Archives of the Vagina: A Journey through Time

by Dr. Margaret Aranda

For my Caring Friends, here's a preview of my newest book, written before the doctor dropped me on the floor in March, 2013. I wrote this book (many of you will understand) because I'm not sure if I'll live long enough to see my daughter live through all the stages of womanhood: the maiden, the mother, and the crone.

                                   Book Cover Photo. Archives of the Vagina: A Journey through Time.

The book starts with my first period, and is very tongue-in-cheek humorous, because we all know where we were when we started our first period. Then I go through history, sociology, anatomy, and the endocrinology of the ovaries.

I discuss what Aristotle thought of menstruation and menopause, how William T. Stead is a hero we never hear about for rescuing children out of prostitution in London's brothels. This book is filled with the sociology of menstruation, including whether women on their periods can fly a plane, and whether women who are camping on their periods attract bear attacks that lead to death.

One of the most surprising statistics that I learned in my research and interviews of women is that in the USA, in women over 45 years old, 40% have had a hysterectomy. Of these, nearly 50% have had normal ovaries removed without proper Informed Consent. I dedicate an entire chapter to "Ovarian Conservation" (i.e., keeping your ovaries), and give you all the risk factors you need to know so you can put yourself on the Chart to see if you are at risk for ovarian cancer, and hence should get them removed. So my next book will be Hysterectomy can be Hell. I hope to get an Army behind me on this one, because it will take a Movement to change our culture. And changing a culture always means that people won't like you. Believe me. I've been there before.

I discuss the HPV vaccination for girls aged 11-12, starting your period, how to put in a tampon, and introduce what most women don't know: the menstrual cup, and the nondisposable pad. I promote a certain program that helps girls in Africa obtain menstrual pads so they don't have to miss school, be drop-outs, get pregnant, contract HIV, attain a lower socioeconomic status, and die earlier than the girls that are more educated. So expect a Movement there, too, ladies and girls.

I go through the Women's Health Initiative and basically tear it to shreds, because it had, in my opinion, no application to women in menopause suffering symptoms of vaginal dryness and hot flashes. I let you skip a very medical chapter if you would like, but I also put it in there for medical personnel to evaluate it for themselves. I dissect menopause and give the man's perspective, too, hopefully leading you to more self-discovery and compassionate understanding. Pretty funny stories there, too, my friend.

The last half of the book is dedicated to such things as Invisible Diseases, the Low Glycemic Diet, Immunonutrition and Fish Oil, Telemeres, Living for not only Health & Wellness but also for Quality of Life, Caregiving (and the effects on women, by ethnicity), Long-Term care, and death and dying. I empower you to ask questions, eat Spoon by Spoon, and Don't Fall when you are elderly. I tired of seeing women come into the Operating Room for hip fractures from a fall. You need to know your bone density, and take your Vitamin D or Calcium. The role of an Endocrinologist in your care can not be underestimated. I also believe that Cenegenics has an excellent program for Concierge Medicine, private pay by cash, that is mostly utilized by Presidents and CEOs of companies. They are mostly men. This needs to change, because there are plenty of millionaire women out there. And women need to stop spending all their time nurturing others, and start spending some time nurturing themselves. So I took all this knowledge in my head and told it to you before my traumatic brain injury and DI occurred; and I thank God that I did it.

There. I said it. My opinion rings throughout this book, and it is backed up by over 200 Stanford-quality references that are NIH-funded. I list them all for you, and many of them are dated in 2012 and 2013. Nothing but the best for you, my friends. Nothing but the best. Be prepared to learn, to grow, and to  ROCK your WORLD. You can PRE-ORDER the book (February launch date perhaps) on The Aranda MD Shoppe. My official site is Coming Soon....and I hope you like it. 

God Bless You in all that you do.

