Women's Wellness Blog: 2018

Most of you have heard the old joke, “What do you call a bus load of lawyers going over a cliff?…A good start!” Or how about the old maxim, those who can’t do, teach. Those who can’t teach, go to law school. I realize some in this PC world may take offense, but rest assured I am not an attorneyphobe, but a couple of recent newspaper articles reignited my reticence in dealing with the legal eagles. Let me say for the record that I have many good friends who are lawyers and they are all upstanding guys and gals, so this diatribe is not targeting the vast majority of ethical, hard working attorneys. This rant specifically is against the blood sucking worthless pieces of epidermis that are illustrated by the following examples.

Recently the mega company Johnson & Johnson was hit with a $417 million dollar verdict alleging that their baby powder was responsible for a woman’s ovarian cancer. This is in spite of groups like the National Cancer Institute issuing statements like “The weight of the scientific evidence does not support an association between perineal talc exposure and an increased risk of ovarian cancer.” And that is just one statement, Google this stuff and there are literally hundreds of well done research papers that concur, there is no connection between baby powder use and ovarian cancer. None…that means NOT ANY. So you may ask, how did a jury find for the plaintiff? It’s not about truth, it’s about the show. One of the major plaintiff’s expert witness was Dr.Daniel Cramer, a researcher who has been looking at this question for 30 years, and who has made a substantial living over the years testifying in these cases. Of note, in all his own peer reviewed scientific papers published on this topic, he himself has never written that talc caused ovarian cancer. But he puts on a good show for the lawyers and the jury.

What has come from these studies is a lucrative cottage industry of weasel lawyers who see a pay day from filing and subsequently settling suits. They know that bad publicity and expenses often outweigh the costs of making these fraudulent claims go away. These lawyers are no better than the scamsters who prey on the elderly. One successful class action suit can set them up for a lifetime, and they have no problem throwing ethics out with the sham science.

The second article that got my panties in a wad was from the Wall Street Journal this past weekend. It involved a class action suit against Subway because some idiot thought their sandwiches were too short. They hired an ambulance chaser to file a suit because the “footlong” ad campaign was misleading because some of the sandwiches actually only measured 11 inches. I’m not making this up. I am amazed that the mouth breathers even knew that there was 12 inches in a foot. Some brain challenged judge ordered a judgement of $525,000 to be paid to the plaintiffs because their feelings were hurt by not getting their extra inch. Thank goodness an appeal resulted in the award being thrown out, but unfortunately not all for the right reasons. They didn’t reverse the decision because it was absurd and foolish, but because the lawyers rigged it so that they would get all the settlement money! One judge actually said, “A class settlement that results in fees for the attorneys but no meaningful relief for the class is no better than a racket.” At least he called a spade a spade.

Granted there are some class actions that are justified. Suing Justin Bieber for murdering Pop music is a no brainer, but many of these scams are simply the fodder for unscrupulous lawyers and greedy plaintiffs. I believe we need legal reform just as vitally as we need insurance, medical, and tax reform.

Okay, so no one has really said that E cigarettes will make your mammaries melt, but just think what a deterrent that would be for your high school daughter if she thought that. I mean smoking may still be cool for them, but it will be a lot less cool if they are walking around like a prepubescent boy.

The reality is that E cigs are loaded with problems and not the panacea that some thought they were. I can hear the advocates howling in my ear, “But E cigs will reduce the number of both kids and adults smoking real tobacco, and that’s a good thing.” Once they get down from their hypocritical high horse, they will see studies pouring in that show the presupposition was not true. Numerous studies are appearing that actually say the opposite, that E Cigs are responsible for increased cancer stick use in some populations, especially younger kids. One commentator went as far to say that E cigs were like a gateway drug to Marlboros.

Here’s a big red flag, big tobacco has a huge financial interest in E cigs. Is it good business sense to invest in something that is supposed to hurt your other product line? Of course not, and the executives at the cigarette companies knew this dirty little secret before the general public. David Railton, writing in Medical News Today states, “Samir Soneji — an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College in Lebanon, NH — says that although the tobacco industry markets e-cigarettes as smoking cessation tools, relatively few e-cigarette users are able to quit smoking successfully. Rather, e-cigarette use may actually lead to people taking up smoking.”

E-cigarettes could lead to more than 1.5 million years of life lost because their use could substantially increase the number of adolescents and young adults who eventually become cigarette smokers."

Oops! We didn’t think the general public would figure this one out.

Even if you discount the idea that starting with E cigs, under the auspices that it is “safer”, doesn’t lead to more smoking, the little electronic smoke makers have some intrinsic problems on their own. A recent study reported by Medical News Today found that teenagers who had used e-cigarettes had three times the amount of toxic compounds in their bodies than teenagers who had never vaped. Granted, these toxins may not cause cancer or make junior grow three eyes, but who wants additional toxins. We get enough of those things from just breathing city air or baby sitting your chain smoking senile uncle.

Apparently the little heating coils in the e cigs that make the smoke can also spew forth toxic metals and damage DNA. I don’t know about you, but my DNA is about as damaged as it can tolerate and doesn’t appreciate filling my lungs with residue from miniature radiators.

This is a no brainer…just don’t do it. Don’t inhale any toxins into your lungs from tobacco, a heating coil, or Elmer’s Glue.

