Monday, November 19, 2018

What Is a Cystoscopy


A cystoscopy is an interventional procedure that provides an immediate view of the interior of the bladder and/or urethra, the tube that carries urine from the bladder to outside the body. The test is used for diagnosis and treatment of medical conditions that affect these organs. A thin tube (cystoscope) is inserted into the urinary opening, threaded through the urethra, and into the bladder. A small camera attached to the cystoscope relays live video feed to a monitor, which can be viewed by your doctor.

A cystoscopy can be used to investigate symptoms that involve the urethra or the bladder. You may need to have a cystoscopy to determine the cause of concerns such as:

However, this invasive procedure is typically done after an abnormality of the urethra or bladder has been discovered on an X-ray, magnetic resonance imaging (MRI), or a computed tomography (CT) scan, which are non-invasive tests. Cystoscopy provides your doctor with a different view that can help lead to a diagnosis.

Upon visualizing the inside of your urethra and bladder, your doctor may be able to identify structural abnormalities, areas of inflammation, growths, or ulcerations and diagnose a number of conditions on sight, including:

If a diagnosis cannot be made based on appearance alone, your doctor may obtain a sample of abnormal tissue for biopsy during the procedure so that it can be evaluated. (A cystoscope is often equipped with a tool that can quickly this sample.) If you have a biopsy, this does not necessarily mean that you have cancer. Biopsy is used to examine areas of infection, inflammation, and benign growths as well.

If a cystoscopy is being done for therapeutic reasons, it may be to visualize the bladder or urethra to allow for the removal of small growths, bladder stones, or to treat urethral strictures.

Limitations

A cystoscopy cannot identify every problem involving the bladder or urethra. For example, it often does not find the cause of urinary incontinence or neurogenic bladder. A cystoscopy also is not useful in diagnosing kidney disease.
Risks and Contraindications

In most cases, a cystoscopy is a safe, common procedure without complications. Rare complications can occur, such as an infection or injury. Complications related to general anesthesia are not common and can include respiratory or cardiac problems.
Before the Test

If you are going to have a cystoscopy, your doctor will discuss the procedure with you ahead of time. You may or may not need a biopsy or treatment during your procedure, and that will dictate if you have it done at your doctor's office or elsewhere. Your doctor and medical team will discuss your specific situation with you and explain the plan, as well as what you need to do to prepare. For example, you may be asked to avoid urinating for about half an hour prior to the test so that your doctor can send a urinalysis.

Location

The level of anesthesia that will be used, if it is used at all, will mainly dictate where your procedure is done. This decision depends on how complicated your condition is and the findings of your preliminary tests. Most cystoscopy procedures are performed in your doctor's office with local anesthesia. But if she anticipates that your procedure may take longer than average or may involve painful or extensive removal of tissue or repair of strictures, you will likely need to have your cystoscopy done under general anesthesia in a hospital or surgical center.

Timing

You should expect to spend about an hour or so at the doctor's office if you are having a simple procedure done there. If you are having a cystoscopy under general anesthesia, anticipate spending approximately half a day at the hospital or surgical center.

The cystoscopy itself generally takes about 10 to 30 minutes to perform. The time can vary based on the reason you're getting the test done and what is discovered during the procedure. Your medical team can give you a more specific estimate based on your symptoms and preliminary imaging tests.

What to Wear

You will be asked to wear a gown for the procedure, so you can wear anything you want on the day of the test.

Food and Drink

If you are having general anesthesia, you will be asked to abstain from food and drink for about six to eight hours prior to your procedure.

Cost and Health Insurance

As with most tests, your insurance may require a pre-authorization request. The staff at the facility where your cystoscopy will be done will take care of this, but you can check with them and your insurance company ahead of time to confirm. You may need to pay a co-pay, and you can verify the amount with your health insurance carrier in advance.

If you are paying for the procedure completely out of pocket, you should expect to pay several hundred dollars for a simple diagnostic procedure and several thousand dollars for a procedure that includes a biopsy or therapeutic treatment.

What to Bring

You should bring your order form (if provided), your health insurance card, a form of personal identification, and payment to cover the co-pay or the cost of the procedure, as applicable. If you will be getting general anesthesia, you should also make sure that you have someone who can drive you home after your procedure.
During the Test

You will meet with the urologist, who is the doctor who will perform your test. You will have other team members involved in your care as well, and these may include a surgical assistant, a nurse, and an anesthesiologist or anesthetist.

You will likely have more people involved in your procedure if you are having it done in an operating room, and fewer people if you are having it done in a doctor's office.

Pre-Test

Prior to your test, you will be asked to fill out several forms. These will include an agreement to pay for the test or to authorize your health insurance to pay for it, a patient privacy form, and a consent form stating that you understand the purpose and risks of the procedure.

You will then be asked to undress from the waist down, put on a gown, and empty your bladder. When your medical team is just about ready to perform the test, you will lie down on an exam table and place your feet in stirrups.

Local anesthetics used for a cystoscopy are typically in the form of a gel or other jelly-like substance. If you are to receive this, it will be inserted into the urethra. The doctor will wait a few minutes for the anesthetic to effectively numb the area before inserting the cystoscope.

If your procedure will be done under general anesthesia, you will have an IV placed in your arm or hand, and the anesthetic will be injected. You will also be hooked up to oxygen level and heart rate monitors, which will be checked throughout the procedure.

Throughout the Test

The cystoscope will then be inserted into the urinary opening. It will make its way to your bladder, with your doctor's help, via the urethra. Both may be of interest to your doctor, who will pause at times to view them on the monitor.

Your doctor may use a flexible cystoscope or a rigid cystoscope, which are generally the same size. There are advantages to each. For example, rigid cystoscopes tend to have a better camera and allow your doctor to have more control for removal of a mass or a stone, while flexible cystoscopes tend to produce less discomfort. Your cystoscopy may involve a white or a blue light to visualize the bladder and urethra. Blue light cystoscopy may be better for detecting bladder cancer.

A solution of saline or sterile water will be inserted into your bladder via the cystoscope, once in position. The solution expands the bladder, allowing your doctor to get a more detailed view. You may feel some pressure at this point.

If your doctor finds an abnormal growth, a biopsy may be done during your cystoscopy. While your doctor may have anticipated the need for this in advance, the decision to perform a biopsy may also be made in the moment. It only takes seconds for your doctor to obtain a tissue sample, and you may feel a slight pinch or a cramping sensation during the biopsy.

If you need to have a procedure to remove a mass or a bladder stone or to expand a stricture, it will be performed at this time. This is generally planned in advance.

At the end of the cystoscopy—which generally takes half an hour or less, unless a biopsy or treatment is being performed—your doctor will remove the cystoscope and you should not need any stitches or bandages.

Post-Test

As long as you are feeling fine, you will be discharged once your team verifies that you are able to empty your bladder. You will be directed to a restroom or provided with a bedpan; ask for assistance, if needed.

If you had general anesthesia, it will take an hour or so for you to feel awake. Staff will make sure that you can walk without assistance before allowing you to head home with someone who can drive you.

If a tissue sample was collected, it will be sent to a lab for testing.
After the Test

After the procedure, you may experience a slight burning sensation when you urinate and see a small amount of blood in your urine. You may also feel the need to urinate frequently, even though the amount you produce each time may be low. This is normal and can be expected for up to 24 hours after the procedure.

Managing Side Effects

If you experience significant bleeding, incontinence, urinary retention, or if you see blood clots in your urine, call your doctor promptly. If you develop fevers, chills, or if your urine appears cloudy, you may have a urinary infection, and you should call your doctor.
Interpreting Results

Your test results are based on your doctor's observation of your bladder and urethral anatomy during the test, as well as the biopsy results (if applicable). Your doctor may discuss the results with you during the test itself or immediately afterward, or she may schedule a follow-up appointment later to discuss the results and next steps in detail.

