Prenatal Planning

As I’ve discussed, my wife Jennifer and I are planning to have a baby. While not pregnant yet, we’ve decided where we (probably) want to deliver the baby, and we’ve verified that our high-deductible insurance will cover emergencies related to the delivery and infant. Assuming a normal birth, we’ve already saved ample funds in our Health Savings Account to pay for the prenatal care and delivery, and we’ll have our full deductible saved well before delivery.

Obviously another big key is for Jennifer to prepare her body for pregnancy. As a point of general health, we checked Jennifer’s cholesterol counts. Jennifer also went to the dentist so she won’t need to do that during pregnancy.

Jennifer started taking a prenatal vitamin; her book What To Expect When You’re Expecting suggests that Vitamin B6 can help alleviate morning sickness, and obviously other vitamins are also important. A midwife at Mountain Midwifery suggested that Costco fish oil is a good source of Omega 3 fat, so we’re sticking with that (as opposed to an algae based form of the fat, which is considerably more expensive, even for the Target brand).

One thing I’d never heard of is an “Rh factor” test. According to What To Expect, “In a pregnancy, if the mother’s blood cells do not have the Rh factor [an antigen] (she’s Rh negative) while the fetus’s blood cells do have it (making the fetus Rh positive), the mother’s immune system will view the fetus… as a ‘foreigner.'”

Conveniently enough, PrePaidLab offers the Rh test, so Jennifer signed up for it. So if she tests negative, then apparently I also need to get tested.

While we were at it, we thought we’d get her level of Vitamin D tested. (PrePaidLab also offers that test.) The Vitamin D Council has more general information. One study suggests that a deficiency in the vitamin can cause underweight babies. A second study seems to confirm those results. Another concern is that a deficiency can harm the child’s bone health.

One big question we have is how much fluoride Jennifer should be taking. According to our dentist, she should be drinking regular tap water for its fluoride content during pregnancy and breast feeding, so as to give the child enough of the mineral for strong teeth. A child needs it for several years thereafter, according to my dentist. I’ve heard the claim that fluoride per se is bad, but such claims strike me as unsubstantiated hysteria. However, it’s unclear to me exactly how much fluoride Jennifer should be taking, and when she should be taking it. (If anybody has good, objective evidence on the matter, please share in the comments.)

Tracy Ryan of Mountain Midwifery suggested that Jennifer should have gone off the birth control pill long ago (and in general she prefers the IUD to the pill). But Jennifer is off of it now, so she’ll have at least a complete cycle without the extra hormones.

The next step is the obvious one.

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Comments

Lady Baker April 26, 2010 at 3:41 PM

FYI, you might be able to save the cost of the rh test if she’s ever donated blood (it would be noted in those records). Also, it’s almost never an issue with a first kid. If sensitized, an rh- mom can attack a subsequent rh+ fetus. (If there has ever been a miscairrage early enough that the mom didn’t know, she can be sensitized for a first child.). Just sharing from my high risk maternity nursing background :). Rachel
P.S. This may not bs the best time for her, but donating blood could be a free way for you to find out your blood toe and rh status. It’s a bigger needle, but still just one poke.

Pamela Clare April 27, 2010 at 9:25 AM

Enjoy that next step. Very exciting!

Jenn Casey April 27, 2010 at 2:03 PM

It’s been a while since I’ve revisited the fluoride issue, but I read about it years ago and decided against consuming too much of it. We get bottled water, and I switched at that time to non-fluoridated. This was when my oldest child was a baby. None of my kids have had issues with cavities (anecdotal, so fwiw). I have chosen to have their teeth treated topically with fluoride at their dentist appointments. But none of us drink fluoridated water, and I didn’t drink it while pregnant (except for the first time) or nursing.

