Lorraine Feather

I heard this gal on NPR this morning. She has a wonderful voice that she applies to complicated jazz tunes about simple ordinary things. What caught me was her song "Where Are My Keys?"

http://www.npr.org/templates/story/story.php?storyId=90525180

Blog on Over to 50 Ways!

Just in case anyone comes to visit here, you should know that any free blog time I've had has gone to our book blog. Please come visit there!

50 Ways to Leave Your 40s Blog

Second Hand Smoke

– Peggy Spencer, MD

UNM is considering becoming a completely smoke-free campus, indoors and out. Smoking is already prohibited inside the buildings and within 20 feet of the entrances. I’m a physician, not a politician, but, as a physician, I feel moved to offer information about the health effects of second-hand smoke and smoke-free workplaces.

In case you think this doesn’t apply to you, you should know that 15% of UNM students smoke cigarettes, according to a 2006 survey. Twenty percent of New Mexico adults smoke. FYI, that puts us roughly in the middle. Utah is the lowest, with just under 10% of adults smoking, and Kentucky is the highest at almost 30%. So even if you are a nonsmoker, chances are very good that you will be exposed to second hand smoke.

Second hand smoke (SHS) is made of sidestream smoke, from the burning end of the cigarette or cigar, plus exhaled mainstream smoke, from the smoker’s mouth and lungs. Everyone knows that cigarette smoke is harmful to the health of the smoker. Now we know that second hand smoke is harmful to the nonsmoker as well. In fact, SHS has higher concentrations of some toxins, due to cooler temperatures and other factors.

There are more than 250 toxic chemicals in SHS, including at least 50 that are known to cause cancer (carcinogens). SHS has been classified as a “known human carcinogen” by the Environmental Protection Agency. An example of a carcinogen in SHS is formaldehyde. Formaldehyde is used to preserve biology tissue specimens and to embalm dead bodies.

Besides carcinogens, SHS contains many toxic gases, like carbon monoxide, the deadly gas in car exhaust. Also chemicals, like hydrogen cyanide, which is used in chemical weapons, and heavy metals, like arsenic, which is an ingredient in pesticides.

The health effects of SHS on nonsmokers have been studied quite extensively, using household members and coworkers of smokers who smoke indoors. The degree of SHS exposure can actually be measured. There is a chemical named cotinine (an anagram of “nicotine”), C₁₀H₁₂N₂O, that is a unique metabolite of nicotine. In other words, it doesn’t exist anywhere except in the blood, urine and saliva of people exposed to nicotine, including second hand smokers. More about this below.

Outdoor studies are difficult to do, as outdoor SHS is difficult to quantify, but I have no doubt the evidence is forthcoming. Meanwhile, a degree of extrapolation to outdoor environments is reasonable.

SHS is a respiratory irritant. An irritated respiratory system is more susceptible to colds, bronchitis, allergies and asthma. It is also, as I mentioned above, a carcinogen, estimated to cause 3,000 lung cancer deaths per year in nonsmokers.

Smoking increases heart disease, as you probably know. So does SHS. There are immediate and long term effects. The moment you inhale SHS, the platelets in your blood become “stickier,” and the lining of your blood vessels is damaged right away also. This increases the risk of a clot forming inside your blood vessels, which could translate into a heart attack or stroke, especially if you already have vessel disease.

Long term, SHS causes heart disease just like first hand smoke. In fact, a conservative estimate is that SHS causes 35,000 heart disease deaths a year in nonsmokers. That’s equivalent to the whole UNM student body.

Babies and children are especially susceptible to SHS. Low birth weight, Sudden Infant Death Syndrome (SIDS), and respiratory infections are some of the problems that can be caused by SHS in babies.

Another group that can be adversely affected by SHS is ex-smokers. For some, even a whiff of smoke in the air really triggers their craving and makes it tough to stay quit.

If you can smell smoke, you’re second hand smoking. Will one puff kill you? Doubtful. But if you already have asthma or heart disease, it could trigger an asthma attack or a heart attack. Far more likely than instant death is temporary irritation, of mood and respiratory system, and long term gradual buildup effects discussed above.

How much is too much? The surgeon general has issued a conclusion that there is NO SAFE LEVEL of second hand smoke. The only way to really protect nonsmokers from smoke is to have separate, indoor, isolated buildings for smokers. Called “smoking pavilions” or “butt huts,” these do exist in some places.