Follow-Up

The follow-up plan depends on your results. If you have a urethral stricture, for example, this may need to be repaired with a procedure. If you have an enlarged prostate, this can be treated with medication or surgery. And if you have a benign mass, it may need to be removed if it is causing symptoms. If it is discovered that you have cancer of the bladder, you may need to have chemotherapy, radiation, or surgery, or a combination of these treatments.

A Word From Verywell

Conditions that affect the bladder or urethra can be very uncomfortable, causing pain, or discomfort with urination, and even in between urinating. Having an interventional procedure may also briefly cause additional discomfort. In general, cystoscopy is well tolerated with few, if any complications. Once diagnosed, medical conditions that involve the bladder or urethra can be effectively treated.


You may be surprised to learn that the composition of our body fluids is quite complex. With respect to body fluids, form follows function. Our body synthesizes these fluids to meet our physical, emotional, and metabolic needs. With that, let's take a closer look at what the following body fluids are made of: sweat, cerebrospinal fluid (CSF), blood, saliva, tears, urine, semen, and breast milk.
Sweat

Sweating is a means of thermoregulation—a way that we cool ourselves. Sweat evaporates off the surface of our skin and cools our bodies.

Why don't you sweat? Why do you sweat too much? There is variability in how much people sweat. Some people sweat less, and some people sweat more. Factors that can affect how much you sweat include genetics, gender, environment, and fitness level.

Here are some general facts about sweating:

    Men sweat more on average than women.
    People who are out of shape sweat more profusely than people who are at a higher fitness level.
    Hydration status can affect how much sweat you produce.
    Heavier people sweat more than lighter people because they have a greater body mass to cool.

Hyperhidrosis is a medical condition in which a person can sweat excessively, even during rest or when it’s cold. Hyperhidrosis can arise secondary to other conditions, such as hyperthyroidism, heart disease, cancer, and carcinoid syndrome. Hyperhidrosis is an uncomfortable and sometimes embarrassing condition. If you suspect that you have hyperhidrosis, please meet with your physician. There are treatment options available, such as antiperspirants, medications, Botox, and surgery to remove excess sweat glands.

The composition of sweat depends on many factors, including fluid intake, ambient temperature, humidity, and hormonal activity as well as the type of sweat gland (eccrine or apocrine). In general terms, sweat contains the following:

Sweat produced by the eccrine glands, which are more superficial, has a faint smell. However, sweat produced by the deeper and larger apocrine sweat glands located in the armpit (axilla) and groin is smellier because it contains organic material derived from the decomposition of bacteria. The salts in sweat give it a salty taste. The pH of sweat ranges between 4.5 and 7.5.

Interestingly, research suggests that diet can affect sweat composition, too. People who consume more sodium have a higher concentration of sodium in their sweat. Conversely, people who consume less sodium produce sweat that contains less sodium.
Cerebrospinal Fluid

Cerebrospinal fluid (CSF), which bathes the brain and spinal cord, is a clear and colorless fluid, which has numerous functions. First, it provides nutrients to the brain and spinal cord. Second, it eliminates waste products from the central nervous system. And third, it cushions and protects the central nervous system.

CSF is produced by the choroid plexus. The choroid plexus is a network of cells located in the brain ventricles and is rich in blood vessels. A small amount of CSF is derived from the blood-brain barrier. CSF is made up of several vitamins, ions (i.e, salts), and proteins including the following:


Blood

Blood is a fluid that circulates through the heart and blood vessels (think arteries and veins). It carries nutrition and oxygen throughout the body. It consists of:

White blood cells, red blood cells, and erythrocytes all originate from the bone marrow.

Plasma is by and large made of water. Total body water is divided into three fluid compartments: (1) plasma; 2) extravascular interstitial fluid, or lymph; and (3) intracellular fluid (fluid inside cells).

Plasma is also made of (1) ions or salts (mostly sodium, chloride, and bicarbonate); (2) organic acids; and (3) proteins. Interestingly, the ionic composition of plasma is similar to that of interstitial fluids like lymph, with plasma having a slightly higher protein content than that of lymph.
Saliva and Other Mucosal Secretions

Saliva is actually a type of mucus. Mucus is the slime that covers mucous membranes and is made of glandular secretions, inorganic salts, leukocytes, and sloughed-off skin (desquamated) cells.

Saliva is clear, alkaline, and somewhat viscous. It’s secreted by the parotid, sublingual, submaxillary, and sublingual glands as well as some smaller mucous glands. The salivary enzyme α-amylase contributes to the digestion of food. Furthermore, saliva moistens and softens food.

In addition to α-amylase, which breaks down starch into the sugar maltose, saliva also contains globulin, serum albumin, mucin, leukoctyes, potassium thiocynatate, and epithelial debris. Additionally, depending on exposure, toxins can also be found in saliva.

The composition of saliva and other types of mucosal secretion varies on the basis of the requirements of the specific anatomical sites that they wet or moisten. Some functions that these fluids help perform include the following:
Saliva and other mucosal secretions share most of the same proteins. These proteins are mixed differently in different mucosal secretions based on their intended function. The only proteins that are specific to saliva are histatins and acidic proline-rich proteins (PRPs).

Histatins possess antibacterial and antifungicidal properties. They also help form the pellicle, or thin skin or film, that lines the mouth. Furthermore, histatins are anti-inflammatory proteins which inhibit the release of histamine by mast cells.

Acidic PRPs in saliva are rich in the amino acids like proline, glycine, and glutamic acid. These proteins may help with calcium and other mineral homeostasis in the mouth. (Calcium is a chief component of teeth and bone.) Acidic PRPs may also neutralize toxic substances found in food. Of note, basic PRPs are found not only in saliva but also in bronchial and nasal secretions and may proffer more general protective functions.

Proteins more generally found in all mucosal secretions contribute to functions common to all mucosal surfaces like lubrication. These proteins fall into two categories:

The first category consists of proteins that are produced by identical genes found in all salivary and mucous glands: lisozyme (enzyme) and sIgA (an antibody with immune function).

The second category consists of proteins that are not identical but rather share genetic and structural similarities, such as mucins, α-amylase (enzyme), kallikreins (enzymes), and cystatins. Mucins give saliva and other types of mucus their viscosity, or thickness.

In a 2011 paper published in Proteome Science, Ali and co-authors identified 55 different types of mucins present in the human airway. Importantly, mucins form large (high-molecular-weight) glycosylated complexes with other proteins like sIgA and albumin. These complexes help protect against dehydration, maintain viscoelasticity, protect cells present on mucosal surfaces, and clear bacteria.
Tears

Tears are a special type of mucus. They are produced by the lacrimal glands. Tears produce a protective film that lubricates the eye and flushes it of dust and other irritants. They also oxygenate the eyes and help with the refraction of light through the cornea and onto the lens on its way to the retina.

Tears contain an intricate mixture of salts, water, proteins, lipids, and mucins. There are 1526 different types of proteins in tears. Interestingly, compared with serum and plasma, tears are less complex.

One important protein found in tears is the enzyme lysozyme, which protects the eyes from bacterial infection. Furthermore, secretory Immunoglobulin A (sIgA) is the main immunoglobulin found in tears and works to defend they eye against invading pathogens.
Urine

Urine is produced by the kidneys. It is by and large made of water. Additionally, it contains ammonia, cations (sodium, potassium, and so forth) and anions (chloride, bicarbonate, and so forth). Urine also contains traces of heavy metals, such as copper, mercury, nickel, and zinc.
Semen

Human semen is a suspension of sperm in nutrient plasma and composed of secretions from the Cowper (bulbourethral) and Littre glands, prostate gland, ampulla and epididymis, and seminal vesicles. The secretions of these different glands are incompletely mixed in whole semen.

