I’ll Drink to That!

Some water flowing in high mountain streams is pristine enough to drink without the need of additives to kill or filter out disease-causing microbes. But, in many places on planet earth, water clean enough for consumption is in short supply. In California and other drought-ridden locations, plants and animals are dying due to insufficient water. In many areas around the world, dysentery from drinking contaminated water is prevalent and life-threatening.

We take water purity for granted in the US where chlorinated water pours from our taps. But, during much of the past 10,000 years, before the availability of pure water, the only safe liquid to drink contained alcohol. Today, we see alcohol through many lenses, with both good and bad views.

Alcohol is the metabolic byproduct of the natural process of fermentation that occurs when yeasts metabolize sugars. In the Middle Ages, alcohol was called “the water of life,” aqua vitae. They learned to make wine from grapes, and beer from fermented grain. People of all ages, including children, drank alcoholic beverages as their primary consumable liquid. The alcohol destroyed many microbes causing disease and made it safer to drink than water. The processes for making wine and beer are simple. Today, many people make them for fun. Microbreweries have sprung up everywhere. There are many suppliers, even health food stores carry the products.

All alcohols are not consumable. Some can cause blindness and death. Disinfectant alcohol is applied to surfaces of the body prior to medical procedures, and is the primary ingredient in liquid hand purifiers. Windshield cleaners spew various colored fluids containing alcohol. There are many industrial uses.

20150626_195841The drinkable form is ethyl alcohol. It is used in celebratory toasts, paired with elegant dining, and has been shown to contribute to cardiovascular health. Undisciplined drinking carries health risks and tragedy. Alcohol is a sedative drug and a toxin. Excessive consumption contributes to loss of mental function, also causing addiction and liver failure. Alcohol has become a common social drink and a problem for many who drink to excess.

Our next blog will review a new powdered alcohol product called palcohol. Additional blogs will provide information on health and social issues related to alcohol consumption, common early signs of problematic drinking, and will discuss blood alcohol determinations.

Here’s to safe drinking, designated drivers, and moderation in all things.

Betty and Bev


Influenza is a respiratory illness caused by a virus.

In 1918 a deadly outbreak of influenza known as Spanish Flu occurred. The disease killed about 50 million people around the world. Recent research done on preserved lung tissue from people who died showed the lung damage seen with bacterial infections, not viral. Researchers concluded the Spanish Flu virus caused a severe respiratory illness, complicated by bacterial infection before effective antibiotics were available.

Seasonal flu remains a serious health problem carrying the greatest risk in older people and those with lung conditions such as asthma and chronic lung disease. Ninety percent of deaths occur in people over the age of sixty-five. A bacterial pneumonia is a common occurrence with influenza. The “pneumonia shot” only prevents one type of bacterial pneumonia, pneumococcal, and is recommended for adults 65 and older.

Today, each year in the US more than 36,000 people die and 200,000 are hospitalized with the flu. Anti-viral drugs are available and shorten symptomatic periods by a couple of days. Antibiotics reduce fatalities from complicated pneumonias that often follow influenza. Getting a “pneumonia shot” only prevents pneumococcal pneumonia.

Each year the flu vaccine is formulated to stimulate immunity to the influenza viruses most likely to be present in the upcoming season. The vaccine usually covers 3-4 different viruses. While the Centers of Disease Control and Prevention (CDC) researchers do their best to match the annual vaccine with the anticipated viruses, the vaccine may not prevent all influenza illnesses because the viruses mutate and change each year.

“The CDC notes that around 70% of this season’s H3N2 viruses have been identified as “drift variants” – viruses that possess antigenic or genetic changes that make them different from the virus included in this season’s flu vaccine, meaning the vaccine’s effectiveness is reduced.”

 “… the CDC estimates that the flu vaccine has reduced an individual’s risk of visiting a doctor due to flu by 23%. This result remained after accounting for patients’ age, sex, race/ethnicity, self-reported health and the number of days between illness onset and study enrollment.”

