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The Truth About 10000 Steps and Your Health

by Ellen Williams, M.D.

The Truth About 10000 Steps and Your Health| One woman's story of success walking the road to fitness.| Read for more diet and fitness tips. | Sisterhood of the Sensible Moms

Hear my confession, oh Internet: I was a running snob. I looked down on walkers with 100% Grade A pure disdain with a heaping side of superiority. In the supermarket checkout line, I full-on “pfffted” at magazine headlines proclaiming, “Walk yourself thin.”

I mean walking was for underachieving lazy people. Why walk for an hour and get only one mile, maybe two, when you could run for twenty-five minutes and travel 5K? Oh I was never a speedy runner, but I was fast enough to justify my tortoise and the hare snobbery . . . at least in my mind.

But I have seen the light! Behold the glorious disciple who washed the scales from my McJudgy eyes: my knee!

Internet, Ellen’s knee. Ellen’s knee, Internet.

The Truth About 10000 Steps and Your Health| One woman's story of success walking the road to fitness.| Sisterhood of the Sensible Moms

My knee in all of its swollen glory. My daughter thought it looked like a Cabbage Patch Doll. So she added eyes. Because laughing hysterically at my pain is the same as an “I love you”, right?!

In February of 2014, something popped and intractable pain ensued; leading me to get arthroscopic surgery in April. Now before you pull on your own McJudgy pants (I’m picturing them as plaid) and scoff, “See, that is what you get for running,” just know that it was genetics more than running that got my knee.

Not to brag, but when I woke up from anesthesia my surgeon ever so gently told me that I have the knee of a seventy-year-old woman. But don’t cry for my knee, I sobbed enough for all of us.

And thus the blossoming romance between Booty and Chairbegan.

During my seven week recovery period, Booty and Chair really became an item. They had flirted on and off leading up to the surgery, but no real connection bloomed until Crutches formally introduced them.

And here is a snapshot showcasing just how inseparable Booty and Chair became as the affair progressed.

Erin was trooper enough to chaperone the happy couple, Booty and Chair, all over the airport when we attended Mom Summit 2.0.

Should I have realized that Booty and Chair were no good for each other? That they were on a collision course headed for mom jeans and muffin tops? Sure, in normal times. But when I wasn’t lamenting, I was pouting about how awful it was that I could no longer run. Why bother moving at all if I couldn’t move in the most efficient, hard-as-nails way possible? “No pain, no gain” was the battle cry in the 80s and I was nothing if not a child of those times. Any decade that had “Where’s the beef?” AND “I’ve fallen and I can’t get up!” was a decade whose catchphrases needed to be cherished.

So what did my attitude get me? Fat. It got me fat. By Christmas, I was fifteen pounds heavier than I had ever been pregnant. In a theory I will never be foolish enough to test–my old maternity clothes would not fit me. Take a moment of silence for that soul-sucking sadness.

Something had to change and that something was getting a Fitbit Zip, joining a fitness support group, and logging back into My Fitness Pal to track my calories.

Guess what I learned? I was eating too much and moving too little. Who knew my 44-year-old metabolism couldn’t burn through nachos and cookies every night?

I clipped on my Fitbit Zip sure that in the course of my day I would hit the magic 10000 steps because I knew I was an active person. Um, I hit about 3000.

So did I jump on my treadmill to rectify the situation? No! I turned to the internet to see if this whole 10000 step thing was bogus. And the answer was a retroactive, “it’s legit!”

While the 10000 step concept was originally thrown out there in the 1960s by a Japanese company to sell pedometers (Aha! I knew it was a lie!), American scientists have since performed the research and determined that 10000 steps per day is a pretty good indicator of an active lifestyle. (Science to the rescue!)

In the scientific paper, Steps to Better Cardiovascular Health: How Many Steps Does It Take to Achieve Good Health and How Confident Are We in This Number?, Catrine Tudor-Locke outlines different levels of activity.

Activity Level Defined by Steps per Day

The Truth About 10000 Steps and Your Health| Read for more diet and fitness tips.| Sisterhood of the Sensible Moms |Activity Levels Defined by Steps per Day

Ten thousand steps is a great number because unless you have a very active job like nursing or working in a warehouse, you need about 30 minutes of brisk walking in addition to your normal life steps to reach 10000.

This in turn correlates with the American Heart Association’s recommendations for overall cardiovascular health:

At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150

At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activity

AND

Moderate- to high-intensity muscle-strengthening activity at least 2 days per week for additional health benefits.

So what counts as moderate to intense walking? That would be ≥100 steps per minute. I timed myself on my treadmill and at a mere speed of 3.0, I can achieve about 125 steps per minute.

And here is some of the best news! You don’t even have to tackle the 30 minutes all at once! Ten minute bursts of activity at a time achieves the same fitness results.

So to recap, walking is good enough and humans are lazy liars who are fantastic at deluding themselves. Or at least I am. I don’t know if you were playing along at home, but I was only hitting 3000 steps before my fitness revelation. I WAS A SEDENTARY SLOTH! While sloths are adorable, carrying thirty extra pounds is not. I needed to change.

My Three Point Fitness Plan:

1. Accountability

If you are gaining weight, the truth is you are eating too much and the only way to get to the bottom of it is to keep a food diary. I logged into My Fitness Pal (MFP) app for the first time since 2009 to track my food. It has improved so much! You can easily find calorie counts for Weight Watcher and Skinnytaste recipes and you can scan the barcode of packaged foods.