I think I may have gotten two questions over the past 10 years about the female condom, and both had to do with whether it was real or a hoax. I’ve had more people ask about Bigfoot than the female condom, so initially I was hesitant to devote a blog post to it, but I feel that women are very smart cookies and the more information they have the better decisions they make. Therefore, as a public service akin to Nancy Reagan's war on drugs, I want to enlighten you about this interesting and largely effective mode of birth control.

I’m all about empowering women with choices for birth control, and the female condom is an example of a lessor known method. From experience in my medical practice I can say that this method is one of the least used, and statistics shore this up. There are a number of reasons for this, some of it extends from ridiculously ineffective marketing to the expense, but regardless of the reasons, few women are using it. Data indicates that this method of birth control is about 80% effective (about on par with the male condom), but already you can see a problem as most hormonal methods (pill, depo, etc) are quoted as being 98% effective. That’s a big difference, and needless to say there are a lot of 20% babies out there. However, 80% is better than nothing, as we all know that having sex once in the back of a pickup after prom will guarantee a pregnancy.

Let me back up a moment and briefly explain what the female condom is. It is a non-latex sheath (mainly rubber) that is closed at one end (the end that fits inside the vajaja) and open at the other (otherwise sex would be a challenge). The opening has a ring that fits around the labia, thus providing a safe passage for Mr.WeeWee. This essentially provides a protective covering isolating both genitals from any direct contact, kind of like the Bubble Boy from Seinfeld. This isolation chamber also gives the female condom its second benefit, that of preventing sexually transmitted diseases. Once again it gives the woman some say so in her own protection by not having to rely on her partner.

I mentioned cost can be a deterrent to use. Surveys indicate that the price for a single condom can range from $8 to $11. They are also recommended for single use, so you can see how this might add up. They don’t require a prescription so many who use the female condom order them from the Internet at a discount. A word of caution, know your supplier. Just because they are super cheap, I wouldn’t recommend ordering from the Republic of Ghana. I just can’t vouch for their quality.

One advantage over the male condom is that the female condom can be placed up to 8 hours before sex. This can raise a number of interesting questions, most of which I don’t want to get into, but just know that even if you place it long before the event, it should be removed in a timely fashion afterwards. In spite of some discussion boards, the condoms should not be washed and reused. I would say it would be a mood killer to open your girlfriend’s dishwasher to see a number of washed condoms splayed across the upper level shelf.

If used properly, these devices are reasonable effective at both pregnancy and STD prevention.

For additional information go to : https://medlineplus.gov/ency/article/004002.htm.

There’s nothing I like writing about more than staying…regular. That may be a reflection of my age (and my intellect) but suffice it to say, If your bowels are happy, every thing is happy.

With that somewhat ignoble introduction I want to present to you ten things you can consume that will keep the TP flowing off the shelves.

You really need to know one word when it comes to regularity, fiber. I don’t mean you have to feast on cardboard (although that probably would do the trick), but almost any high fiber food will jump start the process. For example, leafy green vegetables, celery, beans, broccoli and almonds. Hey, why not start your day with a broccoli-almond smoothie. Yum-Yum.

Prunes are the quintessential poop food. Your great grandmother probably force fed prunes to your grandfather, who in turn pumped prunes into your mother. That explains a lot doesn’t it! The reality is that the little dried plums give you both fiber and bowel stimulants in each delicious mouthful.

Continuing in the fruit vein, oranges can help “move” you. Again, they meet the fiber benchmark but also, like many fruits, contain a substance called naringenin, which sounds like a the name of a small Indian baby, but actually works as a laxative.

Here’s one that may surprise you, water. All the fiber in the known universe will not help if you’re not drinking enough H2O. Oh, and it will make you weewee also. Just remember to drink one 8 oz glass with every prune and you will be home free.

I use flaxseeds to help with some menopausal symptoms in my patients, but they are also little powerhouses of fiber. Think of them as multipurpose; kind of like the chief multi-tasker of the grain world.

Rice gets a bad rap for it’s glycemic index value (Google it) but why do you think there are so many jokes about Chinese takeout and diarrhea. It’s not the soy sauce, my friend. Brown rice especially is good for the gut and keeps things flowing.

Popcorn, it turns out, is not just for movie buffs, but for toilet buffs also. Ever wonder what Orville Redenbacher is doing when he is not making bad TV commercials, he’s in the toilet.

When Popeye wasn’t saving Olive Oil, he was visiting the ship’s head because all that spinach keep him on a tight schedule. Fiber rich and full of magnesium (i.e. Milk of Magnesia) this super food keeps you super regular.

Yogurt is not associated with fiber, but it does contain many natural bacteria that make your gut smile. A natural probiotic, this stuff has a number of health benefits but avoid the sugar laden fruit flavored types.

And finally, my favorite, coffee. Okay all you anal retentive types, I know this may not technically be a food, so get over it and go have another latte. Coffee stimulates muscle contractions in the colon, which then helps you go to the bathroom. (Coffee has many other health benefits, too: it improves circulation, your memory, makes your workouts more effective, and is full of antioxidants…it’s a miracle drug!

Happy pooping!

In medical school, the weirdest most esoteric diseases and ailments were always referred to as “interesting cases”. We soon discovered that this was code for “You best kiss your behind goodbye if you have any of these because you’re a goner.” I vowed then and there that if I could go through life and never be an “interesting case” I would be a happy camper.

