Cuban Bread (Pan Cubano)

No matter where we ate in Cuba, the bread was delicious – almost always freshly made, even warm on occasion. Sort of a cross between French and Italian, sometimes like a heavy sandwich bread, sometimes more like a baguette. Then of course, there were those little bite size rolls at El Guarjirito… Needless to say, I came home itching to make bread.

A weekend visit to our cottage in the Endless Mountains was the perfect opportunity for bread making. I have only one cookbook there – The New York Times Cookbook (c 1961)– and as always, it came through, with a recipe for – would you believe it? Cuban Bread!

I don’t know if it’s an authentic recipe or not – I’ve since found others that use a sourdough-type starter. I do know that it indeed tasted a lot like bread I ate one afternoon at a restaurant in Havana. It made us some wonderful sandwiches and toasted up beautifully.

Warning – I am truly a novice bread maker. This post is more a report of my experience and not a lesson in bread making. To hang out with folks who really know what they are doing when it comes to bread making, head on over to The Fresh Loaf or let Bittman show you how he does it (and does it again).

Cuban Bread (Pan Cubano)

This recipe was modified from the James Beard Cooking School. I further modified it because Claiborne did not tell me what to use to grease the bowl (I used Olive oil) and because I did not have corn meal.

1 package yeast
2 cups lukewarm water
1 1/4 tbsp salt
1 tbsp sugar
6-7 cups flour
Olive oil (I assume)
Corn meal

Dissolve the yeast in the water and add the salt and sugar, stirring to dissolve thoroughly, until it starts to foam. Add the flour, one cup at a time, beating with a wooden spoon, until you have a stiff dough. Knead for about 10 minutes till no longer sticky, then shape into a ball and place in a greased bowl and grease the top.  Cover with plastic wrap or a clean dishcloth and place in a warm spot (I used the porch railing in the sun) until it is doubled in bulk.

Turn the dough out onto a floured board and shape into two long, french style loaves or round, Italian style loaves. Arrange on a baking sheet heavily sprinkled with corneal and allow to rise for 5 minutes (I did not have cornmeal, but wish that I did. I love that texture on the outside of bread).   Set a pot of water on the stove to boil while the bread does this last rise.

Slash the tops of the loaves with a knife or scissors, brush the tops with water and place in a cold oven. Set the oven to 400 degrees fahrenheit and place the pot of boiling water on the bottom of the cold oven. Bake the bread until crusty and done, about 40-45 mins.
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Pan Cubano Around the Web

  • Andrea Meyers tells us that my recipe is a “quick” Cuban bread, (as oppoesed to the more traditional method using a starter) and makes a very similar recipe ifrom Memories of a  Cuban Kitchen.
  • Taste of Cuba has the traditional recipe that uses a starter
  • Plantanos, Mangos and Me makes my recipe but in a food processor and with an egg wash. Looks gorgeous!
  • Dino Grrl (does she know Dino Doc?) makes a whole grain bun version.
  • Watch Libby make Cuban Bread in this You Tube video – Nice Job
  • Klaus Tenbergen tell us that authentic Cuban Bread is baked with a palmetto fond atop. (See Lydia’s photo for an example)
  • The Fresh Loaf has a nice thread with lots of Cuban Bread recipes
  • MyBig Fat Cuban Family shares her mothers recipe for use in a bread machine

COMMENTS

Bardiac said…

Wow, that’s interesting that you put water in a cold oven. I wonder what that does? Keep the crust from drying too much?

Now I want to make bread and eat it slathered with butter. :/

AUGUST 07, 2010

Nale said…

I like all sorts of bread. This is new for me, and I will try it. 😉

AUGUST 08, 2010

rlbates said…

Beautiful!

AUGUST 08, 2010

We’re Feeding Dementia Patients with Feeding Tubes???

An article in this weeks NY Times entitled Feeding Demented Patients with Dignity suggests that hand feeding dementia patients may be a better option than tube feeding them.

My God, are we really putting feeding tubes in the elderly demented? When did this happen?