I bought a Fitbit Zip. You can check out why Erin and I picked the Zip here. Fitbit and MFP work wonderfully together to track your energy in versus energy out. MFP will even calculate how many calories you burned from active exercise logged on your Fitbit and figure those into your calories allowed total. Also, you can link up with friends so you can ~~compete~~ compare how many steps everyone is taking.

I confess failures and celebrate successes with the ladies in my fitness support group. You can have your own. It’s as easy as gathering some friends in a secret Facebook group.

2. Moving More

I have fully embraced the American Heart Association’s mantra about exercise: Something is better than nothing!

3. Eating Less

I have invested the time in cooking healthy meals and stocking my kitchen with healthy snacks. I cannot “diet” and deprive myself, but I know how to eat nutritious, delicious foods that boost my health and keep me satisfied.

What does this look in action?

1. Exercise

For the past 30 days, I have moved 10000 steps each and EVERY day. Probably about 3000 to 5000 of these steps are achieved on the treadmill at speeds between 3.0 and 5.0 with most of them happening at 4.0, but if I can get outside, I prefer that. I have also been known to do four extra laps around the grocery store to get my steps in. If I am feeling sluggish, I convince myself walking at 3.0 on the treadmill is better than sitting and usually by a minute into it, I feel like ramping up the speed. I subscribe to the science behind interval training. No matter how fast I am going, I usually ramp up the speed by 1.0-1.5 for about a minute at a time. If I am on the treadmill for 30 minutes, I usually interval up five or six times. I also set the incline for 1 or 2 to make sure my intensity is good enough. I would go higher, but it hurts my knee.

I also have been hula hooping with a weighted hoop every day. Talk about an effortless abdominal and glutes workout! Exercise can be fun. I am a convert! (Caveat: your ribs and hips might feel a little bruised at first, so start with about a minute of hooping. This feeling disappeared for me after about 2 days. I think consciously tightening your abs while hooping also helps.)

I have been doing low weight/high repetition arm work and Pilates style ab work (planks and push-ups are my frenemies) two or three times per week. I often do the weights while on the treadmill. I have also been doing these exercises to strengthen the muscles supporting my knees.

When I hit the inevitable plateau, I will switch up/intensify my strength training.

2. Nutrition

I have MFP set for 1.5 lb/per week weight loss. This allows me 1220 calories per day, which I admit is hard to maintain EXCEPT I really end up eating between 1300 and 1475 calories per day because of my Fitbit exercise credit. It is a bit of a mind game, but it works for me.

2015-02-18 15.36.23

I just cannot eat “diet” food. It tastes like plastic and the portions are miniscule. I must eat food that is delicious and allows for satisfying portions. With that being said, I cannot live on salad alone either.

I have not skipped meals and I never allow myself to become ravenous. Basically, I have been eating around 350 calories each for breakfast and lunch making sure to include protein. To reach these goals, I have banished most bread, but I still eat carbs. I think carbs are delicious and get a bad rap from the haters. For dinners, I have been preparing tasty, family-pleasing options such as Skinny Mexican Casserole, Healthy French Country Crockpot Chicken, and Weight Watchers Baked Spaghetti Carbonara. I generally load up on roasted veggies and have 1/2 cup of healthy grains, too.

While every choice is part of the Big Picture, not every choice has to be perfect. Fitness and health has to be a lifestyle, not some “diet” to blast through.

3. Results

In thirty days, I have lost just over ten pounds (one third of the way to my goal) and several inches from my waist, booty, and arms. I have leveled down to the next size of jeans in my closet. I feel tremendously more comfortable in my own skin already. And of note, I have not felt denied. During this 30 days, I have celebrated my birthday with a wonderful weekend in Philadelphia where I ate the likes of bacon wrapped dates, empanadas, crispy Cuban pork, and salted caramel cheesecake (all in one day, yikes!). Just know on that day I walked for close to 16000 steps all over the city and I locked her down that Monday and Tuesday, eating about 1250 calories each day.

Bottom Line

♦Adequate levels of fitness take more than a casual stroll, but they also don’t require 90 minutes of marathon running and weight lifting. Don’t let the whispers of perfectionism immobilize you- “If you aren’t working hard, what’s the point of working at all?” Just move! An object in motion tends to stay in motion and it’s surprising what you can achieve if you just take that first step. I still miss the “high” from running, but my knee appreciates walking and the ten less pounds it has to haul around.

♦Accountability is key. My overachieving self can’t help but beat the 10000 step goal each and every day on my FItbit. Plus, since I can link up with my friends, THEY can see if I’m reaching my goals, too. Pride, in this case, works for me.

♦If you aren’t recording your food, you are most likely eating too much. As they say in Weight Watchers, if you bite it, you write it. I weigh or measure out every portion I eat.

Now go forth and move! The road to fitness can be walked!

It’s Your Move!

A success story of walking the road to fitness. Here’s the truth about 10000 steps and your health.

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Did you know you can earn money with your Fitbit steps?! Find our all about it here!

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Herd Immunity: Anti-Vaxxers Are Killing It

1. False Premise: Vaccines cause autism.

A few things first. I understand that scientific papers are hard to slug through. And not all research is created equal. Studies that are observational, do just that, observe what has already happened. These rely heavily on patient reporting.

This is a weaker study than the gold standard, randomized controlled trials, in which the subjects are randomly distributed into groups which are either subjected to the experimental procedure or which do not receive it and serve as controls. In this kind of study, there is less bias and it is easier to weed out coincidences.

