LOONEY MONTHS

I came home from work today just after sundown and I saw a full moon rising.  A family friend was over. I mentioned it offhandedly and said full moons were fun. She looked at me straight faced and asked why?  so I started thinking.  Why indeed? As an OB I of course think of the busy obstetrical unit. Full moons are busy nights right?  The ancient lore is that full moons make for very busy labor units. This has been suspected since the beginning of time. The reality is that there may be a small increase of maybe a percent or two, but the lore is very strong. Is there something to the ancient lore? May there be a reason to think that Ob units are busy on full moon nights? Is there some ancient anthropological principle involved? So I did a little investigating.

I started listing for myself why I thought the full moon was fun and interesting.  

First the full moon always rises in the east and looks very very full..  It appears to be giant when rising in the east over a distant horizon. Photos of this effect are striking.  You can easily search for these photos. Do a google search for full moon rising, switch to the images tab, and look at the striking photos.

Second a full moon always rises at sundown.  This means everyone sees it at the end of a workday when they are tired and hungry and ready for dinner.  It seems most impressive then.  When it rises most people are not thinking they’ll be looking for the full moon tonight.  It just pops up huge and bright on the horizon.  

Third a full moon strikes people's mood.  It is what is meant by loony, lunatic, lunacy etc.

Fourth, the ob unit at the hospital always groans that a lot of labors are going to come in.  The feeling is that full moons means more laboring women. We all say “uh oh get ready”.  It'll get crazy. It'll get looney around here. But the purely logical folks say that is just an old wives tales. It means nothing right? Which prediction wins, logic or lore? Will the unit be busy or is it just an old wives tale? (midwives tale might be a better term)

Fifth a full moon is the brightest night of the month.  The moon shines bright and full.  Moreover it shines brightest right at midnight. Why? A full moon is always exactly opposite the sun from the earth.  That is pure astronomical  geometry and that is why the moon is full. So the darkest part of night becomes the brightest. And it is brightest right at midnight. That is just weird at midnight. It is like it is not even night. Especially on a winter night with snow on the ground. It is astonishingly bright on some full moon midnights.

There are a ton of human endeavors that are tied to the idea of a month. Paychecks, rent checks, contracts, meetings, mortgage payments, menstrual cycles, birth control pill packages,  and tons more.

So there I am thinking why would ob units get busy on a full moon night? This is very strong old lore. Maybe there is an old truth to be discovered here.  

Now that I have thought about it I think the answer is obvious.  

But first you'll need to come along with some math again. This time we will do date and time math.

You see a human pregnancy lasts just about 40 weeks. We have pregnancy dating wheels that show exactly 40 weeks. We Ob’s always bemoan that everyone calls it 9 months. It is hard to make 9 months out of 40 weeks. We would more likely make it 10 months, if the month is defined as 4 weeks. Many months are defined as exactly 4 weeks. A cycle of birth control pills is exactly 4 weeks, or 28 days. Many paycheck cycles are 2 weekly or 4 weekly. Now think about a pregnancy of 40 weeks. 40 weeks is exactly 280 days. 40 weeks is exactly 10 months, if a month is defined as 4 weeks. This is 280 days from the first day of the last menstrual period.

But conception happens 2 weeks later. Or 14 days after the first menstrual day.

So labor happens, mostly, about 266 days after conception.

So then I'm thinking what happens on bright full moon midnights? Walks on the beach… can't sleep… too bright … romance…. conception. That is what happens. Romance and conception happens. So if conception happens on full moons… where is the moon when labor happens? Where is the moon?

So I looked up how many days happen between full moons. I found it online. 29.53 days happen between full moons. That is a lunar month. There are a ton of different kinds of months. Calendar months are obvious. But lunar months is what I am interested here.

What is 266 days divided by 29.53 days?

Hold your breath…

9.007 moons happen.

This is astonishing. It is not astonishing that there are 9 moons. That is ancient lore.  It is pretty cool that the ancient lore gets a boost here. But, what is astonishing, is that, on average, a baby conceived under a full moon will, on average, labor under a full moon. In fact, labor should occur within a few minutes of 9 moons later.

So there you have it. The first real explanation ever given as to why the lore of Ob/Gyn’s and midwives expects extra work on a full moon night. It is the same reason so many songs are written about romance under a full moon.

