Monthly Archives: February 2006

Doing the Work that Has To Be Done

I was asked by a colleague the other day if I would be willing to head the medical advisory committee of which I am currently a member. The committee is part of a large organization whose mission includes provision of family planning services. As chair of the committee, I’d have some additional responsibilities, and would have to start attending board meetings for the organization, in addition to the twice yearly advisory committee meetings I already attend.

I don’t like to spending evenings away from family, and try to limit outside responsibilities as much as possible. I never go to drug company dinners, resent my boss for making me join our local medical society (which has monthly dinner meetings), and aside from my voice lesson and choral rehearsal (which I combine on the same night once a week) have no outside evening activities. I told my colleague that I’d think about it and get back to her, because I didn’t think it was nice to say no right away. I promptly forgot our conversation.

A few days later, I was privileged to listen to an esteemed gynecologic oncologist give a lecture about his life’s work. Amidst his tales of the lab, the operating room and the chairman’s office, he told us stories of the old days before abortion was legal. In those days, the hospital wards were packed with septic abortion patients. He told us how many lives they saved by not waiting for cultures to diagnose clostridial sepsis. They used to mix the patient’s secretions with milk right there in the ER, and look for bubble formation (clostridia is a gas forming bacteria). He told of how he stayed up all night long in the ICU with women who had attempted self-abortion with lye, only to have them die in the morning despite all his efforts. And although he had enormous responsibilities in his specialty, he served for years on the board of his local Planned Parenthood. “It was just something I felt I had to do”, he said. “I hope you never live to see the things I saw”.

That same night, I learned that South Dakota has passed a law that outlaws abortion under any circumstance.

Today, I emailed my colleague that I would accept the position.

According to the Alan Guttmacher Institute, in 1962 alone, nearly 1,600 women were admitted to Harlem Hospital Center in New York City for incomplete abortions, which was one abortion-related hospital admission for every 42 deliveries at that hospital that year. In 1968, the University of Southern California Los Angeles County Medical Center, another large public facility serving primarily indigent patients, admitted 701 women with septic abortions, one admission for every 14 deliveries. (AGI also source for graph above)

Category: Second Opinions

Shrimp Louie Salad, Mac & Cheese

Every couple of months or so, my mother-in-law Irene, the Greatest Home Cook in the World, visits us. She and her husband Marvin never arrive without the Blue Cooler. And in that cooler they carry, along with Irene’s special cereal, Marvin’s buttermilk and a few tasty leftovers from their fridge, the ingredients for the dinners Irene has planned for us during her stay. These are often supplemented with items bought by us from the short shopping lists that Irene phones up ahead of time.

I long ago gave up feeling insulted that Irene feels the need to bring food along or plan the meals for her visit with us. I love her cooking too much, and just enjoy both their company and their food. Every once in a while I do put my foot down and insist that she let us feed her, but mostly I just join in and chow down. And what better treat than to walk in the door from work at the end of a long day, and find Iene in the kitchen, Marvin and my husband Paul setting the table, the kids happy and the smell of garlic in the air? If there is a heaven for working mothers, this is it.

This particular night, my in-laws were headed to see “The Odd Couple” with my kids, so dinner was “a quick meal”. Shrimp salad like no shrimp salad I’ve ever had before, and a test run of the latest macaroni and cheese recipe from the NY Times, served with garlic bread. (Susan, no comments please, you’re just jealous you weren’t here to eat it.)

Irene’s Shrimp Louis Salad

This recipe is based on the classic Crab Louis Salad, the origins of which are not entirely agreed upon, but which seems to have been created sometime at the turn of the 20th century in a restaurant on the West Coast. Some say it is named after King Louis XIV who was known for his enormous appetite. It is always pronounced Loo-ey. (Let’s sing it together, shall we? Louie, Louie…)

Irene uses Trader Joe’s frozen shrimp, which are really delicious. She keeps them in her freezer at all times. (One of these days, I will do a post about her two, count ’em 2, kitchen freezers and what’s in them… ) The amounts and proportions of ingredients will really depend on how many people you are serving and what you like, but do keep her proportions of the shrimp and celery, and obviously the dressing and artichoke recipes are made as written.