That being said, I have come across some rather fascinating medical issues that most of you will think I made up, but I assure they are real. And yes, you don’t want any of them. Trichophagia, or Rapunzel syndrome, is where a person (mostly women) compulsively eat their hair. We all remember the weird girl in middle school who constantly chewed on her pigtail. This is not her. Someone with trichophagia actually pulls the hair out and makes the equivalent of a BLT and chows down. If they do it a lot, and who wouldn’t, they can actually get a bezoar. This is better known as a hairball, most commonly found in the family cat. A horrible result of a bezoar can be an infection, intestinal blockage, and even death. Needless to say, this is primarily a psychiatric diagnosis and requires aggressive treatment.

Hirschsprung’s disease, or toxic megacolon, is a largely a childhood disease where the colon’s ability to empty is severely limited. As you might imagine this results in a blockage even the Barbary Pirates couldn’t breach. This is more common in males (finally, something nasty more common in males!) and can manifest with a swollen belly, vomiting, including vomiting a green or brown substance(am I painting enough of a picture here?) constipation, gas, or diarrhea. Basically, anything horrible related to the bowels is generated by this problem.

Witness a report out of China that tells of a man who had part of his colon resected which contained 30 pounds of poop. That’s more poop than a cadre of revelers at a Miralax convention. While not a disease, there are numerous examples of medical wrongdoing that just hurts to think about. While operating on the wrong leg or taking out a left kidney when the right kidney was the problem sounds horrible, it’s not as horrible as what happened to a man in Pennsylvania recently. He went into surgery to have his left testicle removed and the surgeon instead removed the right testicle. Oops!

All’s well that ends well as the injured party received a hefty settlement and tickets to La Cage aux Folles. Hematohidrosis is a rare disease steeped in history. Those familiar with the Bible know the story of Jesus in the Garden of Gethsemane. He was in such anguish that, according to the Gospel of Luke, he “being in anguish he prayed more earnestly and his sweat was like drops of blood falling to the ground.” Since this, many who experienced “sweating blood” were labeled as stigmata, with religious as well as medical interest.

A recent article lists almost 300 cases documented in the literature. As for me, I just prefer to sweat bullets! As an aside, not only do I never want to be an interesting case, I never want a disease named after me. Imagine how Dr. Alzheimer feels. Think of the horror when Dr. Bardet–Biedl’s grandkids see picture of the poor children with the syndrome named after him (webbed toes, obesity, tiny scrotum, multiple digits).

Sometimes being anonymous has its place.

I haven’t been sleeping well lately. In some cultures, insomnia is a result of a jumbled conscience. Maybe I have a constipated consciousness right now. As I was lying awake this morning I started thinking about…kindness. Again, maybe I was unconsciously trying to piece together my lack of kindness by ruminating on it at 5 AM. Who knows.

We don’t have enough kindness today. It’s not the purview of Democrats or Republicans, Christians or Muslims, it’s a human trait that we just don’t practice enough. I really believe it is one of the things that makes us human. You don’t see Giraffes opening the door for each other or orangutans helping each other down the stairs. Sure, some animals care for their young in what appears to be a kindly fashion, but I think most of that is instinctual. Humans can choose to be kind. We need to choose that more often.

It can be so simple. A smile, a touch, some reassuring words. Kindness doesn’t really take a lot of effort. Being mean or thoughtless actually burns way more mental energy.

I remember hearing a scientist tell a story of how a butterfly flapping its wings in Malaysia could influence, through a series of escalating events, the formation of a massive storm on our west coast. I suspect that like that, a single act of kindness could change the world. Who is to say. Literature is filled with stories of kindness that changed lives and in turn, changed history.

The smile you give today may be the trigger that changes tomorrow…for all of us…and for the better.

Happy Thanksgiving!

Some say WWII would have been lost if it wasn’t for SPAM. I suspect the grunts who stormed Normandy would have a thing or two to say about that, but the point is a quick, easy, preservable protein source was needed to feed all the soldiers and as, Caesar was fond of saying, an army runs on their stomachs.

Unfortunately, SPAM (short for Spiced Ham, or Smelly Putrid Appetizing Meat, whichever you prefer) was introduced with a noble purpose in mind, but beware of unintended consequences. SPAM, like all processed meats, has been shown to be less than collegial with your arteries and gut. In fact, many processed meats have been shown to be linked to various forms of cancer. So what exactly is a processed meat?

It is any meat product that has been Frankensteined into something that stays on the shelf longer or tastes better. If you open a can of SPAM or bologna, it may stay sitting there for a millennium before it becomes rancid or full of little fungi. I wouldn’t suggest testing this hypothesis however, simply take my word for it on this one. The whole taste better bit is certainly individualized, but usually it involves sugar, salt, and more sugar. Common processed meats are sausage, hot dogs, bacon, salami, and Alpo.

In 2015, the World Health Organization (WHO are you? WHO, WHO, WHO,WHO) confirmed that processed meats increase the risk of colorectal cancer, while red meats were deemed "probably carcinogenic" to humans. This conclusion came from a review of more than 800 studies. I love the definite nature of their pronouncement.

Well, we can’t really say they cause cancer (because Big Food gives us bunches of money) but it might be the case, wink, wink. A new study takes it even a bit further. Published in The European Journal of Cancer, Dr. Jill Pell and colleagues concluded, “Compared with women who had the lowest intake of processed meats, those who consumed at least 9 grams of processed meats per day were found to have a 21 percent greater risk of breast cancer.” That comes out to about 2 hot dogs a week. I have no idea if this is limited to beef dogs as no mention in the study was made of a difference with chicken dogs, pork dogs, tofu dogs, or reindeer dogs.

