Creamy Cannellini & Chick Pea Soup

Creamy Cannellini & Chickpea soup

This is a variation on a wonderful Tuscan bean soup that has become a household staple. The original recipe calls for 4 cans of white beans and 6 cups of stock. But I only had one can of white beans and a can of garbanzo beans, so I used them and cut back on the chicken stock, using a particularly rich stock called Kitchen Basics Natural Chicken Stock that Serious Eats in taste tests found among the best for soups.

The end result was a soup that is lighter yet even more flavorful than the original, once again proving that necessity (and a half empty larder) is the mother of invention. And often involves canned beans.

CREAMY CANNELLINI & CHICKPEA SOUP

Ingredients

  • 2 tbsp olive oil
  • 1 large onion, diced
  • 4 cloves garlic, sliced
  • 2 sprigs of fresh thyme
  • 1 tsp ground coriander
  • 1/2 tsp ground cumin
  • 1/4 tsp cayenne pepper
  • 1-15 ounce cans cannellini (white) beans, drained and rinsed well
  • 1-15 oz can chickpeas (garbanzo beans), drained and rinsed well
  • 4 cups chicken stock
  • 1 tbsp dry sherry
  • Salt to taste

Instructions

Heat the oil in a large soup pot over medium heat. Add onion and cook till translucent, 3-5 minutes. Add garlic and thyme and cook for another 2 minutes, being careful not to burn the garlic. Add the coriander, cumin and cayenne pepper and cook for another minute to allow the spices to start to toast and become aromatic. Add the beans, stock, sherry and 1 tsp salt. Using an immersion blender, puree the soup in the pot till smooth. Allow to cook another 10 minutes for the flavors to develop. Add more salt to taste if needed.

Yield: 6 cups soup.

Nutritional info (per 8 ounce serving) : 177 cals, 5.4 g fat (0.7 g saturated fat, 0 trans fats), total carb 25.6g, fiber 8.6 g, sugars 1.1 g, Protein 11.1 g

Flaxseed – Anti-cancer Properties in the Breast? An Interesting Question.

Flaxseeds
Flaxseeds

In a fascinating and well-done study, Swedish researchers found that in women undergoing breast reduction surgery, those who took Flaxseed (25 grams daily) had a significant increase in levels of IL-1Ra – an inhibitor of pro-cancerous inflammatory cytokines – in the breast tissue taken at surgery.

The effect of flaxseed was similar to that in women who before the surgery took Tamoxifen, an estrogen receptor modulator that lowers breast cancer risks and is used to treat estrogen-sensitive breast cancers.

Women who were exposed to estrogen before their surgery, on the other hand, had lowered IL-1 levels and an increase in pro-cancerous inflammatory cytokines on their breast biopsies.

Estradiol, Tamoxifen, and Flaxseed Alter IL-1β and IL-1Ra Levels in Normal Human Breast Tissue in Vivo.Annelie Abrahamsson, Vivian Morad, Niina M. Saarinen and Charlotta Dabrosin

Objective: The objective of this study was to elucidate whether estrogen, tamoxifen, and/or diet modification altered IL-1 levels in normal human breast tissue.

Design and Methods: Microdialysis was performed in healthy women under various hormone exposures, tamoxifen therapy, and diet modifications and in breast cancers of women before surgery. Breast tissue biopsies from reduction mammoplasties were cultured.

Results: We show a significant positive correlation between estradiol and in vivo levels of IL-1β in breast tissue and abdominal sc fat, whereas IL-1Ra exhibited a significant negative correlation with estradiol in breast tissue. Tamoxifen or a dietary addition of 25 g flaxseed per day resulted in significantly increased levels of IL-1Ra in the breast. These results were confirmed in ex vivoculture of breast biopsies. Immunohistochemistry of the biopsies did not reveal any changes in cellular content of the IL-1s, suggesting that mainly the secreted levels were affected. In breast cancer patients, intratumoral levels of IL-1β were significantly higher compared with normal adjacent breast tissue.

Conclusion: IL-1 may be under the control of estrogen in vivo and may be attenuated by antiestrogen therapy and diet modifications. The increased IL-1β in breast cancers of women strongly suggests IL-1 as a potential therapeutic target in breast cancer treatment and prevention

It’s a very interesting study, though certainly not enough data to make any kind of statement about flaxseed for cancer prevention. Swedish women undergoing reduction mammoplasty are certainly not representative of the population of women at large.
And before you go stocking up on flaxseed, read this on the potential risks as well as benefits of flaxseed and its oil.

