HRT and Breast Cancer Deaths – Just in Case You Weren’t Listening the First Time…

A new analysis of long term data from the Women’s Health Initiative confirms what we already knew the first time around – Use of combination hormone replacement (HRT*) is associated with a small, but real, risk of breast cancer. This new 11- year follow up data carries that knowledge out to its not unexpected conclusion – namely, that some (although not most) breast cancers can be fatal, and therefore the the use of HRT can increase breast cancer mortality.

While it may seem a bit of a “Duh”, this study was, in fact, necessary to quell the WHI critics who continued to argue that the breast cancers caused by HRT were somehow less aggressive than those occurring off HRT. (They are not.) It was also a wake up call for many women who were continuing to use HRT and thinking that somehow its risks did not apply to them. A fair number of these women appear to be coming off of HRT, at least in my practice. Others are staying the course and accepting the risks as they have been defined. Either of which is fine with me.

The spin going on around this study – both for and against HRT use – is tremendous and ultimately confusing to women.  The pro-HRT crowd (some of whom have relationships to Pharma) is using language like “The increased risk from using HRT for 5 years is the same as if your menopause occurred 5 years later”, which is technically true but so what?  The bioidentical hormone crowd (usually also selling the same) are using the study to further hype how their regimens are safer than the evil Big Pharma products – based on no data. Which leaves the rest of us to try to find ways to help our patients understand the risks, place them into perspective for themselves and make a decision about how and if to treat their menopausal symptoms.

While the breast cancer risks associated with HRT use appear to be quite real, for a individual woman, they are not that large. Here’s how I explain the risks to my patients –

There will be 7 extra cases of breast cancer and 1.3 additional breast cancer deaths for every 10,000 women per year who use HRT. Said another way, if you use HRT for 20 years, your risk of getting breast cancer will be increased by 1.4 % and your chance of dying from breast cancer will be increased by about a quarter of a percent. If you use HRT for less than 20 years, we can cut those numbers down accordingly.**

If you don’t already know it, I do have my own set of rules for prescribing HRT. This new data has not changed them.

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* HRT means estrogen and progesterone taken together, as opposed to ERT, or estrogen alone. In the WHI, ERT use was actually associated with a lower rate of breast cancer, a finding unique to this study that begs for replication before we can bless ERT as breast-safe.

** The formula I used for cumulative risk is CR = 1 – e-IR*t ,where CR = cumulative risk, IR is the annual incidence and t is the number of years (in this case 20). If any statistician types reading this can confirm my methodology or numbers I’d appreciate it.

Graph above from JAMA. 2010;304(15):1684-1692.

Roast Pork Tenderloin with Braised Cabbage and Port Wine Sauce

The coincidental timing of my husband’s birthday near Columbus Day and peak foliage has turned this once minor family celebration into one of my favorite annual events – a weekend getaway to our cottage in the Endless Mountains with Mr TBTAM’s parents. Add in bro Joe with Rachel and clan in a rented RV, bring eldest daughter in from college, make the weather glorious and warm, go for Sunday brunch at Berry Fields Farm and put the Phillies in the playoffs (with a no-hitter reminiscent of the one that occurred on the day Mr TBTAM was born, which is why his middle name is Donald), and this year’s birthday weekend was very special indeed.

My only disappointment was that Joe’s family had already hiked Ricketts Glen before we arrived, and the meager apple harvest this year meant no apple stand or applesauce makers at the Forksville Fall Festival.

Joe, Rachel and my mother-in-law Irene are all fabulous cooks, so the weekend was one long Iron Chef event that started earlier in the week as we planned and coordinated via phone what we’d make and who would bring what. Since we had brought two separate pairs of tenderloin, we even had a brine-off. Irene had started her tenderloin brining Friday night, but Mr TBTAM and I could not start ours till we arrived to the cottage Saturday late morning, in brine that Joe (who had arrive the night before) had made and set cooling at around 7. It was clear by their rich color that Irene’s tenderloin were the superior brine, but by the time the dish was done no one knew or cared which was which.