The best way to prevent the flu is to get your immunization every year. Once you have been immunized it takes about two weeks for the body to generate a response to prevent the disease.Medicine.5

“Despite the low effectiveness of the 2014-15 flu vaccine, the CDC continues to recommend that all people aged 6 months and older receive the vaccine, as it may still prevent infections from some circulating influenza A H3N2 viruses and reduce severe flu-related complications.”

What to do: To protect yourself from influenza, avoid people with respiratory illnesses, avoid hand shaking, use good hand washing technique and utilize alcohol hand purifiers. Early Person Washing Hands with Soap in Washbasinsymptoms are typically muscle aching (myalgias), fever and worsening respiratory symptoms. Isolate yourself if you develop the symptoms. Antiviral drugs must be started within 48 hours of onset of symptoms to have benefit. Call you physician for advice if you are not improving or develop shortness of breath.

Best wishes for health and avoidance of influenza.

Betty Kuffel, MD

Broken Heart Syndrome

Takotsubo Cardiomyopathy

broken heartLosing a loved one, the sudden stress of receiving bad news, intense fear or domestic violence can break your heart. But this isn’t in the emotional sense we usually think about. There is an acute heart problem seen primarily in women of menopausal age in which the heart weakens in the face of sudden stress. The main pumping chamber of the heart balloons instead of contracts. Resulting chest pain and shortness of breath are symptoms indistinguishable from a heart attack.

The electrocardiogram shows classic ST segment elevation found in heart attacks. InSTEMI addition, there is often a small sharp rise in troponin, a heart injury blood marker. In a typical heart attack caused by a blocked coronary artery, the damaged heart muscle cells leak troponin, but usually in larger amounts.

If an angiogram determines there is a blocked artery the cardiologist will likely place a stent. But in the broken heart syndrome known as Takotsubo Cardiomyopathy, instead of finding blockage, the coronary arteries are clear — the results indicate a failing heart with an odd shape. It looks like an octopus trap (a tako-tsubo).


The actual cause of this disorder is not known but is likely related to a surge of stress hormones that stun the heart and prevent normal muscle contraction. Takotsubo is usually seen in older estrogen-deficient menopausal women. However, younger women who lack estrogen because of surgical menopause from ovary removal are also at risk. Animal studies show estrogen appears to protect the heart in stress states.

There are no treatments shown to reverse Takotsubo. Doctors usually order common heart failure medications including beta blockers (to reduce heart rate and blood pressure), ACE inhibitors (to dilate arteries making it easier for the heart to pump) and diuretics (to remove excess fluid). It isn’t known if continuing the drugs can prevent a recurrence, but within two months, most patients fully recover. A few women are left with reduced heart function, and occasionally abnormal heart rhythms occur.

Women in this age group may also have underlying heart disease requiring medical management unrelated to the sudden stress state. Like men, women develop blockage of the major coronary arteries.

Another heart problem most often seen in women involves only small heart arteries. The largeHeart superficial vessels coronary arteries are clear but tiny arteriolar vessels are diseased. Microvascular disease is serious. It can lead to heart attacks and heart failure. A treadmill in combination with continuous monitoring, followed by echocardiogram to check heart function will show abnormalities. Microvascular disease is also treated medically.

YogaTechniques used to help reduce stress hormone surges include: progressive muscle relaxation, exercise, yoga, avoiding alcohol and caffeine. Controlling anxiety is not easy and counseling may be necessary.


Lipstick Logic
Betty Kuffel, MD

Healthy Lifestyle – 2015


Lifestyle means different things to different people. In the past, a healthy lifestyle for hardworking farmers meant getting up before dawn to first milk cows before spending a long day of heavy labor in the fields. A breakfast of fried pork chops and eggs accompanied by homemade bread slathered with butter commonly provided the first meal of the day. A hard working man needed those heavy calories for energy to perform his daily job.

Scan old photos and it’s unlikely you’ll find a fat farmer. They ate food laden with fat and calories but they worked it off. They earned their calories. My grandfather was a farmer. I saw what he ate. My family enjoyed amazing meals, especially during threshing when friends helped friends and families helped families. Eating well was their way of life. For most of us it’s the same today—except now, many people don’t earn their calories.