During college, I worked as a nurses aide in a nursing home outside Philadelphia. For 20 hours a week (40 hours in the summer) for two years, I cared for patients in all stages of dementia, from the walking confused through to the end stage, stiffened victims confined to wheelchairs or beds. But in all that time, I never, ever saw anyone with a feeding tube.

As an aide, one of my main duties was feeding the patients. Whether it was solid food cut into small pieces,soft food mashed, or pureed food, we fed them. By hand. Three meals a day, seven days a week. What else did they have to do all day and what else was I there for, after all? Mealtimes were our touchstones, and we marked our days by them. It gave us all something to do.

I particularly recall one elderly woman I helped care for one summer almost every day for two weeks. She was at the worst, end stages of dementia. Stiffened with contractures and moaning constantly. When she wasn’t moaning, she spoke her catch phrases – they all seemed to have catch phrases – strings of words spoken over and over, almost like a mantra. Getting her up and dressed every day took two of us at least an hour. Changing her diaper, cleaning her, rubbing lotion into her skin to prevent dryness and breakdown, getting her into a chair, then changing the sheets, adjusting the lambswool mattress cover.

Then I fed her. It took a half hour or more.

I gave her tiny, tiny amounts of food on a spoon – for breakfast, hot cereal and a mashed soft boiled egg. For lunch and dinner, pureed meat , fruit or vegetables. Sometimes she ate eagerly. Sometimes I had to cajole her. Sometimes I got frustrated, or annoyed – I expect, at those times, she was as well. I remember that we were told to try to make sure they got protein in some form – soft boiled eggs were a god send in this regard, because almost every patient ate them well and eagerly. I tried to figure out what foods she liked and focused my efforts on those, but sometimes, she downright refused to eat or spit the food out. So we stopped – until the next meal.

And then, one morning, I came to work to find that she had passed. I have no idea what ultimately caused her death. But until the end, we fed her.

Are you telling me that today, this poor woman would have had a feeding tube because she couldn’t feed herself? And that it would take a social worker to intervene to suggest that perhaps someone might try feeding her by hand instead? Infants can’t feed themselves, but we don’t put feeding tubes in them, do we?

I ask you again – how in God’s name did we come to this?

I know the answer, of course, as do you. It’s because we have shifted the dollars in healthcare away from those who actually provide the care to those who make the diagnostic tests, the drugs and the devices.

And the feeding tubes.
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Thanks to Info Snacks, which is fast becoming one of my favorite feeds, for pointing me to the NY Times article.

COMMENTS

Eric, AKA The Pragmatic Caregiver said…

Facilities push them to reduce their exposure in the event of aspiration pneumonia, and reduce the number of CNA/caregiver hours required to feed people. Doctors offer them to make it look like they haven’t “given up” on the patient. Families choose them because they don’t want to “starve grandma to death”.. You’re totally right; it’s utterly horrifying, and there’s plenty of blame to go around.

I got an email from someone in my (former) caregiver support group wondering if I had any preference between NG and PEG tubes – in the setting of end-stage Parkinson’s with autonomic dysregulation!

Frankly, I’m a huge fan of tube feeding before it gets to the end-stage of life. My personal favorite method of tube feeding involves a straw with attached parasol, and my favorite formula is a mixture of molasses-derived ETOH, 40% w/v, coconut and pineapple, blended with ice. It helps treat my pesky symptoms such as “being outraged by the inability of others to appropriately care for terminal patients”.

E

AUGUST 05, 2010

Helen said…

Thank you Eric for this comment .. and thank you Dr. P for this post. I cared for my mother during the last five years of her struggle with Alzheimer’s and Lewy Body diseases. Until the end, and for as long as she could swallow …. I fed her. It was spiritual, kind, humane and life-affirming.

AUGUST 05, 2010

Jayme said…

I agree with you! I work as a COTA at a nursing home in Virginia. Tube feeding is also very disruptive to the patient that can remember that they should eat at certain times…but can’t remember that they already got all of their nurtients through a tube…

AUGUST 05, 2010

rlbates said…

Eric, it’s good to “see” you.