The first portion of ejaculate, which makes up about five percent of total volume, comes from the Cowper and Littre glands. The second portion of ejaculate comes from the prostate gland and makes up between 15 percent and 30 percent of the volume. Next, the ampulla and epididymis make minor contributions to the ejaculate. Finally, the seminal vesicles contribute the rest of the ejaculate, and these secretions make up most of the volume of semen.

The prostate contributes the following molecules, proteins, and ions to semen:

The concentration of calcium, magnesium, and zinc in semen vary among individual men.

The seminal vesicles contribute the following:

Although most of the fructose in semen, which is a sugar used as fuel for sperm, is derived from the seminal vesicles, a little bit of fructose is secreted by the ampulla of the ductus deferens. The epididymis contributes L-carnitine and neutral alpha-glucosidase to semen.

The vagina is a highly acidic environment. However, semen has a high buffering capacity, which allows it to maintain a near-neutral pH and penetrate cervical mucus, which also has a neutral pH. It’s unclear exactly why semen has such a high buffering capacity. Experts hypothesize that HCO3/CO2 (bicarbonate/carbon dioxide), protein, and low–molecular weight components, such as citrate, inorganic phosphate, and pyruvate, all contribute to buffering capacity.

The osmolarity of semen is pretty high due to high concentrations of sugars (fructose) and ionic salts (magnesium, potassium, sodium, and so forth).

The rheological properties of semen are quite distinct. On ejaculation, semen first coagulates into a gelatinous material. Coagulation factors are secreted by seminal vesicles. This gelatinous material is then converted to a liquid after liquefying factors from the prostate take effect.

In addition to providing energy for sperm, fructose also helps form protein complexes in sperm. Furthermore, over time, fructose breaks down by a process called fructolysis and produces lactic acid. Older semen is higher in lactic acid.

The volume of ejaculate is highly variable and depends on whether it is presented after masturbation or during coitus. Interestingly, even condom use can affect semen volume. Some researchers estimate that the average semen volume is 3.4 mL.
Breast Milk

Breast milk comprises all the nutrition that a newborn baby needs. It is a complex fluid that’s rich in fat, proteins, carbohydrates, fatty acids, amino acids, minerals, vitamins, and trace elements. It also contains various bioactive components, such as hormones, antimicrobial factors, digestive enzymes, trophic factors, and growth modulators.
A Word From Verywell

Understanding what body fluids are made of and simulation of these body fluids can have therapeutic and diagnostic applications. For instance, in the field of preventive medicine, there is interest in analyzing tears for biomarkers to diagnose dry eye disease, glaucoma, retinopathies, cancer, multiple sclerosis, and more.
re you interested in optimizing your health? Are you overwhelmed by the amount of information and guidance out there? In his new book, How to Be Well, Dr. Frank Lipman organizes your health into six essential pillars. A leader in integrative and functional medicine and member of the mbg Collective, Dr. Lipman wants you to know these facts about carbohydrate intolerance.

Carbohydrate tolerance is a gray area. The amount of carbohydrates that works for one person's metabolism doesn't always serve another's. In the past decade, I've seen a growing number of patients who for years have limited sugary foods and swapped out refined carbohydrates for whole grain products, sweet potatoes, and fresh fruit. Yet they are overweight or have surges of fatigue, foggy-headedness, or cravings. Sometimes they don’t carry any extra pounds but have worryingly high levels of blood sugar. It’s not unusual for these issues to come on late in life; their response to a diet they used to do well on has suddenly shifted.

Why this happens is a topic of robust debate in nutritional circles. It’s likely a combination of factors: a genetic predisposition combined with a sedentary, stressful, and sleep-deprived lifestyle; decades of processed foods and medications that have altered the microbiome; or even (unfortunately) overconsuming the healthy-seeming multigrain breads, bananas, and beans, which all turn to sugar in the blood. All this can lower your personal "set point" for tolerating carbohydrates so that your blood sugars don’t fall back to normal within two hours of eating as they should. Instead, they stay elevated, going beyond what the cells can handle, and eventually this triggers a chain of effects that lead to insulin resistance, the precursor to high blood pressure, heart disease, diabetes, obesity, possibly Alzheimer’s disease, and even some cancers. The 2017 National Diabetes Statistics report found that an estimated 50 percent of Americans have either diabetes or pre-diabetes and that many are unaware of this fact.

Taking your blood sugar seriously is nothing to sneeze at. When carb intolerance is at play, your body is telling you to get stricter with your intake. To follow a low-carb diet, nix all sugars and reduce complex carbs dramatically, replacing them with plenty of nonstarchy vegetables and generous amounts of fat. In addition, take sleep seriously, work on repairing the gut, and increase the amount of movement you do. The low-carb diet, along with these other fundamental improvements, can often help restore order where there was previously metabolic chaos. To catalyze real metabolic change in cases of significant weight gain or diabetes, it may be warranted to take the low-carb approach to its ultimate extreme: the ketogenic protocol.

There is another, more accurate way to learn your personal carb set point. Use a glucose monitor to measure the impact of a range of carbohydrate-rich foods on your blood sugar. Twice after eating, at the one-hour and two-hour marks, you can get snapshots of how your body metabolizes starches like grains, beans, and potatoes. If this level of detective work speaks to you, try the protocol outlined in Robb Wolf’s book Wired to Eat. His program of dietary change, basic blood work, and a seven-day carb test can help you zero in on your set point and your level of insulin resistance.

We all know that exercise is supposed to be good for us, but only about 20 percent of people move regularly. Those of us who exercise may be drawn into popular workout trends, like CrossFit or hopping on the elliptical for 60 minutes, but in my research, I've learned that overly aggressive high-intensity interval training (HIIT) or chronic cardio may not be the smartest way to look and feel our best.
Overexercising releases two key hormones.

Overexercising releases two key hormones: CRH and cortisol, both related to the stress response. CRH increases the permeability (or leakiness) of the intestinal wall as well as the permeability of the lungs, skin, and blood-brain barrier. Cortisol levels rise with rigorous exercise, such as running, which may cause too much wear and tear and accelerate aging. High cortisol also alters tight junctions between cells such that small harmful substances may pass through the barrier. Additionally, high cortisol reduces gut motility, blocks digestion, blunts blood flow to the gut, and lessens mucus production, an important immune function. For people with dysregulation of the control system for CRH and cortisol, the hypothalamic-pituitary-adrenal axis, you may need to back off your workouts in order to fully heal, as part of a comprehensive functional medicine protocol. Even elite athletes get help from several workarounds, such as by supplementing with probiotics, omega-3s, and vitamin C; however, moderation may be your best bet.
Sometimes weight loss is counterintuitive.

Personally, I love to run. But at age 35, I discovered that my serum cortisol was three times what it should be in the morning. Intense exercise raises cortisol even further, which was causing several downstream problems for me: weight gain, short telomeres, blood sugar problems, knee pain, leaky gut, fatigue, and I was stuck in a pattern of revving my body too much with my workouts. When I backed down on running mileage each week and added more adaptive exercise like yoga, Pilates, gyrotonics, and barre class, my HPA healed and I got a better response to exercise. I lost weight. My joints were happier. My telomeres were better.
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How much exercise is too much?