The body is an efficient metabolic machine. When you eat more calories than you burn your body stores the excess as fat. So lifestyle today is different from the lifestyle of the past, and practices of the past are unhealthy today.

Exercise is the single most important activity that correlates with a long and healthy life. A close second are: your food choices and the volume of food you eat. We need to eat to live, not live to eat.

A new twenty year-long study of 70,000 women confirmed a healthy lifestyle could prevent 75% of heart attacks in young women. Death rates from heart disease in the US have slowly dropped over the past four decades, but in women ages 35-44, this is not true. The study published in the American College of Cardiology reported health habits make the difference. Women with unhealthy lifestyle choices began showing increased heart risks by age 47.

Below are seven top ways to improve your lifestyle and reduce risks for heart disease:

• Don’t smoke
• Consume a maximum of one alcoholic drink/day
• Maintain a normal body mass index (BMI)
• Watch seven or fewer hours of TV per week
• Exercise at least 2.5 hours per week (35 minutes per day)
• Eat a quality diet based on Harvard’s School of Public Health healthy eating plate.
• Have an annual physical that includes a lipid panel

Smoking: Quit. Ask your doctor for assistance if you can’t do it on your own.
Alcohol: Wine: 5 ounces, Liquor: 1.5 ounces, Beer: 12 ounces
Plate and portions: Healthy Eating
BMI: At the link below you’ll find health information and a BMI calculator to check your current BMI. For the calculation you need to know your weight in pounds and height.

Make 2015 a healthy year for you and your family. Monitor your blood pressure, address your weight, add exercise every day and encourage others to do the same.

Betty Kuffel, MD and Bev Erickson

Lipstick Logic (TM)

Motherhood and Apple Pie

k9293041Motherhood and Apple Pie is an idiom used to express a wholesome concept of traditional life in the United States. Unfortunately, times have changed so much over the past 50 years the intended meaning no longer applies. If we look at motherhood and child health over the past 25 years, the US has failed. Maternal deaths are at an all time high. Even with a decline in infant mortality between 1990 and 2010, US infant deaths surpass those of other industrialized countries.
International comparisons of infant mortality show the United States has more infant deaths than most European countries, Japan, Hong Kong, South Korea, Iceland, Israel, Cuba and Canada. Monaco and Japan have the lowest infant death rates in the world.
How can so many mothers and babies be dying in the United States – a country that touts itself as having the best healthcare in the world? Let’s look at some of the reasons.

Cardiovascular disease and infection are the most common causes of maternal death. Because many US women have delayed pregnancy until they are older, they are more apt to have developed chronic diseases including obesity, heart disease, high blood pressure and diabetes prior to their first delivery. All of these common medical problems place additional health risk on both mother and infant.
Medical costs for pre-natal care, delivery and post partum care are high. Choosing to avoid these high costs by delivering at home also places the mother and child at increased risk, especially if urgent interventions for complications become necessary for a safe birth. On the other hand, technology in medical centers has improved treatments to mitigate life-threatening complications such as hemorrhage and obstructed labor requiring C-sections. Going forward, the Affordable Care Act will help participants obtain easier and more affordable access to both maternal and child healthcare.

In reality, the safe, heartwarming values associated with Motherhood and Apple Pie didn’t apply to all mothers even in years past. As recently as the 50’s and 60’s, unmarried girls and women suffered terribly at the hands of society. Young unwed mothers were often whisked off to maternity receiving-homes by their mortified families who wanted to hide the shameful pregnancy. The babies of these young women were typically removed from them in emotionally devastating ways, often not allowing the young mother to even see the infant before the child was placed for adoption. Mothers mourned the loss of their babies. Treatment of many women in that era is found in The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Rove v. Wade, written by Ann Fessler.

According to the data presented in Fessler’s book, inhumane practices during labor and delivery were common. Treatment by medical practitioners, nurses and child welfare services often left the mother with physical and emotional scars that never healed.
Today, many unmarried women are giving birth. Most of them choose to keep their children. In fact, more than half of US births are to unmarried women. These births are often to couples living together. From the National Center of Health Statistics, in 2009, 41% of children were born outside of marriage and 53% of children were born to women under 30, but not all of these pregnancies were unplanned. The stigma of being a single parent has decreased and many women elect to raise a child alone. However, few women disagree that a two parent household is advantageous.