Medi-Baskets(TM)

by Dr. Margaret Aranda

Medi-Baskets(TM): Diagnosis-driven, Individual Care Packages 

are a Novel Method to Prevent Complications and Optimize Quality of Life 

at the Time of a New Diagnosis

When a person is given a new diagnosis, many times there is a lag of time between the day of diagnosis and the time that the patient acquires key ingredients and supplies that are tailored to the diagnosis. For bad arthritis, one may need a grabber to get things off of high shelves. Or, the patient may have a new diagnosis of Heart Disease or Diabetes. It may or may not have taken months or years to get that diagnosis, and that is why we exist. We are here to cater to your individual needs, because every patient is different.

In the former days of medicine, the doctor gives the diagnosis, the patient may or may not receive a Brochure, peruse websites, talks to another doctor, and/or participate in an Educational Clinic or two. These are all great avenues to become educated about a Diagnosis and how important it is to watch the blood glucose levels, but they stop short from bringing practical and useful items into a patient's home and every-day life. These items are chosen for everyday use, to prevent complications or to optimize health and Quality of Life. Either way, we hope you have a little fun with it, and mostly, we hope you use it!

With MediBaskets(TM), we go beyond this continuum. We strive to supply you with key ingredients that are specific for your diagnosis. So, for diabetes, your insurance will pay for your a glucometer to check your blood glucose (sugar) levels, and you take it home with the insulin bottle and syringes. These are  standard items that most people obtain to check their sugar levels. We don't just stop there.

If you are new to a diagnosis of diabetes, perhaps you do not know that a great pair of softening socks may help you keep your feet from cracking. It doesn't matter if you are rich or poor; diabetes will cause amputations in people of all societies. Foot cracking can lead to bleeding, infection, and gangrene. With diabetes, foot and leg sores can develop into severe lesions complete with eaten-away skin. In the worst case scenario, foot lesions can lead to gangrene and the need for emergency amputation. That is a medical fact. I've seen it in the Operating Room too many times. Then people suffer from phantom limb pain. And it all started with what you ate. What you put in your mouth. How much of it was green? How much of it came out of a box? Do you have abdominal obesity, putting you at risk of heart disease, chronic inflammation, metabolic syndrome, and death? What can you do now, today?

Some prevention or delay of kidney failure may be possible. Even if you don't have high blood pressure, studies from 20 years ago show that if you are simultaneously placed on an anti-hypertensive ACE-inhibitor, you will 'spill' less protein into your urine, protecting the kidneys. You're not supposed to spill any protein into your urine. So let's keep your kidney functioning normally for as long as possible, ok? We need you to visit your grandchildren or your children instead of spending 4 hours/day, 3 days/week going to a dialysis center. You'll have to have an iv port in, but you can buy special clothes that have zippers so you can hook your dialysis catheter up to the machine. But we don't think that was in your head as a real idea of a fashion statement. Your blood pressure goes down during dialysis, and the most common complaint after dialysis is a headache. Do you see how your Quality of Life will change? It's not funny. It's serious. And it's pretty much All in Your Hands.

So we try to think ahead for you. Whether you have a new diagnosis of heart disease, menopause, diabetes, dysautonomia, traumatic brain injury, hypertension, or you have a friend, relative, or co-worker who has a list of diagnoses we now serve, we can send them a MediBasket (from you or a group of co-workers, or a group of friends) to fit their needs. We know what it feels like to be suddenly athletic and then to be suddenly bed-ridden and sick, and we think we can make things better. 

So our President and CEO, Dra. Margaret Aranda vowed to make use of what we do know, and to pass it along to you!

Sample Medi-Basket(TM) for Diabetes. Individually made per patient, the Medi-Basket(TM) comes in four ascending sizes. The goal is for Preventive Medicine to rule, providing the patient with needed supplies for the mind, body, and soul. Perhaps a dash of humor here, and some body-soothing products will ease the physical and mental aspects of a new diagnosis. A physician is available to ask questions, but please realize that the answers are not meant to provide a medical diagnosis, treatment, advice, or cure.

But we think you are sure to feel loved by the person(s) that sent it to you, because our CEO knows what it's like to be a patient, having been bed-ridden from dysautonomia for 6 years. She was getting better until she sustained another head injury, giving her DI. But she pushes ahead on the Medi-Basket (TM) because of you. Because Keeping you in the Community and Out of the Hospital?