On the flip side, inactivity and sitting too much are not good for you either. In particular, sitting too much increases your risk of diabetes and heart disease, plus it makes your hip flexors tight, which can contribute to low back pain and stiffness. Just like Icarus's mandate not to fly too high or too low, there's a middle ground that provides the greatest longevity benefits. When you don't exercise enough, it can harm your immune system, reduce your stress resilience, and dysregulate your circadian rhythm. When you exercise too much—too long, too intensely, too frequently, and without sufficient recovery—you may cause problems to your stress-response system, leading to immune problems, injury, and a leaky gut.

In summary, like many things when it comes to health, exercise has a U-shaped association, meaning that moderate amounts are optimal but low or high levels can be harmful. The general recommendation I subscribe to is to exercise 20 to 30 minutes per day four times per week.

What kind of exercise is ideal? I call it targeted exercise—burst training and adaptive workouts, like Pilates, barre, or yoga. These will stabilize cortisol levels, help with weight loss, and keep your muscles toned.

Here are my basic tenets for optimal exercise:
1. Move less but more often.

Aim for bursts of movement that fold into your natural rhythm. Do a one-minute burst of enthusiastic dancing after you wake up. Invest in a stand-up or treadmill desk, and use it daily (I've walked more than 2,000 miles on mine while writing my newest book, Younger). Practice heel lifts while you chat on the phone or stand in line at the grocery store. Perform 12 push-ups after going to the bathroom. The point is to incorporate moments of movement rather than only forced discipline that's devoid of pleasure. Start small by adding one to five minutes of new movement to your routine each day during this week.
2. Burst-train.

In the morning or before 1 p.m. two to three times per week, do an exercise where you focus on fast-twitch muscle bursts. Cave men and women tended to exercise in bursts: a quick run to the river to fetch water and carry a bucket back to the tribe, a jog with a sick infant to a neighbor's dwelling for help. Our bodies perform well with burst training and then recover at a moderate intensity for one to three minutes. Protocols vary; use one that makes the most sense for you. Burst training can be applied to cardio exercise (e.g., intermittently sprinting on a trail alternating with a jog) or weight lifting (lifting a weight, such as with a biceps curl, as many times as you can with good form for one minute, followed bya one minute of rest). Other examples:

    Walking three minutes fast (approximately 6 or 7 on an exertion scale from 1 to 10, or the green zone of 70 to 80 percent of your maximal exertion), then alternating with three minutes at a normal pace.
    Chi running with sprint intervals or regular running with 30-second sprints.
    High-intensity interval training (HIIT) with weights or cardio (stationary bike, elliptical, treadmill), alternating two to three minutes at a moderate pace with one to two minutes at your maximal pace.

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3. After burst training, get a recovery drink.

It increases muscle mass and keeps the mTOR gene turned off. This is only for people who perform burst training (at least four to five bursts per session) or vigorous training of at least 30 minutes' duration. What's proven to work is a combination of macronutrients high in protein and carbohydrates, even in older folks. But drink it within 45 minutes of your workout; immediately after your workout is ideal. Avoid sugar. The best formula is somewhere between 10 to 40 grams protein (I suggest 20 grams for the average woman), 7 grams or more of carbohydrate (I suggest 10 to 20 grams for women), and up to 3 grams of fat.
4. Get enough sleep!

For optimal weight loss and energy levels, I recommend getting to sleep by 10 p.m. and sleeping seven to eight and a half hours. If you're not getting enough sleep, try to aim for a nap if you're feeling tired. This is so important for your body to produce enough growth hormone and repair itself after a workout. Sleep cleanses toxins and rejuvenates our cells in profound ways.
5. Schedule and take sufficient time for recovery.

Exercise affects your hormones, and adequate recovery keeps your hormone profile in balance so that your adrenals don't get fried and take your sex hormones and thyroid down with them. It's about galvanizing the full arsenal of repair mechanisms in your body: stitching together microtears in your muscles, ironing out the fascia when it gets jangled, reinvigorating mitochondria so you're brimming with energy rather than feeling worn down or burned out. The official definition of recovery is your ability to repair tissues damaged during exercise, rebuild muscles, provide functional restoration of the body such that you prevent injury, rejuvenate emotionally and psychologically, and feel prepared to meet or exceed performance the next time.

Previously, I'd chronically limit my recovery, and I wonder if the same is true for you. If you exercise five days per week, then at its simplest, recovery means 24 hours between bouts of exercise and two rest days. If you exercise four days per week, you take three rest days. For me, my weekends are my harder exercise days, and Mondays and Fridays are my rest days.

Recovery allows you to heal from oxidative stress, which you may or may not feel as fatigue and muscle soreness. But recovery runs deeper; in a larger sense, it's about paying attention to the messages of your cells, your inner voice, and not letting ego run the show. My ego tells me to overexercise and under-recover, which is a recipe for injury, spasm, and weak mitochondria. Don't let that happen to you. Recovery is also about tuning into the messages your body is sending you—the ache in your left sacroiliac joint or the twinge in your right knee. Ironically, I taught myself to ignore those signals during medical residency when self-care came last, but I've been learning to hear and feel those sacred messages from my body in my recovery.

Even if you haven't been exercising consistently, you still have the chance to get on track. Choose an exercise that you enjoy and break a sweat four times this week. As we know, exercise combats stress, helps us sleep better, and raises endorphins. It's good for your sleep, weight, stress, genes, and mind. Even walking counts! Ideally, start to notice your heart rate at rest and while exercising, and after paying close attention to your body, weight, and mood, you'll sort out the perfect route toward feeling and looking your best.
Erythroblastosis fetalis of neonates, also erythroblastosis neonatorum or hemolytic anemia of the newborn is caused by the transmission of antibodies to the red blood cell of the fetus through the placenta in intrauterine life. It is caused by incompatibility of the maternal blood group and the fetal blood group, mostly the Rhesus D antigens of the blood. Erythroblastosis fetalis only occurs when the mother is Rh-.

Erythroblastosis Fetalis
Erythroblastosis fetalis occurs as a result of the sensitization of the mothers Rh- blood due to exposure to Rh-D antigens either by blood transfusion or tearing of the placenta during child birth in which case the blood of the Rh+ fetus mixes with that of the Rh negative mother. As a result of the production of anti-bodies, subsequent Rh+ babies will be subjected to erythroblastosis fetalis because the body of the synthesized mother will attack the baby’s red blood cell due to the presence of Rh-D antigens.
The first Rh+ child of a Rh- woman is free of this disease if the mother is yet to be sensitized by any other means.  If the subsequent child is Rh-, the child is also free from this disease. Other fetomaternal incompatibilities that may lead to erythroblastosis fetalis are the Kell, kidd, MNSs, Diego, Cc, Ee, Xg antigen systems, among others. ABO blood group incompatibility doesn’t cause erythroblastosis fetalis.
Diagnosis

The first step of diagnosis is prenatal maternal blood typing and screening. The blood group and Rhesus factor of the woman is determined. She is also screened for anti-RhD and any other anti-bodies that may have developed due to exposure of any of the antigens that may lead to erythroblastosis fetalis. If the mother is found to be Rh+, normal pregnancy procedures are carried on. If the mother is Rh- and has any of the anti-bodies caused by erythroblastosis fetalis causing antigens, then the next step will be to test the blood of the father, if the paternity of the child is certain.
The blood of the father is screened and tested to determine his Rh factor and to determine if he has any of the antigens that may lead to erythroblastosis fetalis. If the father has neither of the antigens, then the child will be 100 percent free of these antigens and will be free of erythroblastosis fetalis. However, if he is Rh+ or has the anti-body causing antigen, the next step will be to measure the maternal anti-Rh antibodies titers
If the titer value is positive but not up to the laboratory specific critical value, then they she comes back to have them measured every 2 to 4 weeks after the 20th week. If the critical value is exceeded, middle cerebral artery (MCA) blood flow is measured to detect high output heart failure indicating high risk of anemia.  Elevated MCA blood flow during gestational age would lead to consideration of umbilical blood sampling and intra uterine blood transfusion. if the father is heterogynous for Rh-D antigen or any of the anti-body causing antigen, the Rh factor of the child is uncertain so the MCA is still carried out and elevated blood flow means high risk of anemia as well.
Treatment:

If the fetus is at risk of anemia, fetal blood transfusions will be carried out by a specialized in a well-equipped hospital every1 to 2 weeks. This is done until about 32-35 weeks when the child would be delivered. Delivery may be required earlier if the MCA blood flow increases severely.
Prevention

When the Rh- woman is pregnant with her first Rh+ baby and she has not been previously sensitized, she is given Rh-D immune globulin at:

All these processes help prevent her from being sensitized against the Rh-D antigen. The Rh-D immune globulin consists of anti Rh-antibodies that neutralize the fetal Rh positive red blood cells in the mother after delivery.
Sensitization can occur earlier during the pregnancy so Rh-D immune globulin is also given at about 28 weeks into the pregnancy. A 2nd dose is also recommended if termination of the pregnancy has not occurred by the 40th week. It should also be given after any occurrence of vaginal bleeding and After amniocentesis or chorionic villus sampling

However, by familiarizing yourself with the do’s and don’ts when it comes to sex, you’ll be able to protect yourself as much as possible from contracting an STD. Unfortunately, if you’re having sex, you’re not 100% guaranteed not to catch an infection, even if you’re using dental dams and condoms. So, unless you abstain, you are at some risk, but knowing your sexual partners and your own body will go a long way to keeping you happy and healthy.
Other Ways You Can Contract an STD:
Refraining from genitally penetrative sex is not going to protect you from contracting an STD because STDs can also be transmitted through genital contact, anal sex and oral sex. Even kissing can! Essentially, an STD transmission can occur whenever bodily fluids are being exchanged – so always be wary of this too.
Even though you can’t catch an STD by sitting on the toilet seat after an infected person, there are indirect ways you can catch an STD. For example, if someone with pubic lice uses a towel and someone without pubic lice uses it after them, they are at risk of contracting this parasite themselves. Again, this is low-risk but it’s just something else to be wary of.

How to Prevent STDs:
We’ve already established that abstaining is the only sure-fire way to protect yourself from an STD but if you don’t want to do that, there are a number of safety measures you can put in place to protect yourself.
Firstly, as awkward as it is, when you meet a new partner, you need to have the “safe sex” conversation with them. It’s incredibly cringe worthy but hugely important and it’ll make sure you’re both safe when you’re having sex. And, if neither of you are sure, you should both go for STD testing before you have sex.
Lowered inhibitions are another way you could put yourself at risk of an STD, so try to avoid alcohol and drugs for this reason. These may lower your guard and might see you taking risks that you wouldn’t normally take if you were sober. You might forego the usual sexual protection, which could put you at risk of STDs and a range of other problems too.
Latex dental dams and condoms are must for each sexual act, whether it’s anal, vaginal or oral and you should never use a lubricant that’s oil-based (e.g. petroleum jelly) when you’re using one of these as it can make them ineffective.
It’s not recommended to use condoms that are made from natural membranes either as these aren’t as effective at preventing the contraction of STDs. You should also bear in mind that even though condoms will protect you to some extent, they’re not as effective when it comes to STDs that involve genital sores, e.g. herpes or human papillomavirus (HPV). Other forms of contraception such as intrauterine or oral contraceptives are not a protection against STIs.

If you’re exposed to An STD:
If the worst happens and you think or know you’ve been exposed to an STD, you should seek medical advice straight away. The sooner you can do this, the sooner you can be tested to see if you have been infected by anything. Equally, if you have contracted an STD, you can be given the right medication to help treat the STD.
It’s also important that you don’t jump to any conclusions if you find out that you have an STD, like immediately assuming that your partner has been unfaithful. STDs can often go undetected for quite some time and you may find that a previous partner has infected you or your partner without you knowing.
Discovering you have an STD is traumatic and you may feel angry that someone has put you at risk of contracting an STD, and you may also be ashamed that you could have put others at risk too. However, health care workers can provide you with a lot of support as you come to terms with it, and being open and honest with your partner and previous sexual partners can help to prevent this awful disease from spreading any further.

The prostate is a small gland shaped like a walnut present in men only. It is a gland that envelopes around the urethra of a male as it exits from the bladder just before the rectum. It is a major part of the male reproductive system.
The function of the prostate is that it helps in the making of fluid in the semen which helps in the carriage of sperm from the testicles just as ejaculation occurs. In other words, the prostate produces fluid which serves as a medium of transport in which sperm cells can swim through and be carried from the testicles into the erect penis during ejaculation.
Normally, the prostate gland usually starts out small in size but as a man grows older, it grows larger. This means that as a man grows, the prostate gland grows alongside with him. This is a normal aging process in the life of a man.
Remember we said as the man grows, the prostate gland grows with him but also remember that the prostate gland surrounds the urethra. Once it grows so big, it will begin to push and press against the urethra causing difficulty to pass out urine.

Prostate cancer is one of the most common types of cancer in men that can go on without being detected for sometimes a long period of time. Usually, the cancer grows little by little and mostly it stays only within the prostate gland where it doesn’t cause problems hence the reason why it can go undetected for a long time.
The problem begins when the cancer begins to grow out of the prostate gland and when it becomes so aggressive and it moves so rapidly through the cells of the body.
Prostate cancer starts immediately the cells in the prostate begins to divide and enlarges. If a person has for example a single cancerous cell in the prostate gland, the problem begins when due to the fact that the prostate grows as a man grows and for growth to occur, there has to be division of cells hence this cancerous cell as well will grow and divide as well increasing in both size and number.
These cancerous cells usually grow faster and more rapidly than the normal prostate gland cells hence competing and eventually stuffing out the normal cells hereby they kill other normal cells by competing for space and due to the fact that they grow more rapidly than the other normal cells, the normal cells can’t keep up with their growth rate hence they will die off and become replaced with the cancerous cells growing rapidly hereby causing prostate cancer.
When these normal cells die, the abnormal cells will take up their space accumulating and therefore a cancerous tumor. This cancerous tumor can hereby begin to spread to surrounding regions which contain blood, lymph nodes, tissues, bones and also organs.
When these cancerous tumors begin to attack the lymph node, they can travel very far alongside lymph through the lymphatic system. Since lymph nodes are present in almost all parts of the body, once the cancer enters the lymph node, it can basically spread to everywhere in the body.
Prostate Cancer

You may be wondering what then are the symptoms of prostate cancer? Remember we said that if the cancer doesn’t go out of the prostate gland, it doesn’t cause any problems and might not even cause any problems as it is still at the early stages but when it goes into the late stages, and it begins to progress outside the prostate and begins to spread across to other parts of the body, then several symptoms begin to show up and these includes

    Frequent and sometimes painful urination: When the prostate gland becomes enlarged, it will press against the urethra making it difficult and painful to pass urine. And because the prostate is closely associated with the bladder, once it enlarges, it will also press against the bladder causing the frequent expulsion of urine or the frequent feeling to always want to pass out urine.
    Finding it difficult to urinate: Apart from the fact that the prostate helps in the creation of seminal fluids, it also helps and enhances the passage of urine. Once the cancerous cells I.e. the abnormal cells begin to grow, it will hamper this function making it very difficult to pass out urine.