If you doubt this then think about evolution of the human species. We have been on the planet as genetically and anatomically modern humans for 250,000 years. For more than 200,000 of those years, a moonless night would have been abjectly absolutely dark. A person would not have been able to find their spouse or their baby, even if they wanted to. They would likely have not even seen their hand in front of their face. So romance, conception, and delivery of babies, would have been really difficult. And very dangerous for the baby. The new mother would have really struggled without effective assistance from any midwives that might have been there. Babies would be far more likely to die. There would have been a very strong Darwinian Evolution pressure to not deliver on dark nights. Bright moon filled nights would have been no problem. For the 200,000 years before humans had fire the human race might have arranged for biology to make conceptions on full moon nights, and labors exactly 9 moons later.

40 weeks has nothing to do with 9 months.  Maybe more like 10 months. But ancient midwives 10000 years ago might have known that a bright moon now meant labor in nine more moons. Or, if not that, they certainly would have known that full moons meant more babies were to be born. That is something we talk about even today in a modern Ob unit. We usually joke about it. But this may be the ancient history of the 9 moons connection.

This 9 moons time frame is too much coincidence for me to ignore. Babies are generally laboring to within minutes of 9 moons after they are conceived. This is crazy. This is lunacy.

Thanks for reading.  

Comments are of course welcome. And questions are welcome as well.

John W Marcus MD FACOG PC

89 North Maple Ave

Ridgewood NJ 07481

Phone 201-447-0077

Fax 201-447-3560.

Family Powers of Two

I have just come back from The Valley Hospital where I delivered a beautiful baby boy, a first baby, to a wonderful couple. The baby came out right onto the mothers chest and abdomen, and he was moving around, pink, and of course crying. He took his first 5 breaths, which are mostly in breaths, before he started crying from being born. I think that babies do not like being born. It is like getting evicted from a warm easy 98 degree bath that one has floated in for 9 months. I can't imaging getting evicted like that. And then babies have to do the hard work of actually breathing and digesting. It is called transition by the baby care staff. Transitioning is important, and it can be difficult for babies that are born in a stressful manner. Difficult or stressful births might be a premee or an infection. This could include influenza or strep sepsis, for instance, or a placental abruption. Transition is also sometimes a bit difficult for C Section babies that have not experienced labor. I think that the babies that don't get squished or compressed by uterine contractions have a harder time with transition. They breath harder and faster, and sometimes need oxygen, suctioning, and stimulation. They have more amniotic fluid in their lungs that needs to get expelled somehow. We call this transitioning difficulty "Transitional Tachypnea of the Newborn".  Here is the Wikipedia page as of 2 PM on December 7th. https://en.wikipedia.org/wiki/Transient_tachypnea_of_the_newborn. Notice that Wikipedia calls it transient tachypnea. That is another name.

But as a mathematician and a amateur philosopher I have been thinking about generational genetic math again. One of my patients has done the 23andMe genetics service and has found out some genetic history. This may be very valuable to someone who has no known family history. It can elucidate particular genetic risks, and will be valuable for the whole family, and her kids. (I can use the pronoun "her" because I only have female patients, as per my board certification rules, which disallow male patients under most circumstances).

Lets think about generational math. Realize that you have two parents. Your parents have two parents, meaning you have 4 grandparents. Your grandparents have two parents each. This means that you have 8 great grandparents. Notice that each generation has a power of two. Powers of two have very easy calculations, especially for a computer scientist as they deal with powers of two all the time. 2 to the 8th power is a byte, and there are 256 different bytes, starting at zero and ending at 255.

Anyway, lets continue. Two to the 16 is 65,536. This means you have 65,536 great great... 16th generation... grandparents. And so does everyone else.

Powers of two have an "exponential" growth rate. There is an astronomical amount of power in an exponential growth rate. Two to the 32 is 4, 294, 967,296.  

Here is the first kicker. 32 generations ago, was how long? If we allow 20-25 years per generation, we get 640 to 800 years. There was not 4 billion people on the planet back then. This was the European middle ages, the Ottoman empire, the Shogun's of Japan, the natives of the America's, which came over from Asia via multiple routes during the last Ice Age 10,000 or more years ago.