We all crammed into the kitchen to cook the birthday dinner together, with Irene and Joe sharing Chef de Cuisine while Rachel and I played Sous Chef. Everyone got along famously, and the dinner was incredible. We served the tenderloin with a side of green beans, homemade applesauce and roasted herb potatoes. The birthday cake was a dense ginger cake with whipped cream (recipe coming soon…).

I don’t have space or time to detail the rest of the food we made that weekend, except to say that the pork leftovers went great with Frugal Fig Flatbread and salad for Sunday dinner, and leftover salad and fig flatbread were delicious additions to omelets and sausage for Monday morning brunch.

But better than the food that weekend were the moments with one another.  Joe and Em jamming on guitar, Joe and Marvin kibbutzing on the porch, me hanging with Rachel under the stars while the kids and the boys watched the game at The Barn, Luke drawing, Mr TBTAM blowing out his candles, laughing with Grace and Nats in the middle of the night, Irene and Rachel cooking breakfast, going on the world’s longest wild goose chase for those elusive fall apples, worrying we’d get tossed out on our ear by the Lake association for parking an RV in the driveway, hiking the lake and just sitting around the fire together talking.

Thanks Irene and Marvin, for joining us again, and thanks Joe, Rachel, Luke and Grace for making the long trip up north. And thank you, Mr TBTAM, for being born on the best weekend of the year.

Roast Pork Tenderloin with Braised Cabbage and Port Wine Sauce

This recipe is based on one from Chef Mark Peel (which can be found in the Gourmet Cookbook) with Irene’s modifications. It’s a lot of work and worth every second. The recipe below will serve 6. We doubled the meat (but not the cabbage) to serve 10 with leftovers.

Peel’s original recipe uses pork loin and brines for 2-3 days. We used tenderloin and brined for 6-8 hours. We also substituted chicken for veal stock in the port wine sauce. We saw no need to blanch the cabbage before sauteing, as Peel does in his original recipe. Finally, doubling the cabbage and using red onions and more garlic adapted it further to our tastes.

Brine
2 quarts water
1/3 cup Kosher salt
3 tablespoons granulated sugar
4 cloves garlic
2 tablespoons cracked black peppercorns
A few red pepper flakes
1 tablespoons dried thyme
4 whole cloves
4 whole allspice, cracked
1 bay leaf

Pork
2 pork tenderloins, 3/4 to 1 lb each
1 head (2 pound) red cabbage, cored, split and cut into thin slices (The thinnest you can get without using a food processor or mandoline)
Freshly cracked black pepper
2 large red onions, peeled and cut into 1/2-inch-thick round slices
1 tablespoon olive oil
2 large garlic cloves, peeled and chopped (2 teaspoon)
1/4 cup balsamic vinegar
8 fresh sage leaves, chopped fine  (optional – we left them out)
1 tablespoon drained capers

Port Wine Sauce
1 tablespoon (1/2 ounce) unsalted butter
2 large shallots, trimmed, peeled, and chopped (2 tablespoons)
1/4 cup balsamic vinegar
1 cup ruby port or sweet marsala wine
1 cup canned beef or chicken broth
1 tbsp butter (to add at the end)