Ingredients
Shredded romaine lettuce
1 ½ pound cooked shrimp, cut into bite sized pieces
3 stalks crisp celery, cut up
Some sliced scallions
Louis Dressing (recipe follows)
Marinated artichoke hearts (recipe below)
Cherry tomatoes
A few hard boiled eggs, cut into quarters
Black olives
Cucumber, peeled and sliced
Red onion, slivered (salted or not, your preference)
Slices avocado
Lemon or lime wedges

Toss the shrimp and celery together with just enough Louis dressing to hold it together, really just a little. (You’ll serve more dressing on the side late, so keep it light at this point.)

Plate the lettuce on a large serving platter. Heap the shrimp salad in the middle. Arrange everything else prettily. Scatter scallions atop everything. Serve with lemon wedges and Louis dressing on the side.

Irene’s Louis Dressing
1/3 cup French vinaigrette Dressing (Made using the ingredients below)
– 1 ½ tbsp Dijon
– 1 tbsp Worcestershire
– 1 tbsp honey
– ¼ cup olive oil
– salt and pepper to taste
1 cup mayonnaise
¼ cup chili sauce
1 tsp Worcestershire sauce
¼ cup sweet India relish
1 tbsp minced scallions

Mix well.

Irene’s Marinated Artichoke Hearts
Trader Joes again, this time a bag of their frozen artichoke hearts. (Manhattanites, take heart – a Trader Joes is coming to Union Square, finally!)

Put artichokes in just enough water to cover, with some chopped garlic and a little olive oil. Simmer till most of the water is evaporated and artichokes are tender. Add 1 to 1 1/2 tbsp champagne vinegar, and salt and pepper to taste. Cool before using.

Creamy Macaroni and Cheese (adapted from the NY Times)

Julia Moskin wrote a really nice article in the NY Times recently about her search for the ideal mac and cheese recipe. This was one of the ones she made. Some minor changes were made for this meal. Irene left out the butter and the extra cheese for the top, and baked it in a 9 by 12 glass baking dish instead of a smaller pan as called for in the original recipe. This change in pans results in lots of the crispy top and bottom of macaroni and cheese that is my favorite part of the dish. It was still quite rich, and I’m going to make it myself sometime soon using a little less cheese.

1 cup cottage cheese (not lowfat)
2 cups milk (not skim)
1 teaspoon dry mustard
Pinch cayenne
Pinch freshly grated nutmeg
½ teaspoon salt
¼ teaspoon freshly ground black pepper
1 pound sharp or extra-sharp cheddar cheese, grated
½ pound elbow pasta, uncooked.

1. Heat oven to 375 degrees and position an oven rack in upper third of oven. Use 1 tablespoon butter to butter a 9×12 inch glass pan.
2. In a blender, purée cottage cheese, milk, mustard, cayenne, nutmeg and salt and pepper together. Reserve ¼ cup grated cheese for topping. In a large bowl, combine remaining grated cheese, milk mixture and uncooked pasta. Pour into prepared pan, cover tightly with foil and bake 30 minutes.
3. Uncover pan, stir gently, sprinkle with reserved cheese and dot with remaining tablespoon butter. Bake, uncovered, 30 minutes more, until browned. Let cool at least 15 minutes before serving.
Yield: 6 to 8 servings

Category: Food

Another So-Called “Teen” Pregnancy

She’s 16 and 9 weeks pregnant, having come to the resident’s clinic this afternoon complaining of bleeding after intercourse 2 days ago. The baby is fine (very cute on sono, we all agree), but it’s clear by her exam that she has a rather severe infection of her cervix, most likely due to Chlamydia. On further questioning she admits to having been treated for Chlamydia not too long ago.

“Did your boyfriend get treated?”