Naturally, I would be happy if nobody ever smoked again, for the sake of their health and everyone else’s. But smoking is a legal activity, and we can’t stop people from making legal behavior choices. Since smoking affects others, however, it becomes a public health issue. Over the years, measures to protect the public from SHS have broadened in scope, from smoke-free sections of rooms to whole.

Our neighbor Arizona was the first state to institute bans on smoking in public buildings. Most other states have followed suit. Federal measures have led to smoking bans on airplanes, federal buildings and facilities that provide federally funded services to children. New Zealand and Norway have laws that all workplaces must be smoke-free. In this country, some businesses such as Nike and Scott Paper now have 100% smoke-free campuses. Over 100 colleges and universities in the US are completely smoke-free as well.

Public health policy is only as good as the health outcome. It turns out, smoking bans actually help people quit, and that is good for their health. Their coworkers and household members benefit as well. Body fluid levels of cotinine, that nicotine metabolite, have fallen 70% overall in the last 15 years. However, there are still measurable levels of cotinine in 43% of nonsmokers in the US.

The healthiest way to deal with cigarette smoke is to avoid it. Don’t start smoking in the first place. If you smoke, quit. This is far easier said than done. Tobacco addiction is extremely tenacious. Most smokers who quit take a long time and several tries to get there. But it is possible. The good news for UNM students is that there is free help available to help you quit.

My sources for this article are the US Dept of Health and Human Services, the National Cancer Institute, the Centers for Disease Control, and the National Institutes of Health.

Endorsements for 50/40

Dear Friends,

The book is going to the printer this Friday! We are very excited. Meanwhile, our wonderful publisher has collected some awesome endorsements for us. Check them out:


"Good, juicy, inspiring words and ways to live as a gloriously aging soul."
--- SARK author and artist of Fabulous Friendship Festival



What a treasure trove! 50 Ways To Leave Your Forties is a joyful, irreverent (and at the same time, very reverent) enthusiastic, and incredibly informative book. The authors present their suggestions for zestful and meaningful living in wonderfully inviting ways. I loved it!

--Sue Patton Thoele, author of Freedoms After 50, The Courage To Be Yourself, and The Mindful Woman


"So far, the statistics are convincing: everyone ages. How we age, however, is largely a choice. In 50 WAYS TO LEAVE YOUR 40s, Sheila Key and Dr. Peggy Spencer serve up a delectable recipe for healthy aging that is both delicious and joyful."

--Larry Dossey, MD, author of The Extraordinary Healing Power of Ordinary Things

Dipping into this treasure trove of a book makes me want to go back in time so I can leave my 40s again. 50 WAYS TO LEAVE YOUR 40s offers so many creative ideas, so much thoughtful information and is so darn much fun, I’m sure I’d do it more gracefully, heathfully, and happily the second time. Congratulations and thanks to Sheila Key and Peggy Spencer for giving all of us a life-affirming map to follow no matter what our age.

-- Judy Reeves, author of A Writer’s Book of Days

“Sheila Key and Peggy Spencer know that a new decade of life is the beginning,
not the end, of something great. With generous helpings of wisdom and wit, 50Ways to Leave Your 40s is a recipe for joy during what comes next.”

— David Niven, PhD, author of The 100 Simple Secrets of Happy People and The 100 Simple Secrets of the Best Half of Life

The Book is Done!

Finally, at long last! The infamous book is finished and on its way to the printer in a matter of days. The cover is what you see here. Publication date is mid-March 2008. Watch this space for more information and links. Post your email or snail mail address here if you want a notice when the book is available, or email me at pspencer@unm.edu. It has been a long and educational road, a lot of fun, and boy am I glad it is over! I know you'll love this book.

Urinary Tract Infections

Q: Are all UTI’s caused by sex?

A: Thank you for this great question. The answer to your question is, “No, but…”
UTI stands for Urinary Tract Infection. It might also be called a bladder infection or cystitis. We see a lot of it at the Student Health Center, mostly in women. It is often related to sex, but indirectly, and not always. To explain, I need to subject you to a mini anatomy lesson. Bear with me.

The urinary tract is the system of organs that makes, collects and excretes urine. You have two kidneys, one on each side, located roughly behind your stomach. Each kidney makes urine and sends it down two tubes called ureters to your bladder, which collects it. Your bladder is located inside your body above your genitals. It is a soft, stretchy container with thin muscles in its walls. When your bladder is full, the urine is expelled from your body through another tube called the urethra. You control this process by consciously relaxing a muscle called a sphincter, which opens the urethra. Your bladder helps by contracting the muscles in its walls. The outside end of the urethra, called the meatus, is at the tip of the penis in men. In women, the meatus is on the vulva, between the vagina and the clitoris. This anatomical difference is why women get UTI’s more often than men, and why it is related to sex, as I will explain, after a mini microbiology lesson. Hang in there.