All that said, I still find this a very interesting study with a biologically plausible result, and hope there’s more data coming from this group an others on this approach to cancer prevention and treatment.

Ina Garten’s Perfect Roast Chicken

Ina Garten

The best roast chicken I’ve ever made. Made even more perfect by using a grass-fed free range chicken from the green market. Serve with Potatoes Anna and fresh green beans for a memorably delicious dinner that won’t keep you all day in the kitchen.

Recipe here. Better yet, let Ina show you.

Brooklyn Winter Flea

Brooklyn Flea

Until now, flea marketing in NYC for me always meant the Chelsea now Hell’s Kitchen Flea Market, and occasionally, the Greenflea on the Upper West or our own local Flea at PS183.

Brooklyn Winter Flea 2

But this is the new New York, whose heart for many now lies across the Brooklyn Bridge in the borough where second-hand is the ultimate statement of individuality. And it is here that this next generation of New Yorkers has brought the flea market to a whole new level of curated cool.

Brooklyn Flea 10

The Brooklyn Flea is is not necessarily the place to go for discovery, to sift for hours among the junk to find the treasure.

antique postcards Brooklyn WInter Flea

That picking has already been done for you by these mostly young and hipster vendors, who seem to be letting us in on the secret, albeit for a price a bit higher than you  may have expected.

Brooklyn Flea 14

But hey, reality check, they need to make a living and this is, after all, New York.

Brooklyn flea 3

Brooklyn Flea 12

Brooklyn Fela 13

Medical paraphernalia is in evidence throughout, perhaps reflecting the modern fascination with health,

Brooklyn Flea 9

old medical text

and included this skull, which my friend and neurologist Allen informed me is rare because it has all the bones of the inner ear,

brookln flea 4

and this gorgeous print from an old medical text that I just had to buy.

breasts medical textbook

Amidst the antiques, of course, are the crafts – handmade soaps,

brooklyn flea 8

recycled vinyl

brooklyn flea 6

hand-printed fabrics, wood crafts and handmade jewelry.

But for me, flea markets are where I go to discover the past, and the Brooklyn Flea allows me do so through the lens of a whole new generation of curators. I’ll definitely be going back.

Brooklyn Flea 11

In winter months, The Brooklyn Flea is located in in the massively beautiful old Williamsburg Savings Bank, but becomes much larger when it moves outdoors in April to locations in both Fort Greene and Williamsburg. The Flea also hosts the Smorgasburg Food Markets and pop up markets throughout Brooklyn and Manhattan.

Pommes Anna

Pomme Anna TBTAM
Pommes Anna

Pommes Anna – Crunchy on the outside, soft and delicious inside. Everything a potato was meant to be.

This classic French recipe, made with just four ingredients – potatoes, butter, salt and pepper – will wow your friends and family and make them think you slaved hours in the kitchen, when all you really did was run a few potatoes though the thin slicing blade of the food processor, layer them in a skillet with butter, salt and pepper, bake them in the oven and then flip it over onto a plate.

I still haven’t gotten the flip part down perfectly – probably because my cast iron pan still isn’t seasoned well enough – and parts of the top still stick. But I’m getting there.

Continue Reading

Is Your HPV Test FDA Approved?

bd sure pathSome doctors and their patients will be surprised to learn that the test they are using to screen for HPV may not be FDA approved, according to a special investigation by the Arizona Republic/USA Today.

HPV Testing can be performed on the same specimen as the pap smear, often after the pap result is found to be mildly abnormal, in a process called HPV co-testing.

But if your pap smear has been obtained using Becton Dickinson’s Sure -Path pap collection system, you and your doctor need to know that the specimen it is not FDA approved for HPV co-testing, due to higher than acceptable false negative HPV results resulting from specimen degradation in the SurePath media over time.

This has not stopped some of the nations largest labs, including Quest Dignostics, Lab Corp, Aurora Diagnostics, Sonic Health, Bio-Reference Labs and ARUP labs, from using the Sure-pap specimen off label for HPV co-testing, based on studies each lab has done to confirm the validity of the test in their hands. Although such off-label use is perfectly legal, the FDA and the manufacturer issued a letter in June warning the labs that they should be using an FDA-approved system test and not the SurePath for HPV testing.