  • Brine the pork. Combine 2 quarts of water, 1/3 cup kosher salt, sugar, garlic cloves, peppercorns, red pepper flakes, thyme, cloves, allspice, and bay leaf in a large stockpot and bring to a boil. Reduce the heat to low and simmer for 15 minutes. Remove the stockpot from the heat, transfer the brine to a large mixing bowl, allow to cool to room temperature, then refrigerate until cold, at least 2 hours. When the brine is thoroughly chilled, add the tenderloin, ensuring that it is completely immersed, and refrigerate, covered, for 6-8 hours. When ready to roast, remove the meat from the brine, and dry with kitchen towels.
  • Cook the pork and onions. Preheat the oven to 400 degrees. Season the pork lightly with black pepper. (It should not need salt.) In a large cast-iron skillet, over medium-high heat, brown the pork loin on all sides, then remove the pork to a platter and reserve. Distribute the onion slices on the bottom of the cast-iron skillet and place the browned pork loin on top. Transfer to the oven and roast until the internal temperature of the pork is 150 degrees, about 15- 20 mins. (15 mins if you like it pink, 20 mins if you like it more well done.)
  • Prepare the Port Wine Sauce. While the pork is roasting, prepare the Port Wine Sauce. In a small saucepan, over medium-high heat, melt the butter. Sauté the shallots until wilted, about 5 minutes. Pour in 1/4 cup balsamic vinegar and cook until completely absorbed, about 2 to 3 minutes. Add the port wine and cook until 1/2 cup remains, about 5 to 10 minutes. Add the stock and cook until the sauce begins to thicken, about 5 to 10 minutes. Strain the sauce through a fine-mesh, stainless-steel strainer into a small pot and keep warm. Add the butter just before serving.
  • Caramelize the onions. Remove the cast-iron skillet from the oven, transfer the pork loin from the skillet to a platter and let it rest in a warm spot. Using a stainless-steel spatula, scrape the bottom of the skillet to loosen any browned particles. Remove an of the onions that are burned. Sauté the remaining onions over medium heat until caramelized, about 10 minutes, remove from the pan and reserve.
  • Saute the cabbage. Add a little olive oil if needed to the pan and heat. Add the garlic and cabbage. Sauté until the cabbage is thoroughly heated through, and crisp-tender, about 4 to 5 minutes. Add the 1/4 cup balsamic vinegar and the caramelized onions, stir briefly, add the sage and capers, and season with kosher salt and black pepper to taste. Remove from the heat and keep warm till the sauce is reduced and ready.
  • Serve. To serve, cut the pork loin into 1/2-inch-to-2-inch-thick slices. Place the cooked cabbage on a large warm platter. Arrange the slices of pork on the cabbage, ladle the sauce over, and serve immediately.

Doc Gurley in Haiti

She’s tweeting her medical mission in Haiti.  So tragic are the unmet medical needs of these people.

docgurley Doc Gurley

Saw an alone 9-month-pregnant 19 yr old. No birth kit, no string for the cord, no plan for who would be with her.

Gave supplies+discussed how to ask helper to wash hands. Nothing sharp&clean for cord so gave scalpel. Acted out birth, w/handwashing #hai

Also saw woman with overwhelming postpartum uterus infection. Someone used hands at delivery to pull out pieces of placenta (see next tweet)

Saw 14yrold girl w/months of excruciating pain, mass in her lower belly, wasting. Ruptured appy? Tumor? Left her w/ narcotics, antibiotics.

Also, women do not have menstrual protection supplies

I’ve been asked, if there are no pads, what do women use? In the cases I saw, one used a page of a magazine & another a dinner-napkin.#haiti

God bless you, Doc Gurley, and the members of your team for all you are doing. What can we do to help?

Baby Born from 20-Year old Embryo

It appears to be the new record for a cryopreserved embryo-birth.

In 1990 a couple underwent In Vitro Fertilization. They eventually had a healthy baby. They also, as is common, had a number of microscopic embryos that hadn’t been implanted, but were viable. They decided to anonymously donate them. Now, one of those embryos has produced a little boy, 20 years after being created. (via NPR)

In related embryo-news, Colorado has another personhood rights bill on the ballot for November.

As used in sections 3, 6, and 25 of Article II of the state constitution, the term “person” shall apply to every human being from the beginning of the biological development of that human being.

So here’s my question – under the proposed Colorado amendment, would this kid be legal to drink on his first birthday? I’m just sayin’…

Seriously, Colorado, just say no to proposition 62. Its proponents plan to use it to try and outlaw birth control pills and IUD’s.

O’Hare Airport Flu Shot Booth

A smart idea for busy travelers with a little down time before the flight. At $35 a shot, thirty to fifty travelers a day are taking advantage of the convenience.

I would have gotten one myself, but I’ll be getting mine free at work.

Someone Finally Did the Math…


Breaking news from what is being called the most comprehensive survey of American’s sexual behavior in two decades –

85 percent of the men said their latest sexual partner had an orgasm, while only 64 percent of the women reported having an orgasm in their most recent sexual event.

Or, as Sally said to Harry –

It’s just that all men are sure it never happened to them and most women at one time or another have done it – so you do the math.

Join the World’s Largest Virtual Choir

Composer Eric Whitacre, who rocked You Tube earlier this year by conducting an online choir of 185 singers from over 20 countries, is now recruiting singers for his next virtual choir.