Also, published research is not a proclamation of fact. It is a sharing of what has been discovered to advance science. It doesn’t mean it is flawless. “Discoveries” do not come from a single paper. Multiple scientists must replicate and advance a finding before a real “Eureka!” moment is reached.

It’s easy to forget this when the press latches onto a concept like “MMR causes autism,” and pukes it from the rooftops to stir panic and fear because that keeps you coming back for more.

All of the MMR vaccine misinformation can be traced back to one paper. The link between this vaccine and autism was proposed by a British physician, Andrew Wakefield, in the February 1998 issue of The Lancet. This finding has never been replicated by any other researchers. More importantly, it was discovered to be manufactured from fraudulent data and has been RETRACTED.

There were only twelve children in the observational study–this means that even if the findings were true, they really only provided a starting point for other research, not for conclusions. However, that hardly matters since the entire causal effect was based on what the parents reported as the length of time from the administration of the vaccine to onset of autism spectrum symptoms AND THAT DATA WAS FALSIFIED. The timelines of the children’s symptoms were misrepresented.

Also damning was Wakefield’s conflict of interest. How could an article with such a small sample size and the title, Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children, cause such a fervor? Wakefield had an agenda to advance because he was a paid consultant to attorneys representing parents with anti-vaccine lawsuits. The General Medical Council in the U.K. revoked Wakefield’s medical license because of his fraudulent report and unethical behavior.

What is atrocious is that it took until 2010 for that paper to be retracted and for Wakefield to lose his license. For over a decade the fires of misinformation have been fanned and stirred into a bonfire so raging that five years after it should be extinguished, it is still smoldering. Why is this paper still used in arguments in 2015?!

But the controversy has expanded. The original autism scapegoat was the MMR vaccine, but the blame game has subtly shifted to focus on the ethylmercury vaccine perservative, thimerosal. This shift was spurred more by activist and political groups than science. Regardless, thimerosal has been removed from vaccines, mostly since 2001.

My heart breaks for the parents who are just looking for answers for their children on the autism spectrum, but I seethe over all of the money that has been diverted from worthwhile autism research to prove over and over again that vaccines are not linked to it. With the combined studies to date, millions of children have been studied and no link has been found.

2. False Premise: Childhood illnesses are no big deal.

In the United States, some parents mistakenly think that refusing vaccinations is a benign choice because they do not remember, or maybe they have never even seen the diseases. But these childhood diseases aren’t just spotty rashes or coughs. They can cause lasting disabilities, and at times death. At the very least, they cause weeks of suffering for the patients, and prolonged time off from work for caregivers. Because these are viral diseases, there is generally no specific treatment once they are contracted.

Here’s a heart stopper. For measles encephalitis (swelling of the brain) which occurs in 1 in 1,000 patients infected with measles, the treatment is still just supportive: rest, fluids, and nutrition. Ribavirin may help, or it may not. There’s not a whole lot of current research going on because measles was declared eliminated in the United States in 2000. So really the treatment is no better than it was when author Roald Dahl’s daughter, Olivia, died from it in 1962. The only difference is he did not have the choice to vaccinate his daughter because it was not available until 1963.

Oh and if your child contracts measles before they are 2-years-old, you get to be on the lookout for subacute sclerosing panencephalitis (SSPE), a very rare, but fatal disease of the central nervous system that results from a measles virus infection acquired earlier in life. SSPE generally develops 7 to 10 years after a person has measles. So that herd immunity is pretty important for infants before they can be vaccinated because the worry never ends.

Thank goodness those complications are rare, but don’t forget measles can cause diarrhea (dangerous for young children because of dehydration), pneumonia, ear infections, deafness, and blindness. An acute infection with measles while pregnant can lead to premature birth.

I can’t believe in the middle of my scientific citations, I’m linking to Buzzfeed, but if you want to see what measles really looks like, they have an excellent article.

Measles remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Approximately 122, 000 people died from measles in 2012 – mostly children under the age of five.

You can’t avoid measles very well because patients are infectious for 4 days before the rash appears, but my goodness we have the power to prevent it.

3. False Premise: Lawsuits equal scientific proof.

While court decisions can be be based on scientific proof, scientific proof cannot come out of court decisions. Just because a jury awards money in a vaccination lawsuit does not prove that vaccines are bad. Many decisions are based on the skills of the lawyers and the height of the emotions.

When discussing adverse outcomes of immunizations, the Vaccine Adverse Event Reporting System (VAERS) is often bandied about. This is a tremendously useful surveillance tool co-sponsored by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) that allows doctors and the public to report any adverse events they think may have been associated with vaccine administration. It receives around 30,000 reports annually.

What it is:

A gathering of unfiltered information. Anyone can submit. (About 7% are from vaccine recipients or their guardians, 36% are from health care providers, and 37% are from the vaccine manufacturers.)
A place to monitor adverse vaccine events.
A tool to trigger further investigation if correlations are shown.

What it is NOT:

It is NOT the final outcome from research triggered by trends.
It does NOT show causal relationships.

No conspiracy theories necessary. (Did you notice the biggest contributor of information was Big Pharma itself?) And it works as can be seen in the case of the RotaShield vaccine.

VAERS detected reports for cases of intussusception (a condition where part of the intestine slides or telescopes into an adjacent part of the intestine) over what would be expected to occur by chance alone after the RotaShield rotavirus vaccine came out in 1999. Epidemiological studies were triggered and confirmed an increased risk, which contributed to the product’s removal from the US market.