BD LETTER

That letter, however, was only sent to the laboratories and not to the doctors using the Sure Path system, meaning that physicians and their patients were unaware of the issue until it was reported this week in the press.

You should know that the BD specimen is just fine for the pap testing itself, comparing favorably to its competitor, the Thin Prep System, and perhaps having lower rates of unsatisfactory specimens than Thin Prep. SurePath is also FDA-approved for co-testing for gonorrhea and chlamydia. But not HPV co-testing.

How big is the potential problem?

Just how high the false negative rate is with SurePath is not clear – since the FDA applications for HPV co-testing with SurePath were withdrawn, the data are nowhere in the public domain. The Republic article tries to estimate the potential impact, but they do not cite the study they are using to make their estimates, so I quote this with some reservation update – see reference in comments –

SurePath accounts for about a third of the HPV tests, or about 3 million a year, estimated Michael Farmer, a market analyst who specializes in the pathology and histology laboratory markets. … extrapolating from the findings of a Johns Hopkins University study (unfortunately, not cited – MMP) suggests a thousand or more women tested each year using SurePath may be told they are HPV-free when they are not.

Why would a lab use a non-fda approved test over one that is approved?

Most leading national labs would not explain to The Republic why they use SurePath despite the warning. But each kit costs labs between $1 and $2 less than alternatives that are FDA-approved for HPV tests.

Both Quest and ARUP labs reported doing their own internal validation before using the SurePath for HPV testing, and Quest’s validation included patient samples, as if they were running their own little FDA trial. BIo Reference Labs states they switched 90% of their clients to an fda-approved test when they got the warning from the FDA. ARUP apparently sent letters to clients in October notifying them of the FDA’s warning.

There appears to be support in the pathology community for using the SurePath system for HPV testing, since the College of American Pathologists states the following  –

Non-FDA approved off-label methods for hrHPV DNA detection are commonly used in laboratories, and are acceptable under CLIA ’88 assuming appropriate self-validation studies are performed. Such off-label use most commonly consists of approved methods (Qiagen or Hologic) used with different non-FDA approved transport medias ( e.g., BD SurePath). In addition, non-FDA approved methods such as polymerase chain reaction (PCR) and in situ hybridization have been used for high risk HPV DNA detection. Because of the high volume of hrHPV testing performed and the implications for clinical management of patients based on the results, guidelines for validations have recently been published and include both analytic and clinical components.

However, Phil Castle, PhD, a cervical cancer researcher who was interviewed for the article, had this to say in his blog about using the BD pap for HPV testing –

Currently, there are 4 FDA-approved HPV tests for cervical cancer screening. However, none of them have approval for use with a liquid-based cytology (Pap) buffer called SurePath. Many pathologists like SurePath for Pap testing. But there is no approval for HPV testing because the buffer degrades the quality of the HPV DNA very quickly. A manufacturer of one FDA-approved HPV test has failed to get FDA approval for use of SurePath several times. Even the company that makes SurePath, BD, is urging clinical labs to stop this practice.

What is disconcerting is that there are plenty of alternative choices for valid HPV testing. So it is unethical to offer women less than optimal care just because a pathologist wants to use SurePath.

I myself would not be satisfied with a lab’s internal validation of a non-FDA approved test when an FDA-approved alternative exists. I had always assumed (naively it seems), that any test a lab uses must be FDA approved. If not, then the result I receive from that lab should indicate to me what test they are using, why it is being used and what issues exist with that test.

I do not use the BD Pap Collection Kit

My patients can be assured that the pap collection system I use in my office (Thin Prep) is FDA approved for both Pap and HPV co-testing.

What should you do with this information?

Ask your doctor what Pap smear collection kit he/she uses – it will be prominently labelled on the collection vial for you to see. If it’s BD’s test, and you need HVP testing, make sure a separate specimen for HPV is taken using an FDA-approved collection device.

If you’ve had a recent negative HPV test, ask your doctor how the specimen was obtained. If it was done using the BD pap system, ask your doctor if there is a need for repeating the test using an FDA-approved collection device. If your doctor thinks it is prudent, then retest. In most cases, so long as your pap was normal, simply doing a pap and repeating the HPV at your next checkup will be all that is needed. If the negative HPV was used, however, to triage an mildly abnormal pap, then a sooner repeat pap or repeat HPV test might be indicated.