Love the post, Dr. P and the above comments.

AUGUST 06, 2010

kathy a. said…

wow. my mother had a stroke a couple of years ago. the cognitive damage was significant — she was not once oriented to time or place after that, had hallucinations, never remembered that she also broke a hip when she collapsed from the stroke, etc. — and there was no improvement after 2 months. it was very like the dementia her own mother had at the end of her life.

that was followed by medical complications: a GI problem they never quite figured out, and she stopped eating. she was a poor candidate for surgery. so i asked the specialist what would happen if she did not start eating again, thinking he would be factual and offer options like palliative care. instead, he snapped, “we’ll just have to put in a feeding tube,” and he bustled away.

really, i was shocked at his response. we were not going to do a feeding tube. i got things straight with her primary, and we got hospice involved right after that. but i really had to advocate for palliative care — i had to know it existed, had to understand that a feeding tube would prolong her suffering, had to flex my power of attorney for medical care.

AUGUST 06, 2010

Joshua Schwimmer, MD, FACP, FASN said…

Thanks for the shout out to Info-Snacks!

Joshua

www.jschwimmer.net

AUGUST 06, 2010

Anonymous said…

Of course, it’s worth pointing out that tube feeding does not, in fact, prevent aspiration. It does cause increased need for restraints to prevent the removal of the tube. Which just makes the whole thing even more inhumane. I know a gerontologist who feels so strongly about this that he will sign off the case if a family insists on a feeding tube.

AUGUST 06, 2010

grapheme said…

This post brought tears to my eyes. Tragic situation in an increasingly difficult world. It has made me think about what I would do in a similar situation.

AUGUST 07, 2010

Daniel F. Kane said…

As the demographics shift from boomer to X/millennial, and the numbers drop to both finance (social security/medicare) and provide care (hand feeding) one can expect more tubes as the same aide in 20 years can hang probably 10 feeding bags per hour but hand feed only two.

Our success at increasing life span (which is a good)co-incident with our success at decreasing birthrate (which is a societal experiment on a scale not seen before in human history) is the root of this issue. Simply stated, if your children can not or will not hand feed you in the winter of your life, in 20 years or so, there will not be anyone to feed you.

A person in a chronic disease state who has the ability to swallow should have the dignity of being fed in a manner that allows them to swallow and live their life to the extent they are capable.

The up an coming demographic, created by us, will likely make this impossible.

AUGUST 07, 2010

Anonymous said…

Good lord, this is outrageous. I’ve never held any clinical position but I’ve hand-fed patients with dementia both as a volunteer and as a ward clerk, back in the 70s. Some of them didn’t really need hand-feeding, just someone to open the cello-wrapped utensils, cut up their food, get them started, encourage them to keep going, and sit with them while they ate. Poor old Violet, it was the only time she wasn’t stressed out over her clothes having been stolen because she thought she was in a pre-War rooming house.

AUGUST 07, 2010

VM Sehy Photography said…

I’m suprised that they don’t have those tubes hooked up to a computer to save time and effort. It’s a sad planet that we live on when people can’t take the time to give things a personal touch. Also, once everthing becomes about money, the soul is sucked out of living. I think I’d rather volunteer for euthanasia then get fed by a tube. I’d be afraid to mention using a tube to feed babies for fear that someone out there will think it’s a good idea.

AUGUST 07, 2010

kathy a. said…

i should clarify that my mom was offered hand-fed food, and sometimes even in the last part she did eat a little. the thought of a feeding tube to force nutrition, though, was awful. she tried to tear out every tube they put in her. we just were not going there.

AUGUST 07, 2010

Cuba – The Food

If I were Ruth Reichl, I’d give Cuba one and a half stars. Because when the food is good, it is very good. And when it is not, the meat and fish are overcooked as to be unrecognizable, or as my friend John called our hotel mystery meat one night  – “some kind of beef”. 