Urinary infections are caused by bacteria. Bacteria are everywhere. You think you’re clean? You probably are, but that does not mean you are bacteria-free. We share our personal space with more than 200 species of bacteria. In fact, there are ten times more bacteria in our intestines than there are cells in our entire body! Imagine that. Now, before you get all grossed out, know this. These little guys are your friends. They are called, as a group, “normal flora,” and they do lots of good. Good bacteria crowd out and kill bad bacteria. They also stimulate our immune system and help it develop, and some of the bacteria in our gut even make vitamins that we can use.

What kind of normal flora you have depends on your genetics, your age, sex, nutrition, stress and hygiene. We all have bacteria on our external surfaces and some internal surfaces, like nose, mouth, throat, intestines, and vagina. As long as they stay where they belong, there’s no trouble. But sometimes during sex, some of these critters can end up where they’re not wanted, like in the bladder. This happens more easily in women, due to the proximity of the meatus to the vagina and anus. Fluid, friction, moving body parts…use your imagination and you can see how it happens.

Sex is not the only way for bacteria to get near enough to the meatus to go in and cause a UTI, but it is the most common in college-aged people. One simple way to reduce sex-related UTIs is to urinate after sex. What this does is wash out any bacteria that have begun their sneaky trek up the urethra. Most of the time this works great. But if you find that you are experiencing burning when you urinate, blood in the urine, or the urge to go frequently, you might have a UTI. This goes for guys and gals. Please do not try to treat this yourself with cranberry juice, vitamin C or any other folk remedies. While some of these things can help you feel better, a true UTI is caused by bacteria, and the only way to kill bacteria is with an antibiotic.

Traumatic Stress Response

Remember the moment you heard about the shootings on the Virginia Tech campus? How you heard of it and where you were? Your reaction? The reactions of your friends and those around you?

Reactions to traumatic events are as varied as people are. Your response may be very different from your roommate’s or your mother’s. We’ll discuss what is normal and what is not, what to do now and when to get help.

Traumatic stress reactions can be loosely divided into physical and emotional, short term and long term. Many people initially feel shock and disbelief, even denial. Also common are anger, fear, anxiety, sadness, hopelessness, compassion, helplessness, and survivor’s guilt. You may feel emotionally numb, or conversely find that you are irritable and jumpy. Your moods may change back and forth quickly. You may struggle in your mind with why this happened, trying to find answers, to make sense of the tragedy. You may worry about something similar happening here. You may have physical responses, like nausea, headache, jitters, chest pain, trouble breathing, difficulty sleeping, or decreased appetite. All of these are normal. However, if you have severe emotional or physical symptoms in these first days, please get professional help.

This is already a stressful time on campus, with finals and graduations just around the corner. A background of existing stress can magnify the effect of a major tragic news event. If you have some kind of connection to Virginia Tech, your reactions may be even stronger. For example, if you knew one of the victims, or know a student at VT, or have friends or relatives or experience in the area, your feelings will probably be more intense.

If you have a history of previous trauma, as many of us do, the news of this tragedy might bring that past trauma to the front of your mind, and you might find yourself thinking, dreaming, reliving or having feelings about the other incident. The previous incident may seem totally unrelated, or it may be a similar event. This can be unsettling at best. The severe form of this kind of reaction is called PTSD, or Post Traumatic Stress Disorder, but most cases are milder, a temporary resurfacing of memories which fade into the background again.

How can you cope with your own feelings and thoughts during this time? Connect with those you care about. Spend time with friends. Call your family. Talk about your feelings and reactions, or write about them. Post your condolences online, along with thousands of others. Above all take good, healthy care of yourself. Eat well, get as much rest as you can, exercise. Avoid the temptation to “drown your sorrows” with alcohol or drugs. Again, if you’re having severe reactions, get help.

While initial reactions to trauma may vary in kind and severity, most people return fairly soon to a competent pursuit of their normal activities. You don’t forget, but you aren’t immobilized either. An abnormal response is when you are affected to an extreme, or when your feelings or thoughts persist after the initial shock period. Next week and beyond, if you find yourself unable to concentrate or sleep well, or if you are having trouble performing your usual activities due to continuing trauma responses, please seek help.
Delayed responses to trauma can happen up to weeks and months after the initial event. Keep this in mind as you observe and care for your own mental health in the near future.