No, he didn’t. He told her that his doctor told him he didn’t have Chlamydia, so he didn’t need to be treated. This of course, cannot be true, because we treat anyone potentially exposed. Which means that her boyfriend did not go to a doctor – he basically lied to her.

He’s 21, the FOB. That means “Father of the Baby” in OB chart-speak, although I could think of a similar acronym that might be more appropriate. He also sleeps with his other baby’s mother, who is 15. She has a 3 month old baby girl.

I ask my patient why she still sees this guy, if she knows he sleeps with another girl. “He’s my baby-father”, she says. “So when I get the urge, he’s the one I go to.”

So this means they all have chlamydia – her, her baby-father, and her baby-father’s other baby-mama. I tell her this, and ask to consider whether she really wants to continue sleeping with him.

And although our former surgeon general was forced to resign for suggesting that teens be taught about masturbation, I take my chances and tell her that there are other things she can do to satisfy her urges that don’t involve exposing herself and her baby to serious infection. I don’t know if I got through, but I hope so.

We treat her infection, talk to her about getting her partner treated, send some labs, talk to social work and make her a follow-up appointment. Her baby is due the end of September.

According to the Alan Guttmacher Institute, fathers of babies born to teens are often significantly older than their female partners. It is estimated that, among girls who have given birth to a child by age 15, 39 percent of the fathers are between the ages of 20 and 29.

Category: Second Opinions

Pasta con le Sarde ala Chita Rivera

pasta and chita 2

In a recent post, in which I basically trashed the recent research on Calium supplements, I noted that the current recommendation is for women to get the majority of their calcium intake from food sources. I decided to take my own advice and made Pasta with Sardines, a classic Sicilian dish. Sardines are a great source of calcium – 4 oz has 300 mg of elemental calcium, a full 1/3-1/4 of the daily recommended requirement for most women.

I planned to make this dish on Saturday, hoping for an early dinner and a nice evening at home with my family. Late that afternoon, all plans for a leisurely dinner were quashed. Around 4 pm, we found out that Chita Rivera’s show “The Dancer’s Life” was going to close in 2 days, which made our tickets for Tuesday night obsolete. My husband had rushed to the box office to see if he could get tickets for the closing night show on Sunday. He returned instead at 5:15 with 4 tickets for that very night! Fine, we figured we’d eat a rushed dinner at 6:30 or so, and still have time to get to the theater at 8. We set to work together in the kitchen, my husband cutting up the veggies while I deboned the sardines.

About halfway through our preparations, the phone rang. My younger daughter’s friend was calling to see why my daughter wasn’t at her house for the special sleepover they had planned (and that we had thought was the following weekend). Now we had an extra ticket! Calls were frantically made to find a friend of my older daughter to accompany us to see Chita. My husband took my younger daughter to the sleepover while I finished the sauce and put it in the fridge to hold. By then it was past 7.

My older daughter’s friend’s father graciously drove us all to the theater. In usual New York fashion, we got stuck in traffic at 54th and 6th. So we jumped out of the car and ran through the freezing night the remaining 6 blocks to the theater, cursing ourselves for not taking the subway, stopping only to warm ourselves on a subway grate (now we knew why the homeless slept there.) We just made the curtain.

We returned after the show to cook the pasta and eat our dinner, in relaxed European style, at 10:30 pm. Luckily, the sauce kept beautifully.

Was it worth all the running around? You bet. Chita was amazing! Singing and dancing for 2 hours at the age of 72! And do you know that her left leg was broken in 12 places in an automobile accident in 1986? Now that’s a woman who must get enough calcium!

Pasta con le Sarde

Most recipes for Pasta con Sarde (and there are probably as many recipes as there are cooks in Sicily) call for anywhere from 1 to 3 8-10 oz. cans of sardines in oil. The recipe on which I based this dish comes from Mario Batali, who calls for 3 pounds of whole fresh sardines! I like sardines, but not that much, so I used about 9 ounces. If I make this again, I will also add a can of anchovies in oil.

