Category: Considerations
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!
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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.
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
Doctors Smell
It’s true, they do. In last week’s New England Journal of Medicine, Andrew Bomback, MD tells us that the odors emanating from his patients aid in his diagnostic and therapeutic decisions. For instance, the smell of uremia makes kidney failure evident before the lab results return. Cigarette odors cause him to expand his differential diagnosis to include nicotine-related cancers.
Smells told him that a patient was dying, but also tell him whether a patient is getting better. “A patient who has showered and brushed his teeth before 6:30 a.m. is obviously getting ready to go home, no matter what his laboratory values might say.”
When I was practicing obstetrics, I could tell that a patient had ruptured membranes before my exam confirmed the diagnosis. (Healthy amniotic fluid has a fresh, light smell unlike anything else.)
We gynecologists actually have something we call the “whiff test” (I swear, it’s true!) By adding pottasium hydroxide to a bit of vaginal secretions, we can identify the telltale amines generated by certain bacteria that sometimes overgrow in the vagina, causing an infection we call bacterial vaginosis.
If we ever get telemedicine going, we will definitely need that “smell-a-vision” that our friend Emiril loves to talk about. (See? I told you I could turn any topic back into food….)
Category: Second Opinions
Signs of Life
I saw my first crocuses today, pushing their way up through the mulched borders at the front of our apartment building. I don’t recall ever seeing them before March. Either they are winter crocuses, or the record warm temperatures have fooled them into thinking it’s spring. This portent of global warming has me worried, and I have visions of Manhattan drowning in the rising ocean waters.
I used to have nuclear nightmares where I had one hour to get out of the city before the bomb hit. I had it all planned out how I was going to get to the train station before the crowd. Now, I’ll have to start planning for the big flood, which takes the tunnels and trains out of the picture. Time to start re-thinking my getaway route…
And yet, even as I ponder my escape from New York, I begin to notice familiar stirrings within me. No, not the stirrings in my loins, get your mind out of the gutter. The stirrings in my thumb. You know, the green one. Because crocuses mean spring, and that, my dears, means gardening…
FYI: If you aren’t into gardening, can’t stand flower shows and don’t like the aroma of manure, then read no further, my friend. This post is over for you. Go watch the Superbowl or something. Because I warn you, I’m about to wax bucolic…
As usual, I’ve ignored my garden since November. The realization hits me that I haven’t watered even once all winter. (Container gardens need water even in winter, since there is no deep water source to draw from, just what’s in the pot or what falls from the sky.) I know, I know, I should use a water gauge, you don’t have to tell me. I got one once, and it cracked before the winter had barely set in. So I rely on my inner-water gauge. Since I have a middle-aged female bladder, my inner-water gauge is always set to “on”, and it hasn’t failed me yet. Still, it worries me that never once this winter did I think about watering.
I rush up to the roof to survey the garden, hoping for the best. When I get there, I am relieved to see that the warm, wet winter has in fact been good to the plants. The lilac bush and apple trees have set their buds, and even the birch trees are showing signs of life. (How stupid was I to plant river birches in containers? And too-small containers at that, since the big ones wouldn’t fit in the elevator or even through the stairwell doors. Yet somehow they have made it through 3 years.)
Of course, it’s way too soon to predict which of the herbs will survive, or if the honeysuckle will return. City gardens are precarious and unpredictable, and a bad stretch of sub-freezing temperature could do much of it in even at this point. Two years in a row I had to restart my Pyrocanthus, till I finally gave in to the realization that the blustery winds off the river were just too much for that plant. Yet somehow, the butterfly bushes, supposedly an annual in this climate zone, always come back. It makes no sense, but that’s how it is.
I seriously doubt the wysteria will make it, having been battered about during the renovations done by our building this fall. That’s okay, it gives me a chance to re-arrange, one of the major advantages of a container garden. I head back downstairs, already planning the changes, hopeful that spring will be just a little earlier this year. I must say I am pleased. Maybe this global warming thing isn’t such a bad idea after all ..
Category: Gardening
My First Food Blog
The very first food blog I ever read was Butter Pig.
It was sometime in early 2003, and I was in the midst of reading “The Making of a Chef“, Michael Ruhlman’s adventures as a student at the Culinary Insititute of America (CIA). That’s the CIA, where they teach you how to cook food, as opposed to the other CIA where they teach you how to cook-up intelligence reports. Ruhlman had written a great book, and I was sure that in my next life, I wanted to become a chef (or a food writer).