Stinky Feet

Dear Dr Peg,

My girlfriend told me I have stinky feet. She thinks it might be a fungus thing and wants me to get it taken care of. I don’t notice it, but she said that her socks even stunk when she washed them with mine. I mostly wear the same pair of shoes, which my brother handed down to me, but I shower every day and put on fresh socks. I’m a clean person. Please help me. She’s sleeping on the couch.

Dear Fragrant Feet,

Your girlfriend is probably right (aren’t they always?). You likely have a fungal infection of the feet, also known as tinea (fungal infection) pedis (of the foot). This is also called athlete’s foot, but you don’t have to be an athlete to score this deal.

We all sweat, and sweat has odor. Foot sweat by itself can have a strong odor, but if your girlfriend’s socks pick up this odor in the washer, it is more likely to be caused by fungus. You said you don’t notice the odor, and she does. This is common. We adjust quickly to our own body odors and often don’t notice them, whereas others might.

There are “fungus among-us” everywhere. We don’t have as many in our dry climate as someone who lives in say, Florida, but we have plenty. Fungi (the plural form) live on and off people, and on gym mats, shower stalls, rotting logs and old food.

A fungus is a life form. It is closer to a plant than an animal, but rates its very own kingdom in the 5-kingdom taxonomy of life forms. Within the kingdom Fungi there are over 100,000 species. A few of these have a special affinity for human skin. They cause ringworm (not a worm at all), jock itch, diaper rash and athlete’s foot, among others.

The ideal habitat for certain fungi is somewhere dark, warm and wet. Shoes fit the bill perfectly. You might have even inherited your tinea along with your brother’s shoes. That’s one reason that, although I’m a big believer in recycled clothing, I don’t recommend buying used shoes (or underwear or hats for that matter). Your brother might have had his own case of resident fungus, which went on living quietly in the cracks of his shoes until your feet came along and spiced up the place, allowing the fungi to multiply and prosper. And reek.

So what to do? Basically, the approach to tinea pedis is two-pronged. First, slaughter the beasts. Second, clean up the neighborhood so their skuzzy relatives don’t move in.

Killing fungus is a fairly straightforward proposition. There are a variety of anti-fungal products available over the counter at any pharmacy. I believe the creams and ointments work on the skin better than the sprays or powders, because they stick to your skin better. The usual dose regimen is twice a day, after washing your feet. Please note: if the fungus has gotten under your toenails, making them yellow and thick, you will need medical help.

You can kill the fungi in your socks by washing them in hot water. Add bleach to whites. Do the same with your sheets. Oh, and your girlfriend’s socks. You can also spray bleach (a 10% solution in water is strong enough) on any mold or fungus you see growing in your shower.

Getting rid of fungus in shoes is much more difficult. Wash them if they’re washable. Spray them with antifungal spray and put antifungal powder in them. Best is to accept that you might have to get rid of them and shell out some dough for a new pair or two.

Keep your feet as cool and dry as possible. Change socks twice a day. Try a pair of super-absorbent odor eating inserts. Change shoes often, or go without when you can. Open shoes or sandals give your feet more air, and fresh air is poison to foot fungi.

Here’s something that might surprise you. You can have “fungus feet” with no odor at all. You know those foot and heel cracks that so many people have? We think it’s just desert dryness, but often it is really a type of fungal infection. After-shower treatment with a pumice stone and antifungal cream will clear those cracks right up. Make this a regular part of your routine and they’ll stay gone.

Having tinea pedis does not mean you are unhygienic or somehow bad. It’s just an infection. And in spite of her socks taking on your Eau de Foot aroma, your girlfriend is not likely to catch it, unless she starts wearing your brother’s shoes too. People are much more likely to get tinea from the gym than from their partner. Take the steps above and soon she’ll ditch the couch and be back in your fragrance-free bed.

Molluscum contagiosum

Dear Dr. Peg,

I went to see my dermatologist a few days ago about small bumps I noticed on my penis. My dermatologist said they were molluscum contagiosum and she used a liquid nitrogen spray to freeze them off. I had 5 bumps and now they have all increased in size, popped, and are starting to scab up (as my dermatologist explained they would). Something I’ve noticed is that it seems like my penis is smaller now in its flaccid state. Is this common? Will it go back to normal size after the scabs fall off? I started to google side effects of liquid nitrogen and really got myself scared seeing things like necrosis and nerve damage. Have you ever heard of this?
Thanks. A very nervous guy.