2 lbs fennel bulbs, greens removed and reserved, bulb cut into sticks.
9 oz whole fresh sardines
flour, for coating
1-1/2cups extra-virgin olive oil
2 medium onions, minced
3 cloves garlic, minced
1 (28 oz) can whole tomatoes with juice, pulsed a few times on the food processor to chop
3 tbsp pine nuts, lightly toasted
3 tbsp raisins, soaked in a little white wine
salt and pepper to taste
7 saffron strands
1 lb dried bucatini (also called perciatelli, basically thick spaghetti with a hollow center)

In a hot skillet, add olive oil and saute fennel until caramelized. (Next time I’ll add the onions at this step and carmelize them too. )

Remove the heads of the sardines and pull out the backbones and entrails. (You don’t need to do this if you decide to use canned sardines instead.) Select a few sardines for garnish. Chop the rest of the sardines for the sauce, set aside.

Season the flour with salt and pepper, and dredge the selected unchopped sardines in it. Heat 1/2 cup olive oil in a small saucepan until it starts to smoke. Cook the flour-coated sardines in the oil until a light golden brown, about 1 minute on each side. Using a slotted spoon, remove the sardines from the pan and set them aside to drain on a paper towel.

In the skillet with the caramelized fennel, add the onions and cook about a minute. Add the garlic and cook a bit. Add raisins, tomatoes, pine nuts and saffron. Season, to taste, with salt and pepper. Bring the sauce briefly to a boil and then lower to a simmer. Add the reserved sardines and cook, stirring occasionally with a wooden spoon, until the sardines have broken into pieces and are thoroughly mixed into the sauce, about 10 to15 minutes. If the sauce appears too thick at this point, add a little of the pasta cooking water.

Bring 6 quarts of water and 2 tablespoons of salt to a rolling boil. Add the bucatini and cook until tender but still al dente. Drain the cooked pasta into a large serving bowl, add 3/4 of the sauce and stir to combine. Top with the remaining sauce and the fried sardines.

This pasta tastes best if allowed to sit for several minutes, soaking up the flavors of the sauce, before it is served. Keep the pasta covered during this waiting period, then garnish with reserved fennel fronds.

Category: Food, Second Opinions

Birth Control as Art

TBTAM the gynecologist was just a little overcome when she read this in a recent post by MegSpohn, who was describing the arts scene in Denver.

“Have you seen “Invesco Field at Mile High?” Looks like a diaphragm that has Jumbo-vision and seats thousands. We also have some weird public art outside the Convention Center that’s kind of a giant, rusty, coiled spring, which of course reminds me of an I.U.D. that someone left out in front of the Convention Center.”

Now that’s a girl who’s in touch with her inner-gynecologist.

OBS Housekeeper’s Favorite Corn Muffins

My sister, the Obsessive-Compulsive Housekeeper, commented the other day that cooking was notoriously absent from by so-called food blog of late. (Hello – It’s called a day job…?) She put herself up as an example for me by lauding her recent foray into the kitchen to make corn muffins. In doing so, she heaped high praise on this recipe from the Heathcote Tavern in Scarsdale, NY.

So, OBS housekeeper, I’m going to make your muffins. Being a doctor, I will doctor it just a little by adding in some of last summer’s corn from my freezer.

Preheat oven to 375 degrees. Grease well a standard 12 muffin tin. Gather your ingredients. (I read recently in Cook’s that Arrowhead corn meal makes the best corn muffins. Actually, the best corn meal I ever used was fresh stone ground from Phillipsburg Manor, a working 19th century farm we visited in the Hudson Valley. Since I didn’t have that, I’m using what’s in my cabinet.)

In large bowl, mix 1 1/2 c. all purpose flour, 1 c. cornmeal, 1/2 c. sugar, 1 tbsp. baking powder and 3/4 tsp. salt.

Stir in 1/2 cup of melted butter (1 stick). (This step I didn’t understand. I would have expected to mix the melted butter in with the other wet ingredients, as if making pancake batter. But I decided to try it the way it was written. Maybe someone can explain for me why this method might be better or worse than the standard method.)

