For the Love of Spring

Guest blog by  Eva Selhub, MD

Spring is the time for new beginnings and growth, when flowers bloom and children play outdoors.  It is the time for new ideas and for plans to burgeon, for future accomplishments to be visualized.

Like the child who believes they are unstoppable or the plant that opens its buds to the warmth of the sun, Spring is your chance to expand to the possibilities of your life.  
 
But often, something holds you back.  Rather than blooming like a flower, you are likely contracting into a bud, ruminating about the past and fearing the uncertainty of the future.  
 
The thing about Spring is that it is also the time to let go of the old to make room for the new.  Thus the term, “Spring Cleaning.”  
 
In order to connect to the myriad of possibilities in your life, the message here is that you may need to let go of what you are holding onto that is keeping you from moving forward.   It means facing your fears and sweeping them out of the closet where they have been buried.
 
Now who really wants to do that?  Who really wants to voluntarily face their fears and open themselves up to uncertainty?  

Well, children do it, unknowingly, all the time.  They take risks.  They imagine greatness and adventure.  
 
How often do you take risks?  How many times have you decided to have an adventure?  When do you use your imagination to help you mitigate uncertainty?
 
If you did, you might be able to face your buried fears and let them go once and for all.   Then, when you make the space, new adventures can be had.  
 
When the stressors of life accumulate, your buried fears get triggered and they activate your fear response.  When in the fear response, you connect to little, least of all the potential of life.   The fear will shut you down, physically, emotionally and psychologically.
 
In fear, the neurobiological mechanisms are such that you lose higher cognitive functioning, your heart rate, blood pressure and muscle tension increase, negative emotions preside, and your sociability is null and void.  You lose your connection to the social support around you; to the resilience person within you; and to the larger universe that can guide you (this includes your imagination). 
 
These are the very commodities that help you overcome stressful situations, stay healthy and happy.
 
So if you are under a lot of stress in the springtime, rather than connecting, you will disconnect.  The more you disconnect, the more you shut down.  Dismal, eh?

Ah! But there is something you can do!  You can begin by connecting to your fabulous self, the love that surrounds you, and the help that may be available to you.  
 
·        First, honor the tension and anxiety you are feeling. You have every right to feel this way.  That’s right.  Create the space for you.
·        Second, acknowledge that this is an opportunity to heal buried fears.  Make more space for you.
·        Third, gently and kindly allow yourself to receive the golden rays of light from the sun in the sky and the aromas of love and life to fill your lungs and your heart (real or imagined).  Bask in it.  
·        Fourth, repeat these words:  “Receiving love and support is my birthright.”  Say these words every time you inhale.  Simply receive.
·        Fifth, let yourself fully and completely exhale, imagining that you are releasing buried fear, tension and negativity.  Out they go.  You can even use your hands to sweep the tension and fear out of your heart as you say these words, “I release the negativity that does not serve me.”  Receive and Release.
·        Sixth, imagine a smaller image of you—as an infant or child—receiving this love and support too.
·        Seventh, run around outside, for no reason.  Then, run around some more.   
Now, you are changing your physiology from stress to balance, opening up the neurons in your brain to perceive possibilities rather than fear and dread.  When you are open, you are open to the people who can help you, the universe that can support you, and the resilience within your own mind and body.
This may not change your life in an instant, but you will certainly feel better and be ready for the Spring!

Simple Solutions to Fire Up Your Metabolism

Guest blog by  "Nutrition Twins" tm
 Lyssie Lakatos, RD, CDN, CPT and Tammy Lakatos Shames, RD, CDN, CPT
Author of Fire Up Your Metabolism: 9 Proven Principles for Burning Fat and Losing Weight Forever

Let's face it, we live in a nation where at any given time, at least 70% are trying to lose weight. Although the majority of those people have desperately tried popular diets, most have not stuck to them, as strict diets require hard work and discipline. Most people really just want a quick fix. No one wants to hear that they have to exercise and eat right to achieve their weight loss goals. 

Sadly, when it comes to weight loss, there is no magic bullet. The good news is that we are about to help you to lose body fat with the next best thing to a quick fix-firing up your metabolism! 

What exactly is metabolism you may be asking? Well, simply, it is the way your body uses calories from the foods that you eat. The calories from food that are not burned up for fuel have a dreaded fate-they end up on your stomach, hips and butt as body fat, which is what happens when you have a slow metabolism. However, when you fire up your metabolism, you help your body to burn more calories so that they are not stored as fat. Follow these simple steps in order to fire up your metabolism. 

Simple Step #1: Include an "always" carbohydrate with every meal.
Eat carbohydrates and fire up your metabolism? That's right! Certain carbohydrates are very helpful when it comes to making your metabolism speedy and helping your body to burn up calories. We call these carbohydrates, "always" carbohydrates, and they include fruits, vegetables and whole grains (like oatmeal, whole wheat breads and whole wheat tortillas, brown rice, whole grain cereals, etc.). 

"Always" carbohydrates give your body the energy to be active and to burn calories-energy for even the littlest activities-they burn calories too. (Without carbohydrates, you would feel so tired that you would try to conserve energy every chance you get-the resulting inactivity leads to weight gain.) "Always" carbohydrates contain fiber (which helps to provide an extended energy boost) and nutrients that help you to convert your food into usable energy. Therefore, be sure to include small amounts (the size of your fist or smaller) of an "always" carbohydrate with every meal. 

This shouldn't be hard-you probably already include carbohydrates in your meals. Now, make sure that you are firing up your metabolism by choosing the right ones and making sure not to overeat them. Instead of having Special K, Golden Grahams or grits for breakfast try Cheerios, Grape Nut Flakes or oatmeal. Swap the roll on your turkey sandwich for whole wheat pita bread or any other whole grain bread. And order your Chinese food with brown rice instead of white. Ditch bagels and try whole wheat waffles, English muffins, whole grain toasts or tortillas and top with fruit slices instead of jelly.  As for vegetables, the more that you eat, the better. The exceptions are peas, potatoes and corn, which should be eaten in no more than fist sized portions like other "always" carbohydrates.

Simple Step #2: Eat protein. Just be sure to combine it with an "always" carbohydrate. 
Protein is the key to a speedy metabolism because it helps you to build lean muscle, which helps burn calories quickly. The more muscle you have, the faster your metabolism. Although many people believe that eating protein gives them energy, it does NOT. However, it takes longer to digest than carbohydrates, so it slows the digestion of the "always" carbohydrates and makes the energy and the metabolic boost from the carbohydrates last longer. So, eating small amounts of protein with "always" carbohydrates prevents hunger and extends the energy boost of the carbs. 

Just remember, eating a large portion of protein at one sitting will make you feel sluggish, as blood rushes to your stomach, working to digest all that protein. Your brain and muscles are left short on blood supply and energy. (Think of how you feel after a big steak meal.) To make it easy, if you eat an "always" carbohydrate the size of your fist, also eat a protein portion that fits into the cup of your hand. 

This is easy-if you are eating Chinese food, like chicken and broccoli, you would eat a serving of brown rice no bigger than your fist, chicken that could fit into the cup of your hand, and unlimited broccoli. If you eat a plate of shrimp marinara, eat a fist sized portion of pasta (ideally whole wheat pasta) and eat enough shrimp to fill the cup of your hand. Mix steamed veggies in your marinara sauce and fill up on those. (Don't worry about feeling hungry--as you will notice in step #5, when you fire up your metabolism, you will be eating too often to be hungry).

NOTE: When it comes to protein, be sensible. Choose the best proteins to help prevent heart disease. Choose beans, skinless poultry breast, skinless fish, lean cuts of red meat like the tenderloin with all fat removed, and choose nonfat or low-fat dairy products.

Simple Step # 3: Fabulous Fats. That's right-you can choose these fats and get skinny!
You see, fat provides long-lasting energy. Although carbohydrates are the bodies preferred source of energy (especially for the brain and nerve cells) and they provide your body with the energy that is stored in the body as glycogen, the body cannot store enough glycogen to provide energy for very long. That is where fat comes in. Fat helps you to spare your glycogen (energy) by providing fuel. Remember, having energy for movement is critical, as all movement (even little ones) helps your body to burn calories. So, fat helps to speed up your metabolism by making carbohydrates available for a long period of time, providing more long-lasting energy.

Also, like protein, fat is digested more slowly than carbohydrates. So, fat helps keep you satiated so that you don't overeat. Combine a little fat (or some protein) with a carbohydrate and you will avoid eating excess food while firing up your metabolism. 

Be sure to choose "friendly" fats (also know as "unsaturated" fats) that help your metabolism without clogging your arteries. Fat "foes," (also known as saturated fats), are artery clogging fats that eventually lead to heart disease, bogging down your metabolism as they make your blood "thick and sticky." This makes all body processes, including your metabolism, less efficient. Steer clear of the fat "foes," which are animal fats like butter, sour cream, full fat dairy products, fatty meats, and hydrogenated fats like, margarine.

Don't worry-this isn't rocket science! For example, you already eat this way when you choose a peanut butter sandwich or oatmeal sprinkled with nuts. (Our book has hundreds of suggestions for you too.)

Simple Step # 4: Never skip breakfast. 
Whether you choose an English muffin and a dab of peanut butter, scrambled eggs wrapped in a whole wheat tortilla, or oatmeal with almonds sprinkled on top, eating breakfast will help you to fire up your metabolism and achieve your ultimate goal. 

Here's why: Overnight, your body starts to feel threatened because it realizes that it has not eaten for a while, and it fears it might not be fed again. Your body's metabolism slows as a protective mechanism to prevent starvation. Your metabolism remains at this depressed rate as it conserves energy (calories). It barely burns calories and fat until it is fed again and feels as though it won't starve to death . 

So, speed up your metabolism as soon as you wake up by eating something! And no excuses about not having enough time-there is always time to grab a piece of fruit on your way out the door.

There are so many good options. Be sure to make a smart choice. Here are some examples (and our book has hundreds too): 
· Sliced apple and a slice of whole wheat bread with a tablespoon of almond butter on each
· Whole-wheat waffle topped with non-fat yogurt and berries
· Whole-grain cereal, such as Raisin Bran in a small bowl with skim milk or soy milk and a hard boiled egg
· Cantaloupe and non-fat cottage cheese

Simple Step # 5: Don't wait more than 4-5 hours between meals/snacks.
Just as your body feels threatened overnight when it hasn't been fed for a while, the same thing happens when you don't provide your body with food every 4-5 hours. 

Don't be fooled, you aren't doing yourself any favors by skipping lunch in order to overindulge at dinner. If you do this, by the time you get to dinner, your body really will be conserving calories and moving in slow gear. Even if you ate a normal-sized dinner, your body would perceive it as an overwhelming amount and would end up storing calories that it should have burned off. Eat a larger than normal meal, and you'll store even more. 

Note: You shouldn't add extra meals into your day. Simply take the food that you are already eating and space it out throughout the day. For example, if you usually have a turkey sandwich, a yogurt and a piece of fruit at noon, eat 1/2 the sandwich at 11:00 am, the other half and the fruit at 1:30, and then eat the yogurt around 3:00. 

Simple Step # 6: Drink the right beverages at the right time.
Water, water, water. Every process in your body takes place in water. Water carries nutrients and oxygen throughout your body. If you are dehydrated, every process in your body will suffer including your energy level, and your metabolism. 

Want to feel full on less food? Water helps fibrous foods to expand in your stomach and make you feel full. It is a myth that you shouldn't drink water with your meals. Make sure to drink water throughout the day and aim for at least 8 cups a day.

Hate water? Try these tips to spice it up: · Add a squirt of lemon, lime or orange or · Toss in ice cubes of your favorite juice


Simple Step # 7: Don't skimp on sleep.
You are more likely to gain weight when you are sleep deprived. First, the hormone that regulates your appetite, cortisol, is affected when you are sleep deprived. This has devastating results-you feel hungry even after eating enough. Meanwhile, you burn fewer calories, as you are too tired to be as active as you would be if you were rested. Additionally, growth hormone is reduced, increasing your body proportions of fat versus muscle (the more muscle you have the more calories you burn). Also, sleep deprivation impairs your body's utilization of carbohydrates, your body's favorite source of energy. Lastly, when you are tired, you look for a quick pick-me-up, and most people usually turn to the thing that will give them energy the fastest… sugar. Sugary foods are calorie-loaded and they cause you to have a short-lived energy boost followed by an energy crash. 

So be sure to make sleep a priority and aim for a minimum of eight hours of sleep a night. Make an appointment time for bed, just as you would make a doctor's appointment. 

Simple Step # 8: Make exercise a habit.
The calorie-burning doesn't only last during the exercise, but is extended for hours afterwards. Choose your favorite exercises and aim for five sessions a week for a minimum of 30 minutes. Don't make excuses, even if it means walking 15 minutes out your front door in the morning and then walking 15 minutes back.

Simple Step # 9: Make strength training exercises part of your routine.
The more lean muscle you have, the more calories your body will burn, even while you sleep. Aim to lift weights three days a week. If you're a woman who doesn't lift weights for fear of getting bulky, fear not-you don't have enough testosterone to build bulky muscles. Instead, you will get a lean, toned, sleek body. 

Sexual Crisis in Midlife

Guest blog by ChicagoHealers.com Practitioner Dr. Marilyn Mitchell MD, BHSP

We are often surprised by changes that occur in our sexual lives during middle age. The two hormones that most affect sexual physiology, estrogen and testosterone, tend to decrease during midlife, in both women and men. As a result of these hormone decreases, the most common symptoms we experience are a decreased libido (desire) and changes in sexual response. But this is just the tip of the iceberg. Sexuality is complex, especially at this life stage, and we go through other shifts on the physical, mental and emotional levels. Our roles and relationships change. While it is common for people to experience changes in sexuality during the middle years, it may not happen to both partners at the same time, further complicating the issue.