You will simply be feeling so pressed but when you get to the rest room to pass out urine, little or no urine will come out. Or you may even start to pass out urine, then you realize that as you continue the process, it becomes quite an uphill but very painful task to pass out urine.

As a special tribute to World Tuberculosis Day 2016, you as the healthy community should know that you can control and stop TB from spreading. Tuberculosis is an infectious disease which is an airborne disease that caused by the germ called Mycobacterium tuberculosis.
Overall, this disease can affect the patient’s lungs but some other cases Tuberculosis or TB also can affect another part of your bodies such as bones, brain and kidneys. The window period of this disease might be within weeks or 2 years later for the symptoms to show up.
Tuberculosis Day
How do you catch Tuberculosis in general?

Tuberculosis is easily infecting people because it is one of the airborne diseases that easy to spread such as H1N1 and Mers-Cov. What makes it so contagious is the germ is released to nearest contact via sneezes and coughs. So the nearest contact will inhale the air that contains the infected droplets and introduce the germ inside of the body.
The easiest contact to get Tuberculosis is among the family members and colleagues because they happen to be in the same place with the infected person. The risk to be infected is high if you are among the person that frequently having contact with the infected person every day. Furthermore, if you have another health issue, it is also the helping factors for you to be more susceptible to be infected. The health concerns are such as:

    Diabetes patient, HIV patient, pregnant woman, or receiving cancer treatment because these people are the one who in the weakest immune condition;
    Poor lifestyle such as smoking, didn’t take a proper diet or a balanced meal, and drinking alcohol;
    The young children and the elder person are also vulnerable because their immunity can be easily compromised;

Can tuberculosis be treated?

The good news is, this terrible and deadly disease is treatable. Once you are diagnosed with Tuberculosis, you have to make sure that you take the medication as prescribed and do not forget to pay attention to your doctor’s advice. 2 weeks after your first medicine intake is the time that you have to pay a high attention to your medication because you need to make the germ got weakened before you can go to work or school like usual.
This germ is a little bit tricky to kill, it has 3 layers of skin and the medication is killing it by destructing the layers one by one. In early medication, you will feel very healthy like a horse again because the first layer of the germ was destructed and the germ was successfully weakened. But, do not stop taking your medication because you still have another 2 layers left to take care off. This is why you have to take the medicine accordingly without missing a single dose to ensure the germ is completely removed from your body or it will be back stronger and attack your body even greater.
October is BCAM, and we know that for our readers, preventing breast cancer—or cancer of any kind, for that matter—is front of mind. We also know that sometimes breast cancer just happens, despite our efforts to live a healthy lifestyle. This paradox is why, this month, we decided to share the top science-backed ways to reduce our risk of developing this disease, which will affect one in eight women during their lifetime, and the story of a doctor with absolutely zero risk factors, who got breast cancer anyway. The hard truth is that we can't always prevent it, but we can try to catch it early and give ourselves the best chance at a full recovery should this illness ever come knocking at our door.

In 2018, about 266,120 new cases of invasive breast cancer are expected to be diagnosed in the United States. There's no doubt about it, a lot of women are going to be suffering—and are already suffering— from this disease.

The good news is that treatments are becoming more effective and less invasive, and we're understanding more and more every day what we can do to prevent this disease that has devastated so many. And so, in honor of BCAM, here are six science-backed strategies to reduce your risk of breast cancer:
1. Adopt an anti-inflammatory diet.

This one probably won't come as any surprise, but eating an anti-inflammatory diet can help prevent your risk of cancer—not to mention diabetes, heart disease, autoimmune disease, and basically any health condition out there. So what does an anti-inflammatory diet look like? It can take a lot of forms. But generally, it looks like lots of fresh fruits and vegetables, nuts and seeds, healthy fats like olive oil and fatty fish, and lean proteins and whole grains. Foods to avoid if you're trying to tame inflammation include common health offenders like added sugars, refined grains, hydrogenated oils, and processed foods of any kind.
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2. Try to avoid environmental toxins as much as possible.

If you're trying to avoid breast cancer, it's time to take a deep dive into your household cleaning products, cosmetics, and makeup. Do you see ingredients like phthalates, parabens, and chemicals with names so long you can't begin to pronounce them? It's no secret that the United States doesn't do a great job of regulating chemicals. In fact, Europe has banned hundreds of chemicals that the United States still allows companies to put in our products—which are going on our skin, hair, face, around our eyes, and are being inhaled through our noses and mouths. This could definitely help explain why the United States has some of the world's highest rates of breast cancer. Many of these chemicals—including others like BPA, pesticides, and fire retardants—are known carcinogens. As Sonya Lunder, MPH, wrote in an article for the Environmental Working Group, an activist group that specializes in research and advocacy for environmental health issues, "Once disputed as a contributor to breast cancer, environmental pollutants are now known to play a significant role. Chemicals in our food, water, and homes can alter DNA and gene expression to change the way breast cells develop, making tissues susceptible to cancer."

Not sure where to start? Try one of these natural cleaners (that you'll want to use over and over and over again) or read our guide to finding the best natural beauty products. You don't have to overhaul your self-care routine all at once—but next time you run out, maybe pick up an all-natural sheet mask, a chemical-free deodorant, or some "5-free" nail polish (these ones are perfect for fall).
3. Be aware of how your birth control method might increase your risk.

New research has shown that hormonal birth control—including the pill and hormonal IUDs—can increase your risk of getting breast cancer and cervical cancer. But before you go throwing your pink pill packet in the trash, you should know that the pill also has protective effects against other types of cancer, like ovarian cancer, endometrial, and colon cancer. This is a tough one, and it's a personal choice for every woman. But if you're concerned about breast cancer, it might be worth exploring non-hormonal birth control methods like the copper IUD, condoms, or apps like Natural Cycles—which was just approved by the FDA as contraception—that use the rhythm method paired with some pretty advanced technology to predict your fertile window.
4. Stop smoking, and keep alcohol intake to a minimum.

Avoiding first- and secondhand smoke goes almost without saying. We all know that smoking is bad for our health and increases our risk of virtually every type of cancer and health problem. What's less well-known is that when it comes to preventing breast cancer, it's also important to keep alcohol to a minimum. So how much can you drink? Unfortunately, even as much as one drink per day can increase a woman's risk for breast cancer. This isn't a reason to deprive yourself of a cocktail every now and again if you have a healthy relationship with alcohol, but it is something to keep in mind if you're a "two glasses of wine with dinner every night" kind of gal.
5. Move your body.

As much as food—and an anti-inflammatory diet—is medicine, exercise can also have powerful health benefits. And the good news is that unlike food, it doesn't really matter what kind of exercise you're getting as long as you're getting it. Don't overthink it: Go on a brisk walk after dinner, join a CrossFit gym, pick up that tennis racket, take a dance class, or go on a jog with a friend. All of it counts toward your health and against your risk for breast cancer. As an added bonus, you'll feel better, as exercise has been shown to improve mood, keep you pain-free and limber, and prevent other diseases as well.
6. If you have the option—breastfeed your babies.

Science shows that breastfeeding reduces your risk of getting both pre- and postmenopausal breast cancer. Wondering how this works? Breastfeeding can keep your menstrual period from returning and prevents ovulation, which reduces your overall exposure to hormones, like estrogen, that are known to promote breast cancer cell growth. You also shed breast tissue during pregnancy and breastfeeding, so it reduces your risk through more than one mechanism.
7. Go. To. The. Doctor.