For RotaShield, a risk was apparent less than a year after release, it was investigated, and the vaccine was removed. The MMR vaccine was released in 1971 to replace single doses of each viral vaccine that had been around for a decade longer. You can feel confident about its safety. I do.

My oldest child was born in 1998 and was due for her first MMR vaccination in 1999, right when the Wakefield autism hysteria was gaining momentum. My husband and I had her vaccinated. I had read Wakefield’s paper for myself and realized the flaws. Also, a well performed study by Brent Miller was already published. He studied 498 children and could not find a link between the MMR vaccine and autism.

Since that time, millions of children have been studied and no links have been found with autism. In fact, the vaccine has been shown to be exceptionally safe on all accounts. Those who claim otherwise are lying or deceived by unreliable statistics. You can read a very good article about this in layman’s terms here.

Please weigh the scientific evidence versus popularized fraud when making decisions for your kids. Your decision not only affects them, but the health of the whole community. Don’t let herd immunity die.

-Ellen

Herd Immunity: Anti-Vaxxers Are Killing It. It’s not just about you, it’s about safety for all.

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A Trio of Skinny Ground Beef Recipes with a Side of Podcast

What can help you flip your switch? Just hit play on the soundbar at the bottom of the post.

Now you were promised the recipe for stuffed pepper soup, but we’re going to give you even more. Here are THREE recipes you can make at the same time. If you’re browning one pound of ground meat, you might as well brown two and have dinner and lunches done for the whole week.

Skinny Stuffed Pepper Soup

Skinny Ground Beef with Greek Yogurt Sauce

Skinny Mexican Casserole

You can follow the links to the fully printable recipes, but here are Ellen’s tips for assembling the soup, Mexican casserole, and Greek beef at the same time.

When making these recipes all at once, Ellen typically uses one pound of extra lean ground beef and one pound of extra lean ground turkey.

She browns the turkey with the onions and peppers for the soup in her soup pot (because it cooks with very little fat draining off). She cooks the beef with the onion and the pepper for the Mexican casserole in a skillet. She drains both separately and removes her quarter cup of ground beef for the Beef with Greek Yogurt Sauce. but then returns half of the turkey to the skillet and half to the soup pot. She does the same for the beef, trying to get more of the peppers back in the soup pot.

She then proceeds with all three recipes. It’s a lot of cooking, but then you have dinners and lunches for days. So worth it.

Now these recipes weren’t the only resources mentioned. Another tool we talked about was this little guide that is so very useful for planning what you are going to eat when you go out:

The Calorie King Calorie, Fat & Carbohydrate Counter 2015: Pocket-Size Edition

Now while you can easily get this awesomeness on Amazon for under $9.00, Ellen mentioned another book that is unfortunately out of print: The Skinny: How to Fit Into Your Little Black Dress Forever by Melissa Clark and Robin Aronson. So since you can’t easily buy this for yourself, we’ll share the two philosophies in it that first helped Ellen “flip her switch.”

1. Eat what you want and banish the guilt. If you really want a food, there is a portion and a way to work it into your day.

2. You can indeed eat a few bites of something decadent, like cake, enjoy each bite, and know that there will be bites of cake in your future. You don’t have to consume it all right now.

Keeping these two philosophies in mind are a great way to supplement a diet plan so that you can kick boredom, bingeing, and guilt to the curb . . . along with your fat pants.

By the way, we were raving about the positive reinforcement our Fitbits give us. We both have Zips. You can look at the details and buy one here:

Fitbit Zip Wireless Activity Tracker

Ooo,oooo! One more thing! We talked about being excited about BlogU. If you are looking for a great conference to take your Blog Beyond, check it out.

Thanks for Listening! And let us know what you think in the comments! How do you keep fit?

Erin and Ellen

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How to Deal With Ebola Panic? Stay Away from WebMD

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Do not search Ebola on WebMD! Seriously!

I know I have a loathe/hate relationship with WebMD, but this is not my prejudice talking. Heed my warning and do not go there. You just might land on this little charmer of a video and if you harbor even a little spark of anxiety over Ebola, it might be ignited into a raging bonfire of panic:

It starts out, to quote: “Everyone knows that Ebola kills, but what exactly does it do?”

Whew! Glad he started out with a little reassurance.

Followed by: “This worm-like virus has a devious way of working.”

Way to soothe by personifying a hunk of RNA with the intentions of a villain.

But at least he follows up with this: “In the current outbreak, 60% of the people have died.”

Where? Where are you talking about?! My local Shoparama?!

It’s not until the last few seconds of the video that we get: “The risk of catching Ebola is extremely low in the U.S.”

Well, hope you were able to grab some smelling salts and hang in through the “particle explosions of virus” storming through your body and “bleeding from your eyes” to get to that part.

Don’t get me wrong. Everything in that video is accurate and Ebola is serious. Serious for the people in West Africa where in the current outbreak there have been more than 4,900 deaths. But keep in mind, those deaths are out of about 10,100 cases, making the rate of death below 50% even with what we would consider sub-par medical care.

In contrast, in the United States, there have been 4 confirmed cases out of a population of almost 319,000,000. There has been one death and he contracted it in Liberia. There are contentions that his diagnosis was delayed, but I wouldn’t lose sleep about future misdiagnoses. Anyone with a fever is prompting cries of “Is it Ebola?!”