Of course, eating in large hotels and restaurants in groups of over 100 people is not the way to sample a nation’s cuisine. What I was longing to do was convince one of our guides to take us home to their Mom and get me a Cuban home cooking lesson.  But that was not happening on our tight schedule, and it’s not like I had Batali and Bittman to show me around…

It’s also important to remember that this was Cuban food seen through the eyes of an American visitor enjoying the privileges of a four star welcome and with money to spend. For native Cubans, who must live with rations and an extremely limited income, it’s a whole different story. (I”ll be talking about agriculture and food supply issues in an upcoming post.)

All that said, I had some memorable meals in Cuba. Enough for me to know that I did not begin to scratch the surface of Cuban cuisine on this trip. Maybe next time....
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Cafetal Buenavista
Las Terraces Eco-Village
This restaurant occupies the remains of Cuba’s oldest coffee plantation, and is located in Las Terrazas, a restored eco-system in Pinar del Rio. (More on that in a later post..) 
The remains of the terraces where they dried the coffee give the grounds the feel of an old Mayan temple.

At Buenavista, we were served a delicious traditional Cuban meal of fresh fruit, salad, chicken, rice and beans and a crispy fried vegetable – was it potatoes, Plantanos, Yucca? I forgot to ask! 

That’s because I was too preoccupied listening to the music. We were serenaded during our meal by Grupo Polo Mantanez, named for the late Cuban singer-songwriter who was the house act at las Terrazas’ hotels until his tragic death in 2002. The group continues to sing his songs today, and the current female lead singer was amazing. (Click below and enjoy while you read the rest of this post.)

Buenavista’s small kitchen is housed behind the restaurant. 
The views are phenomenal, lending the restaurant it’s name.

This was my favorite meal of the trip.
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Don Lorenzo
Acosta No 260-A e/. Habana y Compostele
Habana Vieje. Tel 861-6733

This restaurant was a gift from a local on a hot Sunday after a long morning spent at the Craft Market. A simple request for a recommendation for a quick bite, and we were led on a ramble through the streets of Habana Vieje to an unmarked doorway, where small but well-maintained stairs led us up to this lovely rooftop restaurant. Our volunteer guide waited downstairs for us as we ate, so as to lead us back to our starting point – in exchange, of course, for a peso or two, which we were more than happy to give.

We were down to our last pesos that day, my friend, but the warm weather kept our appetites small enough to fit our wallets and the spontaneous little meal we shared was one of the best of the trip.

First, a mango, decorated with a small umbrella and a sprig of mint. Then bread with assorted accompaniments – in our case, we chose a simple light tuna salad and a tomato salsa. Washed down with cold agua con gas, it was a delightful small repast on a very hot summer day.

We had the place to ourselves that afternoon, and the service was personal and attentive, despite the fact that we warned the waiter up front how little we had to spend. One day, we’ll return to sample the more extensive Afro-Cuban offerings of the wonderful little restaurant.

We so enjoyed the rooftop glimpses of neighboring homes, each a little vignette of life on this island so close, yet so far far from our American shores.

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La Domenica Restaurant
O´reilly y mercaderes. 
la habana vieja. 860 2918

Located near Plaza de la Catedral in the beautifully restored section of Habana Vieja, La Domenica has been called the best Italian restaurant in Habana. We stumbled upon it, attracted by the outdoor tables shaded by white umbrellas and an amazingly cheap patio menu. (The indoor menu is much pricier.) The umbellas came in handy when the afternoon’s regular downpour occurred halfway through our meal, an event that did little to spoil the meal.

The tuna salad appetizer was perfect, served with the traditional cuban salad of shredded carrots, cucumber, tomato and cooked cold green beans. A few olives reminded us we were at an Italian restaurant, and we washed it down with sparkling lemonade.

The chicken was another Cuban leaning dish, served with rice and beans, at the ridiculously low price of 6 pesos! But the best was the small pizza – unlike any I’ve eaten before, spiced a bit differently and made with a bread that was crisp, light but thicker than the brick oven pizzas I’ve eaten here in the States – Perhaps a little Cuban bread crust?