There are four components of sexuality that may be challenged at midlife: 
• Self-perception: At midlife, it is common to experience changes in weight, fitness, appearance and mood causing us to feel less desirable and therefore less interested in sex. The challenge is to do what is reasonable to improve health and appearance, and then move to embrace and accept ourselves as we enter this new phase of life.
• Sex role behavior: Women at midlife experience shifts in their psyches and often have a shift in priorities. Commonly, women begin to focus on their own needs and self care, and have more time to devote to creative endeavors. They often have a change in career and focus. Men are more likely to slow down at work and are looking to balance their lives with more leisure. This impacts behaviors, including sexual behaviors, and can require negotiation of the relationship. This is true in same sex relationships as well. 
• Sexual desire (libido): Loss of libido is common in women as they go through peri-menopause into menopause. Typically, women in this life stage don’t think about sex, don’t initiate, and don’t care that they don’t care! They are surprised at the sudden change. For some, just going ahead and starting foreplay will cause arousal and interest to follow. This dramatic change is the result of a drop in testosterone (mostly) along with lowered other sex hormones. Men may have a decreased libido as well, as their testosterone slowly wanes.
• Sexual response: Women tend to complain of slow arousal and difficulty coming to orgasm. Orgasms may elude them altogether, or be less satisfying. At the same time, men who are having difficulty with sexual response most often report erectile dysfunction. This may be an early warning sign of cardiovascular disease and a medical workup is advisable.

What you can do:
• Healthy diet: Eating for health, mostly fresh whole foods without preservatives, additives, and trans fats will provide energy to all your cells.
• Exercise: Women who exercise has been shown to have fewer symptoms of menopause, including sexual symptoms. Men and women who exercise have better cardiovascular health and sexual interest.
• Sleep: Adequate, uninterrupted sleep is important for stress reduction, hormone production, and sexual desire and response.
• Manage stress: Stress often increases at midlife, especially with the many changes that occur. Taking an honest look at your stressors and working to eliminate any of those that are possible will help. Finding practices to manage stress will improve well being in general, including sexual interest and response. Deep breathing and meditation (even 5 minutes twice a day) have been shown in formal research to improve medical health and sexual health and satisfaction.
• Improve self image: It may be enlightening to focus on your own thought messages to self Working on the above factors can enhance your positive self talk. Improving your relationship with yourself has a positive effect on sexual health. . 

Therapies for treating sexual dysfunction:

• Medications commonly used include bioidentical testosterone supplementation, either oral or cream. This will usually accompany hormonal treatment with bioidentical estrogen or progesterone in either an oral form, as a cream for local external treatment, or in a vaginal form. 
• Medicinal treatment may also extend to adjunctive anti-depressants for you or your partner or a change in current therapy for other diseases. Some antihypertensives and antidepressants will alter sexual function in men or women. 
• Herbal therapies include the herbs Damiana for improved libido, Chinese ginseng for improved libido, potency and fertility, and Yohimbe. Ashwaganda is also helpful on a long-term basis for improving sexual response. 
• Behavioral approaches can help improve sexual satisfaction. An aid to sexual health may be a change in sexual foreplay to accommodate changes in each partner and to rekindle interest. Couple therapy may be helpful, either with a professional or with the couple alone. Intimacy "planning" can help when this part of life seems to get squeezed out. 
• Energy Healing has profound effects on improving sexual health and connection. Higher levels of healing, as used in Energy Touch work, can assist with connections through multiple sets of chakras and quickly improve sexuality on the physical, emotional, spiritual, and relational levels. 

When dealing with the sometimes sudden changes that come in midlife sexuality, it is important to approach this with the same openness and honesty that is used in other areas. Sexual problems often seem insurmountable and confusing, difficult to approach and embarrassing to talk about. Knowing that this is a common problem and there are effective solutions can be helpful in working through the issues. By focusing on specific factors and symptoms and improving communication, a healthy sense of sexual balance can be achieved.

Sugar Addiction

Guest blog by Rebecca Cooper
Author of Diets Don't Work ® 

Proven to be more addictive than cocaine, a closer look at Sugar may help to explain America’s rise in obesity, diabetes and the new focus on food addiction.

A 2007 study (Lenoir, Serre, Cantin, Ahmed), found that intense sweetness surpasses cocaine reward even in addicted and drug-sensitized subjects leading to increased aggression upon withdrawal and a disruption of the dopamine/acetylcholine reward balance in the brain. 

The alterations on brain functioning brought on by highly palatable foods produce many of these hallmarks of addiction - including intense craving, the inability to control or stop use, a pre-occupation with the substance, and withdrawal symptoms - the idea of dessert becomes elevated to a whole new level.

Research is supporting evidence that food addictions has behavioral and neurological qualities that resemble substance abuse and dependence. Increased craving for food or food-related substances leads to a heightened state of pleasure, energy, or excitement (Zhang, et al., 2011)

I think it is ironic that when the government ordered cocaine removed from all Coca-Cola beverages no one would have guessed that an even more consequential substance would take its place. High Fructose Corn Syrup hit the markets in the 1970s as a wonder product. Cheaper than sugar cane with an intense sweetness we associate with confectionery delights, High Fructose Corn Syrup is now used to sweeten candies, juices, cookies, cakes, and has even found its way into less palatable tempting items including bread, soups, snacks and other pre-packaged foods. 

Intense sweetness triggers the same receptor pathways of other ingested addictive chemicals, including cocaine and opiates. It alters the transmission of certain brain chemicals including endorphins, dopamine and serotonin, which, in turn, trigger the pleasure center of our brains, leaving us wanting more. (Nicole, et al., 2008). It is important to note that with the incorporation of HFCS into food products have raised more than 1000% since 1970 (Bray, Nielsen, & Popkin, 2004). 

As an eating disorder treatment center, we consistently see what happens with patients who have an addiction to sugar and what happens when they stop eating sugar. When they eat sugar they get a sugar rush, then their blood sugar levels drop, they become tired and sleepy, they become depressed then they crave more. For some these cravings lead them back into their eating disorder.

Certainly, we can find studies to support any opinion, and much like eating disorders, every one of us is different and the effects of sugar may vary. At Rebecca’s House, we have found that when a person has the courage to realize that their relationship to food is out of alignment or is one of addiction, they can begin to change. Many clients have found that once they are freed from the bondage of sugar, their cravings and binges go away, they are less depressed, they maintain a normal weight without dieting or obsessing and they are able to improve their total health.

It’s so hard today to promote the fact that sugar is an addictive substance, leaving one craving more and more. Unfortunately, there are still many nutritionists, dietitians, and professionals who don’t believe sugar can be addictive to SOME people. In all my years of work with eating disorder sufferers and emotional overeaters - as well as the new scientific studies - prove otherwise. It is just like alcohol. Some people have no problem having a few drinks, but others cannot stop after that first drink. 

Millions of people are addicted to sugar and do not even realize it. The “food” manufactures are only concerned about their bottom line. They know that sugar is toxic and addictive; they add it to make us want their products, to feel that we must have more. We are getting sicker because our addiction to sugar, as well as our eating habits in general, have weaken our immune system. Our health care system cannot keep up with the high costs associated with obesity, diabetes, and associated diseases. 

We are in the midst of an obesity crisis in this country and I’m convinced sugar addiction is a major culprit. I’ve known this from working with disordered eating patients for decades and now with new scientific evidence maybe we can educate the general public that for some sugar can be the gateway drug to a life of obesity, diabetes, and/or addiction. Nothing less than the health of our nation is at stake. 


References
Avena N. M., Rada P., Hoebel B. G. (2008). Sugar vs. Fat Bingeing: Notable Differences in Addictive-like Behaviors; Department of Psychology, Princeton University.
http://jn.nutrition.org/content/139/3/623.long

Bray, G. A., Nielsen, S. J., Popkin, B. M., (2004). Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. American Journal Clin Nutr. 79(4):537-43. http://www.ncbi.nlm.nih.gov/pubmed/15051594. 

Lenoir, M., Serre, F., Cantin L., & Ahmed, S.H. (2007). Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8): e698. 
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000698

Zhang, Y., Von Deneen, K.M., Tian, J., Gold, M.S., Liu, Y. (2011) Food addiction and neuroimaging. Curr Pharm Des 17: 1149-1157.
http://www.ncbi.nlm.nih.gov/pubmed/21492080
www.RebeccasHouse.org. 

Return to Beauty: Old World Recipes for Great Radiant Skin

Guest blog by Narine Nikogosian
Author of Return to Beauty: Old-World Recipes for Great Radiant Skin

It’s no secret that women want to look and feel beautiful. I created Return to Beauty to pass on the wisdom I’ve learned in my twenty years as a professional aesthetician. Beauty is much easier than we think! Your radiance doesn’t require expensive lotions or toxic potions, only simple skincare recipes made from fresh ingredients in the comfort of your own kitchen. For instance, did you know that pumpkin slices under tired eyes can refresh your look for a big night out?

When I was young, I would go with my grandmother and mother to the local salon and watch them receive facials. Then I would come home and experiment on my own face, creating concoctions from whatever fresh ingredients (vegetables, fruits, grains and dairy) were in our kitchen. Some recipes were a success – some were a mess!

As I grew older, I added my love of astrology to skincare, creating recipes based upon the various needs of each sun sign. (Gemini skin needs apricots, walnuts, and extra relaxation. Cancers need a lot of pampering and hot baths.) Then I invited my friends over for beauty treatments. Thus began my lifelong affair helping people fall in love with their own radiance.

I am fortunate to treat some of the most naturally beautiful faces in the world. Women of color have supple skin that ages gracefully, so it’s important to take good care of it. To help prevent skin problems, such as clogging pores, I always remind my clients to keep their skin clean and use non-invasive products. The Cabbage Milk Cleanser recipe is perfect for cleansing without drying effects. If your skin tends to run normal-to-oily or oily, then it’s important not to over-moisturize.

Your skin also has different needs for each season so your regime should reflect changes in the weather. During the dry cold winds of fall, my Creamy Cantaloupe Coconut Face Mask pampers delicate skin. If cloudy weather dampens your mood, a warm bath with the Voluptuous Vixen Decolté Mask makes everything soft and bright again. If it’s hot and sunny - a dab of Avocado Eye Crème does the trick.

Learning your own skincare needs is a great way to empower yourself. It’s easy to stay youthful, radiant, and happy all year long.

Reducing Skin Aging- How to Get The Wrinkles Out!

Guest blog by Shari Lieberman, Ph.D., CNS, FACN
Author of Glycemic Index Food Guide: For Weight Loss, Cardiovascular Health, Diabetic Management, and Maximum Energy
Watch her interview on The Woman's Connection YouTube Vlog!

Researchers examined the diets of approximately 2,000 people who were 70 years and older to see if what they ate made a difference in the youthfulness of their skin.The participants were from Australia, Greece, China, Japan and Sweden. 

Rather than using the skin on the face, the skin on the back of the hand was examined and tested to assess actinic damage or skin aging. The back of the hand was used since some participants may have been using cosmetic products that reduce skin aging and wrinkling on the face. A silicon rubber impression method was used to keep an actual model of the skin, its texture and signs of wrinkling for each participant. 

Oxidative stress in skin is induced by sun damage and inflammation. Also, when damage occurs (e.g. exposure to sunlight) antioxidants in skin may undergo depletion. If antioxidants are not replenished continuously, deterioration of the skin can occur leading to accelerated skin aging and wrinkling. 

Topical application of numerous antioxidants such as vitamins C and E, Coenzyme Q10, alpha-lipoic acid, and flavonoids in green tea, have been shown to decrease sun damage and protect the skin against aging, improve skin wrinkling and possibly prevent skin cancer. Studies using oral antioxidant supplements of vitamins C and E simultaneously have also shown a reduction in sun damage and wrinkling of skin. However, this is the first time that daily food intake was examined to see if specific foods would protect the skin, reducing wrinkles and other signs of aging. 

SOME SURPRISING RESULTS

Overall, those with a higher intake of vegetables, legumes, olive oil, monounsaturated fat (e.g. olive oil) and legumes, but a lower intake of milk and milk products, butter, margarine and sugar products had less skin wrinkling and aging. Eggs, yogurt, legumes (especially broad and lima beans), vegetables (especially green leafy, spinach, eggplant, asparagus, celery, onions, leeks, garlic), nuts, olives, cherries, melon, dried fruits (in particular prunes, apples and pears), multigrain bread, jam, tea and water were all shown to protect against skin wrinkling and aging. Higher intakes of vitamin C, calcium, phosphorus, magnesium, iron, zinc, and retinol (vitamin A) were also very protective against skin wrinkling and aging. Whole milk sweet milk desserts, ice cream, red meat (especially processed meat), potatoes, soft drinks, cordials, cakes and pastries were associated with increased skin wrinkling and aging. 

HOW ARE THESE FOODS PROTECTIVE?

Vegetables have a high content of antioxidants beyond vitamins C and E and beta-carotene. In particular, flavonoids and other powerful phytonutrients present in foods such as tea, apples, onions, garlic and eggplant are extremely powerful antioxidants. Tufts University has identified prunes, strawberries, berries, cherries, and tea to have some of the highest antioxidant activity compared to other foods. These foods are rich sources of polyphenols have a higher antioxidant activity than vitamins C or E. Legumes are a rich source of phytoestrogens that also have potent antioxidant activity. Collectively, these powerful antioxidants protected the skin against wrinkling when consumed in the diet.

Fish intake was shown to reduce skin wrinkling when consumed with other protective foods such as vegetables. Fish is a rich source of PUFA in the form of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). While EPA and DHA are extremely important essential fatty acids that are not only important for skin, but for the cardiovascular and immune system as well, they are still susceptible to oxidation because they are categorized as PUFA. Therefore, a higher intake of fish must be accompanied by a higher intake of antioxidants. 