Logistically, not being able to to an HPV on the pap vial is problematic, since we often do not know until after the pap is read whether or not HPV testing is needed.  By default, then, docs may end up either moving to another pap system or getting HPV routinely with every pap using an FDA-approved collecting system.

Kudos to Bob Ortega at the Arizona Republic for some of the best health reporting I have ever seen.

His article not only gives me almost everything I need to know on this issue as a clinician, but includes information on how the article was complied, and excellent info for patients wondering what to do themselves with this information. Unfortunately, however, he did not link to the Hopkins study that he cited, and I’ve been unable to find the study myself. UPDATE – see reference in comments. Thanks, Dr Austin!

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Recommended Reading

 

S’Mac

S'Mac Mac & Cheese

What if I told you that there is a restaurant in New York City that serves only Macaroni and Cheese. That’s right – just Mac & Cheese. Made to order, in  a dozen different variations, and served bubbling hot in individual cast iron skillets.

What one question could someone then ask you that would make you even happier than I just made you?

How about “Do you want that with or without breadcrumbs?”

smac 2

Dr Phil Gingrey, You Should be Ashamed of Yourself.

Rep Phil Gingrey (R)
Rep Phil Gingrey (R)

Georgia Gongressman Phil Gingrey (R), who ran a “pro-life” Ob-Gyn practice in Marietta, Georgia before joining Congress, has tried to use the cloak of the medical profession to legitimize Rep Todd Akin’s remarks on pregnancy and rape, calling Akins  “partially right” in claiming that “legitimate rape” rarely results in pregnancy.

“… ‘Look, in a legitimate rape situation’ — and what he meant by legitimate rape was just look, someone can say I was raped: a scared-to-death 15-year-old that becomes impregnated by her boyfriend and then has to tell her parents, that’s pretty tough and might on some occasion say, ‘Hey, I was raped.’ That’s what he meant when he said legitimate rape versus non-legitimate rape. I don’t find anything so horrible about that. But then he went on and said that in a situation of rape, of a legitimate rape, a woman’s body has a way of shutting down so the pregnancy would not occur. He’s partly right on that.”

And I’ve delivered lots of babies, and I know about these things. It is true. We tell infertile couples all the time that are having trouble conceiving because of the woman not ovulating, ‘Just relax. Drink a glass of wine. And don’t be so tense and uptight because all that adrenaline can cause you not to ovulate.’ So he was partially right wasn’t he? But the fact that a woman may have already ovulated 12 hours before she is raped, you’re not going to prevent a pregnancy there by a woman’s body shutting anything down because the horse has already left the barn, so to speak. And yet the media took that and tore it apart.”

Dr Gingrey, you should be ashamed of yourself.

As an Ob-Gyn, you must surely know that if anything,  pregnancy rates after rape are higher than one would expect after a single act of unprotected intercourse, and there is absolutely no evidence to suggest that the stress of a rape prevents pregnancy.  Even if you didn’t know it before Akin’s remarks, you should know it by now,  since your own professional organization, ACOG, has called Akin’s remarks remarks “medically inaccurate, offensive and dangerous.”

This man may represent the state of Georgia, but he does not represent science or the medical profession on this issue.

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Update 1/15/13

Gingrey has since issued a statement on his remarks –

At a breakfast yesterday morning, I was asked why Democrats made abortion a central theme of the presidential campaign. I do not defend, nor do I stand by, the remarks made by Rep. Akin and Mr. Mourdock. In my attempt to provide context as to what I presumed they meant, my position was misconstrued.”

And I’ve softened my last statement on this post, having had 24 hours to cool down a bit.

Mirena vs “Usual” Medical Treatment for Heavy Menstrual Bleeding – Depends on What “Usual” Is

MirenaThey’ll be a lot of press this week over a study conducted in the UK reporting that the levonorgestrel IUD (Mirena) is superior to usual medical treatment  for the treatment of heavy menstrual bleeding (menorrhagia).

“Usual” medical treatment for 75% of the women in the UK study was tranexamic or mefamanic acid – drugs that control bleeding through the coagulation pathway, and which are not widely used in the States.