PDM April 30, 2010 at 9:23 AM

The National Academy of Sciences did a thorough review on fluoride in 2006. They documented numerous deleterious effects of fluoride on many organ systems including increased potential risk for bone fractures (the well characterized disease of skeletal fluorosis) possibly increased risk of osteosarcoma, reduced IQ, thyroid dysfunction, endocrine dysfunction and others all 300 pages is online if anyone cares to confirm it. Of course don’t forget fluoride induced dental fluorsosis (i.e. teeth mottling and a sign of toxic exposure to fluoride – the rate has increased dramatically subsequent to widespread water fluoridation with the CDC and others putting the prevalence somewhere around 30%) The NAS study ended with recommending that the EPA should more strictly regulate fluoride. Their findings mirror those in the peer-reviewed medical literature, while Harvard trained toxicologist Phyllis Mullenix also extensively documented behavioral changes in mice upon exposure to blood levels of fluoride not far greater than those experienced through water fluoridation and other sources of exposure. Former, well credentialed EPA scientists have been fired for bucking the political line on this issue. Meanwhile 90% of the fluoride placed into our water supply is not industrial grade sodium fluoride, it is silicofluorides, quite simply, scraped from the sides of Florida phosphate plant smokestacks. If it weren’t thrown into the water supply it would have to be disposed of as hazardous waste. You can read more on this starting here,

http://healthjournalclub.blogspot.com/2009/11/water-fluoridation-part-i.html

Ari April 30, 2010 at 9:40 AM

Sorry, PDM, but those claims are entirely unbelievable. I do not doubt that too much fluoride is harmful, and that is all the cited science demonstrates. But too much of anything is harmful. Too much Vitamin D is harmful, too much protein is harmful, too much iodine is harmful, yet all of those things are necessary for life.

The question is, are modest amounts of fluoride useful in building strong teeth, without causing serious side-effects? To date, I have seen exactly zero evidence demonstrating that moderate levels of fluoride are unhealthy. -Ari

Insurance Covers Emergency Birth

As I wrote yesterday, Jennifer and I are planning to have a kid. One of the major outstanding issues was how insurance would handle this. I was relieved to confirm that our health insurance would cover emergency contingencies related to delivery (after the deductible). Moreover, we have 30 days to add a newborn to our plan, and the child is covered from birth.

We have a high-deductible plan with Assurant that costs us $148.16 per month (for both of us). We don’t expect our insurance to cover any of our routine or moderate-cost care; that’s why the premium is relatively low. Instead, we save the maximum allowable in our Health Savings Account, which is pre-tax money. We already have ample funds in our HSA to cover a routine delivery at Mountain Midwifery.

But, as Tracy Ryan, the owner of the facility, warned us yesterday, in a minority of cases a woman may need an expensive C-section, and the infant may need expensive intensive care. The worst-case scenario could easily cost tens of thousands of dollars.

Our family deductible is $10,000 per year. So, given our insurance covers delivery emergencies, that’s the maximum bill we’re looking at, and by then we’ll have more than that in our HSA.

Assurant also gave me an estimated premium to add a newborn: a family total of $202.69 per month. While decades of political controls have mostly destroyed the market in health insurance, that’s a premium I can live with. The big question for us is whether and how long ObamaCare will allow my high-deductible insurance to exist.

Blog housekeeping: I’m adding a “family” label for posts related to pregnancy and children. I use “PPC” — for People’s Press Collective — for posts on politics. I’ll use a “home” label for everything pertaining to food and the household. I’ll also use a “religion” label.

Kid Planning and Mountain Midwifery

Jennifer and I have been married for over a decade, and we’ve been talking about having a kid since before we were married. We’ve finally decided to go through with it. Further, we’ve decided to share our experiences, not only as a record for ourselves, but perhaps as a useful point of reference for others. Perhaps experienced parents will also be motivated to write in and offer us guidance when we seem to need it.

Today we went a long way toward resolving one of our big decisions: where to have the baby. We visited Exempla Good Samaritan in Lafayette yesterday. Very nice, but not especially welcoming or reassuring. We visited Mountain Midwifery Center (MMC) today, and we both fell in love with the place, so much so that we didn’t make it to our third appointment at Avista in Louisville. (We may tour other facilities in the coming weeks.)

To back up a bit, Jennifer is not yet pregnant. Thus, there are a lot of things that could go wrong between now and birth. We could fail to get pregnant. We could miscarry. We could suffer a seriously deformed fetus — personally my biggest fear — in which case we would obtain an abortion, as we’ve discussed at some length. We could suffer problems during the delivery that could endanger the life of Jennifer or the baby. But we expect a normal, healthy birth, and of course that’s what every parent-to-be hopes for. As with much of life, then, the goal is to expect the best but plan for the worst.