I decided to google the CIA, thinking I might want to take a class there some day. I found them, but also found Tom Dowdy’s diary of his three months at the CIA. That diary led me to Tom’s food blog called Butter Pig.
I was blown away by what I had discovered. I had no idea such a thing as a blog existed at that time, let alone this chronicle of life in the kitchen. Tom wrote well, cooked a lot of great food and clearly had a lot of knowledge about food, which he graciously imparted to his readers. He seemed to have a lot of friends. So many that he recruits them as sous chefs for his annual parties. Tom also has that whole long hair thing going on, which I kinda’ like. (Of course, if he worked in a restaurant kitchen, then he’d have that whole hair net thing going on. Better keep to the home hearth, Tom…)
I began to read Tom’s blog as often as he posted. And between that and Ruhlman’s book, the whole cooking thing began to feel more accessible, less intimidating to me. I really started to think differently about cooking. I had always copied my mother-in-law Irene’s cooking but always felt that I was doing just that – copying. Now I felt set free to expore more on my own. I had found my own cooking territory.
There was no time in my life for cooking school, but there was time to read food blogs and to cook. I bought the CIA textbook The Professional Chef, got myself some good knives, read some Harold McGee and started to cook more and more. I even began to tape my recipes up on the kitchen cabinets just like Tom does.
For awhile, I only read Tom’s blog. I had no idea there were others out there. Then one day, Tom led me to the Julie/Julia Project, and from there the whole world of food blogging opened up to me. When I hit on Kiplog’s Food Blog list, I knew I had found Nirvana. My world has not been the same since. In fact, I discovered so many wonderful food blogs, that I am ashamed to say I somehow lost track of Butter Pig.
Today, however, I stumbled upon Butter Pig again. And it was like coming home. Maybe it’s because Tom was my first. Or that his friends are always around. Or that he shows himself cooking in so many of the photos. Or that his site hasn’t really changed since I first found it. Or the whole long hair thing.
Whatever, it’s good to see you again, Tom. I love Butter Pig.
My apologies to Salvadore Dali for multilating his painting “The Discovery of America by Christopher Columbus”.
Category: Food
Afternoon Delight
When I get those 4 pm cravings, I usually make myself a cup of chamomile tea and tough it out till dinner. But sometimes, like today, I cave in and have a cookie and a cup of Joe. And when I want a really great cookie, I get these Raspberry Oat Bars (with chocolate chips) from a baker on Long Island called Have Your Cake, Ltd.
But I don’t have to go to Long Island, because my friend Mark sells them around the corner at his deli.They are not cheap ($2.99 for 2 large cookies), but they are worth every penny. And the best part is that I only ate one, so there’s another cookie waiting in my desk drawer for tomorrow afternoon. If you want to stop by, I’ll split it with you….
Category: Food
Ben Stiller – Shameless Hanger-On
The Bird Lady is not the only one keeping the same schedule as me. Ben Stiller and I seem to have matching social calendars, and I for one am getting a little peeved at him showing up everywhere I go.
Saturday night, I’m at Theater Row seeing Animus, a new play being shown as part of the INTAR New Works Lab. And there’s Ben in the lobby “talking” on his cell phone during the intermission of Abigail’s Party. Yeah right! More like trying to look casual while catching a glimpse of me, I know those tricks, Benny-Boy…
Then, on Monday afternoon I’m at City Center, minding my own business, watching my daughter dance with The National Dance Institute in a dress rehearsal for some big gala. And who shows up again, but our friend Benjamin! This time, he thinks that by milling around with the likes of Adina Menzel, Natalie Portman, Rosie Perez and Zach Braff, he can enter my inner circle and hang with me and I won’t notice his pitiful hangings-on. Right. Guess again, Ben-Ben.
As if that’s not enough, get this! He has the nerve to go backstage and visit the kids, shaking hands and letting them take photos with him. Ben, that’s sinking a little too low – trying to get at me through my kid. Aren’t you ashamed of yourself?
Zach Braff has it right. When my friend J. told Zach the kids would love to see him, he merely answered “Yeah, someone else already told me that”, and went back to eating his Subway sandwich. That’s the way, Zack-o. You’ve got better things to do with your time than to hang around a bunch of adoring kids.
Ben, get a life!
Category: Considerations
The Bird Lady Says “Shoo!”