If you haven't already read Dr. Sheeva Talebian's breast cancer story, now is the time. Because despite doing all these things—exercising, eating healthy, and breastfeeding two children—she got breast cancer. But she's thriving today because of her own vigilant self-breast exams, which led her to go to the doctor early, which likely saved her life. So go for your mammograms and pap smears, and make sure you're aware of what your breast tissue normally feels like so that you know when something feels abnormal.

So many women are suffering from irregular menstrual cycles, painful cramps, or conditions like PCOS (one of the most common hormonal imbalances out there, affecting between 8 and 20 percent of women). We're constantly talking about these issues on mindbodygreen and reminding women that there's a lot they can do to restore their hormone balance naturally—like change their diets, heal their gut, and reduce stress.

But there's one thing that continues to disrupt our hormones on a daily—or should I say nightly?—basis that we don't give nearly enough attention. It's the mistake of not making sleep a top priority.

Sleep is the last big obstacle keeping so many people from optimal health. For some reason, even the most wellness-obsessed have a hard time prioritizing sleep. The consequences of this are vast and affect so many aspects of our health. In fact, there's a strong argument that sleep is more important than nutrition, exercise, and mindfulness.

So how does sleep connect to your hormones as a woman? According to top functional medicine experts, they're connected in more ways than you could ever imagine. For starters, it's thought that women need more sleep than men. "Sleep is critical for hormone balance in women. Most hormones are controlled by the hypothalamus and pituitary—two organs that sit in our brains and rely on normal circadian rhythms. I experienced this firsthand as a medical student, when my shifting sleep schedule in the emergency room severely threw off my hormones." explained Taz Bhatia, M.D., integrative medicine physician and author of the book Super Woman RX.

And it's not just female sex hormones like estrogen and progesterone; it's all of our hormones—from cortisol to insulin to melatonin. According to Amy Shah, M.D., integrative medicine physician and mindbodygreen Collective member, "Sleep has SO MANY effects on the hormones—from lowered cortisol to better insulin sensitivity to lowered leptin and HGH."

According to a study published earlier this year, just one sleepless night can disrupt your hormones, leading to impaired blood glucose sensitivity the next morning. This will affect your mood and energy levels and can lead to poor dietary choices, which spells even more trouble for your weight and other hormones.

And this relationship also goes both ways. According to research published in 2018 in the journal Nature and Science of Sleep, "Clinic-based studies indicate that sleep disturbances and disorders including obstructive sleep apnea and excessive daytime sleepiness occur more frequently among women with PCOS compared to comparison groups without the syndrome." This means that lack of sleep can lead to hormone imbalances, and hormones imbalances can contribute to poor sleep. The classic snowball effect." According to Jolene Brighten, N.D., a naturopathic doctor and women's health expert, "Our sex hormones are intimately tied to our circadian rhythms. When we skimp on sleep, we can activate an increase in cortisol and decrease in melatonin, which in term can affect progesterone production. As a result, women can experience more anxiety, PMS symptoms, and insomnia, which only makes the issues of hormone imbalance worse."

So how much sleep should you be getting to be as kind as possible to your hormones? According to Dr. Shah, "To ease hormonal imbalance, I often ask women to prioritize sleep. Eight to nine hours can really help keep hunger hormones, sex hormones balanced. When you sleep your body can make more hormones, repair itself, and clean out old or access hormones." What else can you do? According to Alissa Vitti, women's hormone and functional nutrition expert and author of WomanCode, cutting caffeine, increasing your magnesium intake, and experimenting with stress-busting adaptogens like ashwagandha are great places to start improving your sleep for better hormone balance.


Pregnancy and birth are among the many areas of women's lives that have become increasingly medicalized and depersonalized. A woman birthing in the United States has a tremendous chance of having labor induced, a high likelihood of receiving pain medication in labor, and a one-in-three chance of a cesarean section. Each of these interventions—although of course, sometimes necessary and lifesaving—also carry the risk of "unintended consequences," which include, to name a few, a substantially higher rate of adverse medication reactions, hemorrhage, organ damage, infections, and dangerous blood clots above and beyond that for vaginal birth.

In fact, U.S. hospitals are now one of the riskiest places in the Western world for a woman to give birth. Most of us have heard our fair share of horror stories about long labors and challenging births, long before we've even become pregnant ourselves. Naturally, we want to do our best to prepare our bodies ahead of time to have the healthiest and easiest labor possible.

If you, like so many pregnant women, soon-to-be pregnant women, or someday moms, are freaking out at the thought of pushing a small cantaloupe-size head out of your vagina—while also wanting to do everything you can to avoid unnecessary medical procedures, including caesarean—it's important to do your homework ahead of time. With some forethought you can increase the odds that this upcoming passage into motherhood is as short, easy, empowering, and as safe as possible for yourself and your baby.
How to support a healthy labor through diet and lifestyle change.

Thirty-five years of practice initially as a homebirth midwife, and then as an M.D. specializing in women's health, including obstetrics—as well as being a momma of four—has shown me that labor and birth can be hard work but also a beautiful, powerful event. While there should be absolutely no judgment about what type of birth experience you prefer or ultimately require, it's worthwhile to consider what natural tools we have at our disposal to can help us avoid the speed bumps that often lead to preventable birth interventions (the most common being not going into labor within a reasonable amount of time after your due date, having a long labor, or needing pain medication).

Fortunately, our bodies are wise and know what they need to do to bring our babies into the world. That said, we can support the process first and foremost with:
   
It might surprise you, but having the support of another woman in labor—whether it be a doula who is supportive of you and knows the tricks of the trade and how to protect your space if you're birthing in hospital or a midwife in a hospital or at home—has been shown to dramatically reduce the need for medications, forceps, and caesareans. Oftentimes, calling upon these resources leads to happier, healthier moms and babies at the end of the day.

In addition, a few favorite books on preparing for birth include Spiritual Midwifery, Birthing From Within, Ina May Birth Book, and for a deeper understanding of which medical inventions are necessary and which are overused, Henci Goer's book Optimal Care in Childbirth.
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Herbs to ease and support birth.

There's also some good science, and safety, red raspberry leaf and red dates for helping with labor. They are two of my go-to natural remedies for my pregnant patients, and I used them during pregnancy as well. Calling on these natural remedies can give you that little bit of extra assurance that you're doing everything possible to help your body get ready for birth.
1. Red raspberry leaf

Red raspberry leaf comes from the leaves of the plant that provides us with delicious raspberry fruits. It's been used for centuries in Europe and among North American native tribes as a mineral-rich tonic tea to support a healthy pregnancy and to "tone" the uterus, which helps women prepare for birth. It remains popular today, with about 63 percent of midwives in the United States recommending it.

Red raspberry (RRL) leaf is high in vitamins C, E, A, and B and has significant amounts of major minerals like magnesium, potassium, calcium, and phosphorus that not only nourish the uterus but provide the minerals it needs to contract and relax—which is exactly the combination required for labor to work effectively and for the powerful muscles of your uterus to push your baby out. It's also rich in a natural plant constituent called fragarine, which is thought to also tonify and stimulate uterine muscle.

