.9.
The BMI is a measure of your lean body mass (muscle) and percent body fat. Tables for calculating your BMI abound, so it is a number you should be familiar with. As your BMI increases so does the incidence of chronic disease. Another measurement that closely correlates to chronic health risks (especially heart disease) is your waist circumference. This is measuring your waist at its greatest diameter (not where you wear your belt… guys!) and studies indicate that you don't live as long if your waist measurements are greater than 40 inches in men and 35 inches in women.
5. Moderate alcohol consumption.
I know I am going to take some flak for this one, but many studies show that moderate alcohol intake (defined as one glass of wine a day) is associated with greater longevity. This is not either a justification of current consumption or a reason to begin drinking if you are a teetotaler, but the science is convincing that a little nip (and I do mean a little) can provide some antioxidant benefit to the cells. This is a great example of more is not better. It should be noted that overall the health risks of alcohol consumption are greater than the benefits in many cases.

6. Develop two or three good friendships.
In the past several years there have been some fascinating studies that have looked at the positive health benefits of social networking. There has not been a good physical explanation as to why people who have two or three close ties live longer than those who don't, however, I suspect it is more related to the emotional benefits they provide. We all know that our thoughts, feelings, and emotions directly relate to our physical well-being. People who feel good about their relationships tend to have more emotional stability. This can translate into such physical benefits as an improved immune system and a decrease in psychological problems.

7. Join a church.
I am not proselytizing or recommending joining a particular faith or denomination, however a study from 2000 showed convincingly that those who were regular church attendees were 36% less likely to suffer a major illness during the time period of the study. The positive effect of religious affiliation was independent of whether the person attended a church, synagogue, or mosque. It was those who expressed a true belief and practiced the tenants of their religion who had fewer illnesses. It was clear that joining a church for health benefits alone was not effective.

The Fountain of Youth is flowing from the pages of the scientific journals, and we can drink in the knowledge so as to live longer, happier, and healthier lives.

“I’m not kidding; it’s Miracle-Gro for the brain!” The statement reminded me of some ridiculous infomercial infecting late night TV. In this case however, it was generated from the mouth of a world class neurobiologist, so I took notice. He was speaking of a substance called Brain Derived Neurotrophic Factor (BDNF). What immediately intrigued me was he claimed that BDNF was the link between exercise and improved brain function. For years I had read articles in both the medical and running journals touting the psychological benefits of fitness, yet here was proof that fit folks were happier folks. Dr.John Ratey, a clinical professor of psychiatry at Harvard, outlined in his amazing book “Spark: The Revolutionary New Science of Exercise and the Brain” how exercise increased the production of BDNF which in turn stimulated nerve cells to grow and connect in the Hippocampus, a tiny area in the brain responsible for a number of high level functions. This growth of new cells actually translated into better memory and quicker learning. He went on to claim that certain other chemicals were released by exercising muscles that improved functioning in the Amygdala, the emotional center of the brain. The implications of this and other research are monumental.
Twenty-five years ago when I was in medical school we were taught that we were born with a set number of neurons (brain cells) and there were no more to be made…period. I remember joking in college about taking another late night excursion to the disco (yes, I am that old!) to “kill some brain cells” with Singapore Slings and Jack and Coke. We didn’t fret about the wholesale slaughter of brain cells as we all knew from biology class that we only used 20% of our brain anyway. In our way of thinking, that gave us a pretty good cushion! It was the unlucky folks born with fewer brain cells, and we all knew a few of those, who had the most to fear. We were wrong on all accounts. Now research is proving that new brain cells can be created, and formed in areas that have a major effect on cognition and emotions. Don’t take this as permission to guiltlessly get plastered; I don’t need to tell you of the disastrous effects of that, but it does open the door for medical miracles. The study of such alphabet soup as BDNF, IGF-1, and VGEF and other neuropeptides has given hope to developing successful treatments for senile dementia, Alzheimer’s and Parkinsonism. Medicine is not there yet, but we can conclude that getting fit by exercising regularly can reduce the incidence of these diseases as well as certain cancers and diabetes.
The great news is that you don’t have to train for a marathon to reap the benefits of fitness. The studies indicate that a brisk walk for 45 minutes three to four times a week can elicit these life enhancing outcomes.
One of the most exciting applications of this knowledge is illustrated by the Naperville school district. A middle class suburb south of Chicago, Naperville has been the focus of a real-life experiment documenting the benefits of fitness in kids. It is no surprise that kids who are active are more physically fit than their sedentary counterparts, but what has been found in Naperville is that these fit kids are also smarter! Over the past seventeen years the school district, consisting of 11 elementary schools, five junior high schools and two high schools, has made physical education an integral part of the school day (unlike the national average where only 6% of high schools have a daily PE program). Their gym class is not your typical dodge ball, basketball, softball curriculum (the average student in the typical hour long PE class spends 16 minutes actively moving). It is a program that promotes and measures fitness, not competition, and grades based on effort, not ability. They regularly run or ride bikes using donated treadmills and stationary bikes measuring effort by heart rate monitors. And they do it at a lower cost per student than comparable school systems! The results have been amazing. In 2002, 97% of entering freshmen were at a healthy body mass index (BMI) as compared to the national average of 65% and most striking was the impact that fitness had in the classroom. In that same year 96% of the eighth graders took the Trends in International Math and Science Test, an instrument designed to compare student’s knowledge level in different countries around the world. On the science part of the test the Naperville students scored the highest…in the world! Through a strict and comprehensive analysis it was shown that regular physical activity and fitness level correlated with the academic success of the Naperville students!
The message is clear. For adults and kids alike, regular aerobic exercise is not only good for the body, but it is great for the mind.
LINK TO "SPARK"

It was a family affair! On April 26th I had one of my dreams realized. Susan, my wife , and my oldest daughter Katie joined me for the Country Music Marathon and half-marathon in Nashville. Susan and Katie ran the half and I waddled through the full. I started off running with Katie (she is 15) thinking she may have a bit of trouble as her training was, well, a bit lax. At the first mile marker she told me to go on and let her do it at her pace and her way. She is a very independent young thing, so I didn't argue. I never saw her the rest of the race (some parts of the course were out and back, but we never passed each other)I was feeling pretty good at the 11 mile marker where the half splits from the full, so I decided to give it a go and made it through to complete my 12th marathon. I was most proud of Katie however as she had a great race finishing the half in 2:40. A remarkable time given her training regimen. The power of youth shines through! Susan also did grand finishing in right over 2 hours along with two of her running buddies.
The Country Music Marathon is a very well run race with all the amenities of a world class affair. The crowds were great and the volunteers were numerous and helpful. I can't think of anything they could have done better! The expo was one of the best I have been to and the race organizers had everything running like a well oiled machine. One of the highlights of this race is the post race concert. It is free to all the runners and this year featured Lady Antebellum, a group boasting two of Augusta's own, David Haywood and Charles Kelley (who just won the country music association new group of the year!)It was a fabulous weekend made all the more special by sharing it with family.
Run long and be fit!

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Ron Eaker

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