That's our goal. 

We are doing our part to Keep You in the Community by sharing information and education with you, your loved ones, friends, and/or co-workers. This is only by your request or the request of a Caring Friend that you know. So, how wonderful is it to know that you are not alone. Others are rooting for you, so you keep up the good fight, and persevere!

How wonderful it is that people are helping people? We think that It's About Time! Of course we want to see you well, and we wish you all the Best in your Recovery. If you get bored, tune in to Medibaskets.com for some brainteasers and information, or comment, critique, or just be cranky. Don't let anyone tell you not to be yourself. There's nothing wrong with you; it's your injured body that you are living in that's just a little broken right now.

Medical Disclaimer: Remember that your new diagnosis needs to be managed by your doctor, to keep you In the Community and not in the hospital. Nothing is meant as medical advice, treatment, or cure. A doctor has to see you in person for a thorough examination, if needed.

Aranda MD Enterprises, LLC

26500-102 Agoura Road

Suite 656

Calabasas, CA 91302

www.medibaskets.com for Preventive Medicine Gift Baskets

www.MyPerseverance.com for free Resources

My Perseverance dot Com

To celebrate my first Book Launch, I launched a new website called "My Perseverance". I think it encapsulates one way to live life one day at a time.  And even if you don't have to live one day at a time, I think there are sound humanitarian investments that were well worth it.

From dropping off a baby at a fire station, to family matters, abuse, cutting, teenager runaways, Caregiving, The Elderly, and the Suicide and Poison Control 24-hour hotlines, we have done our best to compile actual offices that have people in them that know what you are going through. So if I can't help you, maybe someone I know can help you, or someone they know, etc.

It's my gift to everyone.
It includes office hours and days of the week, and the link to the website, which you need to Copy and Paste.
I hope no one ever needs anything from here. But if you do, and it helps just one person, it will be worth it. I put it together after crying and feeling sorry for myself at all the things I can not do. I got mad and I decided to do something that I could do, and this is what I chose. Hours and weeks went into this; I want you to understand that this was a grand undertaking for me, especially considering all my hospitalizations and episodes this 2013, but hey, life goes on. Roll with the punches.

There are two pages:  Resources 1 and  Resources 2. I tried to make it user-friendly but I'd love your feedback. If I've left anyone out, please notify me and I will verify and add. All items are verified to the best of our knowledge, and should be up to date.


I hope you like it. Peruse. Bet you find something you didn't know existed. A checklist for nursing homes?

The World of the Walking

by Dr. Margaret Aranda 

She was a very ordinary girl, one you would never notice in a crowd. At twenty-six years old, her long brunette hair complimented her petite figure with a flair, and she smiled all the time. She woke up and no doubt, mind you. In thirty minutes flat, she would be turning the key and driving to her job.

Yesterday, she was in The World. The World of the Walking. In The World of the Walking, everyone in this World can just get up and walk whenever they wanted to. In the little self-centered minds of most people, it was all taken for granted. The World of the Walking is where everything is. It is the standard. The World of the Walking means that you can get up and walk and perform the activities of daily living. She went about her business in The World of the Walking, making phone calls, sending texts, writing, writing, going to work, running errands, writing again, forgetting to stop for groceries. She went anywhere she wanted to, and timed everything out by looking at her watch or her cell, and simply decided where she had to be, and WaLa! she was there. The World of the Walking was a "painless" or "free" kind of Heaven that it seemed only the formerly disabled seemed to appreciate the most. Walking now seemed more like flying, and so much of life differed.

Now see that there is a doctor confined to a wheelchair. He's in the World of the Walking, too. He is there on time to work every day. He has to push buttons and everything is hard, but he does it. The function level is high. So he may be mad at me, and rightfully so, but he really is in the World of the Walking, because he operates within their guidelines virtually every day. He gets out of bed. He's not plastered onto the mattress. He is only able to move from point A to point B if he's in the World of the Walking.

So we just have to be grateful. 

And I'd say to stay in the World of the Walking.