MMC, we learned this afternoon, is the largest midwifery center in the nation, with five registered nurse midwives and eight nurses. The center has facilitated 592 births in its four-year history. (I’m not sure if this included a birth today prior to our visit.)

The visits to Exempla and MMC were completely different. I’ll begin by highlighting some of the major differences.

Detail of information — At MMC, Tracy Ryan, the owner, addressed a room full of about 20 prospective parents for over an hour. She told us what to expect, answered in detail questions about medical contingencies, and talked about general birthing facts. At Exempla, frankly I learned more about the in-hospital store than I did about the medical aspects of birthing.

Ritz — Exempla is beautiful. The building is beautiful and the rooms are beautiful, with beautiful views and hardwood (or faux wood) floors. I began my notes at MMC, “Looks like an old Spanish-style Super 8.” There were toys on the floor of the main room. Something was covered by a colorful sheet. It had a definite urban-hippie feel. I wondered in my notes whether this meant that MMC didn’t waste money on frivolities or if it meant that the clinic was unserious. I soon became at ease at MMC, finding its less-formal environment to be “lived in” and meant for real people.

Pricing information — Before we went to Exempla, I spent twenty minutes or so on the phone with a representative of the hospital. After getting a range of prices, the representative noted that she was giving me only the insurance rates. “What are the self-pay rates?” I asked. “I can’t tell you that,” the representative replied; I’d have to call another business office. I got no additional information from our visit to the hospital in terms of pricing. Moreover, Exempla offers a “complimentary welcome home” dinner as well as diapers for the baby. Complimentary, my ass. Somebody’s paying for that nonsense at jacked up rates, and that somebody obviously would be me. At MMC, Tracy made a special point to discuss pricing. And MMC’s prices are much lower, “around” $4,000 plus fees for outside tests. (Of course this is the cost of a normal delivery, not an emergency one.)

Water delivery — Exempla will let the mother sit in the tub during labor, but it offers no water delivery. That’s a facade of “natural childbirth,” not the real thing. At Exempla, you end up on a hospital bed, and that point is pretty much non-negotiable. MMC features water delivery tubs as well as birthing stools. Tracy explained that mothers often have to try different approaches and positions. The point at MMC is to let the woman’s body do what it does naturally, work with the baby’s body, and use gravity to natural advantage.

Expected recovery — I thought it was odd that Exempla offers a room for delivery, then moves the mother into another room for recovery. Obviously this would add to the cost, I thought. I asked, “Can a mother just leave straight from the delivery room?” Oh no! Heaven forbid! Absolutely not! That sort of thing just isn’t done, apparently. Tracy said the normal delivery at her facility is quite different. Often a mother has her child and goes home to bed after a few hours (provided all the health markers are normal, of course).

Crowd engagement — The general attitude at Exempla was “fill out this form and figure out how we do things around here.” The general attitude at MMC was that the mother and her partner are in charge, and it is the job of the midwives to educate the mother and facilitate her decisions. This attitude was reflected among the prospective parents, who chatted before and after the class and peppered Tracy with difficult questions. (One of the prospective fathers there was a doctor, and he asked some great technical questions.)

I felt like Exempla was a good hospital and we’d be in good hands, but we hardly felt like we had found our birthing home. I don’t have much else to say about Exempla, though I thought I’d share my photos of the building and the two rooms:

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I have a lot more to say about Mountain Midwifery Center. I’ll start with pictures, which capture the tubs, a stool, the building, and Tracy standing by photos of her birthday babies:

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I’ll start at the beginning of my notes. Tracy entered the room looking confident, nice, and down-to-business. She was wearing jeans, but in a way that conveyed a let’s-get-busy attitude rather than a casual one. After finding everybody chairs (a few sat comfortably on the floor), Tracy sat in a folding chair facing everyone and began her spiel. MMC is the only licensed birthing center in Colorado, though there are 200 in the country. Tracy is hoping to expand to other locations in Colorado. As noted, her facility has helped with nearly six hundred births in four years.

MMC accepts thirty-six families per month. Five midwives work there. The facility has three birthing rooms. I asked what happens if more than three women go into labor at the same time; Tracy assured me that’s practically impossible.