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El Gaujirito 
Zulueta #658, 2nd floor near Apodaca
Habana Vieja
A bit kitchy, but the service is excellent, and the pulled pork is the best I’ve ever eaten. (It tastes nothing like what we’ve been eating for years at La Caridad here in NYC.) The Cuban rice and beans (Arroz Congri) was also delicious.  The seafood soup was simple – lots of fish in a tomato based spicy broth – and could have been good, but the fish was overcooked, as it was also in the seafood entree. But the bread ! Bite-sized soft balls served along a sombrero brim, with garlic oil for dipping. Enjoy it with a Cuban beer.
You’ll have trouble finding the restaurant, but the cab drivers know it, and will escort you into the unmarked building and upstairs.
Pause and enjoy the art gallery just outside the dining room, and if you’re lucky, you may catch a floor show on the stage there. Don’t let the waitress talk you into ordering too much food, as we did. The portions are large enough to share, so do so.
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El Patio
Plaza de la Catedral, Habana Vieja

Our final night celebration dinner was a feast served to us in Plaza de la Catedral by El Patio, one of Cuba’s most famous restaurants.  Even the downpour that chased us from the square into the restaurant could not spoil the gorgeous setting.  The truth is, I don’t remember much of the meal beyond the mojito, the delicious appetizer – a tower of mango and lobster- the wonderful conversation and the moving speeches and singing. Most memorable moments – singing U2’s MLK – “If a thundercloud passes rain, so let it rain” (and it did…) – and the heartfelt Bawo Thixo Somandla (For you, Sherry…).
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Any Mango Tree 

The mango everywhere was incredible, and the highlight of our daily breakfast. But when we found this mango tree at las Terrazas, we knew we had hit the mother load.

Go ahead – Grab a ripe one down, peel it and enjoy the best fruit you’ll ever eat!  Or, eat it like a native – roll it back and forth between your hands to soften it, then bite off the end and suck out the juices.

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Up next – I try my hand at Cuban Bread

Cuba on My Mind

There is no simple way to describe Cuba to you. Every image, every encounter, every experience evokes a rush of conflicting emotions, because it is a country of such incredible contradiction.

It amazes me to think I actually visited a country whose government suppresses free speech and restricts the freedom of its citizens, and while I enjoyed unlimited internet access (when the router was functioning), Cuban citizens do not.

What amazes me more is that this same government affords these same citizens universal, free medical care, with an infant mortality rate and life expectancy equivalent to ours, a literacy rate of 100%, and an education system so excellent that they are exporting doctors and scientists across South America.

We exit the airpot to see anti-American billboards,

and yet everywhere we go we are welcomed by the people of Cuba with open arms, music, warm hearts (and a Mojito…). 
Cuba’s cities are an ecelectic mix of mid-century and centuries old architecture in colors that brighten the soul,  
and yet many of these same buildings are literally crumbling before your eyes, bringing forth a great sadness. 

It is a place where one cannot get something as simple as an Excedrin, where bathroom attendants dole out small rations of toilet paper like precious jewels and flush the toilets with buckets of water because the plumbing system is unreliable. But the food system is working, and Cuba is now one of the world leaders in successful urban gardening and sustainable agriculture.

We were forced to change our Havana concert venue twice because air conditioning broke down, and the union hall we ultimately performed in, never designed for musical performance but graciously offered for our purposes, had both an out of tune piano and poor acoustics. And yet, in that hall, I heard a flute solo I shall never forget and some of the most beautiful voices I think I will ever hear.

I was told that Cuba was an anachronism, a country trapped in the mid-century, epitomized by the many antique cars we saw on the streets. And while it is true that there are pockets of the past, they exist mostly in the architecture and the automobiles. The people I met were very much citizens of the 21st Century, in many ways poor by our standards, but in some ways rich. Those I met were doing important work in medicine, science, agriculture and the arts, despite what for us might be a crippling lack of resources. And while I remain confounded and disturbed by the harsh realities of their political system, and frustrated by their crying needs for so many of the things we take for granted here, it is the strength, warmth and talent of the Cuban people that I will recall most when I think of my visit there.
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Up next – Cuban Food. 

