Monthly Archives: April 2011

Bialy – My New Bagel

My coffee guy now has bialys and I’m loving them!

A bialy is like a bagel, but smaller, is baked rather than boiled and instead of a hole, has a depression filled with a little mixture of fresh soft onions. Bialys have less calories than bagels – 240 vs 300 calories according to the H&H website, though some websites say the calorie count is even lower. Bialys don’t need cream cheese, so there’s another calorie saving. (Unless of course, you add a very tiny pat of butter, which is what my coffee guy does for me…)

I mostly love that Bialys are from Bialystok, Poland.* This reminds me of Max Bialystock in the Producers, which reminds me of his whacky secretary Ulla who answers the phone “Bialystock and Bloom, got dag pa dig!”, so everytime I get a bialy that’s what I say to myself.

These are the little joys of my morning….

____________________________________________________________

I’m not the only one who loves bialys …

* The Bialy Eaters: the Story of a Bread and a Lost World is Mimi Sheraton’s history of the bialy and the lost community of Jews from Bialystock. It’s on my to-read list.

Sidewalk Chalk Wisdom

NYC street artist James De la Vega seems to have left a few thoughts behind on the sidewalk outside the hospital.  Glad I caught them this morning on the way to work before the rain started.

___________________________________________________________________

I’m not the only one catching De La Vega’s work –

Doctors, Social Media and Patient Privacy

A Rhode Island emergency room doc has been fired for posting about a trauma patient on her facebook page. While the post did not reveal patient name or personal identifiers, it had enough clinical info that a third party was able to  recognize the patient.

I say if you’re going to write online about a patient, you had better disguise them so well they don’t even recognize themselves, and never post anywhere near the time of the event’s occurrence. Some bloggers I know change age, sex and other details, and post events long after they’ve happened, so no one one could ever know for sure who they’re talking about. Some doc bloggers go so far as to disguise themselves – preferring to remain anonymous both to protect themselves and their patients.

Some medical blogsites are rich with teaching cases, including x-rays and clinical information that, if disguised, would alter the diagnostic possibilities. As online venues begin to replace the time honored medical journal or local grand rounds, how do we keep our ability to teach one another with clinical cases and still respect patient privacy?  In the past, the limited circulation of medical journals kept these cases amongst the medical community, but now with the internet (and the lay public’s interest in medicine), the audience for such case histories is limitless.

It may be time to develop some sort of standard guidelines and release before writing about a patient on a social media site. Email and electronic signatures could streamline that process so that we don’t lose what makes the internet different than the medical journals – immediacy and accessibility. As an example, here is JAMA’s privacy policy and a link to their patient consent.

Identification of Patients in Descriptions, Photographs, Video, and Pedigrees. A signed statement of informed consent to publish (in print and online) patient descriptions, photographs, video, and pedigrees should be obtained from all persons (parents or legal guardians for minors) who can be identified (including by the patients themselves) in such written descriptions, photographs, or pedigrees and should be submitted with the manuscript and indicated in the Acknowledgment section of the manuscript. Such persons should be shown the manuscript before its submission. Omitting data or making data less specific to deidentify patients is acceptable, but changing any such data is not acceptable.

It’s a brave new world out there, folks, so be careful. For the record , I won’t post about a patient without her explicit permission, and even then I disguise her so that no one would recognize her. Which is why this blog is a bit light on patient tales. Food is a much safer topic if you ask me….

_______________________________________________________

Other posts I’ve written on this topic

Yaz and Blood Clots – Two More Studies Point to Higher Risks

Update – the FDA addresses clot risks and Yaz

Two studies published in this weeks’ British Medical Journal, one from the US and the other from the UK, report that users of drosperinone containing oral contraceptives (Yaz, Yasmin and their generics) have increased relative risks for non-fatal blood clots compared with users of pills containing levonorgestrel.

While neither study is perfect, and indeed have some very major limitations, they add to a growing body of evidence that pills containing drosperinone may impart higher risks for blood clots than older pills. Yaz is not alone in this regard – other studies have suggested that pills containing the newer progestins gestodene and desogestrel also impart slightly high clot risks than the so-called first and second generation pills containing the older progestins norethindrone and levonorgestrel.

I won’t go into the studies’ limitations here, but will say that trying to get our hands around comparative data on clot risks between various pills is an extraordinarily difficult process given that the diagnosis of blood clots is not always straightforward (or correct), pill choices are not randomized and fraught with prescribing bias, and confounding risk factors for clotting are numerous and difficult to control for. I wish folks would stop trying to answer these questions on the quick and cheap using claims and pharmacy databases without requiring chart review and strict diagnostic criteria. But that’s the way these studies are being done, and that’s the data I am being forced to contend with in my practice, so let’s talk about it.  Continue Reading

Strawberry Rhubarb Pie

Although I did not actually make this masterpiece*, if it were being published in a journal I would be last author, Mr TBTAM second, and my daughter first author. I initiated the project and sent Mr TBTAM shopping for the ingredients, but when I invited my daughter to join me in making the pie, she stated “I want to make it myself”.

And so she did.

Nice job, honey.

* The recipe is from Bon Appetit via Epicurious, although we substituted a double recipe of pate brisee from the Pleasures of Cooking for the shortening crust. I guess they get authorship too, huh? I’m think a dusting of confectioners sugar and a dollop of vanilla ice cream would be an excellent way to serve it at Easter Dinner later today.

The OBG Why Me Blues

If I ever get enough time and guts to put together a cabaret act, this is totally gonna’ be my opening number…

The WHI – Yet Another Follow up

This is the study that doesn’t end…
The longterm follow up extends…
Some people started studying hormones in menopause,
And they’ll continue publishing more data just because…
(repeat)

In yet another paper in a major journal, we hear once more from the investigators of the Women’s Health Initiative. This time it’s the long term outcomes of women who took estrogen alone, now seven years out from stopping their hormones. What new information can we learn from this extensive analysis of new data?

Nothing.

Really.

The WHI’s been telling us the same thing about ERT (Estrogen replacement therapy) and HRT (Combination estrogen/progestin therapy)  since 2002, and all each subsequent study does is reinforce and expand on that initial data. The data on breast cancer risk and estrogen alone was first published in 2004, but the media ignored it the. It is only now making it news.

Allow me to summarize what we know  –  Continue Reading