While RRL doesn't actually appear to be very effective at stimulating or shortening labor, research has found that drinking RRL tea or taking capsules can have a number of benefits. The results of a double-blind, randomized, placebo-controlled trial consisting of 192 low-risk, first-time moms found that RRL tablets, taken daily starting at 32 weeks' pregnancy until labor, reduced the rate of forceps deliveries. Another study found that raspberry leaf was associated with:

    Decreased likelihood of preterm labor
    Decreased likelihood of going too far past your due date
    Decreased need for having your bag of waters artificially ruptured to stimulate labor
    Lower overall rates of caesarean section, forceps delivery, and vacuum extraction

Are there any risks? While RRL has been used for a long time without any obvious downsides, two studies on rats did find some curious results that I want you to at least be aware of. In one study, RRL tea and capsules at typical doses were found to have the effect of stimulating uterine contractions—as we'd expect them to do to support healthy labor. However, in very high concentrations, contractions were inhibited, which is quite the opposite effect we'd be looking for. In another study, this one also conducted on rats, the authors observed that pregnancy seemed to last longer, and there were some changes in the rat offspring (they appeared to go into puberty early). Now, these are not problems that have been observed in humans, in spite of centuries of use, and the rat mamas in both studies consumed RRL products in doses far higher than humans would normally ingest. So while we should be aware of these findings, the bottom line is that there are a lot of differences between rats and humans.

When should you start taking RRL? As a pregnant midwife-herbal-momma, I drank RRL daily starting about halfway into my pregnancy, always carrying my Mason jar of tea with me. This was in the 1980s (long before the days of green juice!), so I got some strange looks when I was out and about having a swig! While some recommend starting it in the first trimester, I generally recommend avoiding it then because, while there are no studies associating it with miscarriage, there is some evidence that it increases uterine contractility. Herbalists and midwives consider raspberry leaf to be a gentle, effective, nutritious herb to use in the second and third trimesters—and I concur.

How much should you take? One to two cups of tea daily is known to be safe during pregnancy, and several studies have now shown that taking one to two cups regularly in the last trimester can make labor easier. You can also use capsules or tablets (1.5 to 5 grams daily) since RRL doesn't have the most pleasant taste when taken as a tea by itself. In my practice, I generally recommend mixing RRL in with some spearmint and rose hips for a delicious tea that can be taken daily throughout the second and third trimesters.

Many of the popular pregnancy teas you see on the market came from one of my original blends, published in my now classic book The Natural Pregnancy Book. This is a simple, delicious version you can drink hot or iced. For use as a "Labor Day" tea, I actually use 4 tablespoons of RRL and make the whole thing in a quart of water for sipping throughout labor and after the baby is born. You can even make ice pops to enjoy during labor.

Make sure any herbal tea products you purchase contain actual RRL because raspberry-flavored teas don't have any of the RRL benefits. Mountain Rose Herbs is a great online source for purchasing bulk organic herbs.
2. Red dates

Date fruits are perhaps one of the most ancient "sweets." Delicious, they are also nutrient-rich, loaded with fats, proteins, carbohydrates, and a variety of vitamins, minerals, and fiber. It also turns out that they are a common remedy for preparing for labor in certain parts of the world. In one study 919 Iranian women were asked what natural remedies they used in pregnancy for labor preparation, and 26 percent said they ate red dates as part of their preparation at the end of pregnancy. Talk about food as medicine! While we still don't fully know how dates work, it appears they might have an impact on the oxytocin we need for labor to start and progress effectively and on time.

A 2011 study found that women who ate six dates a day for the four weeks leading up to their due date were significantly more dilated when they got to the hospital, had a significantly higher rate of intact membranes, were significantly more likely to go into labor spontaneously (i.e., without induction), and had nearly half the length of the first stage of labor. A 2014 study found that women who ate dates from 37 weeks on had greater cervical dilation at admission and higher success rates of labor induction when needed. Another study found that eating dates in pregnancy led to less bleeding immediately after birth.

Are there any risks? Dates are delicious, and unfortunately, they are also high in sugar—which means there are concerns about their effects on insulin levels and blood sugar balance. Studies have looked at blood sugar levels in women eating dates this way and have found no significant negative changes; however, this has not been studied in women with diabetes, so if you do have gestational, type 2, or type 1 diabetes, do discuss their use with your midwife or doctor.

How much do you take? Based on the studies available to reference, it's recommended that you eat about 70 to 80 grams (about 2.5 ounces) of red dates daily starting at about 36 or 37 weeks of pregnancy and continuing until labor begins. The 2007 study I mentioned specifies deglet noor dates and suggests that about six to eight per day is the magic number. Medjool dates are likely fine as well but typically are twice as large, so keep it to three to four of those per day.
A word about intention and surrender.

Each baby and momma have their own story that they create together—and we don't have total control over how it all happens in the end. Our bodies are beautifully wise and know how to birth our babies. In fact, surrender and openness can go a long way toward helping us open for birth. Complex cultural factors and changes in how we live in modern times, along with overmedicalization, mean that we do need to put some intention and conscious effort into creating the birthing experience we hope for. And natural remedies, along with a healthy pregnancy and doula or midwife support (or both), can make this all the more likely.



Thanks to movements like #MeToo and Black Lives Matter, our collective society feels more aware than ever of the systematic oppression faced by women and especially women of color. But while it's more obvious how discrimination can hurt people emotionally, socially, and economically, what about the harm it can cause to our physical health?

In a recent study published in the Annals of Behavioral Medicine, researchers examined whether women's exposure to everyday discrimination could predict the risk of cardiovascular disease. They looked into existing data from the Study of Women's Health Across the Nation, examining responses from over 2,100 women who self-identified as white, black, Chinese, Japanese, and Hispanic. The study asked the women to describe their day-to-day experiences with discrimination, including being treated with less courtesy than others, receiving poorer service than others, or having people ignore them or act like they aren't there. They ranked the frequency of their experiences on a scale—often, sometimes, rarely, or never. Meanwhile, the study also tracked the women's blood pressure, hypertension status, waistline circumference, and body mass index (BMI). The researchers followed up with these women annually for over a decade.

The results? Women who regularly reported exposure to discrimination at least "sometimes" or "often" were more likely to experience increased body fat and higher blood pressure over time.

Interestingly, there wasn't any variation in the link between discrimination and increased blood pressure when it comes to race or ethnicity, suggesting women's experience of discrimination hurts their health regardless of race. However, black women reported the highest rates of exposure to everyday discrimination, which resulted in the highest waist circumference, BMIs, and risk of hypertension.

These findings add to a growing body of research that suggests discrimination really does harm people in a way that goes beyond inflicting emotional distress and keeping its victims at a lower place in society. In addition to the negative impact on cardiovascular health, discrimination has been associated with greater rates of diabetes, respiratory problems, sleep disturbances, daytime fatigue, and depression.

How can this be? One possible explanation is stress, some studies suggest. Every time we're discriminated against, we're adding to the pile of extreme stress that so many of us are carrying on a daily basis—on top of the fear, anxiety, and ever-growing to-do lists that every adult deals with. That chronic stress, which releases an unhealthy amount of the hormone cortisol into the body, can be incredibly toxic.

"When cortisol is not in balance, it can lead to weight gain, low libido, headaches, anxiety, depression, low energy, insomnia, blood sugar issues, skipped menstrual periods, infertility, gut issues, osteoporosis, and cardiovascular disease," explains Dr. Serena Goldstein, N.D. "Cortisol is a huge part of our body's 'fight or flight' response, which is activated in times of high stress—like running from a bear."

But instead of being in a state of high stress when we're actually in danger, that daily dehumanization caused by discrimination—and the latest current events—may be causing many women to experience heightened stress constantly. That's seriously bad news for our bodies, which stop functioning properly when flooded with that amount of cortisol.

These findings highlight the reality of just how tangibly harmful discrimination can be. It doesn't just destroy the possibility of a truly equal society; it's actually wreaking havoc on our physical bodies. People's lives and well-being are on the line, and in a country that was built on life, liberty, and the pursuit of happiness, it's becoming more clear than ever before that these palpable problems require equally palpable solutions.

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