The Earth only got it's first 1 billion people as of the year 1800 or so. So how can you have 4 billion ancestors if there were much less than a billion people on the planet? The answer is that people share ancestors. This is another way of saying that we are all related.

Using this kind of math, we can show that in General, of the 8 billion people presently on the planet, we are no more than, maybe 64th cousins. This is a highly conservative estimate, because 2 to the 64th is 1.8 times 10 to the 20th power. This is trillions of times more than the number of people that have ever lived.

Or, another way to look at it, is that 2 to the 33 is about 8.6 billion. This is way more than the number of humans that existed 33 generations ago. Therefore, we all must share a lot of ancestors to get this high number.

How many generations of humans exist? Anthropologists and geneticists believe the humans evolved from a herd of homo sapiens consisting of about 40 woman, tracked through the mitochondrial genetics. This herd lived somewhere around 250,000 years ago, centered somewhere in Africa, and expanded from there. 250,000 years, divided by 20 years per generation, gives 12,500 generations. So your 12,500th grandfather, is most certainly the same as mine, no matter where you are in the world. The only way this could be different is if your family came from a different planet.

No matter how you do this math, the numbers will add up somewhere in the same ballpark.

We are likely no more than 35th cousin, and we are not possibly more than 12,000th cousin. No matter who you are in the world.

Can 12,000 generations evolve humans so differently? Pale skin was necessary in northern latitudes because humans would die of rickets without vitamin D. Pale skin was necessary to survive the low sunlight levels of northern latitudes.

Pale skin in equatorial Africa was similarly dangerous. A person like myself can get a sunburn in under 20 minutes of hot unmitigated sunshine. Everyday all day without coverage from the Sun and I would eventually get a tan, but I would be seriously challenged by the burn, the blisters, and the cancer that would likely ensue. A darker neighbor would most likely be healthier and have more successful reproduction. I believe that even a few generations like this would evolve humans to have different pigments. So yes, this many generations can evolve a lot of differences.

So, the bottom line, is that we are all related. All Europeans are no more than maybe 32nd cousins. All Asians similarly. All Africans similarly. But, assuming that the races of humans split up at the exact moment of creation of the species and didn't mix since, we can be no more than 12,000th cousin. I believe those conditions were not true, and that humans intermixed over history, so it would be difficult to find humans that are, say, more than a thousandth cousin.

We are all related. We are all one family.

Thanks for reading.

http://doctorjohnmarcus.blogspot.com 

Phone 201-447-0077

Fax 201-447-3560 

Member of: 

Lifeline Medical Associates at LMA_LLC.com 

Medical Society of New Jersey 

Past President of Bergen County Medical Society 

Member of Medical Justice 

Member of the U.S. Woman's Health Alliance at http://uswomenshealthalliance.com/index.php

Member of the American College of Ob/Gyn at www.acog.org 

Board Certified by American Board of Obstetrics and Gynecology at www.abog.org 

Member of The Valley Hospital Medical staff Department of Ob Gyn 

-ex Director, Associate Director, Secretary, Chief of Education, Chief of cancer committee. 

- present member of Ob Critical Care Committee 

Member of Hackensack UMC at Pascack Valley  Medical Staff at http://www.hackensackumcpv.com/

LISTERIA ALERT

Listeria is an infectious bacteria that is particularly dangerous to a pregnant woman's fetus.

Watching the news today I came across a story that all pregnant woman will have to know about. Listeria is once again in the news. 

Every once in awhile there will be a public health alert about some particular food that has become a danger to the public. The American Food and Drug Administration has the mandate to keep our food safe, identify the risks to the public, and eliminate or mitigate the risks somehow. Frequently that will mean recalls. Often the recalls will be some kind of vegetable. I can remember spinach, melons, packaged salad, and very frequently frozen hamburger meat. Once in the past it was Hummus. This time it is some kinds of Sabra hummus. Here is a link to the CNN article. I am sure this article will be updated as more information becomes available. 

http://www.cnn.com/2016/11/19/health/hummus-sabra-recalled/index.html 

Oddly, the article does not mention pregnant woman. In pregnancy the infection to the mother can be a relatively mild flu like illness, but the bacteria gets into the fetus and severely, permanently, or fatally injures the fetus. It is very difficult or impossible to identify the illness in the early stages. The most common diagnosis is on culture of the infected fetal tissues. By then, the damage is to late and many times irreversible. 