(Note – I initially wrote maternal mortality up there and meant to say infant mortality. Cuba’s maternal mortality rate is higher than the US’s, but they are aggressively working towards lowering it)

Endometrial Thickness in Post Menopausal Bleeding – Is 3 mm a Better Cutoff?

An abnormally thickened post-menopausal endometrium

A new meta-analysis suggests that the commonly used 5 mm cut-off for endometrial thickness on transvaginal ultrasound may be a bit too optimistic at predicting the absence of endometrial cancer in women with post menopausal bleeding. European Researchers now suggest that 3 mm is a better cut off point, below which there is a 98% reduction in the chance of having cancer of the endometrium.  A thickness of 4 mm gives a 95%, and 5mm a 90% reduction in odds of cancer.

That means if you have post menopausal bleeding (which has a 10% chance of being a cancer among all comers), an endometrial thickness below 3mm on transvaginal sonogram  reduces your chance of cancer from 10% to  0.6%, while the old  5 mm cutoff would have reduced you odds to 1%.

From what I understand, the researchers created receiver operator curves (ROCs) for each study, and them combined then, as opposed to a single ROC from the combined data, which was what had been done in the past to generate the 5 mm cutoff.  Having a pretty rudimentary knowledge of statistics, I have no idea which methodology is better, and will await commentary and guidance from those who know these things better than I.

I do know, however, that in the past few months I diagnosed two patients with endometrial cancer whose endometrial thickness was below 5 mm.  Given that no cut off value is 100% predictive, this of course was bound to happen sooner or later given how long I have been practicing, but it was nonetheless disconcerting. Interestingly, both women had endometrial thickness which would have put them above the 3mm cut off recommended in this new study.

Ultrasound as a Tool for Evaluating Post-menopausal Bleeding

I, for one, have long appreciated transvaginal sonogram as a non-invasive tool for evaluating post menopausal bleeding.

In years past, a single drop of blood more than a year after menopause meant an automatic trip to the OR for a D&C – that’s  a “dilation and curettage”, also known as a “dust and clean” to my mom’s generation. This would include women who bled from vaginal dryness, infection, blood thinners or even the occasional errant menstrual cycle, most of whom do not have endometrial cancer. That’s a lot of D&C’s.

With the advent of office endometrial biopsy, or EMB as we call it,  most women were saved the trip to the OR, trading it for a quick, but rather painful office procedure.  (If you’ve ever had an EMB, you might not consider it such a good trade off..)

Then along came vaginal ultrasound, and we were able to stop even those endometrial biopsies in all but the few whose sonograms did not make the 5 mm cutoff. The OR is now reserved for those women unable to have an office biopsy or who have obvious endometrial polyps on sonogram (which require removal to rule out malignancy, just as colon polyps require removal.)

There’s nothing more satisfying than being able to reassure an anxious woman that her bleeding is a benign process and she does not need to have an invasive test. (Of course, one must interpret the sonogram results in light of the clinical scenario., and sometimes your clinical sense tells you to biopsy regardless of the sonogram results. If it does, trust it. You just may be right, as I was with those two patients I mentioned.)

Now what?

It’s too soon to say, but I’ll be watching this one closely. If we do move from a 5 mm to a 3mm cut off, I predict I’ll be doing more endometrial biopsies in my menopausal patients, something that will make neither my patients nor me very happy.  The question of course, is how many more biopsies, and at what cost (both financial and in terms of complications such as perforation or infection)? I could not glean that answer from the paper.

But if more biopsies is what we have to do, then we will do it. Because the downside is missing a diagnosis of cancer.

And that’s something none of us wants.
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Timmermans, A et al. Endometrial Thickness Measurement for Detecting Endometrial Cancer in Women With Postmenopausal Bleeding: A Systematic Review and Meta-Analysis. Obstetrics & Gynecology: July 2010 – Volume 116 – Issue 1 – pp 160-167.