A diet rich in monounsaturated fat (MUFA) from olives and olive oil may increase the MUFA content of skin. MUFA is much more resistant to oxidative damage than polyunsaturated fats found in other types of oil. Also, oil assists the absorption of fat-soluble antioxidants such as vitamin E and lycopene. Margarine is made of polyunsaturated fatty acids (PUFA) and frequent intake was associated with more skin wrinkling and aging. This may also be due to the more damaging effects of trans fatty acids and their greater susceptibility to oxidative stress than other PUFA. Margarine contains far more trans fatty acids that are formed during the hydrogenization process than would ever be found in nature. Even though saturated fats resist oxidation, foods high in saturated fat such as meat and butter did not protect against skin aging and wrinkling. 

High sugar intake was associated with greater skin wrinkling. This may be due to a greater production of advanced glycosylation end products (AGE) and less clearance of these damaging compounds. AGE are found in excess as a result of the aging process and also with conditions such as diabetes. AGE are closely associated with oxidative stress and have similar damaging effects. 

SAVE YOUR SKIN

The skin is very susceptible to oxidative damage due its high content of lipids, proteins and DNA all of which are extremely sensitive to the oxidation process. By consuming more vegetables, legumes and switching to olive oil (preferably extra virgin) and eating less meat, dairy, butter and sugar you can protect your skin against wrinkling and aging. 

Selected References

1. Purba M, Kouris-Blazos A, Wattanapenpaiboon N et al. Skin wrinkling: can food make a difference? JACN 2001;20(1):71-80.
2. Boulanger E, Dequiedt P, Wautier JL. Advanced glycosylation end products (AGE): new toxins? Nephrologie 2002;23(7):351-9.
3. Shapiro SS, Saliou C. Role of vitamins in skin care. Nutrition 2001;17:839-844.

Rediscover the Joy of Eating: How a Diet is Helping Thousands Heal

Guest blog by Jenny Lass

What would you do if the comfort food you grew up loving suddenly made you sick? This is what the 70 million Americans with digestive disorders experience, and many don't find the relief they need through traditional medical interventions. The treatment options for gastrointestinal patients usually involve expensive medications with daunting side effects, such as bone thinning, rashes, night sweats and facial swelling. 

Although drug treatment for intestinal conditions is sometimes warranted, what happens when the drugs don't work or the side effects seem worse than the disease? Steroids, a common treatment for many digestive disorders, become less effective each time they're used, so patients are left with little recourse if their symptoms return. Fortunately, there are other options, such as the Specific Carbohydrate Diet (SCD), which has been a welcome option for thousands of people around the world seeking long-term help.

The SCD was developed over 50 years ago by prominent New York pediatrician Dr. Sydney Haas and made famous by Canadian nutrition scientist Elaine Gottschall. It eliminates complex carbohydrates and disaccharides so food is easier to digest - that means no grains, starches or refined sugars. The SCD was actually one of the earliest treatments for celiac disease, which is defined as an autoimmune disorder that leads to intestinal damage when patients eat gluten. 

The SCD got somewhat lost in the gluten-free hype, but many celiacs turn to it if the gluten-free diet doesn't work for them. In fact, the gluten-free diet can take up to six months to kick in, whereas many SCDers find relief within the first week. A 2004 physician-run survey found that approximately 80% of people who try the SCD are helped by it, including those with ulcerative colitis, Crohn's disease and irritable bowel syndrome. Even the autistic community has latched on to the SCD, which is sometimes more effective than the gluten-free casein-free diet.

However, the SCD is not meant to replace drugs or doctors - it's integrative. It can help reduce medication dosages, help medications work better, eliminate medications sooner or even help patients avoid medications altogether. SCDers are encouraged to seek supervision by physicians or dietitians, but they are often left to fend for themselves when the health care professionals the consult aren't aware of the diet. A lack of funding for this non-drug-based treatment has also limited the amount of research that can be done to fully understand the benefits of the SCD. The Elaine and Herbert Gottschall Foundation is finally starting to accumulate funds to support the promotion and further study of this diet.

Another challenge facing the SCD is its elimination of some of the foods we're used to eating - a prospect that might seem unappetizing at first. But a quick review of the SCD's innovative techniques and recipes shows that it is full of your old favorites, made differently. There's the art of eating virtually lactose-free dairy products. Old-aged cheeses, such as parmesan, brick, gouda, havarti, Swiss and cheddar, are naturally lactose-free due to their long fermentation time. The same principle applies to homemade lactose-free yogurt - 24-hour fermentation allows the bacterial culture to break down the lactose, leaving easy-to-digest yogurt that can be used for cheesecake, cream cheese, ice cream and breads. Being able to eat dairy is not only satisfying to the palate, but also essential for fighting low bone density, a condition that often accompanies digestive diseases.

One of the other keys to the SCD's success is its creativity in the absence of all grains. Spaghetti squash, zucchini, egg, Enoki mushrooms and squid replace crepes and noodles, and cholesterol-lowering, vitamin-packed almond flour produces authentic-tasting baked goods that are healthy and easy to make. The SCD provides the simplest gluten-free baking method on the market and uses easy-to-find ingredients. Aside from almond flour, which can be found in the bulk section of many grocery stores, bulk food stores, health food stores or online, your SCD baked-good shopping list might be as minimal as honey, butter, baking soda, spices and fruit. 

Although some may balk at the idea of eliminating a long-standing staple such as grains, it's important to note that there's nothing magic in pasta and cereal - you can find the nutrients in grains in many other foods. Squash is packed with vitamins A, B, C and folate, and almond flour is high in fiber. Eggs are one of the few foods containing naturally occurring vitamin D and red meat is one of best sources of dietary iron. 

The SCD's reliance on almond flour also takes full advantage of the "good fat" in nuts. Research shows that the fat in almonds actually helps instead of hinders weight loss because it satisfies hunger and tends to prevent unhealthy or excessive snacking. And we tend to forget that fat is an important part of a healthy diet. For example, we need fat to metabolize fat-soluble vitamins, such as A, D and E, and fat helps with temperature regulation, hormone production, and the development of the brain and nervous system.

All controversy aside, the SCD warrants further investigation. Medical journals are slowly accumulating case studies that document how this diet that got lost in the shuffle is helping people with digestive diseases who have run out of options or are searching for complementary solutions. 

Dr. Christine Horner's Program To Protect Against & Fight Breast Cancer

Guest blog by Dr. Christine Homer
Author of Waking the Warrior Goddess: Dr. Christine Horner's Program to Protect Against & Fight Breast Cancer
Watch her interview on The Woman's Connection YouTube Vlog

You have the power and ability to influence your state of health more than you ever imagined. Your choices every day significantly influence your chances of staying healthy or developing a disease such as breast cancer. My recently released book, reveals all the research-proven “natural” approaches that can dramatically lower your risk of breast cancer, or if you have breast cancer, help you to fight it and live a long healthy life. Here are a few tips:

1) Eat a plant-based diet high in organically grown fruits, grains and vegetables (especially cruciferous) and whole grains

2) Avoid health-destroying fats like trans fats and saturated animal fats. Instead, eat health promoting fats, like omega-3 fatty acids found in flax oil, everyday.

3) Think Asian: Make whole soy foods, green tea, maitake mushrooms, garlic, turmeric, and wakame seaweed part of your regular diet or take them as supplements

4) Take a good daily multivitamin

5) Take protective supplements daily like calcium D-glucarate, grape seed extract, selenium and CoQ10

6) Avoid red meat, sugar, alcohol, and smoking

7) Keep your weight ideal

8) Exercise regularly

9) Go to bed by 10 PM and get up by 6 AM and make sure your bedroom is as dark as possible

10) Use nontoxic products

11) Practice effective stress-reducing techniques daily

12) Laugh, stay positive, and make it a point to take care of your needs

Pursuit of Happiness Lowest Happiness Level Since 1972

Guest blog by Laura Berman Fortgang

A new study by the University of Chicago’s National Opinion Research Center has just released information that 14 percent of Americans are “not too happy,” the highest percentage since 1972. Whether it’s marital problems, the down economy or the persistent blues, there are easy ways to increase your happiness level.  Happiness means a lot of different things to a lot of different people, so it’s hard to figure out the cause of so much unhappiness. There are many external factors to point to in today’s landscape, however, a few time-honored steps you can take to improve your general mental and physical well-being, making it that much easier to achieve your happiness:

Let the light shine in

Since the lack of sunlight and Vitamin D can cause winter blues, the addition of light boxes and illumination bulbs in your home can help simulate spring and summer sunshine.

Stay Mobile, Get the Blood Pumping

Joining a gym during the winter can be very beneficial, as exercise will balance the brain chemistry and is especially important this time of year. However, if you don’t have the funding available, simple stretches and breathing exercises can be done right at home to get the blood pumping. If it’s not too bitterly cold outside, bundle up and take a brisk 30-minute walk as you marvel at the winter wonderland around you.

Keep Stress in Check

If you are facing unemployment or job instability, try not to take that stress out on your family. Have 'venting' time and supportive folks to include in your current challenges, but keep stress at a minimum by keeping it in check.

It's important to separate your work and home life in order to manage stress levels. Make sure you separate the two to avoid immediate and future negative results.

Find Meaning in the Small Things

Remember to appreciate all you do have. Focus on the good relationships in your life and the activities you enjoy. Do small kindnesses for others and watch your happiness factor rise.

Take a Mental Inventory at the End of the Day

Basically, give yourself a mini “pat on the back” at the end of the day. It will help you focus on all the positive things you did throughout the day, and to avoid dwelling on anything negative.
 

My Sister's Obituary

Guest blog by by Hunter Darden

I never dreamed that I would be writing my own sister's obituary. Her death had come unexpectedly and unnecessarily. Through the foggy haze of it all, I managed to write:

Fran was a rare and special person and you knew it while in her presence. She had a multitude of friends and an ability to extend herself to others. She took great care in the nurturing of her
friendships. Fran not only had beautiful porcelain skin on the outside, but a rare and precious porcelain heart as well. She radiated kindness, intelligence and great wit. She had a wonderful sense of humor and an infectious laugh. Her friends were naturally drawn back for more helpings of Fran's great company. In lieu of flowers, love your familycherish every moment.

My family and I had been on vacation with my sister and her family. She was forty-one years old and the mother to three small children. When she first began getting ill, we thought she had a typical stomach virus. However, shortly thereafter she was in severe pain. She soon became unconscious and went into cardiac arrest twenty-four hours after her first symptoms. The doctors noticed the rash and removed her tampon. There diagnosis: Toxic Shock Syndrome caused by that tampon. She was on a ventilator for two weeks before being disconnected.

How could this have happened to someone so vital? 

TSS was more rampant in the late seventies. I believe that women are under the impression that the problem was resolved; however, the warning is still in the box. My sister's doctors felt that the applicator had caused an abrasion and that is how the staph germ got into her system. It systematically shut down all of her organs. The other symptoms are confusion, diarrhea, dizziness, fainting, fever, and pelvic pain and a sunburn-like rash that usually appears on the soles of the feet and palms of the hand. It can, also, be caused from leaving the tampon in for too long. It is certainly rare now, but one death is too many. We are told that OB that is made out of cotton with no applicator is the safest form to use. Don't let something so unnecessary happen to your friends and family. I feel that creating awareness is the only way to make something good come from something so bad. I think Fran would approve.

Fran's left nostril used to quiver when she laughed real hard. I never told her. I so wish I had. Enjoy every moment with your family and friends. If a relationship is in need of repair, repair it now. In case, there is no tomorrow with a loved one, make sure and tell them you love them more than they will ever know.

You Can (and Should) Have More & Better Sex with Every Decade: How Great Sex Can BE Your Fountain of Youth

Guest blog by Genie James, M. M.Sc.,
Executive: Director of the Natural Hormone Institute
Author of From Hormone Hell to Hormone Well: Straight Talk Women (and Men) Need to Know to Save Their Sanity, Health, and―Quite Possibly―Their Lives

The best present you can give to the man you love is a renewed interest in your sex life.

National surveys report that more than 40 million American adults live in low-sex, no-sex relationships and forty-three percent of women say they suffer from some kind of sexual inadequacy due to lack of desire or loss of pleasure. When asked about the issue, most women and men fondly remember their randy and sexually robust 20's but then, as the decades roll by, mistakenly resign themselves to an increasingly infrequent and lackluster sex life. Age, stress and fatigue are common excuses. And, as pounds pack on and breasts and buns begin to droop, the thought of getting naked is more likely to spawn a full-blown anxiety attack than a ready and primed sexual engine. 

The real reason your sex drive is in the toilet: "It's not your age, your stress or that your body has some road miles on it --Honey, it's your hormones!" So what's a gal or guy supposed to do? Here are a medically-proven, all-natural and wallet-friendly three step plan to boost those lagging hormones and turn back your sexual clock no matter your age. 

In Your 30's
Signs that your hormone production is starting to slack off: You would rather fold an extra load of laundry than have sex in the morning. In addition to a dip in your sex drive- if you can no longer fit into your skinny jeans, you don't have the energy you used to, you are suffering from post-partum depression and/or you are irritable and snapping at your children or husband, -your body is waving red flags that it is missing its much needed progesterone.
Solution: 1.) Start using an over-the-counter bioidentical progesterone cream, 2.) eat foods shown to help restore the balance between estrogen and progesterone levels (such as cruciferous veggies, citrus fruits, flax seed/flax seed oil and whole grains) and 3.) get off your buns and move for at least 30-40 minutes five or more days a week.