The best defense against listeria monocytogenes is avoidance. There are particular food rules that most pregnant woman are aware of to never eat certain foods. Like unpasteurized soft cheeses. This is a basic rule of pregnancy. I think I am going to survey my pregnant patients about this knowledge. And report the results here. Results to be announced. 

Here is the wikipedia page. I last looked at this on Sunday November 12th at 2:30 eastern standard time. (wikipedia pages can change all the time). 

https://en.wikipedia.org/wiki/Listeria_monocytogenes

Sabra is my favorite hummus. Hummus is vegan, extremely healthy, and really yummy. I will not stop buying it. But please throw away any of the listed versions. And for now, pregnant woman should avoid this Sabra hummus. 

It would be too easy to say that Sabra Hummus company is committing a malfeasance by producing hummus like this. I would ask all of you to consider an alternative view. My view, and your view should be, that Sabra is making an effort to keep their food safe, and doing this voluntarily. How many companies do quality control like this? It was not long ago that a peanut butter company did quality control but hid the results and shipped the infected food anyway. This led to unprecedented criminal charges against the leadership of that company. 

But worse, how many companies don't do quality control so effectively? How many don't do it at all? Large egg farms, for instance, have the hens living in poultry barns where there feces exist. This is utterly unavoidable as the birds cannot be potty trained. And keeping the birds on a grid to let the feces fall will only hurt their feet. 

And smaller companies (and restaurants) that make smaller batches or more "homemade" like food will have no quality control at all, other than the skills and cleanliness of the chefs and workers. There are many instances of Norovirus spreading from mildly infected workers. Workers should voluntarily stay away from work when they are ill, but that will be looked upon as a black mark on their occupational record, and might lower their paychecks. Alternatively, workers should be rewarded for due care to protect the food and their customers. I don't know how employers can commit to this. Personally, I don't come to work when I suspect that I might harbor an illness. And, don't be too surprised, physicians and nurses do get sick. I remember the look of shock once when a delivery man came to my house when I was sick and raised his eyebrows when he saw that I was on a sick day. He said "doctors don't get sick" in surprise. I laughed and said I wish that was so. 

So I believe that Sabra hummus is committing to quality control with vigor and commitment. This will make me more likely to buy Sabra, not less. 

Please let me know what you think in the comments below. 

Thanks for reading. 

http://doctorjohnmarcus.blogspot.com 

Phone 201-447-0077

Fax 201-447-3560 

Member of: 

Lifeline Medical Associates at LMA_LLC.com 

Medical Society of New Jersey 

Past President of Bergen County Medical Society 

Member of Medical Justice 

Member of the U.S. Woman's Health Alliance at http://uswomenshealthalliance.com/index.php

Member of the American College of Ob/Gyn at www.acog.org 

Board Certified by American Board of Obstetrics and Gynecology at www.abog.org 

Member of The Valley Hospital Medical staff Department of Ob Gyn 

-ex Director, Associate Director, Secretary, Chief of Education, Chief of cancer committee. 

- present member of Ob Critical Care Committee 

Member of Hackensack UMC at Pascack Valley  Medical Staff at http://www.hackensackumcpv.com/

Why do I ask people about their religion? 

To boil the answer down to a simple one, it is because I don't wish to put people and patients into a state of spiritual strife. Or spiritual danger. If I mistakenly give people a plan of action that they later come to regret, I will feel like an ass.

My medical decision making can be precisely correct, scientifically sound, and delivered in a clear, compassionate, and skillful manner. Yet still it is possible to wreck someones life. I don't want to wreck anyone's life. From professional point of view it would make me a bad doctor. From a personal point of view I would feel like a jerk. I don't want to feel like a jerk.

How could a doctor create spiritual danger? It is remarkably easy. And it is sad to say but physicians don't get any education about spiritual issues. I think that leaders in the medical sciences want to say that modern medicine is "evidence based". Medical leaders want to be scientifically sound. They want all medical decision making to be factual. They want to be able to cite actual scientific journal articles to support one decision over another.