Tracy said that a typical delivery might happen at noon with the woman walking out by her own power by four.

“Pregnant women aren’t sick. That’s just something our bodies do,” Tracy said. Usually there aren’t big medical complications. She urged us to see the film The Business of Being Born — which we own but haven’t yet watched (perhaps tonight!), and said the “best maternity care is not in hospitals.” MMC is “more like a home-birth center,” Tracy said.

However, she quickly added, “We are not anti-hospital.” In fact, Swedish is literally just up the street, and MMC has a good relationship with that hospital and has sent several mothers and babies there who needed extra help.

I learned some new terms today. An “episiotomy” is when the medical assistant basically makes an incision to enlarge the vaginal opening. (Sounds unpleasant.) MMC can do an episiotomy, but it rarely does one, Tracy said. Half the women who deliver there walk out without a stitch.

“We use intervention appropriately,” Tracy assured us. It is definitely not true, she emphasized, that all babies come out naturally and easily. If one looks at a developing region (she mentioned Ethiopia), one finds that more babies die there and women sometimes suffer severe physical trauma.

Eleven percent of the women who have gone to MMC have ended up at Swedish. This drops to a single percent for the second baby, which often more or less “falls out.” (That’s not how the mother would describe it, Tracy clarified.) While most babies do come out naturally, “some babies need help.”

Few “certified nurse midwives” — nurses with additional graduate training — work in Colorado, Tracy said (find more through the midwives association), and five work at her facility (including her). They can do all sorts of things from sew up tears to order lab work.

Tracy said that typically there’s a blood test of the mother-to-be between eight and ten weeks into the pregnancy. While sometimes a nurse at a hospital will draw a woman’s blood without so much as an explanation of the purpose, at MMC the goal is the inform the woman, educate her on the pros and cons, and then enact her decisions. That’s exactly the attitude we’re looking for.

MMC offers all sorts of classes, covering nutrition, birthing, feeding, and so on. She repeated the refrain, “diet, exercise, and three liters of water a day.” (Later she guessed that Colorado’s high premature birth rate is linked to dehydration.)

The staff of MMC will discuss money, family, work, and the “fear of doing labor.” “Everybody has fears of doing labor, but you can do it… Labor is tough. But at the birth center, you get support.”

The attitude at MMC, Tracy continued, is that as a pregnant woman “you are normal and healthy.” Birth is an active event. MMC facilities mostly “hands and knees water birth by candlelight.” (She said it rapidly but thankfully repeated it a few times so I could write it down.)

Tracy said that actually about forty percent of births there take place in the water. Another common position is on the bench. She said laying-down births are more common for subsequent babies, which often come out easier. Practically all the women at MMC get in the tub at some point. Women often need to try different things out and shift around, Tracy said. Moreover, babies can prefer different positions.

Tracy said that at many hospitals — and our friends’ experiences confirm this — the spouse needs to act as the advocate for the woman to enact her birthing plan. But at MMC “we are your birth plan. We are your low-intervention place,” so it’s not all up to the spouse to keep things flowing according to the woman’s intentions.

While MMC allows outside guests, Tracy cautioned prospective mothers to invite in only people they’re comfortable with. “You can fake an orgasm, but you can’t fake your birth,” she said. In other words, the birthing process is an extremely emotional process, and “you need that ability to have intimacy” with everyone present.

The staff at MMC tends to cut the umbilical cord a bit later in order to allow the child to get all the available red blood cells. Then, the staff lets a child adjust before breast feeding. “Give that baby time, give that mamma time,” is the usual advice.

Every mother meets every midwife. That way, whoever is on call can handle the birth. Tracy said she used to serve as a midwife in homes, but she was on call all the time. After missing her own kids’ birthdays one year (and she has five kids of her own), plus her anniversary and Christmas morning, she and her husband decided it was time for a change. Her husband quit his job with Ball Aerospace to become the business manager at MMC. Working from a center allows the midwives to spend time with their own families, too. And pregnant women have the assurance that somebody will be available to help handle the birth.

After the birth the clinic follows up with in-home and in-clinic care.