But just as panic is ramping up here, the World Health Organization (WHO) officially declared Nigeria free of Ebola virus transmission. This is tremendous news because at one point during the summer, the outbreak in Nigeria was feared to be the most potentially explosive one to date.

Let’s focus on the “to date.” Here’s a fun fact, Ebola was first recorded in 1976. This isn’t some new-fangled disease. The people of Africa have suffered through outbreak after outbreak for about four decades. It’s just that the American public didn’t really take notice until it flew onto our doorsteps.

It was the same way with HIV. The first HIV/AIDS epidemic took root in Africa in the 1970s with the spread of the disease exploding in the 1980s. But Americans only really became concerned when it landed in Los Angeles; and it didn’t take long for that concern to rocket to hysteria. The rampant fear spawned discrimination and hate crimes: children were banned from schools. adults lost their jobs, and houses were burned down.

During my medical training, I started my rotation on the HIV infectious disease ward when fears were still bubbling and the FDA approval of life-prolonging multi-drug therapies was still on the horizon. Heck, at the time, AIDS was the leading cause of death for all Americans ages 25 to 44.

But I was not afraid. Because science.

I knew HIV was spread through bodily fluids and I wore my gloves and face shields. With scientific evidence as my guide, I calmly and compassionately took care of those HIV patients.

You need to know, though, that I am not cavalier. There are some things that get me jittery, like diseases with a respiratory route for transmission. We canceled our trip to Mexico in 2009 when the H1N1 pandemic was gripping the world. I did not want to end my vacation in quarantine because an infected person happened to be sharing the recirculated air with me on my tin can of an airplane. If I had to choose between snakes or swine flu on a plane? I would pick the reptiles all day long.

With this evidence and background, I present without further ado, my reasons for NOT panicking over Ebola.

Top 3 Reasons NOT to Panic over Ebola

1. It is NOT transmitted though the air.

To become infected, a healthy person’s broken skin or mucous membranes must come in direct contact with the blood, or other bodily fluids (stool, urine, saliva, semen) of a symptomatic, infected person. Infection can also occur if broken skin or mucous membranes of a healthy person come into contact with environments, such as soiled clothing, bed linen, or used needles, that have become contaminated with an Ebola patient’s infectious fluids .

2. Ebola is highly infectious, but moderately contagious.

Infectious and contagious are not interchangeable. Ebola is highly infectious because only a small amount of the virus is needed to cause disease, BUT it is only moderately contagious because it requires direct contact to catch it. To reiterate: Ebola is not spread through the air, water, food, or mosquitoes.

3. Ebola is not transmissible if someone is asymptomatic.

There are no silent carriers sneaking around amongst us. A person has to be sick to spread it. Even if someone is starting to be ill with a fever and fatigue, they are still not that contagious. Spread of infection becomes very risky once a patient’s bodily fluids are exploding forth because of violent vomiting and diarrhea. By the time a patient is this sick, he or she is incapacitated and not moving about in public.

There you have it. Ebola has gripped our attention because the disease, once contracted, progresses so quickly and is so visibly horrifying; but there is no reason to worry that it is going to storm through our country via casual contact. Be concerned, but do NOT panic. In fact, you may want to save your worry for the health care providers who are treating Ebola patients. Worry that they are following recommendations for personal protective equipment and environmental infection control. Say a little prayer of thanks that there are people willing to take care of us.

And maybe be a little grateful that with this new and glaring Star Spangled spotlight, efforts are finally intensifying to find vaccines and treatments for all of the world.

-Ellen

Top 3 Reasons NOT to panic over Ebola. Spoiler Alert: Science.

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How to Pick Where to Go for a Mammogram

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The PR is good enough that we all know we have to take care of The Girls. You know . . . your milk bags, sweater hams, bee stings, tas-tas, boobies, or if we’re being absolutely mature and proper–your breasts.

The first step is knowing when to get a mammogram. This is thankfully so straightforward that even tabloids and random websites get it correct (although government tasks forces did try to muddy the waters), but I like to go straight to the horse’s mouth. Although “teat” might be the more apropos body part in this case.

The American College of Obstetricians and Gynecologists (ACOG) guidelines recommends:

Mammography screening should be offered annually to women beginning at age forty.
In addition, you should discuss family history and any other risk factors with your doctor to determine if you need to begin screenings at a younger age or if you need enhanced screening.
You should perform monthly breast self-examinations to find any changes in your normal breast anatomy. Any changes should be discussed with your doctor.
Clinical breast exams (CBE) by your doctor are recommended annually for women ages 40 and older, and every one to three years for women ages 20-39.

But where to get this done? Ahh, that’s the stickier wicker . . . or is it trickier wicket? And why am I making references to British lawn games at a time like this anyway? And which game are they talking about: croquet or cricket? Well, picking a mammography center is just as confusing as my metaphor, even for someone like me with a medical degree.

When I was about 33 years old, my primary care doctor wanted me to get a mammogram for a VERY weak indication. I really thought about refusing it, but once a physician recommends a test, it is very hard not to lay awake at night wondering, “Are tumors growing right this very minute?? Are they growing now? NOW??”

At the time, I had a preschooler and a toddler, so I let convenience rule my decision and dropped in at the local corner X-ray Shoppe. My mammogram was squeezed in between the fractured thumb and the drunk softball player’s sprained ankle (he was totally fine, he was just being a wuss). Not really a specialized situation.