In small bowl whisk 2 large eggs, 3/4 c. Milk, 2 tbsp. Honey, and 2 tbsp. Maple Syrup until mixed.

Stir egg mixture into flour just until combined. Batter will be lumpy.

Thaw some of this summer’s leftover corn from your freezer and add it to the batter.

Spoon batter into muffin cups.

Bake for 20-22 minutes, or until a toothpick comes out clean. Amazingly, OBS Housekeeper, this is exactly the amount of time it takes for you to fill the sink with soapy water,

and transform the kitchen from this:

To this:

Oh, and the muffins were delicious.

Calcium Confusion From the WHI

In yet another media “bombshell” from the Women’s Health Initiative and the New England Journal, we are now being told that calcium isn’t as good as we thought in preventing fractures. (See study here.) Moreover, women who take calcium supplements have higher rates of kidney stones than women who don’t. And once again, the media is off and running…

No problem. I can handle this one with my hands tied behind my back…aiebpqiwuy756435yh 46ty2w4… Oh, sorry, I forgot that I can’t type with my nose. Let me get my other shoe off, I’ll use my toes. Okay, are you ready? ‘Cause here we go…

First, let’s talk about the intervention studied by the WHI : Approximately 36,300 women nationwide were randomly assigned to placebo or 1000 mg/day elemental calcium combined with 400 IUs/day of vitamin D. The primary outcome was osteoporotic hip and other bone fractures, with colon cancer as a major secondary outcome. Overall, women assigned to take calcium supplements had no less osteoporotic fractures than those taking placebos.

What???? Oh, wait. I understand. When they looked at women who actually took the pills as advised, there was a 29% reduction in fractures.

So, what they seem to be saying is this – telling women to take calcium and vitamin D doesn’t prevent fractures. Sort of like telling my kids to brush their teeth to prevent cavities – it only works if they actually do it. OK, I’ll buy that.

The statisticians don’t like to hear this. They prefer the purity of an intent to treat analysis, where the only valid comparison is what goup study participants were assigned to, not what they actually did. As a clinician, I alswys have trouble with intent to treat analysis – I tend to want to drill down and find out why. I would argue that this is as valid as the intent to treat.

A benefit was also seen to calcium supplementation in the over-60-years-old crowd. Gee, that makes sense too. I wouldn’t expect to see a big difference in fractures in the under 60 crowd, because that group doesn’t get many fractures. And if someone in that age group is breaking her hip, I’d have a strong suspicion there’s something else going on other than just age. Like maybe anorexia or smoking or an overactive parathyroid gland or malabsorption, to name a few possibilities. No amount of calcium is going to fix that. Hmm…So far, it sounds like calcium is doing exactly what I’d expect it to do.

But that’s not what CBS News says. Their headline? “Calcium, Vitamin D Assumptions Shaken.” Why? Because the big groups analysis showed no benefit to calcium, that’s why. And do you know why? Because the women who received placebo were allowed to take calcium and vitamin D supplements on their own! That’s right. Here it is, right out of the WHI press release: “Since participants were not restricted from taking personal calcium or vitamin D supplements, they had a relatively high calcium and vitamin D intake at enrollment and intake rose even higher during the trial so the impact of study supplementation may have been muted.”

What the researchers are telling you is that since they didn’t control the very intervention they were studying, their results might not be right.

Oh, and one more confounding issue. They also did not restrict the use of Fosamax-type drugs in either group, so about 15% of women ended up on these fracture-preventing meds during the course of the study. This means that most likely the women at risk for fractures in both groups were already taking a more effective medication than just calcium and vitamin D.

Are you getting all this?

Now, let’s talk some more about the WHI’s intervention – namely, giving all women the same dose of calcium, regardless of what amounts they may have been getting in their diet.

You know what? This is not the way we doctors recommend that women take calcium.

Here’s the recommendation of the National Osteoporois Foundation and the American College of Obstetricians and Gynecolgists: “Food is the best source of calcium; however, most Americans do not have enough calcium in their diets. Fortunately, calcium-fortified foods and calcium supplements can fill the gap, ensuring that the daily calcium requirement is met. The amount needed from a supplement depends on how much calcium is consumed from food sources.”