Between now and December 31, singers can videotape themselves singing Whitacre’s composition “Sleep”, using sheet music uploaded from the composer’s website and conducted by him in an online video. Uploading your video to YouTube will then allow Whitacre to grab it and compile the choir for a performance sometime next year.

Whitacre hopes to break the current virtual choir record of 900 singers held by The Amplichoir, a marketing campaign in which singers uploaded themselves singing “Lollipop” in hopes of winning free tickets to the 2009 MTV Music Awards.

There are no freebies being offered for Whitacre’s virtual choir members, other than the chance to be a part of something incredibly special. I’ve signed on and am currently learning “Sleep” , with plans to upload it sometime in October. (You can listen here to some of the videos already submitted to You Tube.)

You needn’t be a professional singer or have the world’s most perfect voice to join this virtual choir. In fact, Whitacre says that he has yet to turn a singer away  –

Just the act of learning the music, singing a take that’s 5 minutes long and uploading it on You Tube to an entire world community, generally weeds out most of the people that would’t make it anyway.  But…one of the great things about choral music, and one of the things that I like – not being a great singer – is that the mass of voices tends to blend out those that aren’t so beautiful.

So if  you love to sing, as I do, I hope you’ll join in the music. It’s going to me amazing!

Topical Hormones Used by Adults May Expose Children and Pets

The FDA is warning that estrogen exposure may occur when children and pets come into contact with the skin where women have used a topical estrogen spray. The warning comes on the heels of adverse event reports of premature puberty, nipple swelling and breast enlargement in children exposed to Evanmist, a spray-on estrogen preparation used to treat menopausal symptoms. Pets exposed to Evamist may exhibit signs such as mammary/nipple enlargement and vulvar swelling.

While the FDA warning applies only to Evanmist, other topical estrogen preparations, including lotions, creams and gels, have been implicated by veterinarians after animals presented with sometimes dramatic signs of exposure to topical estrogen used by their owners.

The North American Menopause Society is compiling a nationwide registry of possible topical estrogen exposure to children and pets –

NAMS asks your help in compiling cases of secondary estrogen exposure in pets or in persons. We’ve established a dedicated email address at NAMS (nams@menopause.org) for you to submit case reports. We also encourage you to report cases directly to the FDA (FDA MedWatch Adverse Event Reporting Form FDA 3500 for persons;6 Form FDA 1932a for pets available online.7 )

In the meantime, if you use topical estrogens, wash your hands after applying and before handling food or touching animals or small children. Make sure lotions, sprays, gels and creams are allowed to dry thoroughly , and cover involved skin before coming into contact with small children or pets. Do not let your pet lick estrogen exposed skin.

The same advice applies to men using topical testosterone gels, which have been known to cause virlization in women and children exposed inadvertently to these hormones from contact with the skin of males using these preparations.

Preventing Breast Cancer Deaths – How Much Credit Does Mammography Get?

Much less, it appears, than we’ve been giving it.

So say researchers who measured breast cancer mortality before and after the introduction of routine mammography screening in Norway. They compared breast cancer death rates between two groups of women in their 50’s – those who were offered routine mammograms and those who were not – between 1996 and 2005.

Their thinking goes something like this – If mammography prevents breast cancer mortality, then women who were offered mammograms should have fewer breast cancer deaths now compared with historical rates before mammogram screening was offered. And they did – about 7 less deaths per 100,000 person-years (the so-called screening effect in that chart up  there).

But here’s the rub – women who did not have screening mammography also had less deaths than their historical counterparts – about 5 less per 100,000 person-years. (The so-called time effect)

This means that the mortality reduction credited to mammograms is about 2 per 100,000 person years, or about a 10% reduction in breast cancer deaths. The lion’s share of mortality reduction appears to be due to advances in breast cancer treatment and possibly medical care in general, something researchers have long suspected but have been unable to prove.

What do the Critics Say?