Tracy believes that inducing pregnancy with drugs, while sometimes necessary, can interfere with the natural, hormonal communication between a woman and child. While such drugs can be “a really great tool,” Tracy said, often they are used when women are “under the gun” to deliver.

Tracy said that the national C-section rate is 33 percent. She said the rate should be much lower than that, and the rate at her clinic is six percent. Of course, the MMC figures look good in part because women with problematic pregnancies go elsewhere to deliver, but I’m convinced that a big part of the reason is the fact that MMC works hard to work with the woman’s body.

“We’ve only called an ambulance four times,” Tracy said, once for a vaginal breech birth (which means the kid comes bottom first, I learned).

MMC features two consulting doctors, and “the best thing about the birth center is our relationship with them… they’re helpful and they’re not adversarial… and it’s the part that you most likely won’t need to see.”

When needed, “then we ask for tools and drugs, because you’ve tried the natural thing here, and it’s not working.”

There are some cases that MMC can’t handle, such as gestational diabetes and high blood pressure. What I like about Tracy’s approach is that she is not irrationally wed either to a “natural birth” or to an interventionist birth, but she instead treats natural birth as the reasonable default and calls upon more intervention when it is objectively needed.

Tracy’s passion is to facilitate a woman’s choices: “I’m a convincing person and I love what I do, but this is not for everyone,” she said.

Tracy said that she could be making more money elsewhere, but “we’re all very idealistic here… We believe this will change your life.”

Jennifer and I also talked with Nancy, another midwife. We had a question about whether Jennifer needed to switch from fish oil (for Omega 3) to algae-based oil. Nancy recommended Kirkland brand fish oil, which happens to be the kind we use. She also recommended pro-biotics. We discussed screening tests with her as well.

Tracy gave us some great advice on birth control (she likes the IUD over the pill). And she encouraged me to make sure our high-deductible insurance covers maternal care. (I have no idea whether it does or not.) Reviewing our insurance is our next major step before getting ourselves into this. I would hate to leave my high-deductible plan, but, as I’ve long argued, the insurance market has been totally screwed up since long before the Democratic health bill. At this point I don’t even know whether or how long my high-deductible plan will remain in existence. So that’s the big variable at this point. But, even if we switch insurance, we’ll use MMC regardless of the plan. (We already have ample funds in our Health Savings Account to pay for a non-emergency delivery.)

At one point Tracy discussed the barriers she’s faced in starting the clinic. Sure, she has faced challenges, but, she noted, “I’ve pushed five babies out,” so she can face anything else.

UPDATE: Here’s a video of a water birth at Mountain Midwifery:

And here’s another water birth that Jennifer and I watched on video:

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Comments

Amy April 12, 2010 at 12:06 PM
Congratulations on your exciting decision, and I hope you enjoy the whole process! My entire pregnancy and water birth experience with midwives at a birth center was wonderful.

You’ve found what sounds like an excellent birth center. This approach is not easy to find:

“What I like about Tracy’s approach is that she is not irrationally wed either to a “natural birth” or to an interventionist birth, but she instead treats natural birth as the reasonable default and calls upon more intervention when it is objectively needed.”

TJWelchApril 14, 2010 at 7:30 PM
One thing you may want to look into, if your wife intends to breastfeed, is if they have lactation consultants available on-site. I will say, however, that at the facility where my wife delivered (eight years ago), they insisted on getting the baby to feed within the first 24 hours, and if the baby did not feed successfully in that time, they urged formula feeding. That policy caused us some unnecessary angst, as we later read that most babies will do just fine without feeding within the first 24 hours.

Ari April 14, 2010 at 10:05 PM
They definitely have “lactation specialists” available, and they seem very supportive of breast feeding, which I am convinced is important for good health of the baby. (A delay of 24 hours seems like quite a long delay to me, but I haven’t researched the particulars.)