Hmm…I don’t see any recommendation that every woman be given 1000 mg of calium as a supplement daily. Gee, I wonder what might happen if women were to take calcium supplements without taking into account their dietary sources? Maybe they’ll get too much calcium. And what can too much calcium cause? (Let’s shout it out together, shall we?) KIDNEY STONES!

Oh, wait, wait… I forgot to tell you about the vitamin D dose studied – 400 IU daily. Unfortunately, it’s too low. The current recommendation is 800 IU daily. (And not 600 IU as the NY Times says.)

Quick take

And there you have it, folks. The WHI researchers designed an intervention that doesn’t match current medical recommendations, failed to adequately control the intervention they were studying, and then used their results to question the very medical recommendations they didn’t follow. Yet despite this, they did manage to get some results that make sense if you understand what really happened.

Fortunately, Gina Kolata at the New York Times understands it. Here’s her headline: “Big Study Finds No Clear Benefit of Calcium Pills”. That just clears it all up for everyone, doesn’t it? And this from Forbes: “Calcium, Vitamin D Won’t Protect Older Women From Fracture.” The fact that it was the older women who actually did show a benefit is irrelevant to the headline. No wonder we’re all confused.

Here are the current recommendations for calcium and vitamin D (click here). I wouldn’t change a thing.

Mrs. O’Leary Milking Daisy by Norman Rockwell
 _________________________________

Comment : define_me
February 16, 2006
Maybe I should aim to get my first publication with the New England Journal of Medicine…hehehe

Comment: Anonymous
February 17, 2006
Between the calcium and fat study, the headlines should read: Impossible to do prospective food study; massive waste of money and time. Conclusion: retrospective food studies, or even large population studies (Japanese on traditional diet v. American diet) are clearly the best information we’ll get—and far cheaper.) I’m not even going to think how many children could be fed and vaccinated, or how much prenatal nutrition could be paid for with the 415 million from the fat study…

Comment: Guinness_Girl
February 17, 2006
That’s all I have to say. Wow

Food Blogger Paraphernalia

The best thing about a new hobby is that it gives you a reason to buy new stuff, and I love buying new stuff. Here’s what I got last weekend:

A tripod so that I can take better pictures of my food. The salesman tried to talk me into a $180 clamp that the professionals use, but I went for the $25 cheapo portable tripod. I tried it for the valentine’s day photo, and I think he was right about that clamp – you need it for the overhead shots. But I still like the little one, mainly because it is cute.

New dishes. My own dishes are green, and although my friend Rachel graciously loaned me a white bowl for a recent post, it was clear that I could not continue to rely on my neighbors for dinnerware. Fish’s Eddy is having a close out sale at the B’way and 77th Street store, so I headed there last Saturday and I now have a great collection of single plates and bowls to enhance my food shots. (Just no room to store them…)

A Clamp-on Light. Well, technically I didn’t buy the light, my brother-in-law did. But I did start using the light in the kitchen this weekend, because we have no over-the-stove light to work (and photograph) by. Suddenly, I can see what I am cooking. Amazing!

Now I just have to get back into the kitchen. The problem with a day job (and a family) is it leaves no time for cooking…

Category: Food

Happy Valentine’s Day!

This week’s Grand Rounds is up at Intueri.org. You must get over there and check it out. She’s made the posts into personal ads looking for love. Brilliant!

Hugs and kisses to you, dear reader. Have a great day.

Category: Considerations and Second Opinions

Stocking up for the Storm

We stumbled upon Black Hound tonight in the East Village, just as the snow was starting to lay. I had trouble deciding what to buy. A little cake, perhaps? That’s what my daughter got.

A little fruit tart? I brought one home for my other daughter.

Some savory pastries?

A cookie?

A mini-apple pie?