Dear Nervous Guy,

Bottom line: liquid nitrogen treatment will not change your penis size. If that’s all you wanted to know, you can heave a sigh of relief and stop reading. If you want to learn a little more about this disease and treatments, keep reading.

Molluscum contagiosum is a skin infection caused by a virus of the same name. Humans are its only host. It is passed by skin to skin contact, or by skin to object (e.g. towel) to skin. Little kids get it from playing together and sharing toys. In adults, if it’s in the genital area, it’s assumed to be sexually transmitted. We see it quite often at the Student Health Center.

Molluscum contagiosum causes small firm bumps with waxy centers. They usually don’t itch or hurt. It can take weeks from the time of contact for the bumps to appear. If you leave them alone, they will go away eventually, but this can take several weeks to months. In the meantime, you are contagious. If you get treated, the duration of the infection is shortened, and your period of contagiousness is also shortened.

Treatment means removing the waxy centers. This is usually done with a tool called a sharp curette, with which we scoop out the center in one swift move. Yes, it hurts a bit, but only for a second. Alternatively, they can be treated with liquid nitrogen, like your dermatologist used. Nitrogen is normally a gas, at room temperature. It’s part of the air we breathe. When it’s cooled and pressurized, it is a very cold liquid. We use liquid nitrogen to treat various different skin conditions, including molluscum, warts, and small skin cancers. By freezing the lesion, we destroy most of it, and your immune system sends cleanup crews to finish up.

There are several other methods of treatment documented for molluscum, including various toxic solutions and lasers. As I said above, the bumps will go away eventually even without treatment, but since it is contagious as long as the bumps are present, I recommend getting them treated.

You asked about complications of liquid nitrogen freezing. This kind of treatment is also called cryosurgery or cryotherapy. As with any kind of intervention, there are possible complications. First of all, pain. It hurts to have tissue frozen, and the area usually stays tender for several days. Bleeding is common, under the skin as a ‘blood blister.’ Infection is possible but uncommon. If the site becomes opened or raw, cover with antibiotic ointment and a bandaid. Long term complications might include scarring, pigment changes, recurrence of the initial lesion, particularly warts, and yes, nerve damage. This last is very rare, I hasten to assure you.

The way your lesions blistered up and fell off is exactly the reaction we’re looking for. Once the underlying sore heals up, everything should be back to normal, including your penis size.

You mentioned that you did an internet search on liquid nitrogen. Let me take this opportunity to comment on internet searching for health problems. Many of our patients do this. Personally, I like it when my patients do some research ahead of time, if it is good research. I especially like it if they have new information for me and can teach me something. I would caution you, however, against sloppy googling. If you’re going to look up health conditions, use reputable sites. Googling by symptom can be especially problematic, because many symptoms can be caused by a wide variety of different illnesses. For example, fatigue can be caused by anything from stress to cancer. Dizziness can simply be from standing up too fast, or it could be from a major heart problem.

One excellent site is http://familydoctor.org. This site is created and maintained by the American Academy of Family Physicians, and can be searched by disease or symptom. A web search is never a substitute for a visit to the doctor, but it can provide you with lots of good information.

Sex in Midlife

You Still Got it Baby!

Remember when we were 18 and tried to imagine people over 40 having sex? We couldn’t, right? No way those old farts could still get it on! And who’d want ‘em even if they could? Now, look at us. We are those old farts. And we’re still “doing it.” Or are we? Does sex change in midlife? Does it get better or worse? Does it even happen? Or is laundry day the only time we shake the sheets?

It turns out there is no simple answer. Midlifers are all over the sexual map. More sex, less sex, higher drive, lower drive, new partner, old partner, no partner…it’s all there. The only thing that is constant across the board is change. Our priorities are changing, our relationships are changing, and none of us experience sex and sexuality the same way we did when we were twenty-something.

For one thing, we don’t have the bods we used to have, and that takes some getting used to. Youth defines sexuality, or so the ad execs would have you believe, and one thing we ain’t is young. The mortal flesh is settling; we’re not the Gumbies of yore. But you and I know that, beneath the wrinkles and the graying hair, we are just as sexy as we used to be. Probably sexier, given a half-life of experience under our belts (so to speak).

This is not to deny the very real physical and hormonal effects of aging. Drying tissues and waning libidos are common. Don’t let that rain on your parade. Gals, pick up your favorite personal moisturizer and guys, isn’t it a bit of a relief to have your gonads out of the driver’s seat? If not, or if you need more help, please do see your doctor.

My advice is this: Treasure your sexual self. Be open to change. Communicate with your partner. And seek help if you need it.