I think that is the goal.

An Anti-Inflammatory Salmon Dinner

This is a simply fabulous dinner for two or three. You can easily multiply the recipe, make the salsa the morning of the dinner, and cook the carrots for longer than the stated time.  The goal here is to get the house smelling wonderfully, serve up a healthy meal, and have a fantastic presentation that is sure to be an eye-pleaser for your guests.  And if you clean the dishes as you go along, you won't have a huge mess on your hands.  We use the same pot for the carrots twice, and we use the same skillet for the salmon twice also, as we return the dish for more flavor and the finishing touches!  

Menu:

Salmon with Dill and Olives

Baby Carrots with Dill, Parsley, and Garlic

Papaya and Tomato Salsa with Cilantro

Water

Papaya and Tomato Salsa with Cilantro

1/2 cup fresh papaya, chopped

3/4 cup fresh tomatoes, chopped

1/4 cup fresh cilantro, chopped

Place all items in a small serving bowl and refrigerate to cool down while the other items are cooking. Sure to be a crowd-pleaser and a great pairing with the salmon and dill. Go ahead and throw away the stems and core of the tomato, cleaning your counter before proceeding with the carrots and salmon.  You'll be glad you did, and the kitchen will look much cleaner. Serves 2 or 3.

Baby Carrots with Dill

1 1/2 cups water

1 cup baby carrots

Dash of salt

2 tablespoons extra-virgin olive oil. Do not substitute.

1/4 teaspoon fresh garlic, chopped finely

1/4 cup fresh parsley, chopped

1/4 cup fresh dill, chopped

Bring water to boil and then add baby carrots.  Bring to boil again, then simmer on medium for 40 minutes.  Do not discard carrot water as it contains water-soluble vitamins.  Check for doneness and then remove all carrots to a cutting board.  Reserve water in a cup. While chopping carrots, saute garlic in same pot.  This will make the house smell wonderful and the neighbors will get hungry. Add parsley and dill.  Then add all the chopped carrots.  Simmer and stir frequently; do not leave the pot.  Gradually use all the reserved water to replenish with vitamins.  Carrots will stay hot for some time because of their nature, but you can simmer them for 2 minutes on medium high when it is time to serve. Serves 3 or 4.

Salmon with Dill and Olives

Atlantic salmon, farm-raised                                 4 fillets

Olive Oil                                                               2 teaspoons per fillet

Black and Green Olives, chopped finely              1 teaspoon per salmon fillet

White or wheat flour, unbleached                         1 tablespoon

Half and half                                                         2 tablespoons

Pour olive oil into skillet on medium high. Add salmon filets, then top with chopped olives.  Cover.  Let simmer for 10 - 15 min.  The olives will bake into the top of the salmon.  Turn over carefully and then Cover again.  Let simmer again for 10 min.  Return to original position and cook for 5 more minutes.  You can turn off the skillet and finish dinner preparations for the baby carrots and the salsa, as you will return the fillets to the skillet for sauce and heating up. Check for doneness and allow for additional cooking if desired.  Remove salmon from skillet.

Keep skillet on medium.  Drizzle flour onto leftover oil.  Whisk rapidly, crushing lumps.  Slowly add half and half, simmer.  Sauce thickens. May add water to thin.  For serving, return salmon fillets to skillet and cook on medium high for 2 min. Dot top of fillet with spots of sauce for extra yumminess.

The IF Tracker

by Dr. Margaret Aranda

Just a short blurb here about the IF Tracker.  It assigns an 'inflammatory' or...as the case may be, an "anti-inflammatory' number to each food you eat.  I've been on the Low-Glycemic Index Diet for about two months now, and I don't think that I will ever go back to eating the way that I did before (that was a Pre-Diabetic diet, and No Thank You!)  There are 2,200 foods pre-wired in to the Ap, and it is very user-friendly.  How did I learn about it?  From the Cenegenics Times quarterly Newsletter!