The Bird Lady and I keep the same schedule, and most mornings as I am walking to the office, I pass her. When I took her photo today, she stared to yell at me, so I figured I’d better go over to talk with her and make friends.
It turns out that she thought I was taking the pictures to turn her over to the Department of Health. Seems like some folks in the neighborhood are against the Bird Lady because she is attracting the pigeons to their apartment window sills, terraces and gardens. “They reported me to the DOH and said I was a health hazard, but the judge says there is no law against feeding the poor birds.”
In an East European accent, through a mouth missing half its teeth, she told me that someone actually knocked her over recently and landed her in the hospital with a pulled shoulder. Which explains why she cowers up against the wall whenever someone passes,
and why now she doesn’t trusts anyone, including me. She actually said that. “I don’t trust you.”
I tried to explain that I was not going to turn her in, I just wanted to talk to her and write about her in my blog. (Try explaining to the bird lady what a blog is…) I had this idea that I’d write a bird lady profile, you know, how she became a bird lady, what she did before, why she feeds the birds, that sort of thing.
No go. She treated me like a regular papparazi. “Just go away,” she told me, turning her head away and putting her hand into my camera. “Leave me alone.” Clearly, the interview was over.
Lesson learned: If you want to get to know someone, don’t start out by taking their picture without asking. It’s rude. Who the heck did I think I was, anyway?
Category: Considerations
Ovarian Cancer Screening – Telling It Like It Is
A very well-written article in USA Today honestly tells readers why an Ovarian Cancer Test Remains Elusive.
I spend a lot of time discussing ovarian cancer screening with my patients who come in anxious about the disease. Most of that time is spent explaining that, unfortunately, we still don’t have a good screening test for ovarian cancer.
I aggressively screen with ultrasound and CA 125 in women with a family history or personal risks factors for ovarian cancer. And I don’t hesitate a second to get a pelvic ultrasound in any woman complaining of the vague, non-specific symptoms associated with this cancer – bloating, early satiety, abdominal pain. (I don’t wait for other tests to be negative before ordering an ultrasound, because even though ovarian cancer is not common, it is usually rapidly growing, and won’t wait for me to finish my workup.)
But for low risk women without any complaints, I really have no screening test to offer, and this article does a nice job explaining why.
Unfortunately, what the writer does not tell women is that there is something they can do that will actually lower their risk of getting ovarian cancer in the first place. What’s that? Go on birth control pills. As little as 3 months of use imparts protection, and long term users can expect up to an 80% reduction in risk. Now that’s something to write about.
If you want more information about ovarian cancer screening and prevention, see these great web sites:
National Cancer Institute
The OvarianCancer Coalition
Contraception Online
Johns Hopkins Pathology
The Gene for Ear Wax
Today’s NY Times tell us that Japanese researchers reporting in Nature Genetics have identified a single gene responsible for determining whether a person has wet or dry ear wax (cerumen).
I remember reading a few years back that there may be an association between cerumen type and breast cancer risk. I decided to read the article itself in Nature Genetics to see if the Japanese researchers had also remembered this connection. They did, only to dismiss it as “controversial”, based on a reference from 1971. However, more recent articles I found, including these studies from 1975, 1981 and 1990, appear to support the connection.
The researchers hypothesize in their article that because folks with dry ear wax also produce less sweat, the genetic variation found may be due to an adaptive mutation that allowed survival in cold climates.
Interestingly, the countries with the highest incidence of breast cancer are Sweden and Denmark, both Northern countries with colder climates. Hmm… Maybe this gene will turn out to be more important than its discoverers realize.
Ear Wax & Breast Cancer
Today’s NY Times tell us that Japanese researchers reporting in Nature Genetics have identified a single gene responsible for determining whether a person has wet or dry ear wax (cerumen).
I remember reading a few years back that there may be an association between cerumen type and breast cancer risk. I decided to read the article itself in Nature Genetics to see if the Japanese researchers had also remembered this connection. They did, only to dismiss it as “controversial”, based on a reference from 1971. However, more recent articles I found, including these studies from 1975, 1981 and 1990, appear to support the connection.
The researchers hypothesize in their article that because folks with dry ear wax also produce less sweat, the genetic variation found may be due to an adaptive mutation that allowed survival in cold climates.
Interestingly, the countries with the highest incidence of breast cancer are Sweden and Denmark, both Northern countries with colder climates. Hmm… Maybe this gene will turn out to be more important than its discoverers realize.