In Your 40's
Signs that your production of more than one hormone has shifted: You feel that having sex once a month, vs. three to four times a week, means you are still healthily 'sexually active'. Other signs of an underlying hormone level imbalance can include: you are wearing jeans with elastic in the back or you have resigned yourself to giving away those great clothes now 2-3 sizes too small, you can't sleep through the night, you are burning up with hot flashes and you believe you are either chronically depressed or suffering from early Alzheimer's or both. 
Solution: 1.) if an over-the-counter bioidentical progesterone cream is not doing the trick, try adding an over-the-counter bioidentical estrogen (estriol) product to your daily regimen, 2.) Eat more phytoestrogen-rich foods such as soy (soy beans, soy milk, miso, edamame and tofu) and, also, try some centuries-old herbal aphrodisiacs and orgasm enhancers such as L-arginine, ginkgo or horny goat weed, 3.) Turn up the heat on your work outs: vigorous exercise for 45 min- 1hr at least five days a week (Remember: what is good for your heart is good for your genitals).

In Your 50's, 60's and Beyond
If you have not had a period for more than one year, you are officially a menopausal mama. This is the time of life that, when your husband wakes you up wanting a little action, you might be tempted to hand him a $100 bill and tell him to go buy a sheep. The biochemical reality is that you have not fallen out-of-love, your body is truly out-of-hormones. Progesterone production has slipped to almost zero, estrogen levels are in the toilet and odds are that your testosterone production has shifted from a regular flow to an erratic dribble.

You now need a full-court press approach to rejuvenating your hormone health and restoring your sex life. 
Solution: 1.) Try adding a herbal testosterone booster (such as Peruvian gingseng or nettle root) to your over-the-counter bioidentical progesterone and estrogen regimen. If your symptoms persist, it may now be time for you to see a physician who can analyze your hormone levels, determine your specific hormone deficiencies and, then, prescribe for you an individualized dosing of bioidentical hormones, 2.) To increase testosterone levels and restore your sexual urge through your daily diet, eat more foods rich in essential fatty acids and L-arginine (flaxseeds, nuts, dark leafy green veggies and oily fish like salmon or mackerel), zinc (liver, oysters, whole grains), and 3.) Start weight lifting. Research shows that an exercise program that works your large muscle groups such as squats, dead-lifts, bench presses and rows increase testosterone levels.

SEX-tra Benefits: More Sex Can Be Your Fountain of Youth
Medical research and clinical studies show that more sex can:
-Give you a better body: sex is a calorie-burning, body-toning exercise.
- Improve heart health: a half hour of steamy sex can increase your pulse rate and get your heart pumping as if you have just run a mile or two.
- Reduce stress and lower blood pressure: people who have more sex stay calmer even under duress. 
- Make you a nicer person: sex releases a hormone called oxytocin that has been shown to cause people to act in more kind and loving ways.

Mommy MD Guide to Pregnancy and Birth

Guest bloggers in blog
Authors in The Mommy MD Guide to Pregnancy and Birth: More than 900 tips that 60 doctors who are also mothers use during their own pregnancies and births (Mommy MD Guides) 

More than 900 tips that 60 doctors who are also mothers use during their own pregnancies and births. Here are ten of our favorites! 

Trying to relax: Meditation is a huge part of my life. It gives me a buffer from reality. I have a fairly intense life, and I do a lot of listening. Sitting quietly in meditation allows my brain to rinse out like clothes in a washing machine. The chance to sit quietly and to learn to be an observer is a helpful skill in pregnancy—and also in parenting. It helps you to be more receptive to what your kids are trying to say.
—Nancy Rappaport, MD

Taking prenatal vitamins: Vitamins are no good to you if you throw them up. One trick if you have morning sickness and can’t choke down your prenatal vitamins is to chew a children’s Flintstones Vitamin instead. Flintstones Complete vitamins, for instance, contain 400 micrograms of folic acid, which is what most experts recommend pregnant women get each day.
—Ashley Roman, MD, MPH

Taking a pregnancy test: When I thought I might be pregnant, I took a home pregnancy test. Actually, I took a lot of home pregnancy tests. When the first one came back positive, I worried perhaps there was something wrong with the test. So I took another. It was positive too. But I took another one the next day just to be sure. I took about four of them before it was all said and done.
—Kerri A. Daniels, MD

Telling your partner the good news: I took my pregnancy test at the hospital, and my med school classmates knew that I was pregnant before my husband did. When I took the little stick home with the positive sign, I just rang the bell and stood there with it in front of my face. My husband’s jaw dropped, and then he just smiled!
—JJ Levenstein, MD

Coping with morning sickness: At some point in the pregnancy, I stopped being able to tolerate flat liquids of any kind—even water. Seltzer water always came to my rescue. It worked best during those times when I was at a restaurant and I felt the nausea wave coming. If you don’t like plain seltzer, try one with fruit flavoring.
—Tyeese Gaines Reid, DO

Fighting fatigue: I was in my last year of residency during my third pregnancy. Standing on my feet was simply too exhausting, so I made great use of the rolling stools in our practice. I sat on one every chance I got. I’d even roll it in the hall between exam rooms instead of walking. Sometimes I’d ask other people to push me! When you’re tired, don’t walk if you can stand, don’t stand if you can sit, don’t sit if you can lie down, and sleep whenever you can.
—Rallie McAllister, MD, MPH

Caring for pets: When I was pregnant, we had a hamster. They carry a disease that can be dangerous for pregnant women. So I relinquished my hamster care duties to my husband. He didn’t think it was so great.
—Sonia Ng, MD

Easing the (heart)burn: When I was pregnant with triplets, I had terrible, unrelenting heartburn. I discovered that eating ice cream and sipping a little milk helped. So I coated that heartburn with some ice cream! The ice cream (plus medication my doctor prescribed) eased the heartburn enough that it wasn’t waking me up anymore. Of course, by then I was waking up for a zillion other reasons.
—Sadaf T. Bhutta, MBBS

Taking the heat. I was pregnant during the summer in Texas, and I was warm all of the time. At night, I set the air-conditioning to 65, but still I was sprawled out on the bed. My husband slept in flannel pajamas under a goose-down comforter. If he rolled over and touched me, I screamed, “Stop touching me! It’s too hot!” I was so miserable.
—Marra Francis, MD

Enjoying sex during pregnancy: Before I got pregnant, my husband and I had a healthy sex life. We had a lot of sex while I was pregnant too. In fact, we had sex the morning my water broke. We just found ways to make it happen. Sex was relaxing for me and lovely for him. It’s good to bank up a lot of “credit,” because after the baby comes, you won’t be able to have sex for a while.
—JJ Levenstein, MD

Handling unsolicited advice: When people give you unsolicited advice, feel free to blurt out the rudest
thing you can think of. Then blame it on the pregnancy hormones.
—Ellen Kruger, MD

Treating back pain: During the third trimester of one pregnancy, I had sciatica, which is pain in the lower back that runs down the leg. There’s not much you can do for that when you’re pregnant. I went to a massage therapist who specialized in treating pregnant women and had a massage. The massage did help a bit—temporarily. But better yet was the hour of relaxing and being pampered.
—Lezli Braswell, MD

Easing swelling. During my pregnancy, I had bad swelling of my feet and fingers. Whenever I had the chance, I’d put my feet up, especially at night when I was watching TV. I think it’s helpful to keep a foot stool nearby. Also, it sounds counterintuitive, but it helps to stay hydrated. Don’t stop drinking if you’re swelling. I drank a lot of water during my pregnancy, and an occasional caffeinated soda.
—Aline Tanios, MD

Coping with cravings: I think it’s important to listen to your body. Cravings are a normal part of pregnancy. They’re not a sign that anything is wrong. If you’re craving something unhealthy, try to eat something healthier, such as yogurt instead of ice cream. But if you really must have that ice cream, eat it.
—Erika Schwartz, MD

Considering cord blood banking: My husband and I decided to bank each of our children’s cord blood. We thought we would do that just in case something happened. Researchers are finding more and more applications for stem cells, so I think that in the future cord blood might be even more useful. It’s like life insurance.
—Dianna K. Kim, MD

Decorating your nursery: I’m a total pragmatist, and I don’t spend a lot of time decorating. It’s not
my gig. When I was pregnant with my twins, I did paint a big picture on the wall of the nursery of my older daughter and the twins holding balloons. While I was painting it, my daughter walked into the room. She took off running, and I heard her yell, “Daddy, Mommy’s painting on the wall!”
—Susan Wilder, MD

Breathing easy despite shortness of breath: My middle daughter was a long baby, and I carried her up high in my ribs. Toward the end I was very short of breath. It was awful. I would feel like the wind was getting knocked out of me. When I had to run in the hospital to deliver a baby, I’d have to sit down and catch my breath before I could catch the baby. I tried to walk as much as possible, not run, and I sat down to catch my breath a lot.
—Marra Francis, MD

Choosing a pediatrician: I went into preterm labor with my first baby. I was terrified that she would be born early, and I found a pediatrician who was also board certified in neonatology. She’s cared for my children ever since, even though we’ve moved twice and it’s now a 45-minute drive to her office. She’s awesome.
—Ann LaBarge, MD

Soothing itchy skin: During my pregnancy, I had itching on my belly. I put a lot of vitamin E and cocoa butter lotion on the area. If the itching was very intense, I put an ice pack on it, which really helped.
—Diane Truong, MD

Preparing your pets for the baby: Our cat was our baby before our babies were born. My husband and I bought a tent for our baby’s crib to keep the cat out of it. We were concerned how the cat would react to the baby because she was already five years old when our daughter was born. We were right. When the baby came home, the cat was not very happy!
—Mary Mason, MD

Packing your birth bag: I packed my bag around a week or so before I went into labor. I packed reading materials, outfits for the baby, and my Boppy nursing pillow to help me breastfeed. I also took my computer because the hospital had wireless Internet. I was actually able to use my computer because the
baby slept a lot!
—Amy J. Derick, MD

Easing your fears: Pregnancy is overwhelming. This is probably good preparation for parenting, which is even more overwhelming. At some point during my pregnancy, I realized that I was doing my best, and then I would just fake the rest. I stopped trying to control every variable. We all muddle through. I just try to use my best judgment.
—Ellen Kruger, MD

Resting up before delivery: I snuck in a pedicure the afternoon before my water broke. That was my
last pedicure in a very long time, and I was so glad that I got it in just under the wire.
—Ashley Roman, MD, MPH

Dealing with foot pain: Be good to your feet, or they will make you pay. My favorite shoes during pregnancy are the brown Hush Pup-pies loafers that I still wear now. They helped me stand for hours while ob-serving surgeries then and now. Of all the orthopedic brands, Hush Puppies had the trendier styles. Before my Hush Puppies, my arches would ache endlessly. They definitely quieted my dogs.
—Tyeese Gaines Reid, DO

Going into labor: When I went into labor, my husband and I both panicked a bit. He’s a cardiologist, and he started telling me to breathe.
“How do you know I need to breathe?” I asked.
“It’s what they do in all of the movies,” my husband said.
So we mimicked what we had seen on TV and in the movies, and it was fine. I don’t remember early labor being very uncomfortable at all because it happened so quickly.
—Diane Truong, MD

Going to the hospital: My second child arrived on time, in the middle of the night in a rainstorm.
My husband sang the Billy Joel song In the Middle of the Night to me in the car on the way to the hospital. I think of that night every time I hear that song.
—Elissa Charbonneau, DO

Controlling pain during labor: I wanted to have an epidural, but I really wanted to feel what contractions
felt like first. I was induced. My mom kept saying that she thought I had been having contractions prior to going in, but I didn’t feel a thing. She insisted I was having them and just didn’t know! 
“I’ve never had a contraction before,” I said. “But I think I’d know it if I felt one.”
Then the contractions got started.
“Nope, I didn’t feel that before,” I said. “I’ll take that epidural now.”
—Kerri A. Daniels, MD

Seeing your baby for the first time: I cannot adequately describe how I felt when my babies were born. At the time, the analogy came to me forcefully that it was just as if I had died and there really was a Heaven with the Prophets and the Angels, and that you could look at them clearly and see they were like real people, with eyelashes and fingernails. My baby’s eyelashes and fingernails seemed that impossible and vivid to me. Just to look at them seemed impossible.
—Elizabeth Berger, MD

Magic Diet

Guest blog by Rachel Madorsky
Author of Create Your Own Destiny! Spiritual Path to Success.

At my parents' house - second to potatoes - red beets were always one of the main vegetables at meals. During my youth, I did not pay any attention to their medicinal quality. Beets only became part of my diet after I have learned about their healing benefits. The Oncology/Hematology Department of the local hospital used beets as an active ingredient in their patient meals because of their miraculous qualities. Many of my patients have asked for specific diets, which reminded me of this wonder vegetable. 

The medicinal value of beets was used by such well-known doctors of the distant past as Avicenna, Hypocrite, Galen and Paracelsus. Doctors of Ancient Greece used beet juice to cure fevers, anemia, and diseases of the digestive and lymphatic systems. 

The root of the beet contains a large amount of sugar, a small amount of fiber, fat, a large amount of cellulose, pectin, organic, pantothenic and folic acids, many vitamins, various microelements (iron, iodine, calcium, potassium, cobalt, magnesium, manganese, copper, fluorine and zinc), pigments and many other substances. 

A beet surpasses many vegetables because it contains amino acids and mineral substances. The beets have a gamma-amino acid, which plays an important role in metabolism. 

The use of beets for medicinal purposes has been proven by scientific study. Research from the last decade validated the curative properties of dark-colored red beets. 

Betaine and betanin - an albuminous, alkaloid-like substance in the red beet - improve the digestion of food and help to create choline, the substance that increases cell activity in the liver, strengthens the walls of capillaries, decreases cholesterol in the blood and improves the metabolism of fat. Choline readily forms salts, several of which have been used in medicine as lipotropic agents in the treatment of fatty degeneration and hepatic cirrhosis. 

