100 Migraines

100 nigraines
Lorie Novak –  photographer, artist and fellow migraine sufferer – has created a painfully real portrait of what if looks and feels like to have a migraine. Her site, called 100 Migraines, is a collection of vivid self portraits taken while in the throes of  a migraine.

I have chronic migraine syndrome, and currently have an average of ten to fifteen episodes a month. They began when I was eight years old. I grew up at a time when migraines were not considered a medical condition, as they are now, but an emotional one. As a child and adolescent, I was told I worked too hard, did too much, and was too stressed out. In other words, it was my fault. In my thirties, I read the essay “In Bed” by Joan Didion in which she gives voice to her migraine suffering through words. It was a life-changing moment. In 2009, approximately twenty-five years after reading “In Bed,” I began to photograph myself every time I have a migraine, and have amassed over 700 self-portraits. When I have a migraine, all I want to do is leave my body so I won’t feel the pain. If I am in a semifunctional state, my laptop is my escape—it allows me to ignore my body and, by photographing myself, see my body. I can express what I can’t articulate and make the pain visible.

If you’re wondering what it looks like to have a migraine, just compare these two pics of Lorie with

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and without a headache.

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I feel your pain, Lorie…

I encourage you to visit the site, which also includes a resource list and information for migraine sufferers.

Saved by the EMR

EMR LIFESAVER.Given all the complaining I and my colleagues do about electronic medical records ,  I thought I’d take the opportunity to tell you about something good that came from having my practice online.

A patient came to see me last week for a check up and requested a prescription for birth control pills.  She’d used them in the past without problems. I wrote the script and sent her on her way.

As I was finishing writing her visit note later that afternoon, I did what I usually like to do but had not had time for while she was in my office – look through her last few visits in the system with other docs. I noticed that she had had a recent CT scan for abdominal pain, something she had forgotten to tell me when I asked about interval medical history. A small presumed angiomyolipoma had been found on her kidney, and was being watched.

I seemed to remember that there was something about angiomyolipomas that could be problematic with hormones. A quick foray into Up to Date and Pub Med reminded me that these tumors, though benign, have receptors for estrogen and progesterone, and have been reported to grow, sometimes rapidly, in pregnancy and on birth control pills.

I immediately called my patient to discuss the issue, and advised her not to fill the prescription I had given her for birth control pills. She would continue to use condoms while considering a copper IUD for birth control. I updated her problem list and medical history to include the CT finding, so that the next doc to see her would find the issue up front instead of fortuitously stumbling onto it while poking around her chart after the visit was over.

This is actually not the first time I’ve happened upon clinically critical information in the EMR that my patients have forgotten to tell me. It’s the one area where the EMR can really make a difference in outcomes.  Of course, this only works when patients have a small enough record, as my patient did, for me to poke around in a few seconds, and best when providers write concise, relevant notes (something the EMR does not facilitate) and update the history and problem lists accordingly.

I’m sure one day someone will figure out a way for that kidney tumor diagnosis to automatically prompt a warning when I go to prescribe birth control pills, but for now I’m happy just to have access to all my patient’s information in one place.

Butternut Squash Polenta With Sausage and Onions

polenta sausage

Quick!  Before  winter ends, you’ve got to make this stick to your ribs, warm the cockles of your heart, comfort food supremo dish of butternut squash polenta with sausage. Thanks to Melissa Clark of the NY Times for this recipe, which I encourage you to read and watch her cook on the NY Times website.  

This really is a perfect recipe for the end of winter,  when you think you’ve had all the butternut squash you think you can stand, but there’s really not much else at the Farmer’s Market.  It sort of sneaks the squash in by melting it into the polenta, adding a bit of “what is that?” flavor while still allowing the corn flavor to shine through. It also rounds out this one dish meal so you don’t need to serve a separate vegetable. (We did, however, put out small side bowls of home made applesauce, which were a perfect accompaniment.)

Melissa’s is a very basic recipe that lends itself to creative tweaking, so we doubled the squash and the fennel seeds and adding grated Parmesan and some chopped parsley to the polenta. We also added a tablespoon of sherry to the polenta near the end of its cooking, just because it seemed like the right thing to do.  Next time, I may try making the polenta with a mix of chicken broth and milk (see video here), and skip the cheese.

In addition to watching Melissa’s video, I encourage you to read this post on polenta making so you know how to tell when the polenta is done – much later in the cooking process than you think.