Experts at the American Cancer Society have criticized some aspects of this study. They point out that while mammography had little impact on mortality in early stage breast cancer, the impact on stage 2 disease mortality was significant. They also criticize the very short follow up period of the study – an average of 2.2 years. Finally, they cite the lack of control of subject behavior (or “contamination” as women may have accessed mammograms outside the national program), and the fact that Norway’s mammogram screening program coincided with a national program of multidisciplinary breast cancer treatment that is not in place in the United States, making mammography potentially more important here.  The ACS continues to recommend annual mammgraphy in average risk women starting at age 40.

The accompanying editorial in the New England Journal of Medicine takes a a different tack, and suggests that the decision to preform screening mammography is, in fact, “a close call”, but stops short of actually making the call.  (I encourage you to read the editorial – it summarizes well the results, strengths and limitations of the Norwegian study.)

My Take

I’m not sure that we should use the results of this population-based data to refute the results of randomized trials, which have shown mammography to reduce mortality by about 25% in women ages 50-59.  In evidence-based medicine, the randomized trials tend to win out.

Still, the data presented make a compelling argument that on a national scale, mammograms may have had limited impact compared with advances in and coordination of breast cancer treatment.

I’ve raised the question before as to whether mortality should be the only bar against which we measure mammography. I wonder if women who get diagnosed with breast cancer on screening mammography have more very early stage disease, more options for localized therapy instead of mastectomy, or less use of chemotherapy than women who do not have mammgorams routinely? I’ve yet to see much discussion on this issue among the decision makers on mammography, but suspect it’s an important consideration for women.

What I’m Doing in My Practice

I’m continuing to recommend screening mammography in women ages 50 and above, and in high risk women at an appropriate age depending on family history. This study is raising important questions for that group, and is sure to generate a few phone calls and fuel some discussions during office hours, but I’m not changing my recommendations just yet in this age group.

For average risk women under age 50, I’ve recently begun to have individualized discussions about the screening mammography, and learning that it’s not an easy discussion to have. To that end, I initiated a project with my colleagues here at Cornell and at Memorial Sloan Kettering Cancer Center to begin to develop tools to assist women and their clinicians in having informed discussions about mammography. We just got a small pilot grant – wish us luck!
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Don’t Blame Me – A Virus Made Me Fat

Finally – the answer to the obesity epidemic.

It’s a virus!

New evidence indicates that children who are exposed to a virus called adenovirus-36 are more likely to be obese than those who are not exposed to it, and to be heavier than other obese kids who were not exposed to it, researchers said this week. The virus… is one of 10 bacteria and viruses that have been associated with a propensity for putting on plural poundage.

Maybe this explains why I and 2 of my sisters all became fat in the same year.

Well, that, combined with the fact that we had just moved to a new neighborhood where there were no kids we knew to play outside with, and we started taking a bus to school instead of walking, and Dark Shadows had just started, leading us to spend every afternoon after school in front of the TV snacking.

But I like to think it was a virus.

Olallie Berry Jam

Thanks to Victoria for this wonderful jam she brought us from Santa Cruz when she stayed with us a while back. I think it is the best jam I have ever eaten – tasty, not too sweet, and with the tiny berries still identifiable in the spread.

I’d never heard of an Olallie Berry before, probably because it is native to the West Coast. It’s the mutt of the berry world, part Loganberry and part Youngberry, which are themselves crosses of Raspberry, Blackberry and Blueberries. Apparently, the Olallie looks like a blackberry, but the flavor is really a wonderful cross between all three.

The Olallie was actually created in Oregon as part of a USDA-Oregon State University cooperative cross breeding program in the 1930’s. I’d say it’s genetic engineering at it’s best.

Can the NBCC End Breast Cancer by 2020?

They think  so.

The National Breast Cancer Coalition (NBCC) is setting a deadline: End breast cancer by 2020. Breast Cancer Deadline 2020. It is time.

Taking a “just do it” approach, the NBCC has decided that by setting a deadline, they can make it happen.

In setting this ambitious goal, the NBCC criticizes the incremental advances in oncologic research that may take a drug to market but not actually impact long term survival from cancer or prevent it in the first place. (For example, Avastin, which is making billions for its manufacturer while not saving a single life from breast cancer to date.)

Researchers and the media often celebrate small accomplishments. We have been conditioned to believe that a drug that may extend life a few months is a breakthrough, that a 2% reduction in mortality is promising, that tumor regression or stabilization are cause for celebration, even though at that point there is no way to determine if anyone’s life was actually prolonged. We have settled for these limited, incremental changes along with the platitude “early detection saves lives” for too long.