But luckily my mammogram was actually fine because when I went for my next test at age 40, that one was clear too. This time I went to the respectable community hospital with the pink awning, herbal tea bar and mood lighting in the waiting room. Lovely experience . . . except for the part where they pulled and squished my small breasts like deranged toddlers with Silly Putty; but that was to be expected.

I had two more straightforward mammograms until what I like to call “The Morning Blood Dripped Out of My Nipple.” Bum, bum, buh. During my monthly self exam in the shower, I expressed blood from my nipple. BLOOD. From my NIPPLE.

Are you freaking out right now? That would be a typical reaction. Luckily, I knew that a benign intraductal papilloma was at the top of the list of possible diagnoses. Seems impossible that bloody discharge is most likely NOT malignant, but the world is a mysterious place. Still, it needed to be checked out.

Off I went to my Feng Shui breast center with an order from my gynecologist in hand. I got the mammogram. I sipped my tea and waited. They couldn’t find anything on the mammogram so they took me back for an ultrasound. Either they ran out of money for the interior designer for this room or they just felt like stuff was getting real if you had to get an ultrasound. The tech pushed and ground the probe into my breast, but couldn’t find anything. “Are you sure you were having bloody discharge?” Um, yes.

Without warning, or even buying me a wine spritzer, she reached over and gave my boobie a squeeze just to double check my story. She gasped when she saw the blood and left to get the radiologist.

Insider tip: Gasping is NOT professional and more than a little worrisome to most patients.

As the minutes ticked away under the glare of the fluorescent lights, my tiny pink paisley gown was no comfort in that icebox of a room . . . probably because she left all of the sonogram gel smeared on my chest. She had explained that she didn’t want the radiologist to waste his time putting on more. I cleaned myself up anyway, my teeth chattering loudly, and waited the eternity for her to return . . . without the radiologist.

“The doctor says you just need to follow up with your OB/GYN.”

“Follow up with what? You didn’t find the cause of the bloody discharge.”

“The radiologist says your doctor will decide the next step.”

“Wait. You’re shunting me away from the ‘Breast Care Team’ back to the doctor who is only really a gatekeeper for breast screening?”

“Well, we didn’t find anything.”

Blessedly, I am now old enough to know when to cut my losses. Why fight for care that was already starting off badly? I left, ignoring the volunteer handing out pink bracelets, and quite honestly, fighting back tears.

How to Pick Where to Go for a Mammogram | Mammograms are important for detecting breast cancer early, but before you can make an appointment, you have to pick WHERE you're going to have it. | Health | Sisterhood of the Sensible Moms

So out of my experience–from someone who should have known better in the first place–comes my personal recommendation:

Get Your Mammogram at the Center Where You Would Want to Get Your Surgery Performed.

So how do you figure this out?

Find your surgeon.

Start with the surgeon you would want to perform your biopsy/procedure and work backwards. Your greatest hope is that you will never need this person, but if you do, it will be a comfort to already have this decision made. Ask friends and medical professionals you trust who they went to or would go to for their own care.

Finding a skilled surgeon is easiest in a university teaching hospital. I personally drive over an hour for my breast care now. What I spend in gas and drive time, I save in peace of mind. Of course, community hospitals have good surgeons, but without strong recommendations, it is easiest to find the best where there is a medical school.

Make sure your surgeon has completed a fellowship in surgical oncology. Some may have completed breast oncology fellowships, although there are only about 40 of these specialized breast programs in the country. It’s not uncommon for the “breast specialists” in community hospitals to just be general surgeons. They’re scheduling breast biopsies around hemorrhoidectomies.

Check out the center’s website . . . BUT DON’T STOP THERE!

Read through what they offer. They should have a complete range of breast imaging service–mammography, ultrasound, and MRI–using all-digital imaging technologies for screening and early detection.

But here is the important part: Call the breast center and ask to talk to the Patient Care Coordinator or Navigator. Say you want to be walked through what the protocol is if an abnormality is found. If you have difficulty at this step, this might not be the center for you. My community center had all of the bells and whistles listed on their website, but those bullet points did not translate into streamlined patient care.

Questions to ask the Patient Care Coordinator.

This list is not comprehensive, but it will get the conversation started and give you a good chance of getting the information you need.

Will my mammogram be checked before I am allowed to leave? Who reviews it?
How quickly will my mammogram be officially read? How is it read and how many radiologists review it?
If there is an abnormality, does the radiologist confer with a surgeon to decide the next step? How quickly does this occur?
At what point would I discuss with a surgeon biopsy/procedure options?

Does it seem overkill to go into this much detail before there is even a problem? It is not. I have seen the fear and confusion play out over and over again when an abnormality is found: the scramble to figure out the next step, the confusion over who is even performing the next step, the fear that creeps in during the waiting period. It’s like reinventing the wheel each time and it shouldn’t be.

Learn from my mistakes born out of laziness to save yourself a cup full of frustration in the future. See what I did there? Cup full? Get it? Whatever. My advice is better than my jokes.

-Ellen

How to pick where to go for a mammogram. Your breasts will thank you. #BreastCancerAwareness

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Addendum: I have since switched away from the center where my benign papilloma was excised. While my care was excellent, they screwed up my billing so badly that it took over 8 months to straighten out. Their customer service was belligerent to put it nicely. All of the signs were there that if I had a problem that required ongoing treatment, I would be spending an infuriating chunk of time on the phone. It pained me, but I packed up my records, began the selection process again and am going to another university center. So far, so good, but the moral is, never be afraid to search until all of your needs are met.