Another analysis of 10 different studies concluded, “a 9 percent increased risk of postmenopausal breast cancer with processed meat intake.” What are these food Nazis going to tell us next, that kale causes hair to grow on the bottom of your feet? Actually, I am glad that this information is coming to light. There is an old saying that you should never see how sausage and laws are made, and I think that is steeped in reality.

I remember reading Upton Sinclair’s landmark book, “The Jungle” in high school and vowing never to eat meat again. After a few years, I promptly forgot that vow until I saw the documentary “What The Health” and remembered. Granted there is always some bias in these types of productions, but it is sobering, and the data seems to be piling up that SPAM and its cousins are not exactly health foods.

Have you ever heard the old saying, “A douche a day keeps the doctor away”? No. Neither have we because that was uttered by no-one , ever.

As part of my ongoing attempt to inform and entertain, what better topic to tackle than the All- American douche. In fact, douching is not a western construct as it has been around for a very long time. Ancient women across many cultures douched with honey, olive oil, or even wine in an effort to prevent pregnancy. It was common for medieval prostitutes to douche between clients, as venereal diseases were rampant. The only problem was that the water up the hoohoo trick didn’t accomplish either. In some respects, it seems logical that flushing out evil spirits would have a healthy outcome, but as we will see, logic never applies when there is a vagina involved.

Some researchers estimate that 20% of the female population uses a douche periodically. I think stipulating that it is the female population that this applies to is a bit overkill as any males trying to use this contraption may run into some technical problems. Today the douche is primarily a tool for “freshness”, kind of like Fabreeze, but historically it was thought of as primarily a contraceptive. Unfortunately, as we have stated, it was about as effective in this realm as squeezing a penny between your knees. Leave it to the French to design a beautiful apparatus (porcelain even) that allowed a vagina owner to pump fluid into the chasm in an ever so delicate manner. It was so popular that the Éguisier irrigator remained the staple of cultured women for 70 years.

This next part you may not believe, but it was on the Internet, so it has to be true. In the early 1900’s Lysol was popularized as the douche of choice. I don’t know who their marketing director was, but kudos for coming up with another magical use for the disinfectant. Unfortunately doctors reported 193 poisonings and 5 deaths from Lysol douching before 1911. Women routinely complained of vaginal burning and blisters, though lawsuits were overturned and reports covered up.

Never admitting fault, Lysol nonetheless changed its formula in 1952 to become a quarter as toxic as before. I can only imagine the late night lawyer infomercials. “Is your wawa on fire? Call me and get a check!” I also find it somewhat alarming that the corporate execs didn’t change the formula until the 1950’s. I’ll bet June Cleaver was a regular Lysol doucher.

So what’s a girl to do? The medically accepted view of douching (and mine as well) is just say no. Douching can alter the natural, healthy balance of bacteria and acidity in the vagina, which helps protect the body from infection. The vagina is self-cleaning, like your oven, so let it be free to do its thing.

If you are compelled to douche by some evil flushing demon, for goodness sakes don’t use a can of Lysol, but get a simple premixed solution of vinegar and water, but know that eating a cup of yogurt may actually do more good.

I normally don’t like to pull back the curtain, but sometimes, in the auspices of full disclosure, I feel compelled to take a closer look at myself.

This is not one of those times; however, I do want to tackle a touchy subject, that of medical mistakes. I realize that a doctor discussing this is like a mafioso talking about their bungled hit list, but since I would never dream of doing any of these things, I feel justified. Just realize that, like making sausage, sometimes it may be better off not knowing some things. Read on at your own risk and don’t, under any circumstances, forward this to any lawyers. Some might say that the whole topic of medical errors is a tempest in a teapot. I don’t really know what that means, but it actually is a significant problem. One recent study stated that 10% of deaths in the US are due to medical errors. That’s more than diabetes, smoking, or elevator music. Now I realize that all statistics are subject to bias and need to be contextual to be meaningful, but even if these numbers are wrong, it illustrates that there is something significant going on.

So what actually constitutes a medical error? Is using the wrong end of a stethoscope considered an error or is it more serious things like substituting Viagra for hair loss meds and having your hair stand on its end?

As you can imagine, the definition of error is about as clear as a politician’s conscience, so this immediately raises some red flags about how the data is collected. Obviously, there are some “errors” that have little consequence, such as taking a rectal temperature instead of an oral temperature, but others may be more impactful.

One of the biggest areas for mistakes is with medications. Probably the number one major error in hospitals are related to the timing or dosage of medications. This can arise from a variety of sources: poor communication, sloppy handwriting, stupid computer programs, or inexperienced personnel. It behooves you, if you are hospitalized, to ask each time you are given a medication what it is, what it does, and how often you are getting it. Don’t ask how much it costs or you may experience immediate heart failure. If you are unable to ask or unaware of your medications, simply inform the nurses that both your kids are attorneys and I promise they will take extra care in what they do.