Here in the US, we tend to use  oral contraceptives and progestins to treat menorrhagia. Unfortunately, the UK investigators  did not break out the comparison between these hormonal treatments and the IUD,  so we really don’t know how well Mirena would perform compared to usual treatment here.  However, given years of seeing how effective birth control pills are in decreasing menstrual flow, I’m going to assume that they still work as well as they always have, and not necessarily better or worse than the hormonal IUD.  Each method has its pros and cons, and every woman is different.

The investigators also reported that the Mirena IUD was less effective than usual treatment in women whose BMI is under 25. This is not surprising, since heavier women could have an element of estrogen excess that would be better addressed by hormonal therapy such as Mirena or birth control pills rather than anti-fibrinolyics such as Tranexamic acid.

None of this, by the way,  is meant to discourage women and their doctors from using Mirena to treat heavy periods – it is indeed a very effective treatment and one that I offer my own patients.

Just trying to give the anticipated hype some context and perspective.

Happy New Year

May the New Year bring health and happiness to you and yours.

If posts are less frequent of late, know that I am healthy and busy and blessed with the most wonderful family and friends a person could have.

Sometimes real life just takes precedence over blogging. And that is as it should be.

See you soon.

Farfalle with Fennel & Mushrooms

Farfalle with Fennel & Mushrooms

This dish was inspired by some lovely fennel  and crimini mushrooms I found at the West Side Market, where I had stopped for provisions on the way home from my voice lesson the other evening.  A quick IPhone search in the store yielded  an old recipe from Regina Schrambling for Hunter-Style Pasta, named for its use of ingredients that “evoke the forest in fall”.  I also found this recipe from Epicurious. (Don’t you love what you can do with a phone these days?)  Combining elements of both, I ended up with a hearty but not too heavy pasta that is a real keeper.

Serve with a large green salad and a crusty French bread. It also makes a fabulous lunch reheated the next day with a little Mozzarella cheese on top.

Farfalle Pasta with Fennel and Mushrooms 2

Farfalle with Fennel & Mushrooms

The key to this dish is to slice the fennel and the dried mushrooms really thin and the fresh mushrooms really thick. I also thought about trying it without the tomato paste – if you decide to make it that way let me know how it tastes.

Ingredients

  • 1 ounce dried mushrooms
  • 1 1/2 cup hot water
  • 1/2 cup pine nuts
  • 1 large fennel bulb, trimmed, halved through core, very thinly sliced lengthwise (about 3 cups), fronds chopped
  • 1/2 pound crimini mushrooms, cut into very thick slices (I the mushrooms are small, just halve them)
  • 1 tbsp butter
  • 1 tbsp olive oil
  • 2 large shallots, peeled and finely chopped
  • 2-4 large cloves garlic, peeled and minced
  • 1 tbsp fennel seeds, coarsely crushed
  • 1/4 cup dry white wine
  • 2 tablespoons tomato paste
  • 1/2 cup half and half
  • a few red pepper flakes
  • 1/2 cup minced parsley
  • 1 pound farfalle pasta
  • Salt to taste
  • Freshly grated Parmesan cheese

Preparation

1. Soak the dried mushrooms in the hot water for about a half hour, till soft, then drain, reserving the liquid, and cut into very thin strips. Set aside. Strain the mushroom liquid if necessary and set aside.

2. While the mushrooms are soaking, start your water boiling for the pasta, adding a tbsp of salt to the water in a large pot. Toast the pine nuts on an un-greased baking sheet in a 300 degree oven for 5-7 minutes, stirring once, until golden brown. Remove from the pan and set aside in a bowl.

3. Heat the butter and olive oil in a large deep saute pan over medium high heat. Add the fennel, shallots and mushrooms, and saute until fennel is almost tender, about 12 -15 minutes. About halfway through the saute, start your pasta cooking. When the fennel is almost tender, add the garlic and fennel seeds and saute another minute. Add the white wine and cook off a bit, then stir in the tomato paste and mushroom liquid, cook a minute and then add the half and half. Season with salt, pepper and red pepper flakes. Cook over medium-high heat until the sauce is thickened, about 5 mins.

4. While the sauce is thickening, finish off and drain your pasta (leave a little pasta water on your pasta if the sauce is thick). Toss the pasta with the sauce and parsley right in the pan. Bring the pan to the table. Serve hot, sprinkled with pine nuts. Pass the Parmesan.

YIELD: 6 -8 servings

There Are Words. Let’s Say Them – “Ban Assault Weapons.”