[This article was originally published in July 2014.]

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Block, Spot, and Stop Skin Cancer

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If I had to choose a food to play me in my Food Network biography, Swiss Cheese would be reclining on the casting couch. She’d be dressed in just a whisper of Dijon mustard and accessorized by some lovely capers.

Yes, this is the time of day when I desperately need a snack, but more importantly it’s the time of year when I get my semi-annual skin check. With my freckled, fair complexion and decades of inadequate SPF leading to major childhood sunburns, each visit to my dermatologist becomes a rousing game of Whack-A-Mole. I’m currently sporting three biopsy sites, hence my Swiss Cheese casting call.

But a pound of prevention is worth ounces of flesh, especially when that flesh is ugly brown moles. I use my skin checks as opportunities to remind my friends and the internet to do it too. I didn’t earn the preventive medicine award at my medical school graduation for nothing.

One friend replied, “Don’t worry. I go to play the death sentence roulette every year.”

I replied, “Great, wait, wh-what!?!”

She explained, “I know there are different types of skin cancer, but I feel if they tell me I have melanoma, they’ll just be telling me how long I have left to spend with my kids.”

This woman is a smart cookie, how could she be missing the prevention part of the equation? Well, queries to friends and Facebook revealed she was not alone, but while her worry was distressing, at least she was getting checked. The answers that rocked me to my clinician core were the “Why bothers?”

Somewhere between “tanning beds are evil” and “sunscreen saves lives,” the message that skin checks are a staunch line of defense AGAINST death from melanoma has gotten lost.

Now is a great time to get your skin checked. Prevention and early detection stop skin cancer. Block, Spot, Stop, Skin Cancer | Health | Sisterhood of the Sensible Moms

THE REASON FOR DERMATOLOGIST SKIN CHECKS: So moles may be removed BEFORE they become cancerous and melanomas are found so early they can be CURED by excision.

Did you get the prevented and cured part? Good. Now embrace the dermatologist part because self-checks are not enough. Unless you are way better at yoga than me, I can only view about 50% of my body. Even if I could check out my own derriere, it wouldn’t matter because when I tested myself on 28 pictures of moles, I only picked the cancer four times. And, remember, I have an M.D.

So here is how you sleep at night. Go to your dermatologist and become familiar with your baseline. From that point on, look for the “ugly duckling” or the mole that doesn’t belong. Moles grouped together generally look alike, but you can have more than one pattern present on your body–for example, a dark pattern and a lighter pattern. Look for the odd duck in a grouping: a reddish one appearing in a cluster of dark ones or a black one appearing in a pattern of light tan ones. Take note and call your doctor if you see anything new or find a mole with irregular borders, scaling, bleeding, or itching.

You can also test your skin cancer IQ here.

When it comes to skin cancer, prevention is key.

Stay covered up with hats, shirts, and sunglasses. There is great SPF protective clothing out there now. Find some here.
Slather on sunscreen of at least SPF 15. This means applying the equivalent of a shot glass (two tablespoons) to your face and body, and reapplying at least every two hours.
Avoid sun exposure between 10 am and 2 pm.
Never use tanning beds.

However, the skin cancer you get today is from the exposure you had in your past. So have you scheduled that professional skin check yet? If you are still not convinced, here are a seven reasons to make that appointment today.

Now is a great time to get your skin checked. Prevention and early detection stop skin cancer. Block, Spot, Stop, Skin Cancer | Health | Sisterhood of the Sensible Moms

In the meantime, use measures to block the rays, self-exam and make your appointment to spot the “ugly duckling”, and know that prevention can stop skin cancer.

Now, embrace that pale is healthy and looking like Swiss Cheese for a few weeks is worth years with your family and friends.

-Ellen

Block, Spot, and Stop Skin Cancer because you can. Here’s how.

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The Real Deal on Oil Pulling Plus Other Oral Fixations

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Oil pulling. Maybe you don’t know what that is because you don’t scroll through the internet like it’s your job? It sounds like what a dastardly comic book villain would do to hold the world ransom. All the world except for Prius owners; they would be safe.

But really, it is an old (maybe ancient) folk remedy where you swish a spoonful of sesame or coconut oil around in your mouth for a random twenty minutes and then spit it out. According to legend (the internet), your mouth will be healthier and your chances of winning the lottery will increase ten fold, but you won’t care because you’ll be sneezing diamonds.

Okay, maybe not all that, but there are lavish claims about how it pulls the toxins out your body curing everything from dry hair to arthritis to MS.

Um, nope.

First: Your gums are not semi-permeable membranes, nothing is getting pulled from your bloodstream through them. Thank goodness.

Second: Toxins just aren’t hanging out in your body. Your kidneys and liver make sure of that. Let’s give them the respect they deserve for all of their hard filtering work. Send them a thank you card or a pajamagram. Nothing says appreciation like a pajamagram.

All jesting aside, there is a connection between oral health and general health that all comes down to bacteria. Periodontal disease has been linked to coronary heart disease and anyone with heart valve issues must take antibiotics before getting dental work. When I was training as an OB/GYN, we were very concerned if our patients had bad teeth because it could be a risk factor for preterm labor.

So a healthy, clean mouth is not just a tag line for chewing gum, it’s important. And get this, oil pulling has been shown to reduce the bacterial count and inflammation in your mouth. The studies were small because, let’s face it, there are bigger fish to fry in terms of research dollars, but oil pulling is a pretty low risk endeavor. There is one study in India that used adolescent boys to compare mouthwash to oil pulling.