One of the most innocent but frightening medical areas is in misdiagnosis. Every doctor, if they have been in practice for more than 6 mo has misdiagnosed an illness. It is just the nature of medical care that nothing is guaranteed or exact, as many illnesses initially mimic each other in their presentation. A cold, allergy, flu, bronchitis, pneumonia, or asthma may all look exactly the same in their initial symptoms. If I ordered a CT scan for every patient who had a headache, not only would I be practicing poor medicine but I would be paying for a radiologist's kid’s college. I hate like the devil to admit it, but doctors are human, sometimes, and mistakes will be made. Luckily most are very minor and of no consequence, and virtually all are unintentional. What can you as a patient do to help prevent medical errors? Here is a list to peruse:

1. Make sure that all of your doctors know about every medicine you are taking.This includes prescription and over-the-counter medicines and dietary supplements, such as vitamins and herbs.

2. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.

3. When your doctor writes a prescription for you, make sure you can read it.If you cannot read your doctor's handwriting, your pharmacist might not be able to either.

4. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?

5. If you are in a hospital, consider asking all health care workers who will touch you whether they have washed their hands.

6. If you are having surgery, make sure that you, your doctor, and your surgeon all agree on exactly what will be done.

7. If you have a choice, choose a hospital where many patients have had the procedure or surgery you need.

8. Ask a family member or friend to go to appointments with you.Even if you do not need help now, you might need it later.

9. If you have a test, do not assume that no news is good news.Ask how and when you will get the results.

10. Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.

For additional suggestions go to https://www.ahrq.gov/patients-consumers/care-planning/errors/20tips/index.html

The modern world is an amazing place to live. I mean, we have 24-hour reruns of Murder She Wrote, Microwave popcorn, and deodorant for our feet! Today’s world is filled with all kinds of technological advances that promise to make our lives easier, yet far too many of us succumb to stress and illnesses associated with that stress. Perhaps it's because all of this technology is constantly bombarding and distracting us so we never get a chance to truly relax, and end up feeling overwhelmed instead. Or, perhaps we are just 12-year-old kids in an aged body who forgot that they can’t play Call of Duty 8 hours a day. But worrying about stress only makes the problem worse, but the good news is that there are several ways to relieve stress. (and no…none of them involve Xanax)

Some people want to know if hobbies relieve stress. The short answer is yes unless your hobby is running a Meth lab in Tacoma. The truth is that choosing the wrong hobby can only make you more stressed than if you didn't have one in the first place. Here are some things you should consider before deciding on a hobby that's a good match for you: 1. The best hobbies are those that will help you not think about the obligations and responsibilities you have in your life, at least for a while. In other words, veg out! After all, picking a hobby that only makes you more tense isn't going to be all that effective. For example, a lot of people like to golf as their hobby. Now, this may be fine for some, but if you're too competitive, then what would be a leisurely game of golf for others will turn into a stressful situation for you if you are down by a few strokes. Also, if you tend to have anger management problems, you may consider avoiding sand traps. Furthermore, golf tends to be a bit expensive, (especially if you only play Trump courses) so if money problems are causing stress in your life, then an expensive hobby doesn't make a lot of sense. 2. Find a hobby that you can enjoy from beginning to end. Going back to golf for a moment, it has the advantage of being pleasurable from the first hole until the last (assuming you don’t lose all your balls on the lake hole). Something like gardening can be a good choice, too. It gets you outside just about every day, and you can enjoy your hobby, then when it comes time to harvest, you can also enjoy all of the fruits of your labor. Remember, in the right state, there is a lot of money to be made in marijuana. 3. Moving beyond the norm is a great stress reliever for a lot of people. The very act of learning something new forces you to focus on it, and that means your focus is not on the things that are causing you stress. There is also the added benefit of enriching your life in some way, which can actually help you cope with stress even when you're not engaged in your hobby. For example, if you are a nurse, you might consider learning about collecting gnomes instead of collecting bedpans. So, the answer to the question "do hobbies relieve stress?" is "yes, so long as you choose the right ones." The cool thing is that there are so many different hobbies out there, that there is sure to be a few that are a good match for you.

My kids call me the “Health Nazi.” While being compared to a war criminal may be a bit extreme, I understand their frustration with a dad who is constantly preaching “Do this, Not that”. It’s easy to fall into an annoying mantra of dictated behaviors when you are so engrossed in promoting a healthy lifestyle, so sometimes you have to take a baby step back and examine exactly what you so passionately preach.

While being introspective and self-critical is harder for me than getting a politician to cut taxes, nevertheless I have winnowed out several supposed healthy practices that I have harped on in the past which now appear either completely useless or downright ignorant.
1) Eating low fat. I have had to eat low-fat crow on this one for the past few years. I landed squarely in this camp, like many of you, based on the propaganda masquerading as education. Ever since the notorious Seven Country Study by Ancel Keys in the 50’s, we had been indoctrinated to believe that fat consumption led to weight gain, heart disease, and bad breath. The reality is that certain types of fat are worse for you than others, but sugar is the real baddie. An eight-year trial involving almost 50,000 women, roughly half of whom went on a low-fat diet, found that those on the low-fat plan didn't lower their risk of breast cancer, colorectal cancer, or heart disease. Plus, they didn't lose much weight. If you have to watch anything dietarily, watch the carbs!