(See recipe after the jump) Continue Reading

Penne w/ Broccoli Rabe, Sausage & Sun-Dried Tomatoes

Penne w: broccoli rabe, sausage and sundried tomatoes

If you’ve spent the afternoon at the Signature Theater seeing Open House by Will Eno (“People have been trying nobly for years and years to have plays solve in two hours what hasn’t been solved in many lifetimes. This has to stop.” I laughed so hard I cried…) and want to have dinner over in time to watch the Oscars,  this is the dish to make. I hate to even use the word “quick” to describe this meal, because it cheapens it. This is no fast food you’ve ever eaten before. It is rich, complex, and absolutely delicious.

Thank you, Lidia Bastianich for this recipe. If there were an Oscar for great Italian cooking, it’s be yours.

(See Recipe after the jump)  Continue Reading

Celery Root Soup with Caramelized Pears

CERELRY ROOTSOUP WITH PEARS

A huge shout out to Adam Roberts, whose blog The Amateur Gourmet has been a constant source of great recipes, fun stories and sometimes silly songs, for pointing me to this wonderful soup recipe from chef Alfred Portale’s cookbook Simple Pleasures.

This was indeed a delicious soup,  and may very well be one of the best we’ve ever made.  If you want to make it too, here is the recipe.  The only thing I’d do differently is to add a little more stock to thin the soup a bit.

This is what I love about food blogs – they point us to great cookbooks that may have passed beneath our radar when they were first published, in this case Portale’s Simple Pleasures (C 2004). A quick perusal of the web finds several recipes from the book, which I’ve linked to below.  I hope to try a few more of them (The Filet with Madiera and the Spinach Custards for staters), and have added Portale’s book to my must get list and his restaurant Gotham Bar and Grille to my must go list.

I know, I know. You’re wondering how I’ve never heard of Portale or Gotham Grill before, especially since I claim to have lived here in New York for so many years. But you see, as much as I love food, I’m more a home cook in the Big City that a Big City restaurant scene player.

This soup may very well change that.

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More recipes from Simple Pleasures 

No, It’s Not Within Your Parental Rights to Perform Your Daughter’s Abortion

scales abortion vs safety

I’m as pro-choice as a person can be, but this story about a mother purchasing medical abortion meds online and administering them to her daughter gives me the chills.

There are those who will use this story to claim that abortion restrictions are leading to illegal abortions.

With clinics closing across the country, illegal medication abortions are and will continue to be a growing reality. This latest case is a red flag that anyone can be arrested as aiding a patient, regardless of age or relationship.

We all fear that at some point this could happen, but this was not the case here.  Abortion is legal in Pennsylvania, and an adolescent can obtain an abortion with one parent’s consent.

I think we need to be very, very careful that in supporting a woman’s right to choose, we also support the protections necessary to ensure that women’s lives are not endangered.

Pro-choice does not mean that we need to have an abortion provider on every corner.   It does mean that we need to have abortion that is safe, accessible and affordable.  For now, at least in Pennsylvania, we have this, and this mother and her daughter certainly had it.

All this mother needed to do was to drive her daughter to Planned Parenthood in Wilkes Barre or any of the other legal and safe family planning providers in central Pennsylvania, most less than an hour away.  I know this area of rural Pennsylvania very well, and pretty much everything, including the mall, is almost an hour away. This is not an unthinkable reality or an unreasonable barrier to care.

Though I do not agree with Pennsylvania’s parental consent provision, it did not pose a barrier to this woman’s daughter obtaining an abortion.  What worries me more is whether this mother’s unwillingness to use the medical system was so she could control the outcome and be sure the abortion happened.  

What this woman did for her daughter was not safe. She claims to be a nurse, (turns out she is a nurse’s aide, not a nurse) which makes what she did even more egregious. She bought drugs over the internet without a prescription, practiced medicine without a license, and endangered her daughter’s health.

What she did was stupid, and what she did was illegal.

Even More on Nuvaring and Clot Risks

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Merck, the makers of Nuvaring, have announced that they will settle the lawsuits pending against them from women who claim harm from using the ring.  It may be a wise business decision, but surprising given the two recent studies that, unlike the large Danish study published in 2012, find no increased blood clot risk among new users of the Nuvaring compared to women who use older birth control pills.

I’ve updated my prior post on the Ring to address the newer more reassuring data, and point you to this wonderfully written article in the NPR Shots blog for the best summary of the evidence and opinion to date.

Bottom Line

All estrogen containing contraceptives can increase the risk of blood clots. Nuvaring’s risk may or may not be higher than that of older pills containing the protesting levonorgestrel, and more in line with that from desogesterel or drosperinone (YAZ, Yasmin) containing pills.  However, the preponderance of data at this point suggest that the ring’s risks are not higher than that of older pills. Time (and perhaps more studies) will tell if this will change.