As indigestible cellulose, pectin and organic acid contained in the beet travel through the digestive system, they absorb and remove from the body poisonous substances of microbic origin, salts of heavy metals, radioactive isotopes and cholesterol deposits. In addition, these substances in the beets strengthen peristalsis, promotes active secretion of digestive juices and bile. Red beets also promote wound-healing, act as a diuretic, anesthesia, laxative, or anti-inflammatory. Red beets also aid in the lowering of blood pressure. 

For medicinal purposes, it is best to use the root of the beet, its juices and its leaves. In case of illnesses of the liver, constipation, digestion, obesity and hypertension, it is recommended to eat 100-150 g. of cooked beets on an empty stomach. One or two tablespoons of beet juice also can be taken before meals. Better effects are achieved when beet juice is diluted with water and other juices. The regular consumption of beet juice rejuvenates the skin. Juice from raw beets or freshly grated beets is richer in vitamins and minerals than juice made from cooked beets. However, cooked beets or cooked beet juice is better for digestion problems. Hungarian physicians recommend drinking beet juice in dozes not more than 100 ml. daily. During my trip to Turkey, I noticed that local residents drink beet juice after they consume meat.

Making Healthy Restaurant Choices

Guest blog by Editors of Prevention Magazine with Ann Fittante, MS, RD

At a popular pizza chain, the personal pan pizza with sausage packs 740 calories and 39 grams of fat. And at one major fast-food joint, a triple cheeseburger with everything has 810 calories and 47 grams of fat -- two meals' worth of calories and more fat than most of us should scarf down in an entire day. 

The bright spots in this grease-spattered scenario? First, you. Your power as a restaurant patron lies in your order. The waiter, cook, and manager want you to leave happy -- just tell them what you want. Second, more and more fast-food spots, casual dining eateries, and even upscale restaurants offer healthier alternatives on their regular menus. 

We believe that a meal away from home should be delicious and enjoyable -- there's no need to order dry chicken breast, have only a glass of water . . . and sulk. The trick? A little preparation so that you can outwit the menu, sidestep temptation, withstand the siren song of enormous portions, and leave the table happy. 

Have it Your Way

Eating out is, in a sense, eating blind. You don't usually have access to nutrition labels, so you don't realize how the cheese, butter, oil, sugar, and oversize portions are adding up. (That focaccia club sandwich? It packs 1,222 calories and 65 grams of fat!) The veggies may arrive dripping with butter and cream. The bread's heavenly, but it's white. That salad that seemed so healthy may have more calories and fat than a cheeseburger, thanks to fried chicken strips and an ocean of dressing. 

And then there are the portions. When a pair of New York University nutrition experts weighed and measured the everyday foods served up in Manhattan's delis, bakeries, and sit-down restaurants, their results were amazing: Compared with government-recommended portion sizes, pasta servings were five times heftier, cookies were seven times larger, and muffins weighed three times more. Why you might not notice: Portions have slowly, slowly increased in size over the past 30 to 50 years. "What I found was appalling," says study author Lisa Young in her book Portion Teller: Smartsize Your Way to Permanent Weight Loss. "The foods we buy today are often two or three times, even five times, larger than when they were first introduced into the marketplace." 

If you suspect that restaurant eating is a minefield, you're not alone. Even chefs have food issues when faced with a yummy menu -- or the temptations cooking in their own kitchens. (If you were constantly surrounded by chocolate lava cake, fettuccine Alfredo, raisin nut bread, and bacon-wrapped filet mignon, what would you do?) "Having lunch at a restaurant is where I can get into trouble," confesses chef Sara Moulton, host of Cooking Live with Sara Moulton and Sara's Secrets on the Food Network, cookbook author, and executive chef at Gourmet magazine. Who wouldn't find it hard to resist the extras (like foie gras or a six-dessert sampler) that chefs often send to her table? 

Yet Moulton stays slim -- and even dropped a few pounds when she was about to start hosting a live television show several years ago. ("The camera really does add 10 pounds," she says.) Her strategy? Don't let yourself get too hungry, especially before a dinner out. "When you're hungry, your resistance to snack on tempting foods plummets," she says. She does splurge a little on weekly dinner dates with her husband. "Knowing I can have some cheese on Friday night helps keep me disciplined the rest of the week," she says. At lunch, Moulton sometimes can't resist eating an entire 714-calorie mozzarella, tomato, and basil sandwich. And yet, she believes in not letting a diet detour derail her successful efforts to maintain a svelte figure. She gets right back on the horse: "On those days, my dinner is a 300-calorie Lean Cuisine." 

How can you achieve -- and maintain -- a lean silhouette while still enjoying a night out at a bistro? These strategies will help. 

Step 1: Prepare Your Plan of Attack

It's amazing how much trouble you can get in even before your meal arrives. Take a proactive stance against the unhealthful food assault catapulting in from all sides. 

Spoil your appetite. Before you leave for dinner, eat something substantial like a bowl of soup, a piece of leftover chicken, a piece of toast with low-fat cheese and leftover vegetables, yogurt with fruit and nuts, a hard-cooked egg, or apple slices sprinkled with cinnamon. Any healthy minimeal will be lower in calories and fat than an over-the-top restaurant appetizer. 

Know where you're going. Become familiar with the dining guidelines for different kinds of restaurants, and try to picture what you're going to eat before you even walk in the door. Don't let the menu sway you! If you've been to the restaurant before and can resist the temptation, keep the menu closed. Order what you'd like, and let the waiter sort it out. It's your meal -- have it your way. 

Avoid the bread basket. It's one of the leading causes of overeating at restaurants. Send the basket back -- out of sight is out of mind. If that's unthinkable, take one slice of bread to enjoy with your meal. Bread can tack on an additional 500 calories to your meal's total -- not even including the butter or olive oil that usually accompanies it. 

Limit yourself to one alcoholic drink. Alcohol, whether in the form of a cocktail, wine, or beer, can weaken your resolve for exercising thoughtful moderation with your food. Plus, it dehydrates you and offers no nutritional benefit. When you go out, limit yourself to just one drink -- or order a bottle of fancy water instead. 

Because the body will use the alcohol for energy first (followed by carbohydrates, protein, and fat), when you drink and eat, the excess calories are often stored as fat. To keep the pounds from piling on, skip higher-fat entrées (such as duck and filet mignon) in favor of lower-fat fare (including white fish, pork, poultry, and venison) when having wine with dinner. 

Drink water. You've heard this before, but we'll say it again: Drink water before, during, and after every meal, whether you're at a restaurant, at home, or anywhere else. 

Step 2: Place Your Order With Confidence

If you feel intimidated by servers, stop right now. Don't worry that you're holding them up with your questions and requests. Don't feel shy. Running interference between the kitchen and your table is a server's job, and he or she wants to please you. (There's a tip at stake here . . .) 

Be constantly aware of portion sizes. Trust us: You likely won't need an appetizer and an entrée. Some restaurants have been known to serve up to seven times the normal portion for a meal. 

Plan to leave food on your plate -- or request that half of your meal be wrapped before it even comes to the table. Why you want to keep the extra food out of sight: In a Pennsylvania State University study, researchers found that all the volunteers who were given extra food on their plates ate it -- without reporting feeling any fuller afterward. 

Appetizers are generally more realistic portion sizes. Order your favorite as a meal with a side salad, or order two appetizers -- one that is more vegetable-based. 

Ask, ask, ask. Is it fried? What kind of sauce comes with it? What sides are served with each dish? Can I get brown rice instead of white? 

Always request sauces and dressings on the side. You'll realize how little sauce and dressing you really need. 

Don't order something new when you're very hungry. If you do, you'll likely order too much food, overeat, and regret it later. If you're starving, order a standby that you know is good for you. 

Order plenty of vegetables. Get a large mixed salad, or order vegetables sautéed in a bit of olive oil or steamed with sauce on the side (so you can lightly dip them in the sauce). 

Sip some broth. Soup is a good high-volume food that will fill you up. Look for vegetable, broth-based, and bean soups. Avoid cream-based soups and chowders. 

Step 3: Finish With a Flourish 

Don't let down your guard after the server scurries off to the kitchen with your order. You'll still need to exercise some caution when your perfectly ordered meal arrives. 

Stay alert. It's easy to get caught up in an engaging conversation and eat everything on your plate without even thinking about it. After you've finished your allotted amount, have the server wrap up your leftovers. The bonus is that you have tomorrow's lunch (or dinner) already prepared. 

End your meal with refreshing green or herbal tea. Ginger tea can help with digestion, and green tea is good for your overall health. Many restaurants now offer a variety of exotic teas, so treat yourself to some! Some teas are so fruity that they're a perfect replacement for dessert. 

Order a dessert for the table. Three bites of the chef's signature chocolate bread pudding with butterscotch sauce won't hurt -- just make sure someone else will finish the rest. 

The Last Medical Taboo

Guest blog by....sources below

"Taboo" health conditions, such as Stress Urinary Incontinence (SUI), create monumental challenges for the medical community. More than 90 percent of people suffering from SUI are women, and, according to the National Association For Continence (NAFC), SUI symptoms affect an estimated 34 million women in the United States today. In fact, in a recent survey on SUI conducted by NAFC, one quarter of women aged 18 or older reported leaking symptoms in the month preceding the survey.1

While these statistics are daunting, the most alarming fact is that most of these women suffer silently, have not reported their symptoms to their physicians and, thus, have not been diagnosed properly. 

The following explores SUI, its impact on sufferers and available treatments.

Urinary Incontinence: "The Last Medical Taboo"

Urinary incontinence is often referred to as a "widespread disease and one of the last real medical taboos for many people"2 The shrouded nature of the condition leads many epidemiologists and women's health experts to believe that the true number of sufferers in the United States is more than reported. In the US alone, urinary incontinence affects three in ten women and is more prevalent than diabetes, hypertension or depression among female patients in the primary care practice setting.3 Due to the embarrassing nature of their symptoms; however, nearly half of these Americans are too ashamed to discuss this problem with their health care professionals. 

Incontinence manifests itself in a variety of forms, and women suffer from three main types: 

Ø Stress urinary incontinence (SUI) - an involuntary loss of urine with an increase in abdominal pressure caused by a physical activity such as coughing, laughing, sneezing, lifting or exercising. In patients with SUI, the urinary sphincter lacks sufficient strength to prevent urine leakage when an abdominal pressure increase causes an increase in bladder pressure. 

Ø Urge urinary incontinence (UUI) - occurs when there is involuntary loss of urine associated with a strong sensation of the need to void. UUI can appear in women somewhat later in life than does SUI. It can occur when the bladder is irritated or overactive or, most commonly, when the ability to suppress bladder activity is lost (idiopathically).

Ø Mixed Urinary Incontinence (MUI) - occurs when a patient has a combination of both stress urinary incontinence and urge urinary incontinence symptoms (SUI + UUI)

Other forms of urinary incontinence exist. For example, the condition may appear as a side effect of a surgical procedure like a hysterectomy, or it may stem from a neurological disorder or a disease like Alzheimer's disease. Leakage from urinary incontinence may also occur with bladder problems. In overflow incontinence, for example, a patient may experience leakage when the quantity of urine exceeds the bladder's holding capacity.

Yet SUI, a distinct form of UI, differs markedly from other types of incontinence, including overactive bladder (OAB), and it is the most prevalent form of the problem. 
The primary causes of SUI are:

· Nerve damage,
· Muscle damage or weakness, and · Damage to the support of the bladder and urethra

Two types of events cause SUI: those that directly damage or weaken the pelvic muscles, or those that indirectly damage other pelvic support structures like muscles, nerves or the blood supply.

Other factors that may promote the onset of the disease include childbirth, obesity, smoking, and constipation.4 In certain cases, women may have a neurological, anatomic or muscular predisposition to develop SUI.5

Overcoming the taboo about SUI requires addressing several misperceptions and facts, including the following:

· SUI is a legitimate medical condition, but eight out of 10 women mistakenly believe that it is a normal part of aging. On the contrary, women in the prime of life suffer from SUI. Research published by the World Health Organization (WHO) confirms that SUI affects 35- to 60-year old women

· Only one out of 12 women seeks help for her condition, preferring instead to cope for several years before discussing the disease with her doctor

· Sufferers say the condition is embarrassing, socially isolating and debilitating

SUI: The Emotional and Psychosocial Impact

Stress urinary incontinence presents a tremendous emotional burden for the patient. The emotions result from three areas of impact: self-image, lifestyle and relationships.

Emotional Impact of SUI on Patients

SUI sufferers find the condition to be embarrassing, socially isolating and debilitating, impacting them emotionally. Many see the condition as a personal failing, damaging self-image and often creating a pervasive, perpetual sense of loss of self-control. 

At the same time, SUI can inhibit a sufferer's lifestyle. Relationships - and intimacy -may become constrained and a woman may feel rejected, as she tries to conceal the condition, avoid possible embarrassment and keep others from being repelled by the condition. 

"Incontinence wreaks havoc on your life," says Riesa Gusewelle, an SUI sufferer. "I felt unattractive and unappealing. It stressed my sexual relationship with my husband, even though he reassured me that everything was fine. I was depressed and always felt that I could smell urine. Any bearing down motion like bending over to pick something up from the floor caused leakage. As a result, I really restricted a lot of my daily activities."

Coping Mechanisms

Stress urinary incontinence disrupts peoples' lives in both little and big ways. Sufferers tend to isolate themselves because they're afraid of having an accident in public. Women wear sanitary napkins or wads of tissues in their undergarments. Many adjust to the condition by avoiding favorite activities, like exercising, gardening or picking up a child. According to the Simon Foundation, some are afraid to venture far from home, fearful of having an accident in public. Sufferers may find themselves mapping out paths to restrooms before they leave their homes. The majority simply learn to tolerate their symptoms because they think this is something that is supposed to happen to them. 