Kelly Elmore April 16, 2010 at 8:21 AM
Ari, this birth center sounds fantastic. I wanted to comment that the rate of 11% hospital transfer is pretty good. The homebirth midwife that I used (and worked for) had a 10% transfer rate for first time moms, and it was one of the lowest I found. Good for you and your wife for researching so carefully and finding a place you feel comfortable in! And I labored in water and loved it!!

catherine April 17, 2010 at 5:32 AM
Congrats on your decision! I love being a parent, I wish the same amazing experience for you two! Two thoughts: I have read that nursing within the first hour is a good way to launch breastfeeding, that’s what I was able to do with my full-term birth, and close to it for the preemie birth (pumping). Went to a couple LaLeche meetings before birth that proved very helpful. 2nd thought: Since you are already visiting birth centers, I would recommend reading up on parenting a little bit over time as well. I recommend the Nursing Mother’s Companion, Your Self-Confident Baby, Healthy Sleep Habits Happy Child. Will reserve my conception advice!! All the best!

With Paleo Diet Blood Counts Look Great

Largely due to the influence of Diana Hsieh, who recently started the Modern Paleo blog, and the book Good Calories, Bad Calories by Gary Taubes, my wife and I have switched to a largely “paleo” type of diet. The results, as indicated by our recent blood work, are positive.

Basically the diet means that we have cut out most grains, sugars, and vegetable fats. Largely the diet consists of trading off carbs for healthier fats. We’re not as strict in our diet as some are; I still eat an occasional slice of sprouted bread or a bowl of beans. However, most days I don’t eat any grains, and my intake of processed sugar is low. I have a soda or glass of juice maybe once a month. I buy chocolate of between 60 and 100 percent purity (which contains much less or no sugar).

I just bought a freezer full of grass-fed beef from Lasater Ranch, and we enjoy other kinds of meats. We eat plenty of vegetables, eggs, and nuts. Unlike stricter “paleo” eaters, we drink (whole) milk, and we eat moderate amounts of fresh, frozen, and dried fruit. So we are getting considerably more carbohydrates than are stricter “paleo” eaters, though our carb intake is dramatically lower than seen in the typical American diet, and our carbs are a lot healthier.

Earlier this week I paid the King Soopers pharmacy $20 to test the cholesterol levels in my blood. (Because I pay for my health expenses out of a Health Savings Account, I tend to seek good value for my money, unlike the case with most American health consumers.) My triglycerides are comfortably low at 51 (milligrams per deciliter), and my high-density lipoprotein (HDL) count is nice and high at 65.

My wife has seen a dramatic improvement in her blood counts with the diet. Four years ago her triglycerides were nearly 300; today they were 127. Her HDL count is even better than mine at 81.

Eating real food works.

April 12 Update: I neglected to mention the fact that Jennifer and I are also taking fish-oil supplements for Omega 3 fat. Dr. Eades points to a study indicating the benefits of Omega 3 supplementation for triglyceride and cholesterol counts.

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Comment

Monica April 9, 2010 at 5:48 PM

“Eating real food works. ”

It sure does. Fantastic, and congratulations. My bloodwork is similar. I wish I’d gotten it done before going paleo-ish so I’d know how much I improved!

Headlight Doctor

Headlight functionality is a matter of safety. So I was pleased to learn that it is possible to polish up plastic headlight casings, rather than replace them. Our headlines have been getting progressively dimmer because the plastic was so scratched and cloudy. So I called up a local business to polish them. The difference is dramatic:

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Driving Skills, Keens, Xlerator

After a fender-bending incident in the household, I decided it was time to review some basic driving safety principles. I purchased two videos that I’ve been pleased with. I definitely recommend them for families with young drivers, as well as for adults who want to review the basics.

The first video, The Art of Intelligent Driving (Kevin Brett Studios),featuring Jonathan Kinberg, has the production value of little better than a home video. But contains some great advice that has inspired me to rethink several ways I handle the road. First, I now drive with my side mirrors set considerably farther out than they had been. This eliminates blind spots. With the current settings, as a car passes me it appears in my rear-view mirror, then appears in my side-view mirror, then appears in my peripheral vision as it leaves the side-view mirror. I also learned about braking to allow the car to “set up” — roll the weight onto the front tires — rather than slamming on the brakes or pumping them. Finally, I learned how to downshift in a manual by revving the motor while breaking so as to match the engine RPMs to the gear. (I can’t do it very well, but I get the idea of how it’s done.) The video could have been more detailed regarding this last point.

The next video is Wheels in Motion, a Texas-approved defensive driving course. Just ignore all the material about online testing and such. While the narrators are awkward at times, the video contains some very good, basic information about safe driving.