For example, on Day One, I ended up with 1,200 positive points, only because I ate Atlantic salmon for dinner.  Surprisingly, my boiled egg, yogurt, salad, and carrots did not add up to much on the anti-inflammatory roster. None of these foods do much to 'add' to the anti-inflammation aspects of your diet.

On Day Two, I ate salmon, carrots, and salad too, but this time I skipped items that did not land me in the 'positive' range.  So at the end of the day, I could still drink my coffee with half-and-half, and wala! I'm 2,400 + points toward anti-inflammation.

I had no idea that peas, grapes, and papaya don't do much for me here.  It's the Serrano peppers, onions, garlic, olive oil, and fish that add in by adding a huge positive value to the roster.  Especially the fish. Wow, I can't believe how good fish is for you, and after only two days of the IF Tracker, I'm hooked.

Here's my dinner tonight:

FOOD	PORTION	IF VALUE
Atlantic Salmon, farm-raised	4 oz	1,182
Olive Oil	2 tsp	53
Baby Carrots	¼ cup	39
Dill, fresh	¼ tsp	39
Garlic, raw	1/8 tsp	9
Onions, raw	1/8 cup	73
Tomatoes, cooked	2 tbsp	2
Papaya, fresh	1 1/3 tbsp	3
Cilantro	1 1/3 tsp	3
White flour, unbleached	¾ tsp	-3

Add to the above: lox for breakfast with cup of coffee; almond snack; tuna salad with lettuce and tomatoes, zucchini, carrots.

My total IF Tracker points for the day? 2,479.
Calories = 1,104
Fat (g) = 72
Protein (g) = 79
Carbs (g) = 39

I'm loving this! I know that I still have a long way to go to really 'get' this, but hey, it's only Day Two!

The kids eat the whole plate, company raves aloud, and everyone feels great after a meal!
Here's the Menu:

Salmon and Olives, with Olive Sauce
Papaya and Tomato Salsa, Cilantro Bits
Baby Carrots, Garlic, Parsley, and Dill Weed

Mmmmm!  This dinner is a keeper!

The Ovaries: Reproduction and Endocrine Function

The Ovarian Follicle: Reproductive and Endocrine Organ

The female body is endowed with the uterus and ovaries as reproductive organs.  But having babies is not their only function. Initial breast bud and pubic hair formation occurs because of hormones produced by the ovaries.  Later, a girl will have her first period.

A girl begins to menstruate because her ovaries are producing estrogen and progesterone.  The 28-day menstrual cycle may not begin with the first period.  It may take 2-3 years for a girl to be ‘established’ with monthly periods, as she may have her periods only once or twice in the first year, then more often as time progresses.

Women are born with two ovaries, one on each side of the uterus (See Figure 1).

Figure 1.  The female pelvis.  The uterus is behind the urinary bladder.  1 = Fallopian tube; 2 = urinary bladder; 3 = pubic symphesis; 4 = vagina; 5 = clitoris; 6 = urethral opening; 7 = vagina; 8 = ovary; 9 = fascia; 10 = uterus; 11 = posterior cervix; 12 = cervix; 13 = colon; 14 = rectum.

It is important to understand that the human ovary serves two functions:  reproduction and endocrine.  Both of these functions are tightly coupled, as the release of hormones makes the uterus ready for fertilization of an oocyte that comes from the ovarian follicles (See Figure 2).

Figure 2.  Reproduction:  The Ovarian Follicle and the Cycles of Menstruation.  With the monthly cycle, the ovarian follicle prepares an oocyte for maturation and release to the Fallopian tube, with the possibility of fertilization and reproduction. 

There are three types of cells in the human ovary:  the oocyte or mature egg, the granulosa cells, and the external thecal layers.  The follicle houses the oocyte that is maturing to the time of release.  The granulosa cells are in the follicle, and they surround the oocyte.

Hormone production dictates what happens to the follicle. When testosterone increases, the number of granulosa cells decrease.  When gonadotropins (i.e., protein hormones produced by the anterior pituitary gland) increase, the granulosa cells increase in number, not size.  Pituitary gonadotropins include:  follicle-stimulating hormone (FSH) and lutenizing hormone (LH).  FSH tells the granulosa cells to make LH receptors on the cell surface so that when LH is produced and binds to the receptors, the end of the cycle proliferation occurs.  This makes the period stop (see Figure 3).