My husband got a rum ball. And I finally settled on a checker-ball,

because I knew that when I got it home and cut it in half, it would look like this:Category: Food

How to Get Pregnant, Part III – The Male Factor

In my previous two posts about this topic, I advised women who want to get pregnant to relax and trust their own bodies. Unless, of course, their bodies were over age 35, in which case they should stop relaxing and just get to it already. Unless, of course, they happen not to have a male partner, in which case we do have sperm donors and egg freezing.

In this post, I would like to address that afore-mentioned, often overlooked male partner, whose role in this whole business has up to now been taken for granted. That’s right – taken for granted. C’mon – do you seriously ever hear men worrying if they are going to be fertile? Hanging around with their buddies throwing a few beers back after the game talking about their deep-seated fear that they won’t ever be someone’s baby-daddy? Correct me, guys, if I’m off-base here, but I don’t think so. You all assume the plumbing works, don’t you? No inner fears, no doubts. Every one of you. Your baby-daddiness is a given, you just need to choose the time and place (and lucky baby-mama.) And if I read one more article about Tony Randall…

Doctors are not immune to this sort of blind thinking. Case in point: My friend Kathy (not her real name) who visited Famous Infertility Doctor after she was unable to conceive a third child, despite trying for five years after her second child was born. The (male) doc just assumed that it was her problem because she was now 33 years old. At the first visit, when she asked if perhaps it was her huband, the doc said it was highly unlikely because of course hubby had fathered her first two children. Oh, I get it, she says. A man fathers a baby, his studliness is assured for life, whereas a woman’s ability to conceive is what? Beginner’s luck? Just do the semen anlaysis, doc! (Did I tell you she has a forceful personality?) Of course they did test her husband, but really only to prove their point. (He was fine, but so was she, it just didn’t happen again for them.) But just so you know, about one-third of infertility is due to a male factor, and another third to a combination of male and female factors. So don’t assume he’s fertile just because he’s studded before.

Well, this is one doc who doesn’t make any assumptions. Which means that when my husband and I decided to start our family, I for one was not going to waste my time trying to get pregnant if he was shooting blanks. Of course, I knew I was fertile, not only because my cycles were clockwork regular, but because I resembled my mom, who had had nine kids in a row starting at age 28, without a single miscarriage. I was sure I had the gonads that went along with my rosy complexion. But my husband gave me no such assurances (other than his major studliness, of course). So what if he looked just like his dad, and his parents had had three kids, which for a liberal Jewish family is practically a population explosion ? This was one book I was not going to judge by it’s cover.

So what did I do? (And I swear that what follows is true…) Well, like any reasonable female gynecologist worth her salt, I brought my microscope home from the office. And that night, after the deed was done, I jumped up out of bed, naked, and did my own post-coital test using the microscope right there on the bedroom floor. For you non-gynecologists, a post-coital test is when you take a sample of cervical secretions from the woman shortly after intercourse, smear it on a slide, put on a cover slip, and count how many live sperm you see in a high power field. Sort of a field test for the sperm, to see how they do out there in the real world, as opposed to in a plastic cup in the lab.

I am happy to report that my studly husband passed our little test right there and then, and with flying (or should I say swimming?) colors. And, I became pregnant that very night. Since that night was also the first time I had ever had sex in my life without birth control, I believe I more than validated my assumptions about my own inherent fertility (thanks, Mom!). And since I had always used the diaphragm for birth control, it was a testimony to just how effective that under-appreciated method can be when used reliably (and obsessively…)

“You’re Nuts!” I hear you saying. Yeah? More like Ahead-Of-My-Time is what I say. Because do you know that they now actually sell do-it-yourself home semen analysis kits? I have no idea if they are reliable, and I’m not sure who buys them, but I’ll betcha’ it’s not the men. If the rest of the female sex is in any way at all like me (you know, control freaks), they’re the ones buying the tests, and asking hubby to ante up a specimen so they can check him out.

“So, what are you saying?” you ask. “First you tell us to relax and trust our own bodies and forgo the high tech, then next thing you’re telling us you went and checked your husband’s sperm count before you had barely started to try to get pregnant!! Make up your mind! Which is it, relax or go high tech?”