While I’m discussing products, I have a couple other honorable mentions.

I just went on my first jaunt in my new black Keen shoes. I got them to serve as a comfortable walking shoe that would look okay with dressier clothes. I got a size 12, which is just big enough for me; the next size up is 13, which is definitely too big. Love my Keens.

Finally, while I usually hate air hand dryers, I finally found a model that actually works: the Xlerator. This thing pumps out air so fast it actually makes your skin ripple. So if you own a public facility with puny air dryers, do your customers a favor and throw away your existing dryers, then replace them with the Xlerator. This is the only air dryer I’ve ever tried that I actually prefer to paper towels.

Graston Soft-Tissue Tools

I was skeptical, but today I paid my chiropractor to use the Graston tools on my shoulder muscles. I’m pleasantly surprised by the results.

The idea is to “massage” muscles with stainless-steel tools to smooth out knotty muscles. (Just don’t call it “massage,” because that’s illegal.)

After a relatively quick and painless process, my muscles feel like they’ve been through an intensive traditional massage. They have the same fatigued feeling. Apparently the steel tools get into the muscles without the pressure required by a hand or elbow. At the time I didn’t think the Graston tools were doing much, but immediately afterward I could feel the effects. I did get some surface bruising, but I guess that’s pretty normal (and it doesn’t bother me).

So, if you have persistently knotty muscles, you might want to let somebody have a go at you with the Graston tools. I’ve even thought about picking up some for personal use, but they’re insanely expensive, from what I’ve seen. Perhaps somebody will make a knock-off. Until then, chances are pretty good that I’ll occasionally pay my chiropractor to use them on me.

Microwaved Eggs

It occurred to me that often only the complicated dishes make it into published recipes. But I usually eat very simple meals that require no recipe. A standard dish for me is vegetables, meat, and spices sauteed in coconut, olive, or stock fat. I don’t mind cooking, but it is by no means a passion of mine, and usually I focus on quick and easy dishes.

Like fried or scrambled eggs.

Only now I usually make them in the microwave rather than in a skillet. This is faster and it generates fewer dishes. There are two basic ways to microwave eggs. You can microwave a single egg in a bowl for around 40 seconds. If you don’t break the yoke, the egg hardly sticks to the bowl.

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Or you can microwave more than one egg, with or without additions. For example, yesterday I microwaved two eggs, sausage, and two cubes of cauliflower puree. First I microwaved the puree for around a minute to dethaw it. Then I stirred in the eggs and sausage. The edges tend to cook faster, so you have to stir it about every half a minute for a few minutes. This sticks more than does a single egg with an unbroken yoke. But it’s still easy, fast, and good.

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No-Sugar Cheesecake

For New Year’s, Jennifer made a great cheese cake without sugar or any added sweetener. We topped it with blueberries or apples sauteed in butter and cinnamon, so of course that added the fruits’ sugar. The texture of the cake was fantastic.

We used a low-carb cheesecake recipe, except we didn’t put in the “artificial sweetener” (because, yuck). While I like it fine without any sweetener, we discussed putting somewhere between a quarter cup and a half cup of sugar in future attempts if we want a sweeter dessert.

One thing we got out of this recipe that will be useful for other things is the almond meal crust. We’ll probably make this for quiche and mousse pies.

To make the crust, mix a cup of almond meal and two tablespoons of melted butter (Jennifer just used a fork for the mixing). We thought we’d increase the quantities by half next time. Press the mixture into the bottom of a pie plate, then bake for 8 to 10 minutes, until slightly browned.

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To make the filling, mix in the following ingredients, one at a time in order, with a hand mixer, scraping the bowl with a spatula between each ingredient:

* 3 packages (1.5 pounds) cream cheese (room temperature)
* 4 eggs (preferably room temperature)
* 1.5 teaspoons vanilla
* 1.5 teaspoons lemon juice
* sweetener (if desired)
* 0.25 cup sour cream

After you add the last ingredient, beat the mixture for an additional minute.

We used a water bath to bake the cake. Ours worked great for an hour at 350 degrees Fahrenheit. It puffed up a bit and then settled back down as it cooled.

Here’s the finished cake in the water bath:

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Cooled, sliced, and topped:

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