Choosing teen boys for a cleanliness study is kind of funny, right?

Anyway, it was found that both the mouthwash and oil pulling groups showed reduced bacterial counts, but the mouthwash group showed significant reduction in twenty-four hours, while the oil pulling group showed reduction after one week.

This is where my Little Scientific Soul trotted out to the barn to get her high horse. Why, WHY, would you oil pull when mouthwash was so much more efficient? It just didn’t make sense. A mouthful of gooey oil or two teaspoons of modern miracle?

And I was all poised to write about the ridiculousness of it all when my Little Scientific Soul paused from saddling up that horse and admonished, “Should you really knock it without trying it?”

I knew I had coconut oil somewhere. It took some serious cabinet diving, but I found it hanging out with the flax seeds and agave syrup gossiping about how I needed to lay off the Cheez-its.

On to the pulling! The general procedure is to take a tablespoon to a teaspoon of the oil and swish for twenty minutes.

I chose one teaspoon and had at it. By the way, you might be picturing this wrong. Coconut oil is a solid at room temperature, with a fluffy consistency and a pleasant aroma. Not drippy or greasy at all.

It must be delicious. It says so on the label.

Here’s the re-enactment:

Swish, swish, swish. This is okay. Swish, swish, swish. Tick, tock, tick, tock. Okay. Swish. Tick, tock. I’m gonna be sick. Spit. Sputter. Wow that was a loooonnng minute.

I made it one minute before I thought I was going to hurl. I thought, “That’s it. Oil pulling sucks.” And then I thought about how much I how to dig around to find the oil, so I checked the jar.

2009!

Word to the wise: Coconut oil five years past it’s expiration date might be a little nasty.

I’m a good scientist, if not a good housekeeper, so I tried again with fresh reagents.

With non-rancid oil, the pulling was not so bad. In fact, it was more than borderline pleasant. I tried to return to my usual swishing with Listerine after my oil pulling “experiment” and I couldn’t stand it. It felt like burning acid. And if I’m being honest, I never really used the mouthwash frequently anyway. Maybe because it was like burning acid.

However, there is no magic here. In my (non-extensive) literature search, I found indications that both coconut and sesame oils may have antibacterial/antifungal properties, but I could not find conclusive evidence that they work on the types of bacteria in the mouth. Most of the benefits of pulling probably come from increased attention to oral hygiene, the mechanics of swishing, and the bacteria becoming emulsified and removed.

Things to keep in mind:

Amount: You REALLY only need a teaspoon. I feel like it’s called pulling because it pulls a TON of saliva into your mouth. After about a minute, it’s really like swishing water, that is, if your oil is not rancid.
Type: Some people use sesame, some use coconut. Some get worked up over types: refined, unrefined, cold-pressed, or virgin. As I said above, the benefits are probably from the mechanics of it, so pick what tickles your tonsils.
Time: There is no research saying twenty minutes is best. It’s arbitrary and surprisingly tiring. I do five to ten and call it a successful swish.
Disposal: Spit it in the trash. Remember coconut oil is a solid at room temperature. Not good for the pipes and weird to explain to the plumber.
Swallowing: <Insert joke here.> Lots of articles make a big deal about NOT SWALLOWING THE TOXINS. But remember, you’re not drawing out any toxins and your stomach acid is pretty fierce, so if you swallow a little, you’re okay. Really.

So I’m a convert. Cue the choirs and stable my high horse for another day. But I felt unsatisfied. I was ready to roast some quackery! Lucky for you, my internet research threw these Pinterest Pintershizz gems in my path. Soooooo . . .

Oral Atrocities to Ridicule of Instead of Oil Pulling

1. iPhone Case

Maybe this is funny in a quirky sort of way if you’re a dentist or hygienist?? Maybe?? It is definitely a bad call–pun intended and relished–for a funeral director. And does the background of this picture look like a prison?

Pinterest Source

2. Hair Accessories

Even if you thought the phone case was kind of kitschy, you CANNOT think these are acceptable. Even the tooth fairy couldn’t pull these off unless she was ditching the pixie dust and preparing for her debut on Criminal Minds.

Pintereset Source

3. Tiny Portraits

These are real teeth. With portraits etched on them. Really. random. portraits.

Pinterest Source

4. Jewelry

For those people who are all like, “What am I going to do with a bowl full of tiny teeth portraits? Give me something I can use.”

Pinterest Source

5. That Which Should Not Be Allowed

For the evangelists amongst us who not only love oil pulling, but want the world to see! Like a washing machine, except totally and horrifically different.

Pinterest Source

Whew, I feel better now! These photos did what no amount of oil pulling could: flush the judgmental snark out of my system.

So what is your opinion of oil pulling?

-Ellen

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Stop Skin Cancer Because You Can

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May is Skin Cancer Awareness Month and we are shouting it from the mountaintops or maybe we should say, blogging it from the molehills. Get it? Mole. Hills. While skin cancer is no laughing matter, we are willing to use whatever means necessary to kick you into gear to get your skin checked.

Prevention + Detection = Health

When it comes to skin cancer, prevention is key: staying covered up with hats, shirts, and sunglasses, slathering on sunscreen, and never using tanning beds. However, the skin cancer you get today is from the exposure you had in your past. Everyone needs a professional skin check. If you are not convinced yet, here are a seven reasons to make that appointment today.