Figure 3.  Endocrine:  The Ovarian Follicle and Hormone Production.  The human ovarian follicle produces estrogen and progesterone during the Follicular Phase and Luteal Phase, respectfully.  At the time of the early menstrual period, estrogen dominates.  Once the egg is released and there is no fertilization, progesterone dominates.

Another human gonadotropin is produced by the placenta, and this is known as human chorionic gonadotropin (hCG).  The hCG is the hormone test for pregnancy that is commonly used on pregnancy strips.  If hCG is present, placenta is making it.  As the placenta increases in size during the early stages of pregnancy, the hCG also increases in number.  During pregnancy, the placenta also produces estrogen.

During the nonpregnancy state, the human female ovaries produce estrogen, progesterone, and testosterone.  Granulosa cells in the ovarian follicles and the surrounding corpora lutea make estrogen.  Other organ cells participate in estrogen production, but to a lessor extent:  the fat or adipose, liver, breasts, and the adrenal gland.  Postmenopausal estrogen production can still occurs from these extra-ovarian sources, but a woman's individual blood levels must be measured to know what phase her ovaries are in.  In the nonpregnant female, the highest levels of estrogen occur just prior to ovulation, near the end of the Follicular Phase (see Figure 3). 

Figure 4. The metabolism of cholesterol.  A variety of biochemical reactions exist whereby cholesterol is metabolized to progesterone, then on to dehydroepiandrosterone, testosterone, dihydrotestosterone, or estradiol.  Cholesterol is not all bad, and our bodies must produce cholesterol not just in order to procreate, but to develop neurologically. Cholesterol is important to the structure of cells, as well as being a precursor of oxysterols, bile acids, and steroid hormones.  

Cholesterol is the "Mother Molecule" of androgen and estrogen steroids (See Figure 4). Actually, you may be surprised to learn that the cholesterol molecule is a major part of the human brain, and there is no organ in the human body that contains more cholesterol than the human brain (Orth, 2012).  In fact, about 20% of the body’s cholesterol is contained in the brain.  The brain does not have the same metabolic pathway as other organs, and the brain is responsible for what is called de novo synthesis of cholesterol.  This means that the brain makes it freshly. It was Couerbe who, in 1836, described the cholesterol molecule as being “un element principal”, meaning ‘a key element’ in the central nervous system (Couerbe, 1834).

It is important to note that the ovary is uniquely tied into the hormones that they produce.  The ovaries are an organ, and they synthesize and coordinate the lifecycle of a girl and a woman. In old age, the same ovaries dictate how menopause is approached.  

If a woman undergoes a hysterectomy and the surgeon also removes the ovaries, this is 'surgical menopause'. A woman undergoing a hysterectomy gets a 'crash course' in menopause if the ovaries are removed, and she should be offered a discussion of whether or not she should be placed on hormone replacement therapy (HRT).  Backing up for a moment, wait just one moment.  Actually, we must first question whether the ovaries should be removed at all.  Stay tuned for the next article, which will address this issue.

References:

Couerbe JP. Du cerveau, considere sous le point du vue chimique et physiologique. Annales De Chimie Ed De Physique. 1834;56:160-193.

Orth M., and Bellosta S.  Cholesterol: its regulation and role in central nervous system disorders.  Cholesterol, 2012;2012:292598, doi:10.1155/2012/292598. Epub 2012 Oct 17.  http://www.ncbi.nlm.nih.gov/pubmed/23119149

____________________

Additional Articles by Dr. Margaret Aranda

Menopause and Painful Intercourse

The Cochran Report

What Aristotle Thought of Menstruation

From Menarche through Menopause

The History of Menopause

The Different Types of Hysterectomies
Low Sexual Desire: Is It HSDD?

Surgical Menopause and Testosterone Therapy

Bears Can Smell the Menstruation: Or Can They?

The Ovaries: Reproduction and Endocrine Function