2) Going gluten free. This movement has all the makings of a cult. Unless you're among the 1% of Americans who suffer from celiac disease, gluten probably won't have a negative effect on you. I know this is heresy, but the science doesn’t lie. Most folks have no issue with gluten and avoiding all the products that contain gluten can leave you with an unbalanced diet. The no gluten fanatics are about as rabid as Tom Cruise Scientology lovers, so I probably will have to hire a bodyguard after this is published, but go ahead and enjoy your wheat!

3) Juicing…anything. A few years back anyone staying up past midnight was lambasted by an infomercial touting a device that would “juice” anything from an orange to a turkey leg. Is was if pulverizing something in a blender magically endowed it with miraculous health benefits. What it really did was make it suitable for babies and old dudes with no teeth, and that’s about it. When you juice fresh fruits and veggies, you remove all of their fiber, the key ingredient that keeps you feeling full and satisfied until your next meal. What you keep is the sugar. In the short term, a high-sugar, low-protein diet means constant hunger pangs, mood swings, and low energy. So essentially when you juice you take out all the good stuff and leave the crap…that sounds healthy, right?

4) Using hand sanitizer. It was time to jump out of the nutritional world and into the world of germs. So you think that slathering on the hand sanitizer will ward off the plague, viruses, and boring small talk? Nope, it will just make your hands sticky. If you wash your hands regularly throughout the day, hand sanitizer is almost entirely unnecessary. Plus, it can't kill all the germs that plain old soap and water can. Surprise! Now, if you find yourself in the jungles of Kenya where clean running water is as rare as cellulite on a supermodel, hand sanitizer may have a place, but not so much in suburban America.

5) “Detoxing” anything. This is one of those terms like “natural” that can mean anything to anybody. In most cases, it is a marketing buzzword that sounds good but means little. I mean, who wouldn’t want to be rid of toxins? No one needs to detox. Unless you've been poisoned, you already have a super efficient system for filtering out most of the harmful substances you eat. It's made up of two toxin-bashing organs: the liver and the kidneys. The liver spends its entire lifetime getting rid of the bad junk we ingest, much better than a colonic or sweat lodge, while the kidneys spit out bad mojo in your weewee with amazing efficiency.

This is a touchy subject, filled with the potential for multitudes of infantile references and innuendo, so naturally I embraced discussing it. Realistically, I decided to blog on this subject because of the torrent of both young and old patients who have recently contacted an STD and were baffled as to where it came from. And these are not uninformed, naive college freshmen, these are mature, professional women who just didn’t understand the new reality of the dating world. Most of this is directed at the single female, as the married female or one in a monogamous relationship have generally far fewer concerns. So here is a quick primer on what to look for and what to avoid. First, understand that the more contact a guy has had the more likely he is to carry some unwanted baggage. This may apply to his psychological makeup as well as his hygiene. In this age of Internet hook ups and casual encounters, unless you have a certificate from their doctor, it’s safe to say that their likelihood of having something is directly proportionate to the number of hits on their Tinder profile. I realize that I am making some major generalizations here, but the reality is that no longer are STDs just something you can take a drug and get rid of…some can kill you. Take HPV for example. Human Papilloma Virus is as prevalent as nerds at a math camp. This virus is largely responsible for pre cancerous and cancerous changes in the cervix, so much so that many organizations recommend doing away with the Pap smear and simply testing for HPV. The problem is that there is no effective treatment for the virus. You simply have to let your body’s immune system act like little Pac Men and chew up the offending critters. Luckily most women will clear the little buggers from their system, however, as long as they are present they can cause these abnormal changes. Unfortunately, many men have no idea that they are transmitters of HPV. Some do get attractive genital warts, which is a great reason to avoid contact if he happens to announce at dinner that he has more warts than a witch’s nose. What about the magic sheepskins you may ask, and I am not talking about a diploma. Condoms can reduce the incidence of HPV spread, along with other things, but nothing is perfect. The only proven prevention is abstention, and I don’t think I have to tell anybody that that is about as popular as leprosy. Another “tool” of destruction is our friend herpes. If I guy tells you he had this once but it is gone now, run don’t walk to the nearest exit. Once you have this virus, unlike HPV, you always have it. You may not have outbreaks but every leap year, but rest assured it is there and can potentially be spread. I suspect there are some folks out there that sincerely believe that they have been “cured” but just trust me, I’m a doctor, they haven’t. Most of the time a guy can spread the joy only when he has an active ulcer, but he can be what is known as an asymptomatic shedder (great band name) meaning if you do it, you can get it. In a perfect world there would be no STDs, no elevator music, and no under cooked chicken, but this is not a perfect world. Be smart, be careful, and be protected.

So you're sitting on your couch one lazy evening watching Game of Thrones reruns and your wife/girlfriend/significant other/not so significant other/ casual acquaintance, suddenly bursts into tears.
Your proper response is:

A) start crying with her to show your sensitive side
B) run to the bathroom to see if you have any extra Xanax
C) change the channel to something less intense like The Property Brothers or
D) In your head go through all the stupid things you have said over the past few hours to see if that may be what is bothering her. This is actually a trick question because the proper response is to do nothing other than offer a hug and a Kleenex. Welcome to the world of hormones.

I don’t want to patronize or minimize the hormonal hurricanes that some women experience (Katrina was a rain shower in comparison) so as a medical professional and a guy, I can say that these fluctuations are real, chemically based, and to be respected. Most guys have the understanding of a tree frog when it comes to women’s physiology so it’s not incomprehensible that they don’t appreciate the nuances of serotonin and estrogen. Here’s my attempt to educate, enlighten, and potentially prevent relationship meltdown for dudes in dealing with PMS.