“There are no words.”

It’s what we all said on Friday, when we learned of the unspeakable horror visited upon the teachers and children at Sandy Hook Elementary School, and on their families, friends and neighbors.

On Saturday, we began to finally be able to talk about the horror, began to find the words to comfort those in pain, to remind us of what is real and important in our lives and to tell our children and family how much we love them.

And on Sunday, we listened as our President so eloquently spoke for all of us to the community of Sandy Hook, saying what we wished we could say to them.  “You are not alone.”

Now it is time to find the words we need to say as a nation to make our country a safer place for our children and for us all.

Three simple words – Ban Assault Weapons.

You can say them here. Or here.

And demand that your representatives say them for you here. And here.

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More from Around the Web on This issue  (Just a start  – send me yours to add to this list)

5-Hour Energy “Pinkified” for Breast Cancer – Really?…

The Komen Foundation set the bar low when it partnered with Kentucky Fried Chicken to fight breast cancer, urging women and their families to buy the fat-laden meals despite the fact that obesity increases the risks of breast cancer.

Now the Avon Foundation has slid right under that bar by teaming up with the makers of 5-Hour Energy Drinks to sell pink energy lemonade, with a portion of the proceeds going to fight breast cancer.

Really?….

This is, after all, the same Energy Drink that has been linked to 13 deaths over the past four years and is currently being investigated by the FDA. The drink that comes with a warning label stating “Do not take if you are pregnant or nursing, or under 12 years of age. If you are taking medication and/or have a medical condition, consult your doctor before use.” And despite claims that it only contains as much caffeine as a cup of coffee, the label also warns ” Do not exceed two bottles of 5-hour ENERGY® shots daily, consumed several hours apart”.

This is the drink we need to be buying to help fight breast cancer?

What’s next –  Pink cigarettes?

HPV in Menopause – Old Infections or New Relations?

Menopausal couple cropped
New love comes at all ages.
So can HPV.

When HPV occurs in the menopause, is it due to reactivation of a previous HPV infection or a newly acquired infection?  That’s the question asked, but not properly answered in this doc’s opinion, by a new study published this week in the Journal of Infectious Diseases.

Researchers performed HPV testing in 843 women age 30-60, and found an increased prevalence of HPV infections among women in the peri-menopausal age group who also reported having had >5 lifetime partners, but not necessarily a new partner within the past 6 months. They concluded that this second lifetime peak of HPV infections (the first peak occurs in the second decade) was due, not to new HPV infections, but to infections acquired in the earlier years that were now re-emerging with older age and waning immunity.

The fact that we have not seen this peri-menopausal HPV peak in prior population-based studies, they say, is because most women in this age group until now have not had so many sexual partners.

The study’s findings contradicts what we are now telling women, which is that most HPV infections permanently clear within two years of an initial infection that occurs primarily during the second and third decades.

Erroneous conclusions based on a flawed study design

I take strong issue with the study’s conclusions, based on over two decades taking care of peri-menopausal women in a country where 50% of marriages end in divorce.

The flawed conclusions of this study stem from what I believe to be a flawed methodology – namely using 6 months as a cut off for defining women as having had a recent new partner, an artificial categorization that makes no sense socially or biologically. As a result, the researchers may have missed much of the important new sexual activity in their cohort that could explain an increase in HPV infection around the age of menopause.

Sex, HPV and the Middle-Aged Woman

Many women in their middle years have new relationships through divorce, dating and often, remarriage. HPV infection can occur at any time in a recent relationship, not just in the first 6 months (a part of which time many couples use condoms). These infections can persist up to 2-3 years before they clear and be diagnosed any point in that time frame.

In my own clinical practice, the overwhelming majority of HPV infections in this age group occur in women who have had a clear change in partnership within the past 1-5 years. Not surprisingly, theses HPV infections clear in the same 12-36 month time frame as the infections I’m diagnosing in the younger crowd.

Remember too, that it is at middle age that some of the husbands will start to wander – bringing home a new infection to a woman who has not had a new sexual partner in decades. The study does nothing to address this possibility. Not that any study can, of course, but you get my point.

A better study design would have been to ask how long the subject has been in her current relationship , and correlate that with HPV prevalence.

Bottom Line –

The study raises interesting questions, but unfortunately its design limits its conclusions, which to this clinician don’t make sense given what we know about HPV infection and the social lives of women.