Parenting is supremely important for the emotional, social and intellectual development of a child. Today, more and more grandmothers are filling this important role in childcare by helping to contribute to the care and emotional stability of their grandchildren.
Single low income women with children are at a huge disadvantage in our society. If they can find work, their incomes are often too low to provide adequate housing and appropriate childcare. Sharing households and receiving support from family members who help single parents support their efforts toward the American Dream is helpful, but even with support, the dream has become harder and harder to reach.

motherhood-guruAdults provide the role model for children. Raising children with self esteem and confidence contributes to their successes as an adult. Children tend to mirror their parent’s and caregiver’s behaviors so adequate childcare is essential for single parenting to be successful. Encouragement, respect and love can also be provided by extended family members and baby sitters. Studies show even severely abused and neglected children can be nurtured into confident adults by a caring supportive mother figure.
Today, motherhood has huge challenges and little apple pie. With over 8 million single mothers providing sole support for their children, their options to find good paying jobs are few. Single mothers can be just as successful in child rearing as married mothers, but they may need a little help from their friends.
On this Mother’s Day, please honor women and remember the poem written by William Ross Wallace (1819-1881) The Hand That Rocks the Cradle Rules the World.

(Last verse)

Blessings on the hand of women!
Fathers, sons, and daughters cry,
And the sacred song is mingled
With the worship in the sky—
Mingles where no tempest darkens,
Rainbows evermore are hurled;
For the hand that rocks the cradle
Is the hand that rules the world.

Statistical data source: http://www.geoba.se/index.php
Poem of the Week http://www.potw.org

Betty Kuffel, MD

St. Patrick’s Day Tribute

A Tribute and Thanks to a Phenomenal, Part Irish, Woman –170px-Irish_clover

Mom passed away two days after St. Patrick’s Day in 2006, with her family by her side.

It’s hard to believe how quickly time has passed since then and even harder to write about Mom using the past tense – she was always so full of life and energy. She exuded an endless pursuit of learning and teaching throughout her 89 years. In fact, the month before she died, she was teaching cribbage to some local students. They joined her on Sunday afternoons at her senior living campus apartment, to learn a game she enjoyed playing over a lifetime and had taught to her grandchildren to help them improve math skills.

Of German and Irish descent, Mom was a daughter, a sister, a wife, widowed twice, a mother of four daughters, grandmother of twelve, great grandmother of 28, an aunt, an excellent cook, creative, skilled, resilient, ambitious, a good friend to many, a devout Lutheran and above all, she loved her family dearly.

On my desk is a photo of Mom holding an array of colorful flowers, each one given in honor of herLila -80th birthday - LL Blog 80th birthday at a surprise party hosted by her daughters. Each attendee was asked to bring one flower to the party. Nearly 100 family members and friends gathered. Being among so many who loved and honored her made for a magnificent celebration.

Mom loved life, loved baseball, loved dogs, read a lot, loved to garden and was an avid exerciser. She walked the Heartland trail a couple miles a day as long as she was able. In inclement weather, she picked up a friend and drove to the high school to walk the halls prior to the start of classes. Yoga later replaced walking and helped her remain limber as osteoporosis crept in.

One evening, about 3 weeks before St. Patrick’s Day, Mom fell in her apartment, broke her hip and ended up in surgery. Her recovery did not go well. She required oxygen related to a worsening lung condition and after several failed physical therapy sessions to help her walk, she asked to have all treatment and medications stopped. Mom told me and my sisters, I showed you girls how to live. Now, I will show you how to die.

Rather than move her to a care facility, we chose to move Mom to our home. With hospice support, along with my three sisters and our husbands, we provided her care.

Emotions of both joy and profound sadness filled our home during those last two weeks as she said her goodbyes to friends, family members and their dogs, who all came to visit. She said she had lived a good life and it was her time to die. Her strength helped us through those last days.