For women unable or unwilling to accept the small but real risk for clots from using estrogen containing contraceptives, there are plenty of great, and sometimes even more effective, methods out there – IUDs, progesterone only pills, shots and implants.

Poached Pears

POACHED PEARS

Wonderfully simple, delicious, and almost decadent when paired with chocolate in any form, like a chocolate torte perhaps?… Even better when paired with good friends, lively conversation and a few well-chosen readings at a wonderful dinner party thrown by Paula and Tony.  Thanks, guys, we had a great time!

POACHED PEARS

I was inspired by David Lebowitz’s post on how to poach pears, which is really not a recipe but a suggestion. I made up my own combo and proportions of spices, and you should do the same. But I  found the sauce begging for a touch of salt, so I added it. Perfection!

  • 4 Bosc pears
  • 1 quart water
  • 1 1/3 cup sugar
  • 2 small or 1 large stick cinnamon
  • 2 large slices crystallized ginger
  • Juice of one clementine + 1/2 its rind.
  • Juice of one lemon +  1/2 its rind
  • A few peppercorns
  • 1/4 tsp salt
  • Parchment paper

Dissolve sugar in water in a large saucepan over low heat. Peel, quarter and core the pears, and add to water-sugar mixture along with the spices. Cut the parchment paper into a circle with a smaller circle cut out in the middle and lay atop (See Lebowitz’s post for pics and detailed instructions – it keeps the pears from browning).

Simmer on low heat for 30 minutes, till pears are soft. Remove pears and spices with a slotted spoon and boil down the juice to about 1/2 cup. Store in fridge till ready to serve, then briefly reheat the pears in the sauce and serve warm. Each pear serves two.

The Book of Mormon

Book of Mormon

Loyal readers know that this morning, when I awoke to a major snowstorm, my first thought was “Book of Mormon tickets!”

The Book of Mormon has been selling out months in advance since before it opened, but a major snow storm? That means cancellations and empty seats and maybe, just maybe, a shot at a ticket in my lifetime.

So Mr TBTAM, who teaches at a private school and had a snow day, headed on over to the box office this afternoon to see if he could score us two seats.

And as it turns out, there were cancellations. At $170 and $250 a seat. But you don’t know my husband. Full price for a theater ticket? What, are you nuts?…

But wait!  There were SRO tickets for $25 apiece!  (Who knew?…)  But you don’t know me. Stand for a whole play? What, are you nuts?…

That left the daily lottery. Which was what we were banking on.

I mean it was a literal blizzard out there. How many people stand outside the box office in the snow two hours before showtime hoping to get their name pulled out of a hat for a couple of lousy $32 single seats?

About 350 people, if you really want to know.

Really.

And that’s about 50 more than the average on a Thursday night. Guess I’m not the only one who woke up today with a bright idea.

The good news was that because of the storm, there were a few more seats than usual available for the lottery. Thirty seats in total, to be exact.

But the best news?

WE WON THE LOTTERY AND SCORED TWO SEATS!

I mean, what are the odds?…

So at 5:30 I ran out of the office, then home to feed and walk the dog, then over to take the R train to 49th and 7th, arriving to meet Mr TBTAM at the theater with 30 minutes to spare. That meant time for a bathroom stop before the play, while the ladies’ rooms was empty. (I mean, what are the odds of that?…)

And as for the Book of Mormon musical itself, all I can say is SEE IT. It is absolutely brilliant.


There are moments when I pinch myself, wondering if I really am living the New York City dream.

But tonight? I know I am.

Think Like a New Yorker

Quick!  You’re a New Yorker.

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What’s the first thing you think when your rooftop looks like this and your walk to work looks like this

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and this

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and this?…

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If you answered  “Book of Mormon tickets!”  you’d be right. 

Wish us luck.

Baked Kale Chips

Kale chips

We were having kale for dinner last night, but we bought a bit too much for just the two of us. So while Mr TBTAM sautéed some up with garlic using his now-famous recipe, I took the rest and made kale chips for snacking. It was all we could do not to eat them all before dinner.

BAKED KALE CHIPS

This recipe is modified from one I found in the Beard Foundation Newsletter.