"SUI has a huge impact on a woman's self-esteem, as her most cherished relationships become affected by various coping mechanisms," says Diane Newman, MSN, and author of Managing and Treating Urinary Incontinence. "For example, a woman may decide to stay home and give up her favorite hobbies in order to avoid embarrassment. Over time, this has a devastating impact on a woman's view of herself and her life."

Doctor-Patient Communications

Many women refuse to discuss the condition with their doctors - or they wait years before doing so.

"Doctors need to know that embarrassment is a major issue for women with stress urinary incontinence," said Dr. Nicolette Horbach, Associate Clinical Professor of Obstetrics and Gynecology at George Washington University Medical Center and a practicing physician. "I personally suffered from stress incontinence following the birth of my son, and it made it difficult for me to get down on the floor and run and play with him. I tell my patients that embarrassment shouldn't stop them from living their lives."

Financial Impact of SUI: A Lifetime Medical Concern

Stress urinary incontinence also exacts a significant financial toll. Annual expenditures for SUI are similar to other chronic diseases in women. In 1995, the total societal cost of incontinence worldwide was estimated at $27.8 billion per year.6

Absorbent pads and undergarments are not inexpensive: they can cost daily users several hundred dollars or more a year. Nationally, adult incontinence products, including adult diapers, comprise a $541 million-a-year market, according to Information Resources Inc. Since these products are generally not covered by medical insurance, they can take a significant bite out of a budget. 

Recently, the Society for Women's Health Research conducted a study quantifying the significant added medical costs for women treated for SUI in the United States. The findings showed that the incremental, lifetime medical cost of treating a woman with SUI is $58,000, compared to treating a woman without the condition. 

"These findings show that the medical costs for treating SUI are staggering and should prompt a much needed Call to Action," said Nancy Muller, Executive Director, NAFC. "The study helps us raise awareness of the need for women to educate themselves about SUI and their potential health risks, since the condition is so prevalent among women in our society."

Consulting a Physician

To establish the SUI diagnosis, a physician will ask about a woman's medical history and urinary habits. Since this may embarrass some women, they might consider keeping a voiding diary, recording when the bladder empties and bringing it to their physicians.

Specialists, including urologists and urogynecologists, use a variety of testing methods to measure:

· The amount of urine a patient is able to retain before urinating
· The force of the urine leaving the body
· The amount of pressure within the bladder as it fills with urine
· The strength of the bladder valve muscle function

Tests commonly used to establish a diagnosis include:

· Urinalysis - examines urine for signs of infection, blood or other abnormalities

· Stress test - measures any urine loss that may occur when pressure is put on bladder muscles through common physical activity

· Urodynamic testing - examines bladder and urethral function. May involve inserting a small tube into the bladder. X-rays may also be used to visualize the bladder function.

Treatments for SUI: An Unmet Medical Need

SUI presents an unmet medical need: behavioral approaches often fail, there are currently no approved drugs to treat the condition, and surgery is often a patient's last resort. 

Following are existing alternatives for SUI treatment: 

· Behavioral Intervention: Physicians generally pursue non-invasive therapeutic interventions before attempting to treat SUI with surgery. Such interventions include: 

o Kegel exercises: exercises designed to help women with SUI strengthen weak pelvic muscles around the bladder. Often the first line of treatment, Kegel exercises strengthen the pelvic floor muscles and assist in toning the bladder valve muscle. These are, however, difficult to perform and, because most women do not take the time necessary to ensure their success, the compliance rate is low

o Changing fluid intake: for some people, increasing or reducing fluid intake or changing the timing of fluid intake allows them to increase bladder control

o Biofeedback: electronic devices or diaries to help patients track, and ultimately control, incontinence when the bladder and urethral muscles contract. Often used in concert with Kegel exercises and electrical stimulation

o Electrical stimulation: electricity can stimulate contraction of the muscles in the lower pelvis, which reduces the symptoms of SUI

· Medications: Since no approved drugs are currently on the market to treat the condition, and medications used to treat overactive bladder are not effective in treating SUI, MDs have limited treatment options.

· Surgical intervention: surgical intervention may be appropriate for some women. In some cases, surgery may lift a bladder and/or urethra in the correct alignment and prevent the loss of urine as a result of laughing, coughing or sneezing. The invasive procedure can be performed through abdominal surgery or transvaginally. In other cases, implants are injected into the tissues around the urethra to add enough bulk to close the urethra and reduce stress incontinence. Collagen (fibrous natural tissue from cows) and fat from the patient's body have been used for implants. The procedure has only a partial success rate, and injections must be repeated after a time because the body slowly eliminates the substances. 

Recently, research has uncovered evidence supporting a connection between the central nervous system and the proper functioning of the lower urinary tract. This research suggests that the central nervous system plays a critical role in regulating lower urinary tract function and control, and scientists are continuing to study this area to advance the use of pharmaceuticals to treat SUI.

First Steps: "A Call to Action, Focus on SUI"

To raise awareness of SUI and its impact - and to break down barriers to effective communication about the condition - a group of twenty influential women's health, professional and patient advocacy groups, including the American Foundation for Urologic Disease, the American Urological Association, the American College of Obstetricians and Gynecologists, the Society for Women's Health Research, and the National Women's Health Resource Center, met recently and endorsed a five-point SUI Call-to-Action. These five key points address all facets of SUI, including the emotional, psychosocial, communication, economic and treatment issues surrounding this condition.

The five points are:

· Place Stress Urinary Incontinence on a public health agenda
· Enable access to patient-friendly information
· Unite to help improve access to new and effective treatment options for women with Stress Urinary Incontinence
· Break down the barriers and sensitivity to Stress Urinary Incontinence
· Empower women with the condition to live life to the fullest

Reprinted with permission from "Euro RSCG Life NRP"

Sources
_________________________

2002 NAFC survey conducted by HarrisInteractive.
2 Voelker R, International Group Seeks to Dispel Incontinence "Taboo," JAMA, 1998, Vol. 280, No.11:951-953.
3 Stress urinary incontinence in women. Bandolier - Evidence Based Health [serial online]. November 1998; doc 57-6. Available at: http://www.jr2.ox.ac.uk/bandolier/band57/b57-6.html. Accessed August 9, 2001.
Diabetes Statistics. National Institute of Diabetes and Digestive and Kidney Diseases; National Diabetes Information Clearinghouse. Available at: http://www.niddk.nih.gov/health/diabetes/pubs/dmstats/dmstats.htm. Accessed August 9, 2001.
Health, United States, 1995. Hyattsville, MD: National Center for Health Statistics; 1996. DHSS publication 96-1232. 
Bhatia SC, Bhatia SK. Depression in women: diagnostic and treatment considerations. Am Fam Physician. 1999; 60: 225-240.
4 Bump, R., Norton, P., Epidemiology of Natural History of Pelvic Floor Dysfunction, Obstetrics and Gynecology Clinics of North America, 1998, Vol.25, No.4.
5 Bump, R., Norton, P., Epidemiology of Natural History of Pelvic Floor Dysfunction, Obstetrics and Gynecology Clinics of North America, 1998, Vol.25, No.4.
6 Wagner and Hu, Economic costs of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunt; 1998, 9:127-128.

Know Why You Gained Weight It May Stop You from Regaining It

Guest blog by Judith J. Wurtman, PhD
Author of The Serotonin Power Diet: Eat Carbs--Nature's Own Appetite Suppressant--to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain

Sharon, my new weight-loss client, laughed when I asked her whether she had been on any other diets. "How much time do you have? My mother probably put me on a my first diet when I was around eleven. since I am now fifty, that means forty years of dieting."

I nodded. The story was a familiar one. The only clients who had never been on a diet were people who had gained weight from medication such as antidepressants. All the rest had bounced from one weight-loss program to another, often following whatever was fashionable. Some had even had bariatric surgery to reduce drastically the amount of food they could swallow. Yet they had managed to gain weight by constantly eating small amounts of extremely caloric foods. 

Sharon talked about her inability to control her eating when she switched from liquid low-calorie beverages or calorie-controlled prepackaged meals to her own food. She related how much she overate when she went off of diets without carbohydrates or three-day fasts or a week of residential spa food. She was now considering surgery but she wasn't heavy enough to qualify. 

She told me that she thought her weight gain was due to her love of food but when I pointed out that many thin people love food also, she grew quiet. Eventually she said that she suspected she ate out of emotional needs. "My needs keep changing but my response is always the same. When I eat, my problems disappear -- for the moment."

Dieters like Sharon are likely to regain their weight unless they have insight into the causes of their overeating and are helped to develop strategies to control it. Unfortunately, diet programs tend to focus on how to get the dieter to his or her weight-loss goal rather than giving the dieter tools to prevent the weight from reappearing again. Even Oprah Winfrey, who certainly receives more support in her weight-loss efforts than the average dieter, has lost and regained weight continually during her television career. 

The most effective way of preventing weight gain after a diet is to tackle the problems that caused it. Although each of us has our own overeating triggers, usually they can be grouped in a few categories:

1. Logistics or too much to do and too little time to do it. Sometimes the problems caused by impossible schedules seem insurmountable and affect everything from the ability to shop for food to getting too little sleep. Often the dieter's life has to be brought under control before the eating can be controlled. With either family or professional help (like a life coach), this usually can be accomplished. One client who used to overeat when she came home from work and found the beds unmade and dirty breakfast dishes in the sink solved her problems by making her kids get up earlier and doing chores before school. 

2. Work schedules, business travel and meals, toxic supervisors and fear of unemployment. Some work situations place almost unlimited obstacles in front of the dieter, especially when personal relationships are involved. And these days, the option of leaving a virulent workplace is difficult. Recognizing how work stress is affecting eating is an important first step. The dieter should seek out help, either from the weight-loss counselor or someone trained to deal with worksite problems, to develop strategies to deal with the problems. However, sometimes a job change is really necessary, as in the case of a client who worked as a pastry chef. 

3. Family and social problems may influence everything from menu planning to emotional well being. Neither the dieter nor the diet counselor can hope to solve chronic problems that may have led to years of overeating. Recognizing them and seeking help (whether from a dating service, divorce lawyer or therapist) will increase your chance of not gaining weight after the diet is over. If the problems are particularly difficult to handle, it may even be wise for the dieter to consider putting weight-loss efforts on hold to concentrate on resolving the issues that caused the weight gain. Temporarily stopping the diet may also be necessary when financial, medical or family crises arise. Seeing how your eating changes when a crisis arises is helpful in preventing overeating after the diet is over and another crisis occurs. 

4. Sabotage by not-well meaning friends, family, co-workers and casual acquaintances. Especially those who have not managed to lose weight may regard a successful dieter as a weight-gaining time bomb. Often subtle and not so subtle methods will be used to make the dieter overeat, such as asking the dieter if she has been very sick recently or mentioning that a particularly caloric dish won't hurt her. Self-sabotage is also common, especially if the successful dieter is now complimented on his or her appearance. Many clients have told me that they both enjoy and resent the attention they receive when they have lost a lot of weight. A college student made herself gain about 75 pounds after losing that amount because guys who had ignored her the year before when she was fat asked her out on dates.

Losing weight is not as hard as keeping it off. Still, as someone who was called "butter-ball" in second grade, I know it can be done.

For more information, please visit www.SerotoninPowerDiet.com.

How To Age Well

Guest blog by Shirley Madhère, M.D.
Watch the interview www.youtube.com/thewomansconnection

Aging is a natural phenomenon; we will all experience it. How we age is a matter of a number of variables, including genetics, lifestyle, health, stress, the environment, and choice. One such choice that is popular in age management is within the realm of plastic surgery. For those who choose to undergo some “intervention,” it may be in the form of minor, in-office procedures as injectables (Botox, fillers, etc.) and skin rejuvenation (laser, chemical peel, Vitaglow, etc.), or a “nip/tuck” (operative plastic surgery). Nevertheless, regardless of how one chooses to manage and show one’s age, whether or not with the help of a surgeon’s needle or knife, it is beneficial to age well and to look good for one’s given age, i.e., to be a better version of one’s current self. Before one can undertake an age management program, it is important to empower oneself by understanding how we age and what can be done to influence the process.

There are a number of factors that contribute to aging. These may be generally classified as intrinsic and extrinsic. Intrinsic factors are those with which we were born and thus cannot be controlled. Extrinsic factors are typically learned or acquired and therefore can be altered. Factors that lend to aging which may not be adjusted include genetics, skin type, and pore size, while those that may be changed for improved health include lifestyle, nutrition, and stress. Of note, appearance and how one feels about different variables of his/her life are now believed to play an increased role in wellness. In fact, the World Health Organization modified the definition of health as “… a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Moreover, wellness has been defined by the National Wellness Association as "an active process of becoming aware of and making choices toward a more successful existence." Therefore, aging well is an individualized and holistic process that encompasses internal and external aspects of health and living.

The outward manifestations of aging occur on the level of the skin and begin by age 30. As we age, the facial skin becomes dry, less elastic, less firm (from the loss of collagen), and may show signs of sun damage. It may also be uneven, discolored, sagging, and develop wrinkles and loss of volume or facial fat. These manifestations are the result of a combination of natural aging (intrinsic) as well as extrinsic aging. Although each individual is genetically programmed differently and the rate of aging will vary from one person to the next, these changes will nonetheless occur to some extent at some point. For example, the 40 year old woman will have hopefully built a healthy skin foundation that she began in her 20’s, adjusted for her 30’s and now, in her 40’s, will modify to suit the particular changes her skin has undergone, namely dryness, loss of firmness and elasticity, and possible sun damage. Typically, more definitive steps should be taken to address these issues. While a healthy skin regimen should be a part of every woman’s (and man’s) routine, it may be appropriate also for women in their 40’s to consider office-based rejuvenation procedures as Botox (to soften hard facial lines), fillers (to add lost volume), chemical peels (to even out skin tone), Vitaglow (to help increase facial blood flow and help stimulate collagen), and plastic surgery to help manage excess, sagging skin that may not respond to other therapeutic modalities. The decision to undergo any of these procedures is highly personal, where one considers one’s beauty philosophy, budget, time, and expectations, and should discuss with her plastic surgeon. 