TBTAM at Women’s Health.gov

I was privileged to be the featured interview this month at the Spotlight on Women’s Health series at Womenshealth.gov, the website of the Office of Women’s Health. Thanks to the editors for their thoughtful questions and  for the opportunity to speak to women about HPV, healthy living and, of course, cooking!

Women’s Health.gov is a fabulous website that  features fact sheets on over 100 various health topics,  drug and drug interaction information links , clinical trial information, health statistics and much, much more. It’s a great first stop for any information you’re seeking on Women’s Health, whether you are a patient or a health professional. It’s a real honor to be featured on the site, especially when I read the interviews with the wonderful women who preceded me in the series.

Embrace Life

Back home, promise Cuba posts coming. In the meantime, watch this gorgeous video from the UK promoting seatbelt use. And buckle up!

Hola de Habana!

I’m here in Cuba on a concert tour with the Yale Alumni Chorus. (No, I did not go to Yale, but when you sing, you meet some amazing folks who extend some amazing invitations…)

Internet access is too unpredictable in our hotel and our schedule is too jam-packed for more than an occasional brief post, but I promise I will tell all when I return next week. I will tell you that last night’s joint concert with the small but brilliant local Coro de Camara de Matanzas was an experience I will never forget.

In the meantime, a little taste of Cuba –

Oh yeah – Zippy’s Here

Zippy* managed to get through customs (maybe he has relatives here?) and is having a marvelous time. He does want Dr Rob to teach him to drive when he gets home.

He also says to tell you all that he loves the Cuban kids – they always have a smile!

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*For those of you who don’t know him, Zippy the Lobster is a crustacean on a mission to see the world and raise money for Children’s Brain Cancer Research, thanks to the efforts of his adoptive father, Dr Rob.  If you’re reading this post, why not donate a few pesos to Zippy’s cause? Maria and Zippy raised over $200 last week when Zippy visited her in New York City. Let’s see if we can top that!

Soft Shell Crabs on a Bed of Leeks with Warm Herbed Potato Salad

It amazes me to think I spent more than half of my life not knowing that soft shell crabs existed. Seriously, I didn’t taste my first soft shell, cooked to perfection by my future mother-in-law on her stovetop in Philadelphia, until I was almost 30 years old. Today, Irene’s simple method – sauteeing flour-dredged and salt and generously peppered soft shells in butter – remains my favorite way to enjoy these amazing delicacies. Actually, I don’t cook the soft shells – Mr TBTAM does. His mom taught him, after all.

Sauteed Soft Shell Crabs on a Bed of Leeks

Mr. TBTAM may cook the crabs, but I present them. And tonight, it was on a bed of leeks, with a side of warm herbed potato salad and some sliced tomatoes. We got our crabs from Fairway, where they were so fresh, they wriggled ever so slightly if you touched them. I think these may be the last of this season for us – the shells were just starting to head towards the hard side on the edges. This short season is what makes soft shells so special.

For the leeks
4 large leeks
1 tbsp olive oil (If you can handle the calories, add also a tad of butter..)
Salt and pepper to taste
White wine to deglaze (optional)

Trim off bulb and dark green parts of leeks, then slice longways. Wash thoroughly in a bowl of cold water, rinsing and refreshing several times until all the sand and grit are gone. Drain on paper towels and blot dry. Cut in half again across and then slice very thin. Heat 1 tbsp olive oil in a large saute pan till hot. Add leeks and saute over medium high heat until softened, about 10 -15 minutes, adding salt and pepper about halfway through.  Remove leeks from pan to a small bowl. If you want, you can deglaze the pan with 1 tbsp of wine and add to the leeks. Cover with foil to keep warm while sauteeing the crabs.

For the crabs
6 soft shell crabs
1/4 cup flour
salt and pepper
3-4 tbsp butter

In the same pan, melt 2 tbsp butter. Lightly dredge the crabs in flour and sprinkle one side with salt and freshly ground pepper. Add to the pan (salted side down) and saute about 2 minutes till brown. Sprinkle a little more more salt and pepper on top before turning, then add another 1-2 tbsp butter to the pan. Cook another 2 minutes or so till done. If you do it right, this is what your soft shells will look like –

To serve, divide the leeks among the plates and place a crab atop the bed of leeks. Serve with a side of potato salad and sliced tomatoes. Split the remaining two crabs for second helpings. Serves 4.