While not doubting the integrity, sincerity and dedication of researchers, the NBCC appears to have lost patience with the system that creates and supports them and the industries that benefit from their discoveries.

More than 40 years and billions of dollars have not ended breast cancer. It has, however, created a robust cancer industry that thrives on raising awareness and producing drugs, screening devices and genetic tests. It has also created an academic system that generates hundreds of thousands of articles about breast cancer and builds careers for thousands. Although there is no doubt individual researchers sincerely want to end breast cancer, every system is perfectly designed to achieve the results it gets. The current system is perfectly designed to be lucrative, cautious and incremental.

They appear to be looking for an “outside the box” approach to breast cancer prevention and treatment that bypasses the conventional research and pharmaceutical industrial complex, and focuses solely on the eradication of breast cancer in a decade.

Their first initiative is the development of a breast cancer vaccine.

As our first project in the campaign we are currently working with a diverse group of stakeholders to create a five-year strategic plan to catalyze the development of a preventive breast cancer vaccine that could revolutionize breast cancer prevention.

My take

While I sympathize with the NBCC’s frustration with the research and pharmaceutical infrastructure, and with the lack of significant progress towards a cure for breast cancer, this 10 year goal is looking a bit pie in the sky to me.

They make comparisons with the eradication of polio. But they forget that we knew what caused polio – a single virus. We don’t even know yet what causes breast cancer –  so developing a vaccine against it seems premature. Even if we were to develop a vaccine, the long lead time to development of breast cancer mandates much longer than a 5-10 year project to prove efficacy. And let’s not forget subject safety – we can’t throw caution to the winds here, folks, or we risk losing even more lives to the race for the cure.

They recall John F Kennedy’s race to the moon – a goal that was clearly defined and visible in the night time sky to any child, and the path to which could practically be drawn with one’s hand. But the multi-factorial nature of breast cancer means that there are dozens of moons, in solar systems we cannot even see, with hundreds of possible paths to get there, and thousands of dead ends on the way.

We just may not be close enough to get there in 10 years.

I am reminded…

The NBCC ultimatum reminds me of two women I know who gave their longtime live-in boyfriends a deadline of New Year’s Eve to propose or get out.  That first one gave her ultimatum over 25 year ago, and it worked – they are still married today. The other gave hers just last year, and well, you can guess the outcome – he moved out.

While a 10 year deadline may have worked years ago – when science was simpler and the problems less complex –  such an approach may be a bit outdated today. After all, we have pretty much tackled the simple stuff and are on to the complicated things like cancer, drug resistant infections, HIV and the multi-factorial problems of hypertension, obesity and dementia.

If we knew how to do it, we would have done it by now.

All of this could change, by the way

A deadline would work, by the way, if we were to find a single necessary cause for all breast cancers – in the same way  we now know that the HPV virus causes cervical cancer.

If this were to happen, then yes, we could eradicate breast cancer – maybe not in 10 years,  but certainly in my children’s lifetime.

That same potential now exists to eradicate cervical cancer – if we could develop a vaccine that targets all the cervical cancer causing strains. Instead, we are vaccinating girls right and left with a vaccine that will certainly prevent some cervical cancers, but will never eradicate cervical cancer because it does not target the entire range of viral strains that cause cervical cancer.  It has, however, brought millions of dollars to the pharmaceutical companies that have developed it.

In this sense, I share the frustration of the members of the NBCC, who see profit-driven goals impeding the long term goal of disease eradication.

So I guess I’ll just wish them all the best in their efforts.

And send them a check.

The Threads of Circulation


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………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… As envisioned by artist Victoria May in her installation “Collateral Damage“.

Herb-Roasted Potatoes

The bad news is that our terrace herb garden went unwatered for our entire vacation, and we returned home to find everything pretty much dried out.

The good news is that rosemary, thyme and tarragon are just as good dried as fresh. Maybe even better.

Herb-Roasted Potatoes

The smaller the potatoes are cut, the faster they will cook. Try to get all the pieces the same size so they will cook evenly.