While we cannot completely discount the possibility of reactivation of dormant HPV, this study, in my opinion, does little to answer the question it raises.

Unfortunately, the publicity around this study is sure to drive anxiety among every menopausal woman out there, especially as we are now telling them that they can back off on pap smears if theirs have been normal up till now. (I myself am not 100% comfortable with the new pap recommendations, by the way...)

What if you have a positive HPV and have not had a new partner?

I see two possible ways that a women can have HPV and not have a new HPV infection.

One is a longstanding persistent HPV infection that is only now causing precancerous changes, which as we know can take decades to appear. Is this reactivation of a dormant HPV infection or just delayed detection? After all, we only recently began testing for HPV, so unless we have a prior negative test, it’s hard to say, isn’t it?

The second is that menopause itself can lead to low grade pap abnormalities related to estrogen deficiency rather than true pre-neoplastic changes.  In women without HPV, these are so called false positives. But in women who may have a persistent HPV infection, this estrogen-deficient pap may be the first time she has ever had an HPV test.

The important point with these two scenarios is that not every HPV infection necessarily comes from a new partner (or a wayward husband).

Which is good to know.

Home Tours – My Secret Addiction

The Ultimate Online House Tour
The Ultimate Online House Tour

I admit it. I’m a house and home voyeur.

It was something I discovered while house hunting in Philadelphia over two decades ago – there is nothing more fun than going to an open house.

Not because I want to spy on others, though that’s part of the fun.  But what I really want to do is get design ideas. See how real people in real spaces make it work. Look how they arranged their living room! What a clever closet!  Is that really an IKEA kitchen? It looks gorgeous!

In the old days, my husband and I would sometimes spent entire Sundays at open houses, even after we were no longer in the market for a home. As our family grew, and time became more precious, I was forced to confine my house tour voyeurism to Halloween – ostensibly being a good parent accompanying my small daughters, what I was really doing was finding out what the folks on the 10th floor were doing with their place.

Unfortunately, that ruse lasted only so many years, at which point my kid and her friends refused to let me join them trick or treating, and the neighbors began to look at me funny when I showed up alone at their front door without a costume…

Fortunately, just around that time, I discovered Apartment Therapy, and I was off and running in the work of online home tours.

Now I can practice my addiction in the privacy of my own home, where I will sit up till all hours of the night checking out how the rest of the world lives. No one has to know. No one gets hurt.

And I get my fix.

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Home Tours Online

Here are just a few of the places I go for my fix of other people’s spaces –

  • NYTimes Real Estate Section – Let’s face it – we’re all addicted to the Time’s Real Estate section. For most of us, it’s like reading the bios of the lottery winners. Pick a neighborhood, drag the price range bar as high as it will go and enjoy the fantasy.
  • Apartment Therapy – Young and hip folks and the places they inhabit. It frustrates me that it takes so many clicks to get into a given tour, but once you’re there it’s almost always worth the journey. The spaces can be anything from an early post-college shared space to a settled family home. Some are amazing, others more ordinary, and occasionally, some disappoint. That’s what makes them real.
  • The Design Files Daily – Australian Homes.  The site is clean and easy to use, and has convinced me that I need to visit Australia and maybe live there if this is the kind of light and color that inhabits that country.
  • Design Sponge – Sneak Peeks – I feel really old and terribly unhip looking at these spaces.Where do these kids get their eye for things? Of course the site is run by a very hip young woman from Brooklyn. Which I will never be.
  • Ikea – I never stop loving how stuff so cheap and flimsy can look so good. The room tours are always inspirational, and the clutter very real looking.  One of these days I’ll show you how we transformed our cottage using IKEA furniture. Of wait, that would be a house tour, wouldn’t it?
  • Home Designing – Modern design home tours; really fabulous ideas here that I will never be able to afford to do. Try to ignore the ads – they’re everywhere.
  • W Magazine – Tour the homes of the rich and famous. Or not.
  • Martha Stewart – You can tour all of Martha’s own homes, those of her editors, and then by category – suburban, waterfront, etc. Some great spaces here, though trending to traditional. Once you’ve entered a tour it’s hard to get back to the tour home page, so I recommend you right click on the house tour link and open each tour in a fresh browser window so you can find your way back home. Just like Martha did from prison.