First, PMS does not stand for Punishing Men Slowly nor Potential Murder Suspect, it is Premenstrual Syndrome. Let’s break that down. The Pre part means before, like prepubertal where most guys are in their mental development. So this illustrates a salient point about PMS, it occurs at a very specific time of the cycle, that is generally the two weeks before the period. If a woman has PMS symptoms all the time it may be due to other conditions, or that she just hates you. The second term, menstrual, is a topic most guys just love talking about. Get over it. Just be thankful that you don’t bloat, ooze body secretions, and get sore nipples every month.

Importantly, however, is that these changes have to be linked to the menses for it to be true PMS. It is not wise to make snide comments about “that time of the cycle” unless you want and deservedly get a stiletto boot up your butt. Finally, the word syndrome is important as it clarifies that this is a spectrum of symptoms and not just moods and emotions. We understand that it is hard for most guys to grasp the concept that more than one thing can happen at a time (“You mean I have to watch TV and answer the phone?”), but most women with PMS will have a range of symptoms.

So what is the best way for a guy to react if a woman he loves is dealing with PMS symptoms? First, make yourself transparent. That is not to say be open and honest, literally be unseen, disappear, get lost. You will likely just aggravate her more by being around and you are a convenient target for pots, pans, Molotov cocktails, and anything else she can throw at you. Not that you probably don’t deserve that, but it saves on medical bills. If you are the understanding and sensitive type, you may be okay to stay, just don’t try to do anything other than be understanding and sensitive. Don’t patronize, try to fix things, or use this time to expand your action figure collection.

Treat your lady friend/spouse/cubicle partner/mother of your children with respect during these fluctuations. This is not a time to make fun of or minimize her discomfort. She knows she doesn’t feel well or is not at the top of her game. She doesn’t need your probing insight to tell her that she has cankles and terminal bloating.

Provide support and understanding that is genuine. Sometimes listening and not fixing is the best you can do. This is a real, physiological disorder that is no fun for the one you care about the most, so your demeanor and understanding should reflect this.

This is not to imply that all women have PMS or that all mood changes are PMS related. Guys, never assume that just because you don’t understand why your wife/girlfriend/neighbor acts a certain way that it’s hormones. Most of the time it’s simply that you are a turd and have done something disrespectful.

The bottom line for dudes is to recognize PMS is real, temporary, and lethal if you don’t respect it.

Life is full of moments. In fact, the reality is that moments are all there are…a series of never repeated fragments pasted together into a tapestry that is who you are. Okay, I realize that sounds like I just took a puff of a funny cigarette, so let me come back down to earth a bit. It is in those moments that change happens. When we talk about our health, or anything else for that matter, it’s largely about change. Our bodies change, much to our chagrin most of the time. Aging is nothing but change. The joy is in the realization that we can control some of the things that change. And that’s where the moments come in again.

Change happens in two stages. The first is in the decision to change and the second is in the implementation of change. Let’s say you want to lose weight. The choice to lose weight comes in a moment. You simply decide it’s a good thing. There are millions of reasons you may decide that, but at some point, those have to coalesce into the idea of change, and that is the moment it happens. In the real world that is the easy part. That is the moment that is necessary, but if orphaned will blow away like a tumbleweed.

The follow through is the hard part. I’m not telling you anything you don’t already know. How many times has each of us had a brilliant moment only to find it choked out of existence by procrastination, laziness, confusion, or lack of clarity.

Take weight loss again. You make the decision but it hits the wall like a marathoner at mile 21. Here’s a bit of advice as to how to bust through that wall. Be accountable. Tell someone, anyone, everyone, about your moment, whether it’s weight loss or changing jobs, or proposing, or taking out the garbage. Let the world know. That one step can motivate you to follow through almost more than anything else. The desire to change has to be intrinsic (internally driven) but the follow-through can be extrinsic (externally driven).

Ideally, tell someone who will care. If they care, they will cajole, badger, applaud or even join you in your change moment. We are social creatures, yes even you introverts like me occasionally need the input of fellow humans. Change is hard, and we need to use all the resources available to facilitate persistent change. Whatever your moment, realize that you can accomplish the unthinkable, move the immobile, dream the unlikely, or change the unchangeable. It all happens in a moment

Most normal people think that running a marathon is bizarre. Imagine what they thought if they tuned in this past Monday and saw 30,000 people running the Boston Marathon in the worst weather since the Mesozoic Ice Age.

The Boston Marathon is the Super Bowl, the World Series, the Olympics…well, you get the point, of marathon running. Thousands of young Ethiopians wake up every morning hoping to one day get that call from the Boston Athletic Association inviting them to compete against the best in the world. Those who got the call this year, regardless of their country of origin, will go back with a story for the ages. It won’t be how they out kicked their countryman for a photo finish, but how God in all Her fury released a torrential downpour of Noah-like proportions upon the scantily clad harriers lined up in Hopkinton, Mass..

This April 16th will be remembered as the marathon you could barely see on TV because the rain was so torrential and the wind was blowing flags upside down. These crazed runners faced head winds, side winds, back winds, winds that blew up their nether regions, and winds that were colder than Hillary after she lost the election. Luckily I was watching the live stream and not trying to swim upstream on the course this year as even a hard core loony tune like me didn’t want to cross the finish on Boylston St. on this day.