Taking a holistic approach to beauty and wellness is how I advise my patients to look as great as they feel. I believe that beauty emanates from within and that healing occurs from the inside out. Therefore, to age well, I “prescribe” the following 10 tips to looking fabulous at every age:

1. Establish a good foundation: take care of your skin. Moisturize it, protect it from the sun, and stop touching it throughout the day! Whether with injectables or actual surgery, healthy, well-moisturized skin responds better to the needle and the knife;
2. Practice a holistic approach to beauty. The healthier you are overall, the better your skin and tissues will respond to a surgeon’s “interventions” or any other treatments. Also, know who you are and know who you are not: understand what effects look good on you; know your own face. What fits your best friend’s cheeks may not be suitable for yours;
3. Keep your mind active and your brain performing; engage in lifelong learning;
4. Stop smoking. Period. If you need help, get it;
5. Avoid prolonged, unprotected sun exposure. Enough said; you have heard it all before;
6. Be emotional: maintain an optimistic attitude and try to live an emotionally enriched life every day. Also, nourish your spirituality and have faith. Explore your metaphysical core. Be present. Practice detachment. Look for deeper meaning;
7. Honor your temple with good nutrition. A proper eating regimen will help to ensure normal healing, maintain active metabolism, and encourage efficient elimination of toxins. If healthful eating is lacking, take vitamins and supplements as directed by your physician or nutritionist as a complement to eating well. Limit intake of sugar, fat, and alcohol and stay hydrated to help your body clear itself of toxins. This is particularly helpful after surgery when your body enters into a state of relative dehydration and is briefly deprived of nutritional support;
8. Remain social: studies have shown that a strong social network may improve health and that close friendships may increase natural immunity;
9. Exercise regularly. There is really no way around it;
10. Manage stress effectively and often. Get consistent and adequate sleep every night. Listen to your body.

Aging well is as dynamic as the aging process itself. To look and feel well involves a balanced lifestyle that incorporates a variety of factors to help achieve successful living. With or without the knife, it cannot be argued that beauty is health and healthy is beautiful!
. Shirley Madhère is a plastic surgeon who practices “holistic plastic surgery” in New York City. 

Healing Pain Healing Lives

Guest blog by Cynthia Knorr-Mulder MSN, NP-C, CHt
Watch her interview on The Woman's Connection YouTube Vlog

Many of us first experienced pain as a child. A fall off a bike, a bee sting or a scrapped knee from the pavement can cause even the bravest child to run home crying to their parents, seeking comfort and healing. A hug, a band-aid and some soft music can stop bleeding in a second and comfort even the biggest bruise in a matter of minutes. 

Healing pain is as simple as it was when I was 5 years old, but along the way as I have studied medicine, I have found that many of us as healthcare professionals have forgotten what heals us best - our relationships, how we live our lives and our feelings of wholeness and belonging. For all the technological advances in pain management, modern medicine still has much to learn about healing pain. Healing is not only a one to one relationship it is a multidimensional aspect of energy. 

Pain is a symptom of imbalance. A true healer of pain recognizes that pain is not only a symptom of disharmony of the body, but a disharmony of the patients' life. Heal the patients' pain - heal the patients' life. Patients' with pain are connected to other people, to families, communities, work, their home, and yes even to the their surrounding environment. All of these relationships need to be in balance in order to heal the patients' pain and heal their lives. In fact all of the patients relationships need to be in harmony and balance in order to maintain health. 

To start the healing process the patient with pain seeking medical care must find a therapeutic relationship with their healer. This is the most important aspect of achieving healing. Many of my patients are referred to me as the last resort. They have tried everything and nothing has helped their pain. They present in my office with no hope, no emotional strength, no support, no relationships and sometimes a belief that pain will always be a part of their life. But they all present with one thing in common - pain and the intent and desire to get rid of it. I can give them all the medicine in the world, but there is little that I can do to heal them and take their pain away unless they seek healing. It takes more than just medicine to heal the pain these patients experience. It takes intent on the patients' part and a therapeutic, caring and humanistic relationship on my part.

I find myself in a constant struggle between two worlds, the scientific one where I truly believe that nothing works unless data has been researched. Then there is the intuitive side of me - a patient walks in my office and I begin to know their whole life story, why they experience pain and what it will take to change their course towards healing. To care for a patient experiencing pain is an opportunity to enter sacred space, a place where the mind-body-spirit connects to a dimension of healing far beyond this universe. 
In order to heal your pain, you need to find a therapeutic relationship with a practice that can nurture and support you. Your relationship with your physician and nurse practitioner should in a sense be a form of preventative medicine. You should feel as if you are in a sacred space where healing occurs. The healer that works with you should look searchingly into your eyes and communicate a sense of caring and trust.

Having experienced my own pain was by far the best and most important part of my training in pain management because I learned what it was like to be on the other side of my profession, as a patient with pain. I got to see through a patients eyes what is like to be a patient in pain. I will never forget this lesson and will never see pain management in the same way again. 

To care for my patients I view their pain as more than just a symptom. In order to do this, I have to remember that each patient has a story, each one a reason why they experience pain. I believe that in order to understand pain, you must understand the reason behind the pain, the life force, energy, chi, the thing that connects all things and is within all things, and the consciousness of which we are all a part. 

The art of healing is a magnificent experience. In spite of my University education that has taught me to accept the significance of researched theory, I believe that energy healing techniques can dramatically change ones experience of pain. The spiritual intensity and energy that surrounds a patient during a integrative modality session can help the patient return to a way of balance and guides the patient's body back to a pain free state.

As I see how my patients respond to my caring and humanistic philosophy it makes me appreciate the therapeutic relationship and thereby become a better healer myself. Each day I am constantly reminded that the way my patients heal and decrease their perception of pain has as much to do with the patient as it does my skills as a practitioner. 

Imagine using the best of modern medicine, the best interventional procedures and the best therapeutic relationships in a multidimensional approach that recognizes the patient as a whole, more than the sum of their body-mind and spirit. At any given moment we all have the ability to heal or be healed. Meshing together both worlds while practicing this philosophy is a very strong pain management medicine. This is what I do each day. This is what I call Integrative Medicine. 

Got Milk?

Guest blog by Dr. Jana Klauer
Author of How the Rich Get Thin: Park Avenue's Top Diet Doctor Reveals the Secrets to Losing Weight and Feeling Great

Fat-free is clearly preferred. Why waste calories on putting 2 percent milk in your coffee? Soy milk is not an ideal choice, either, because it is not a complete protein, as milk is, has extra calories, and does not give you as much calcium. 

Keep milk cold at the back of the refrigerator, at 35º-40ºF, not on a door shelf. Each 5ºF rise in temperature shortens milk's shelf life because of bacterial growth. 

The sad fact is that teens are drinking half as much milk as they did thirty years ago. Milk has been replaced with newfangled drinks including designer bottled waters, exotic juices, iced teas, and soy beverages. But the saddest fact of all is the replacement of milk with carbonated sweetened beverages. When milk is replaced with carbonated beverages, the result is a loss from the diet of protein, calcium, magnesium, and vitamins A and D. There is an almost linear relationship between the rise in consumption of carbonated drinks and obesity in teens. Teenagers need to build bone mass that will last for a lifetime. Because of this, we have to look for new and creative ways to get the calcium we need every day. Space your intake of calcium during the day and also take a calcium supplement as an insurance policy. 

Which Calcium Supplement Is Best? 

Supplemental calcium comes in two forms: calcium carbonate and calcium citrate. Calcium carbonate must be taken with meals. This is also the type of calcium found in TUMS. By consuming this indigestion remedy, you are giving your bone density a boost. Calcium citrate may be taken any time -- with or without food. I recommend that my patients take at bedtime a supplement of calcium citrate containing vitamin D. 

Even if you receive your calcium requirement from food, I recommend adding a calcium supplement just to insure adequate intake. If you have trouble swallowing calcium tablets, as many people do, try another form of calcium. TUMS and calcium chews are popular, and easy for most people to consume. They contain calcium carbonate and must be taken with food for the calcium to be digested. Calcium citrate can be taken with or without food. Make sure that your calcium supplement also contains vitamin D, for optimal absorption. 

You need to be aware of the amount of elemental calcium any supplement contains. The term "elemental calcium" refers to the amount of calcium in a supplement that is available for your body to absorb. Most calcium supplements list on the label the amount of elemental calcium. Some brands list only the total weight -- in milligrams (mg) -- of each tablet. This is the weight of the calcium, plus whatever may be bound to it -- such as carbonate, citrate, lactate, or gluconate. For calcium, the % Daily Value (DV) is based on 1,000 mg of elemental calcium, so every 10 percent in the Daily Value column represents 100 mg of elemental calcium (0.10 x 1,000 mg = 100 mg). For example, if a calcium supplement has 60 percent Daily Value, it contains 600 mg of elemental calcium (0.60 x 1,000 mg = 600 mg). It is also important to note the serving size -- the number of tablets you must take to get the % DV listed on the label. 

When choosing a calcium supplement, check the label for the abbreviation USP. The best supplements meet the voluntary standards of the U.S. Pharmacopeia (USP) for quality, purity, and tablet disintegration or dissolution. Generic brands of calcium supplements are often cheaper than name brands. However, they may not meet voluntary standards for tablet disintegration. In other words, they may dissolve more slowly, which decreases their effectiveness. Avoid calcium supplements that contain bone meal or dolomite, as these may also contain toxic substances, such as lead, mercury, and arsenic. Check the label for "no added sugar." Chelated calcium tablets tend to be more expensive and really do not have any advantage over other types of calcium. Coral calcium is also marketed as superior calcium, which has not been proven. 

Many of my patients love Viactiv Calcium Soft Chews -- chewy little squares that taste like Kraft caramels and come in several dessertlike flavors. Although they are very sweet, two squares contain 100 percent of the Daily Value of calcium and include vitamins D and K. Each VIACTIV Calcium Soft Chew contains 500 mg of elemental calcium from 1,250 mg of calcium carbonate. 

Calcium and Blood Pressure

Glimmerings of this important relationship began in 1982, when Dr. David A. McCarron noted that a diet low in dairy products increased a person's chance of developing high blood pressure. A study of the entire population of the United States confirmed his hypothesis and revealed that the people who ate the least amount of dairy products had the highest blood pressures. In fact, the normal diet of the majority of United States doesn't meet the minimal requirement for adequate calcium. This led to a 1997 clinical trial, Dietary Approaches to Stop Hypertension, or the DASH trial, which showed that blood pressure could be lowered by a diet high in fruits, vegetables, and low-fat dairy products. While fruits and vegetables lowered the blood pressure somewhat, it was the addition of dairy products that made the difference. The importance of maintaining an optimal blood pressure cannot be overstated. High blood pressure stresses the heart, strains the arteries, and increases the risk of heart attack and stroke. How remarkable that we can lower the risk for these terrible consequences simply by adding dairy products to our diets! I am constantly surprised that my patients who have high blood pressure have not been told anything about this relationship by their primary care physicians. 

If you have high blood pressure, you should have a minimum of one dairy product at each meal. This can be easily accomplished by adding a glass of skim milk, 2 ounces of low-fat cheese, or a 6-ounce container of low-fat yogurt at each meal. This can be as vital as your taking your medication. 

Marcia is a forty-seven-year-old divorced mother of two teenage sons who works as a museum curator. She was referred to me by her primary care doctor for weight reduction. When I first met Marcia, she was five foot three and weighed 160 pounds. Her cholesterol and blood pressure were elevated and she took medication for both of these conditions. On the positive side, she had a commitment to exercise and swam three times per week for the last twenty-five years. However, Marcia's diet was sadly deficient in the foods that she needed to control her blood pressure and cholesterol. Her typical breakfast was coffee and a croissant with butter, lunch was a sandwich, and dinner was often her sons' leftover pizza. These foods were the worst possible choices for someone with her health problems. In revamping Marcia's life, I suggested that she start a walk-run program, which she readily committed to. There is greater weight loss with walking or running than with swimming. For food, I suggested that she begin her day with a vegetable omelet and a glass of skim milk. For a midmorning snack, she had some plain yogurt and fresh berries. (This reminded her of the summer she spent in France, where she began each morning with fresh raspberries and yogurt.) Lunch was a fruit salad with low-fat cottage cheese. I pointed out to Marcia that it was in her best interests to encourage her housekeeper to stop indulging her sons' pizza cravings, and to have her prepare a wholesome meal for them instead. Her housekeeper began preparing grilled fish or chicken with fresh herbs, two vegetables, and a salad for dinner. She set aside a portion of the meal for Marcia, who had a glass of skim milk with dinner and a calcium supplement prior to retiring. 

The changes Marcia experienced were truly remarkable. She became a devoted runner, lost 40 pounds, and no longer required medication to control her blood pressure or cholesterol. Her health problems had been totally resolved by dietary changes. Even her sex life improved. She proudly showed me a bikini she had purchased for a vacation to France with her new boyfriend! 

Calcium and Cancer Risk Reduction

Population studies indicate that a diet high in calcium lowers the risk for colon cancer. In both the Nurses Health Study, which included 88,000 women, and the Health Professionals Follow-up Study, with 47,300 men, people with the highest calcium intakes had the lowest rates of colon cancer. There was an inverse risk of colon cancer, meaning that the more calcium consumed, the lower the risk for cancer. The way that calcium reduces colon cancer is by binding digestive acids that could potentially harm the cells of the colon lining. The cells of the colon are susceptible to damage by fatty acids and bile (produced by the body to digest dietary fat). If they are subjected to these acids on a regular basis (as is the case with a high-fat diet), the cells proliferate and polyps form. Colonic polyps are precancerous tissue. They are not cancers but, allowed to grow, may evolve into cancer. (This is why it is important for everyone to have a colonoscopy after fifty. As we age, the colon cells are more apt to form polyps. These are easily removed during a colonoscopy before they have a chance to become cancerous.) When digestive acids are bound to calcium, they are inactivated and rendered incapable of damaging the colon cells. Furthermore, when people prone to developing polyps consume high amounts of calcium, formation of polyps is reduced.