As a young girl, Mom’s red curly hair and freckles were an indication of her Irish ancestry. Her strong will, attention to cleanliness and order were expressions of her German heritage. But, her love of family was the truest expression of who she was. As her daughters, we were loved unconditionally, and enjoyed living in a well cared for home where we were treated to the some of the finest cooking ever, including many fabulous German meals. But, on St. Patrick’s Day, we celebrated our Irish heritage by wearing green and savored an annual meal of corned beef and cabbage, boiled potatoes and Irish Freckle Bread. She didn’t serve green beer but she did sip a beer with us now and then.

Mom was strong and loving to the end.

We miss our wonderful German-Irish Mom.


170px-Irish_cloverDid you know the real St. Patrick wasn’t Irish and the original color associated with St. Patrick was blue? Why then is Saint Patrick the patron saint of Ireland and around the world people parade in the streets wearing green?

The son of a British Christian church deacon, Patrick was kidnapped at age 16 and sent to Ireland. There he was enslaved as a sheep herder on a chilly Irish mountainside. After escaping bondage, he made his way back to Britain, but returned to Ireland to convert the Irish to Christianity. When explaining the Trinity to the pagan Irish, he reportedly used the three leafed shamrock plant.

Centuries later, St. Patrick became known as a patron saint of Ireland and in the 1600’s Saint Patrick’s feast day became a holiday in the Roman Catholic Church. In 1903, St. Patrick’s Day became an official public holiday in Ireland. Wearing of the green meant to wear a shamrock on one’s clothing. The St. Patrick’s Day parade in NY City is the largest parade in the world.

For us, St. Patrick’s Day is a fun celebration of our Irish heritage and it centers on an annual meal of corned beef. For an easy healthy holiday dinner, corned beef, cabbage, boiled potatoes and Irish Freckle Bread are favorites.

Corned beef is common in many cuisines. Corned is a term from “corns of salt” used to preserve the meat. Irish corned beef was traded in the 17th century and used as provisions for British naval fleets and North American armies. The preserved meat has a long a sordid history with use on ships involved in slave markets. When fresh meat was rationed during World War II, this salt-cured product became important. The preserved beef, often cooked and canned, was preserved in “tins” and exported from Ireland around the world. Kosher cured beef became popular with the Jewish population. Today South America is a major supplier of canned corned beef.

Corned beef is found in most deli shops and the favorite Reuben sandwiches. Pastrami is smoked corned beef with added spices. Preserved and salted food, such as corned beef, are not for those on low salt diets, but for the rest of us, an occasional meal is acceptable.

Crock Pot Beef in Beer

3-4 pounds corned beef brisket

Trim all visible fat from meat

Vegetable selections: potatoes (peeled and quartered), 2 medium onions (peeled and quartered), 1 cup thinly sliced carrots, 1 small cabbage cut in wedges.

Place vegetables of choice with one bay leaf in crock pot.

Place meat atop vegetables.

Pour beer or one cup of water over beef.

Cover and cook on LOW heat for 10 hours.

Cool meat on cutting board for 10 minutes, then cut across the grain in thin slices.

Serve on large platter surrounded by vegetables.Corned beef meal

Irish Freckle Bread

1 pkg dry yeast

8 tablespoons sugar (divided)

1 cup warm water (110 degrees F.)

½ cup butter, melted

2 eggs

¼ cup warm mashed potatoes without butter or milk

3 ¼- 4 cups flour

1 cup raisins

Dissolve yeast in warm water in a large bowl and add 1 tablespoon sugar. Add the butter, eggs, potatoes,Freckle bread unbaked salt, remaining sugar and 2 cups flour. Beat until smooth. Stir in raisins and enough remaining flour to form a soft dough.

·  Turn onto a floured surface. Knead until smooth and elastic. Place in a greased bowl, turning once to grease top. Cover and let rise in a warm place until doubled, about 1 hour.

·  Punch dough down. Turn onto a lightly floured surface. Place on baking sheet. Cover and let rise untilFreckle bread baked doubled, about 30 minutes.

·  Place pan on a baking sheet. Bake at 350° for 25-30 minutes or until golden brown. Place on a wire rack to cool. Yield: 1 loaf, 12 servings.