And what a day it was. Desi Linden, the first American female to win in 33 years, kicked butt from Framingham to downtown Boston with a show of guts tantamount to old Teddy Roosevelt lurching up San Juan Hill. She was invincible in spite of temperatures in the thirties, monsoon rain, and a contingent of Ethiopians and Kenyans all gunning for the title. In fact, the U.S.of A. put on a show that would’ve made even Donald J. Trump proud taking seven of the top ten female spots. That’s like the Jamaican bobsled team winning four consecutive Olympic golds. What was also great was that nobody had heard of the other US women who placed, even the second pace winner Sarah Sellers. You may be saying, “Sarah who?” You wouldn’t be alone because when she crossed the finish line Monday about 5000 journalists around the world were frantically Googling her name. The elements made the African contingent a non factor and allowed talent, pain, persistence, and hutzpah to reign.

On the men’s side, a Japanese runner by the distinctly Japanese sounding name of Yuki Kawauchi took the win, followed by — get this — six American men in the top ten! The last time that happened was…never! If this is the trend, I think all future marathons should be run in tornados or blizzards so the Americans can dominate.

The real story for me lies in the determination of the other 29,975 runners who, having no chance to win, braved apocalyptic conditions to complete their dream. The back story for these folks is equally amazing. I have been fortunate to run Boston five times, so I know what they endured even before the race. Remember, it was cold (39 at race start) and a persistent torrential downpour and most of the rank and file had to be bussed in four hours before the start. You amass on the playground and ball fields of Hopkinton High and Middle school, with nary a shelter. The B.A.A. places a tent in the middle of the field, generally to provide shade from the normal heat, but even if everybody was inappropriately touching everyone else, if would only fit maybe a couple of thousand. The rest of the hoard is exposed to the elements, regardless of what that consists of. I have been frozen, sweaty, and comfortable depending on the year, but nothing like I imagine it was last Monday.

So here’s to both champions and chumps, the elite and the elated, my hat goes off to all those who finished the 130 running of the Boston Marathon. Like the Jews are fond of saying, “Next year Jerusalem,” well, I say maybe “Next year Boston.” But then again, I’m old and crotchety so maybe I’ll just run in warm Boca Raton.

I suspect that you realize this is a rhetorical question as I am not in possession of a uterus myself. I guess I could have titled this, “If I exercise, would my scrotum burst?” but I don’t think it would have the same impact.

Back in the Victorian age, when men were men and women were objectified, patronized and ignored there was a prevailing belief that vigorous exercise on the part of the fairer sex would result in terrible physical maladies. This largely led to ivory skin (they never went outside without a parasol), 65% body fat, and vitamin D deficient females who were really good at drinking tea and embroidery. I suspect this misappropriation of energy was largely due to the misogynistic belief that women were incapable of vigorous activity and for them to perspire was tantamount to social isolation. In reality, it was probably related to sex in some fashion, as most everything was. Those poor women who did suffer from uterine prolapse (most likely from having 10 children) could no longer satisfy their Cro-Magnon companion, so they had to come up with a theory as to why. Obviously, it was the “wandering uterus” (hysteria for those Latin scholars) that was to blame, and anything that made you bounce (i.e. exercise) was an obvious culprit.

That reminds me of an interesting aside. The term hysteria today means an uncontrollable emotion or excitement. It is derived from the Latin word for womb (see above). There was a general belief by old white men like Plato (pay close attention, you will start to see a pattern here) that many of a woman’s ills, ranging from physical diseases to mental conditions were due to the uterus literally migrating around the body, the wandering uterus, as it was. To quote a modern paraphrase of an ancient medical text, “The uterus could move upwards, downwards, left or right. It could even collide with the liver or spleen. Depending on its direction, a wandering womb could cause all kinds of hell. One that traveled upwards might cause sluggishness, lack of strength, and vertigo in a patient; while a womb that moved downwards could cause a person to feel as if she were choking. So worrisome was the prospect of a wandering womb during this period, that some women wore amulets to protect themselves against it.” That was the modern medicine of ancient times.

So this hysterical womb has figured as a prominent facilitator of a variety of problems through the ages, so it’s not surprising that many old white men thought, well into the mid 20th century, that vigorous exercise, like distance running, would result in the uterus hitting the pavement at about mile 20. Granted, if you did 50 squats a day with 100-pound weights, you might initiate some organ laxity, but even then, your womb will not stick out of your vajaja. Believe it or not, in our enlightened modern age, some old white men didn’t even let women run marathons in the Olympics until 1984. They felt that they were doing women a favor by not allowing them to train for such an event because surly the highways and byways of the country would be littered with dropped uteruses if they did so.

Needless to say, Joan Benoit Samuelson, the winner of the first women’s Olympic Marathon, still has all her parts, as far as I know, so it became clear to most old white guys that their apprehension of women and extensive training was bunk. Today, in fact, some of the best ultramarathoners (those masochistic souls who run 100 or so miles at a time) are women, and I have yet to see any YouTube videos of ultramarathoners resting at a water stop, refueling and dropping off their uterus.

There is no reason a woman should fear physical damage from vigorous training as long as they are doing it wisely. Chances are they will quickly surpass most old white guys in both physical prowess and mental capability.

(Note to all who suffer with PMS: remember, a good sense of humor may be a tool for coping)

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Ron Eaker

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