3 lbs red bliss potatoes
1/4 cup olive oil
Dried rosemary
Dried thyme
Dried tarragon
1/4 cup olive oil
1 tbsp Kosher salt
Lots of fresh ground pepper
1 tsp paprika

Take a scissor to your herb garden and bring in a bunch of herbs, about 1/4 cup total once they are stripped from the stems.

Clean, and dry the potatoes, then cut into 2 inch pieces (sixths or eights, depending on the size of the potato). Toss in a large bowl with the olive oil. Sprinkle on the herbs and spices and toss to coat evenly. Spread evenly on a large baking sheet or roasting pan in a single layer.

Roast at 425 degrees Fahrenheit for 20-30 mins, turning with a large spatula about halfway through to brown evenly. Serve hot.
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This post is my contribution to Weekend Herb Blogging, hosted this week at Anna’s Cool Finds, with four years of wonderful archives at Cook Almost Anything.

Into the Woods

Into the woods without delay,
But careful not to lose the way.
Into the woods, who knows what may
Be lurking on the journey?
Into the woods to get the thing
That makes it worth the journeying.
Into the woods!
Then out of the woods,
And home before dark!

At the end of our street in the Endless Mountains is access to a forest trail system that leads into World’s End State Park, where it joins up with the 59 mile long Loyalsock Trail.

Although we’ve owned our cottage here for 4 years now, until this summer, I’d never ventured onto the trails that link with World’s End, because, well…I was afraid of getting lost in the woods.

I think it was leftover fear from the time when I was 8 years old and actually did get lost in the woods of a Philadelphia suburb for an hour or so one sunny summer afternoon. That adventure earned me the nickname “Crow Girl” in honor of the bird cries that my Uncle, who found me, claimed led him to me. (I hated that name, by the way…)

My Local Trails

But then a few weeks ago, a kind and wonderful neighbor offered to take us on a guided tour of our local trail system. With a knowledge of the woods gleaned from a generation of hiking and daily walks with her dog, she taught us how to read the trail markers (you read them as if they were laid down on the ground)

and pointed out natural landmarks, flora and fauna,

all the while regaling us with tales of the town. The fact that there were eight of us on that hike (plus two dogs) made the whole thing a real lark and I wasn’t afraid for a moment of getting lost.

This gave Mr TBTAM and I the courage to head out on our own a day later, retracing our previous hike’s steps before venturing just a tad farther along the Yellow Trail, barely skirting World’s End before turning back towards town along the bridle trail. Now we were pointing out the landmarks to one another – spots like Table Rock

Fat Man’s Squeeze

The Pine Woodlands (where you can take the blue trail shortcut)

and The Old Rail Bed.

Canyon Vista Trail

By the time Paula and Tony joined us the following weekend, we were ready to venture off the local trail system and into World’s End on the Canyon Vista Trail. Paula and Tony are veteran hikers, equipped with walking sticks and Paula’s great knowledge of the outdoors, so we felt bolstered by their presence. (Long time readers will remember Paul from our Aquaduct Trail Ride, where she lectured us on the secrets of the black walnut).

The Vista Trail is actually an easy hike, although we needed two separate trail maps to follow our route. From the end of our street, take the yellow access trail to the railroad bed, then take the Red Trail to the park road, turn left onto the road for a short distance till you see signs for Canyon Vista Trail /Loyalsock Trail,

which you follow to the vista.

While at the Vista, take a short hike farther up the hills to explore the Rock Garden –

but do be careful up there as the trails are unmarked.

Fortunately, all you need to do is head downhill and you’ll find yourself in the Vista parking lot. Earlier that morning, we had left a car there to save ourselves the hike back (We had other things to do that day, like roll grape leaves with Paula. I’ll show you that in another post…)

So them’s my woods, folks.

I still would love to get me a good GPS for the fun of it, and join in on the many hikes sponsored by the Eagles Mere Conservancy and the Alpine Club. I feel like a whole world has opened up to me now that I’ve taken the plunge into World’s End, and I hope to someday know these woods like the back of my hand and teach them to my grandchildren.

One Last Thing

Oh yeah – There’s one more thing I need to tell you about my woods…

There are bears.

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Into the Woods, lyrics by Stephen Sondheim