  • Olive oil (1 tbsp per large bunch of kale -you barely need any oil)
  • 1 large bunch of kale, rinsed and pat dry, leaves cut away from stalks and torn into large bite size pieces
  • Sea salt
  • Pepper

Preheat oven to 425 degrees fahrenheit. Put about a tbsp of olive oil in a large bowl, then add kale and rub with the olive oil so that both sides are coated. Season with salt and pepper. Place kale on a baking sheet and bake for 5 minutes  or until leaves just start to brown. Turn and bake another 3-5 mins. Be careful, they burn quickly. Remove from oven, let cool and eat. Or store in an airtight container for later snacking.

Kale Chips TBTAM 1

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More Kale Chips from around the Web

  • Smitten Kitchen crumbles her homemade kale chips on popcorn.
  • Kalyn massages her kale with olive oil in a zip lock bag and adds vinegar.
  • Kitchen Treaty has some gorgeous prep pics
  • A Cup of Jo makes here with sesame oil, soy and sesame seeds. (I’m totally trying these.)
  • David Lebowitz compares kale chips baked at different temps.  (He likes them both ways)
  • Whole foods recipe uses Parmesan cheese. Another must-try variation.
  • Vegans like their kale chips with nutritional yeast, red pepper, walnuts and maple syrup coating.

Maternal Age and Congenital Anomalies

Pregnant womanThere will likely be a bit of press this week on a study presented at the Society for Maternal Fetal Medicine that found lower rates of congenital anomalies at second trimester ultrasound screening among mothers over age 35 compared to their younger counterparts.

[The] group looked at the routine second trimester ultrasound screenings of 76,156 euploid fetuses over the course of 18 years at Washington University Physicians, and the data were split into younger than 35 and 35 and older.

Overall, 2.4% (1,804) of those screened had a major anomaly. But contrary to previous beliefs, only 1.7% of women of advanced maternal age had a fetus with a major anomaly compared with 2.6% of younger women (aOR 0.59, 95% CI 0.52-0.66,P<0.001).

The study was well done, but the headlines about it  – Older Maternal Age Tied to Lower Risk of Fetal Anomalies – are misleading. That’s because the study did not look at all women over age 35, just those carrying infants with normal chromosomes  who made it to the second trimester and presented for a sonogram.

Risks of chromosomal abnormalities increases with maternal age

One of the biggest risks of advancing maternal age is abnormalities in chromosome number, the most common of which are Down’s syndrome (trisomy 21), as well as trisomies of chromosome 18, 13 and abnormalities in sex chromosome number. Fetuses with abnormal number of chromosomes  have multiple congenital anomalies of the heart, genitourinary, brain and GI tract.

The risk for trisomy increases from around 1 in 500 at age 22 to 1 in 200 at age 35 , 1 in 65 at age 40 and 1 in 20 at age 40. Those risks are probable an underestimate, since the majority of a fetuses with abnormal chromosome numbers will  miscarry early in pregnancy, an explanation for the higher miscarriage rates in older mothers.

miscarriage and ageMost miscarriages occur in the first trimester of pregnancy, which is why a study that only looks at pregnancies in the second trimester will miss a low of abnormal pregnancies. If you then confine your study further to only those pregnancies with normal chromosome number, you’ve eliminated the majority of infants with congenital anomalies.

Bottom line

This study is not adding much to what we already know about pregnancies in older women, other than to tell us that pregnancies in older women who have had normal chromosomal screening and make it into the second trimester are in general going to do well. Even better in some ways that that of a younger woman.

Think of it as survival of the fittest. The older woman’s fetus has had a harder row to hoe and made it this far.

It is one tough little cookie.

Date-Orange Scones

CENTRAL PARK SNOWI think nature gives us lengthening days in late January and early February to help us get through the interminable winter and remind us that spring is just around the corner.

More than once this past week I have headed out of my windowless office after a long day, having braced myself for the cold and dark, only to find my spirits uplifted by a still light blue sky. That same evening sky beckoned me to forgo the crosstown bus twice this week and walk through the snow covered Central Park instead.

fifth ave snow

If Punxatawny Phil is correct, we still have another five weeks of winter.  I prefer to think if it as five more weeks of increasingly long days. Sunset today is at 5:30 pm, but on March 16, it will be at 7:04 pm!  By then, it may even be warm enough to bike a loop in the park after work.

If that’s not enough to cheer you up, maybe these scones will.

ZUNI SCONES

DATE-ORANGE SCONES

These scones were modified from the recipe for Orange-Currant Scones from the Zuni Cafe Cookbook, written by the late great Judy Rogers and acclaimed by many as one of the best cookbooks ever written.