If you have had colon cancer or colonic polyps, or have a family history of colon cancer, it is wise to lower the amount of fat in your diet and increase your calcium intake. The best way to do this is by incorporating low-fat dairy products and adding a calcium supplement. 

Calcium and Weight Loss

Even more intriguing than the association of a reduction in blood pressure and cancer risk with calcium is the association of calcium with weight loss. The relation between calcium and body weight was first noted more than twenty years ago in the National Health and Nutrition Examination Survey. This study of the nutritional habits of the entire United States reported that the slimmest people had the highest intakes of calcium. Since there was no known mechanism for how calcium kept people thin, the finding was written off as pure chance. When the study was repeated ten years later, it was found that not only did the slimmest people have the highest calcium intakes, but the heaviest people had the lowest calcium intakes! Now, this got researchers' attention: Perhaps there could be a connection between calcium and weight. 

A study at the University of Tennessee found that when fat cells were exposed to a calcium-rich environment, they broke down fat much more rapidly than when they were in a calcium-depleted environments. That was a very interesting finding but it was done in a Petri dish, not in human clinical trials. The reasons for the cells behaving in this manner are believed to date back to our prehistoric origins. In ancient times, our diets had much more calcium, due to the consumption of nuts, tubers, and roots grown in calcium-rich soil. Examination of the skeletons of prehistoric man shows bones with high amounts of calcium. Some researchers estimate the ancient diet had two to three times the calcium consumed today. In light of this, it may be that the body may respond to a low calcium intake as a state of starvation, causing it to hold on to fat stores more closely. Of course, this is all speculative. 

What about real people and calcium? Can calcium really help them lose weight? In 2004, a published study showed that this was indeed the case. This weight-loss study, also from the University of Tennessee, divided overweight subjects into three groups. Each group was restricted by the same amount of calories, and the proportions of fat, carbohydrate, and protein were the same for each group. But they differed in the amount of calcium in their diets: One group had 1,200 to 1,300 mg of dairy (food-derived) calcium per day, another had 800 mg of supplemental calcium per day, and the third received no additional calcium. What do you suppose happened? The group that received 1,200 mg of dairy calcium lost 70 percent more weight than did the calcium-depleted group! And the group that consumed dairy products lost more weight than the group that got the same amount of calcium from supplements. 

This tells us two very important things: 

1. Calcium can help us lose weight. 
2. There may be an as yet undiscovered factor in dairy foods that works with calcium to aid in fat breakdown.

Introduction to Breast Cancer Q & A

Guest blog by  Charyn Pfeuffer
Author of Breast Cancer Q and A: Insightful Answers to the 100 Most Frequently Asked Questions

"I never went to Europe," my mother sighed in a Percocet-induced state of delusion. (That comment was followed up with "And I can never have sex again," but I readily ignored that statement.) It was a Thursday night, exactly two weeks, before my mother's 38-year old body would surrender to a brief, half-year battle with metastatic lung cancer. At the time of her diagnosis, I was 17-years old, and cancer was a topic that never, ever occurred to me. I grew up in a cookie-cutter Philadelphia suburb where, except for the occasional tragedy or accident, people just didn't die until they were good and ready. So, you can only imagine my shock and disbelief when I later found out that best-case scenario was that my mother had three months to live. From the moment my family was handed the dreaded "C" diagnosis, I immediately embarked on an exasperating educational crash course in the world of cancer, health care, and medical experts. 

My mother was first treated for what doctors thought was a blood clot in her right arm that resulted from overexertion. Although my mother was statuesque, she wasn't exactly Wonder Woman when it came to physical strength. If her right arm was ever overexerted, it was from lifting the cordless phone to her ear, obsessively vacuuming the house, schlepping shopping bags from Saks Fifth Avenue, or from mixing 5 o'clock cocktails. I would later come to appreciate that she made up for her physical shortcomings in the emotional department. 

My mother, Christine Pfeuffer, spent my pre-senior year summer (1990) in and out of the hospital. When she wasn't horizontal and hooked up to intravenous blood-thinning drips and taking smoke breaks with the nurses, she was taking a carefully timed, around-the-clock regimen of prescription drugs. Her condition was hardly improving as her arm and neck swelled to unattractive proportions, and doctors kept fumbling for a possible diagnosis. One moment it was Hodgkin's Disease, Lyme's Disease the next. My notion that doctors were all-knowing creatures (in the same realm as parents and teachers) slowly dissipated. 

One hot-as-hell August day, she was in the midst of a week-long inpatient stint at the hospital. Her throat started constricting and she physically turned blue. Doctors were at a loss of what to do, and she was transported via helicopter to the intensive care unit of another Philadelphia-area hospital. When I arrived at the latest and greatest hospital, during the designated family-members-only visiting hours, and saw her semi-conscious body, I realized the uncertainty and seriousness of her condition. I didn't know what was wrong with her, but for the first time, I knew that she could die. 

A CT scan later; a suspicious mass was discovered. The mass was aspirated, and the fluid was sent out for cell count and cytology evaluation. Cytology came back with Class IV cells, raising suspicions amongst the doctors of adenocarcinoma. A few days later, my mother's ever-changing condition had a name: non-small cell lung carcinoma. The doctors also made an alarming discovery: a tumor existed on very first CT scan taken in June. The report accompanying the original CT scan stated in the very last paragraph (on the fourth page) that the underlying problem was cancer, but two months later, it was the first we'd heard of it. 

Doctors were surprised that the original hospital and throng of doctors didn't mention cancer, and were reluctant to confirm how long she had had the disease. We skeptically wondered if she'd been transferred to cover the initial hospital's mistake. Lesson learned: it's crucial for the patient or the patient's advocate to review all x-rays and reports, and not take the doctor's word as the absolute truth. 

Pissed off, but grateful to know what we were working with, I immediately set about researching the diagnosis and treatment options. The doctors had given us disappointingly little information to go on: a few photocopied handouts, a short recommended reading list, and numbers for family therapists. The books we did consult required medical dictionaries to simply navigate, let alone fully comprehend. I was scared to death. My mother was dying for chris sakes. I felt helpless, left in the dark, and appointments and treatments were being scheduled too fast to keep up. Making decisions, let alone informed decisions, was damn near impossible. As I look back upon my mother's medical records, I wince at her scrawled signatures on countless consent forms, knowing that she had little knowledge of the choices she was making. 

Once my mother was stable enough to be cared for at home, she started seeing doctors at a top-notch, specialized cancer center on an outpatient basis. She was consulted about the possibility of chemotherapy and radiation, and managed to receive about a month of radiation treatments. The radiation was brutal on her fragile body, and nightly I would soothe her burned skin with lotions, tickle her back, and brush her hair. It was the least I could do, and these simple pleasures brought her so much joy. But her condition rapidly deteriorated, and doctors ruled out the possibility of chemotherapy. It was clear that she wasn't going to survive with or without chemo, but the doctors snatched up this opportunity of a last ditch effort away. Life was moving faster than ever, and although the doctors and nurses tried to keep us up to date on her status, we always felt two steps behind. 

My mother's quality of her life became the most important issue. We knew she was going to die; she was given three months to live, maximum. Throughout the dying process, my mother claimed minimal pain, but after one look, you knew she wasn't a very skilled liar. Women are rarely given societal permission to express feelings of pain or distress, and my mother prided herself on being the dutiful housewife and my father's secretary. Many women with cancer experience feelings of intense guilt if they dare kvetch about any of the side effects, such as pain, menopausal symptoms, psychosexual effects, etc. They are living with cancer and how dare they complain about anything else when their strength and focus should be on conquering this disease? Sheesh. 

Doctors were endlessly adding to my mother's medicinal artillery. The more scripts they wrote, the less I recognized the woman my mother had morphed into. Her connection with reality was long gone, and although I found much-needed moments of comic respite in her hallucinations and delusions, I would've given anything for the way things were pre-cancer. 

Exactly one week before my mother died, she was checked into the chi-chi Suburban Philadelphia cancer clinic. She'd been on a never-ending wait list, but somehow, my father finagled her admittance. The evening before she passed away, my dear friend, Marc, and I made the 45-minute schlep to the hospital bearing irises. I left her spa-like room knowing that would be the last time I would see her breathing. Sure enough, the following morning, I had a lingering, sick feeling around 10:30am. Lynard Skynard's 'Free Bird' came on the radio. I don't particularly like Classic Rock, but for some coincidental reason, 'Free Bird' would come on the radio at pivotal times throughout my mother's sickness. 

I knew in my gut that she had passed away, and I knew that nobody would be able to find me. Reluctantly, I made an appearance at school, and my instinct was confirmed by the Vice Principal-the last man I would ever hope to be consoled by. The moment that my suspicions were verified, I knew exactly what I was supposed to do. I'm not a religious person, but it was like some immaculate conception took place in my mind. I had always considered my mother the ultimate taskmaster, queen of the 'to-do' list-but during what should've been an emotional meltdown, I was able to maintain some semblance of sanity and put one foot in front of the other. I wish I could say the same for my relatives, who, to this day, are still in deep denial about my mother's death. I guess we all deal with death differently-some better than others. 

Fast-forward a decade: my father married an amazing woman-a high school teacher and a wildly creative and insightful woman. I acquired two incredible stepbrothers in the process, and have grown considerably closer with my sister, Carrie. Yes. I still mourn the loss of my mother, but I have learned to rejoice in the positive things that life has dealt me as a result. Cancer makes you take a step back and re-examine your life and what you want it to mean. My mother's brave spirit and words, "I never went to Europe," have inspired me to live my life fully, kindly, spontaneously and with purpose. 

When I moved to San Francisco in 2000, I desperately wanted to give something back to my community. I'm a freelance journalist with a flexible schedule and a hunger for human interaction. As much as I love my 10-second daily commute to my trusty computer, giving dating advice to girlfriends via Instant Messenger isn't exactly what I had in mind in terms of a humanitarian contribution.

I found the Women's Cancer Resource Center (WCRC) in Berkeley, CA, participated in an intense training program, and immediately began volunteering. At WCRC, I assist with the annual fundraising event (Swim-A-Mile) and staff the Information and Referral Helpline once a week. Breast cancer is an issue that comes up far too frequently, and, as a woman, it's hard not to take notice. Calls from women with cancer, their friends, co-workers, employers, family members, and loved ones flood the Helpline, helping me to refine my listening skills. As a volunteer, I am able to provide these panic-stricken women with immediate information about support groups and services, traditional and complementary treatment options, and information on local physicians and other health care providers. 

I think it's important for women to evaluate all of their treatment options, both conventional and complementary. Much of the information and opinions currently available are biased towards one method or another, and I hope to present many of the possibilities free of weighted-down medical jargon. Much of the research for this book was conducted at WCRC's extensive library. And since you won't find a Ph.D., MD or RN after my name, I've had the appropriate information reviewed by two women who are experts in their respective fields. Lillie Shockney is a breast cancer survivor and the Director of Education and Outreach at Johns Hopkins Breast Center. Beverly Burns is a mother, practicing acupuncturist, and Clinical Director of the Charlotte Maxwell Complementary Clinic in Berkeley, CA. I asked Diane Estrin to write the Foreword, since my experiences at WCRC have far exceeded any expectations I may have had. I sincerely want women near and far to know about all of the wonderful services and comfort that WCRC provides. It has been sort of an extended family for me. And to return the support these groups have provided me, a percentage of the proceeds of this book will be donated to these incredible women's organizations. 

Breast cancer is by far the most common cancer among women. This year, breast cancer will account for nearly one out of every three cancer diagnoses in women. The good news is that an estimated 2,167,000 women are living with breast cancer. These shocking statistics and my personal experiences with cancer, however, prompted me to write this book. If a woman hasn't been affected by breast cancer, she is at risk. Over 70 percent of breast cancers occur in women who have no identifiable risk factors other than age and only 5-10% of breast cancers are linked to a family history of breast cancer.

Whether you're newly diagnosed, in the midst of treatment, picking up the pieces post-treatment, or facing a recurrence-coping with breast cancer can be a frightening journey. A diagnosis of cancer inevitably brings with it countless questions and becoming an instant breast cancer authority can be overwhelming. Whatever your reaction may be: it is normal. Cry, get angry, feel fear, scream and shout, belt out some Aretha Franklin, or do whatever it is that you need to do. In this time of crisis, you must become your own advocate. I cannot emphasize enough the importance of patient empowerment. Whatever your questions or concerns, you should never hesitate to share them with your treatment team. You'll be faced with making difficult decisions that you may not feel comfortable making. That said, doing research on your own can make the dialogue with your treatment team much more productive. It is essential to remember that you have time to gather information, and then make decisions based on the facts and personal considerations, (i.e.; your life style, emotional well-being and philosophies)--not knee-jerk emotional responses. 

Remember:
This is your life and your breast.
You are an individual, not a statistic.
You have needs that are unique to you. 
Information is a valuable tool.
You have every right to be involved and in control of your medical care and decisions.
Questioning authority, respectfully, is often difficult and fraught with self-doubt. Doing so is often necessary and productive. One should do so without fear of making the wrong decision, no matter how vocal and determined are the forces against doing so. 
The fear of the unknown tends to be worse than the actual treatment.
Treatment for cancer has greatly improved and survival rates are at an all time high.
Think of the future.

"The most courageous act is still to think for yourself aloud."  Coco Chanel