The older generation of docs used to complain bitterly about  this turn towards science, towards checklists, and away from the art of medicine. Older docs called it "cookie cutter" medicine. Or "recipe" medicine, or something like that.

A arrogant young medical doctor might scoff at the notion that a person's religious belief would interfere with sound medical care. A self important doctor might tell a patient that "there is only one way to do this, and it is my way. Religion has nothing to do with it.". This is spiritually dangerous territory. Even for atheists.

Let's give an example:

A newly married Catholic woman comes to my office to ask about contraception. She has strong faith. During the consultation I find that she has no knowledge of the Catholic rules pertaining to conception and contraception. If I didn't care for her overall well being I might recommend the birth control pill or an IUD. If I did this deliberately it is even worse. Catholics have some simple and important rules to follow when it comes to contraception. Catholic rules prohibit ejaculation outside the vagina. And even more importantly Catholic rules prohibit interfering with an embryo. If an embryo gets created, then it must be allowed to implant and grow. No one can take any action that prevents embryo implantation. Since the birth control pill will allow rare ovulations, there will be embryos created. But the birth control pill also thins the uterine lining. When the uterine lining is thin the embryo has nowhere to implant. So the embryo menstruates out. The Catholic theology is that an embryo is a human, And obviously no one wants to hurt an innocent human.

Notice that this is simply an extension of the right to life movement all the way back to sperm and eggs.

Personally I don't adhere to the notion that an embryo isn't human yet. I think embryos are human. There is no magical point of time when an embryo ceases to be inanimate, and suddenly becomes human. The embryo is and always will be human. It is silly to point out an event and say, now, the baby is human. Before, not so much. Embryos are constantly growing. Whether a person is pro-life or pro-choice, people have to get rid of such misconceptions.

Discussing these issues is important. These issues are deadly. Of life and death importance, Many gynecologists have been shot or bombed because of disagreement over these beliefs. Many people have died over this issue.

So yes, spiritual competence is an important skill for a physician to have. And when I ask you about your genetic heritage, ethnicity, and religion, I am simply trying to be a good doctor, and avoid things that might harm you. And if you don't tell me your religion, then I might inadvertently give you bad advise. My advise might be scientifically sound but spiritually wrong.

As an interesting aside, there are many times during consultations when people claim to not have a religion. They might even get annoyed by the questions. Many people claim to be atheists. But, many times, they are not. They are wrong. They are not atheists. What they really are is agnostic. When a person claims "there is no God", then they are an atheist. That is not so common. Many people really want to say, "I don't know if there is a God". That makes them agnostic.

For another example of spiritual danger, consider the Jehovah's Witnesses. Jehovah's Witnesses believe that they cannot take another person's blood into their bodies. If they do, they will not get to go to heaven when they die. Many people are flabbergasted when they hear that someone would rather die then take a blood transfusion. It is only comprehensible when you understand that going to heaven is for eternity, and our life here on earth is only temporary and short. No one wants to make a mistake that would cost them an eternity of happiness. So Jehovah's Witnesses would rather die than take a blood transfusion. So the standard surgical consent form now has a Jehovah's Witness clause. It is an answer to the question, "Will you accept a blood transfusion if it is necessary to save your life?". The question must be asked and answered. Because I don't want to destroy someones long term plans of eternal happiness in Heaven.

Another example is Ramadan. Many Muslim women want to fast during Ramadan. I can help them. There is some theological controversy about the fast in pregnant women. But if my pregnant patient wanted to fast, I will try give her good advice about how to keep it safe. But I cannot give this advise if I don't know she is Muslim. Ramadan starts today.

In some religions woman cannot be touched by men. Not even to shake hands. For these women, you will put them in a bind if you offer to shake their hand. Nobody wants to be rude by refusing. But nobody wants to violate their own beliefs either. Again, if I didn't know someone was of that religion there would be uncomfortable moments. Medical care requires physical examination, but does not require a handshake. So there is unnecessary stress over a handshake.

If anyone asks about me, I am a theist. I am not an atheist.

Thank you sincerely for reading.

Dr John W Marcus
89 North Maple Ave
Ridgewood NJ 07450

Blog is at doctorjohnmarcus.blogspot.com.