This recipe breaks from traditional scone recipes by using an egg, which is thought to act as a leavener and extend the shelf life of a scone.   It makes sense that a cafe chef would use an egg in her scones, which are notorious for becoming dry and stale very quickly, to allow for advance preparation.  Rogers also bakes her scones at a lower temperature, doubling the baking time. If you want a more traditional scone that bakes in 10-15 mins, try my perfect scone recipe.

I’ve also made these scones using sheep’s milk yogurt instead of milk (adding a tbsp or so of skim milk or water to thin it before using). The recipe makes 12 scones, and the extras freeze well – just reheat in the oven or a wide toaster. Or cut the recipe in half to make 6 scones.

  • 3 cups flour (13 1/2 ounces)
  • Scant 1/2 cup sugar
  • 4 tsp baking powder
  • 1/8 tsp salt
  • 2 stick cold butter, cut into pieces
  • 1/2 cup chopped dried dates
  • 1 tbsp freshly grated orange rind
  • 1 egg
  • 1 cup whole milk

Preheat oven to 350 degrees fahrenheit. Line baking sheet with parchment paper.

Combine flour, sugar, baking powder and salt in a large bowl. Cut in butter till the size of small peas. Add dates and orange zest and mix well. Whisk  egg and milk together and add quickly to dry ingredients.  Don’t over mix.

Divide the dough in half, dump out onto a floured surface and pat each half into a one once think round. Cut like a pie into 6 wedges.

Bake until golden and firm to touch, about 25-30 mins.  Best served warm form the oven.

date-orange scone 4

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More on scone recipes and technique from TBTAM

Other food bloggers try the Zuni scones

  • Tea for Six gets a gorgeous rise out of hers. So does Angela. Hmm…maybe I need to freshen up my baking powder…
  • Alice Garden makes a Meyer Lemon and Blueberry version of the Zuni scone
  • Cooking Zuni has the same thoughts I have about scones helping make it till spring

 

Landline Bye-Bye

Landline BYe-Bye

So we weighed the chance of another NYC power outage making us the only ones in the building with a working phone line, and decided that the monthly cost of upkeep for a landline we barely use anymore was just not worth it. This will also take us off the grid for political pollsters, but we figured that as long as we can still walk to the polls, we’ll be okay. As for the telemarketers, well, they want have us to push around anymore.

We were considering also getting rid of cable TV, but we’re too scared.

If you need to reach us, use our cells or work numbers or E-mail or Facebook or Twitter or Peggy’s Blog. And if they all fail at the same time, we’re doomed anyway. Or there’s been another NYC power outage.

In which case, we made the wrong decision.

See you in the future.

Sunday in the Tropics (and Roast Cauliflower Soup)

BBG2Leave it to my friend Paula to get me out of my hunker on a cold January morning, as only she can do, with an email entitled “This Sunday in the Tropics”, in which she proposed a walk at the New York Botanical Garden. “The weather is supposed to be clear and warm (25 degrees!). This the cheapest trip to the tropics ever! Can you feel the winter funk lifting?”

Well, Paula, lift it did. On snow covered trails,

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that took us along the flowing Bronx River

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through the Ornamental Conifer Grove

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past a stand of redwoods

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flowering crabapples,

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and budding pussy willows carrying the promise of spring. 

Pussy WIllow

The bright snow provided a sharp contrast to the winter foliage

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and while the ornamental gardens and conservatory beckoned

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by 1 pm the sun had retreated,

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as did I, home to a warm bowl of roast cauliflower soup.

Cauliflower soup

ROAST CAULIFLOWER SOUP

This recipe, enlightened from one on Epicurious, is a great way to use leftover roast cauliflower. You can adjust the amount of chicken broth to the amount of cauliflower you have left.  This recipe serves four. 

  • 1 head cauliflower
  • 1 garlic clove
  • 1 shallot
  • 1 tablespoons olive oil
  • 2 cups chicken broth (plus a little water if the soups seems too thick)
  • 1/2 teaspoon finely chopped fresh thyme leaves
  • Small bay leaf (or 1/2 large)
  • Salt and pepper to taste
  • Croutons or sheep’s milk yogurt to garnish

Preheat oven to 425°F.

Cut cauliflower into 1-inch flowerets (about 5 cups). In a large baking pan toss cauliflower, garlic, and shallots with oil to coat and roast in middle of oven about 30 minutes, or until golden.

In a soup pot, simmer broth, water, roasted cauliflower mixture, and herbs 30 minutes, or until cauliflower is very tender. Remove the bay leaf. Puree in the pan using an immersion blender. Serve with croutons or a dollop of sheep’s milk yogurt.