Good point. And the answer is – you can do both! I did. The whole post-coital test thing was a real hoot, and my husband and I had a great time with it. Here’s what I say – If you can embrace the technology and still enjoy the process, please, by all means, go ahead. As Mr Science says, “Science can be fun!”

But if the technology only breeds anxiety (which I find is what it does for many women), don’t use it. Ignore this post and go back and review Part I. Because making babies is supposed to be fun – not a chore and certainly not an anxiety-producing experience.

Now, get out there and have a good time!
___________________________________________________________
Read Part 4 in the “How to Get Pregnant” series- Mom’s Medals

Acne Spam

Sothe other day, I log in and check my comments section. For the past week or so, it has been very very quiet, which of course feeds my insecurities that I am a complete loser. So imagine my delight when I see four (count ’em 4!) comments to may latest post.

The first is from my new friend Bardiac, who has a great suggestion for forcing bulbs, and tells me that the weather in the midwest is also unseasonably warm. I begin to suspect that he is a fellow gardener, and that we’ll have lots to talk about as the season sets in…

Eagerly, I click on the next comment, which begins “Love your blog…” Oh good, a fan! My heart sinks when I see that it is spam. Someone trying to get me to link to his web site for “natural” acne treatments. I reject the post. I’m just glad I chose to moderate comments.

The next post starts “Interesting…” but it is anything but. It is another spam from the same site. Now I”m getting pissed.

The final comment starts “Wanted to comment…” Yeah right! Comment about your acne site!

I had turned off the word verification because some of my readers complained they couldn’t comment using it. Unfortunately, I just turned it back on. Because that’s the only way to prevent this sort of harrassment. Sorry.

I guess some folks just like to …

Sex After Sixty

Still Doing It is a documentary film profiling nine older women as they talk about themselves, sex and love in later life. I was privileged to sit on a panel with the film’s maker, Diedre Fishel, at a recent showing. The film was well-recieved by our audience of mostly women healthcare professionals, and the discussion that followed was both lively and interesting.

Still Doing It tackles the stereoptypes and preconcieved notions about sex (or the lack of it) and aging. The women profiled are thoughtful, insightful and brutally honest as they talk about their aging bodies, their needs for intimacy, what they are still doing and what they wish they could do.

The film has a good mix of traditional and non-conventional women, including a sexual radical and a lesbian activist. This is not surprising, since more traditional women would not exactly want to talk about sex in a documentary. My favorite character was Frances, the 87-year old blind, wheelchair-bound woman who found her soulmate in the nursing home. And yes, they had sex. “Aware that many people see her as “nothing, but an old woman in a wheel chair,” she is defiant in living her life on her own terms. “When I’m having sex nobody matters. I’m in my own world, David is in his own world and we don’t give a damn.” (That’s them up there in the top photo.)

Also included among the nine women featured are a 74-year old woman who has a lover 40 years her junior, a newly-married couple in their 60’s , two African-American women, one ex-hippy, a New York Jewish widow and a lesbian couple. (I didn’t see any couples that reminded me of my parents, but maybe that’s a good thing…)

Fishel takes on the nursing home, health care and retirement community industries and challenges them to recognize that sexuality is a lifelong issue for their clients. She also criticizes the prevalent images of youth that drive our culture and our self-esteem. In attempting to counter this, the film does not shy away from images of the aging female body, in various stages of undress and in all it’s variety. Fishel also points out that European films still portray older women as sexy, while American films do not. I might have to take issue with that, having seen Diane Keaton in Something’s Gotta’ Give. (Although why she she picked Jack Nicholson over Keanu Reeves, I’ll never understand…)

Still Doing It is a great vehicle for opening up the dialogue around sexuality and age. I encourage you to see this important documentary if you are afforded the opportunity.

The filmmakers are also going to be doing a book, and hope to expand both their subjects and their audience. If you know of anyone who would be interested in being interviewed for the book, you can contact them through their website.

Category: Second Opinions, Considerations