Warm Herbed Potato Salad

12 small red potatoes (Not the teeny-tiny ones)
1/4 cup mayonnaise (Try 1/8 cup first and that may be enough for you..)
2 tbsp rice wine vinegar
1/4 cup chopped fresh herbs (I used tarragon, parsley, chives and a tiny bit of mint)
salt and pepper to taste

Clean the potatoes but don’t peel them. Slice into quarters and place in a stock pot, cover with water, add a tsp salt and bring to a boil. turn down heat and simmer till just cooked, but not too soft (about 15 minutes). While they are boiling, chop your herbs and mix them in a small bowl with vinegar and mayo. Drain potatoes, place into serving bowl, pour on dressing and toss gently.  Serve warm.

A Virtual Choir

Composer/conductor Eric Whitacre has created a virtual choir. He videotaped himself conducting, then asked singers to record themselves singing their respective parts and send it on to him. He then merged their voices and videos electronically. The end result is the amazing recording above – 185 singers making exquisitely beautiful music together.

Adding such joy to the world. That’s not virtual – that’s real.
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You can be part of Whitacre’s next virtual choir performance – no auditions are necessary, according to info on his facebook page, where he states he wants to compose an original piece and assemble a choir of hundreds, even thousands.  Watch for the announcement, either on his facebook or youtube pages, then make and send in your recording. You can be sure I’ll be sending in mine!  

Forskalin for UTI? Maybe – If You’re a Rat

A patient came into the office the other day carrying a small clipping from a reputable Women’s Health newsletter touting new research on an herbal remedy for urinary tract infections. Having recurrent bladder infections, my patient naturally was wondering if this was something she should try.

The article was entitled “Herbal Remedy Effective for Urinary Tract Infections”, and began with this startling revelation –


The common herbal extract forskolin can greatly reduce urinary tract infections and could potentially help antibiotics kill the bacteria that cause most bladder infections. 


but advised that the “popular” remedy was not FDA approved for this indication, so she should “ask your doctor.”

Googling it, I quickly discovered the research study being touted in the article – a small pilot study from 2007, in which researchers instilled a solution containing the herb Forskolin (Who thought of that name? Sounds like Foreskin…) into the bladders of lab rats previously infected with e coli, then sacrificed the rats and compared their bladders to those instilled with saline solution. Their findings – less bacteria in the forskolin irrigated rat bladders.

Needless to say, once I simply explained the research findings to my patient, she had absolutely no desire to try this untested herbal remedy.

“I’m no rat and I’m no guinea pig” she said.

Smart woman.

OBS Housekeeper’s Pulled Barbecue Chicken – From Philly to NYC

A few Fridays ago, I decided to drive down to Philly for the evening – my grade school was closing, and how could I miss the final party?

But I was having my Musical Theater Class over for our cast dinner on Saturday evening. And I wanted visit my Mom before leaving Philly on Saturday morning. How could I get it all done?

Enter my wonderful sister, the OBS Housekeeper and her amazing Pulled Barbecue Chicken!

Not only did OBS put me up Friday night, but Saturday morning while I visited with Mom, she (along with sis Basket Mom) shopped, then cooked the chicken for me to take back home to New York City, packing it in a covered aluminum tray for safe transport.  I popped it into the fridge when I got home, then whipped up some red pepper crostini, lemonade and a cucumber salad. My guests brought more sides, beer, wine, appetizers and desserts. (Thanks Ronnye and Paul for coming early and helping!) The rain held off till after dinner was over, and we had a great time singing around the piano during dessert.

Thanks, OBS and Basket Mom for making my weekend. And my party. I couldn’t have done it without you!

OBS Housekeeper’s Amazing Pulled Barbecue Chicken 

Actually, the recipe comes from Rachel Ray , but OBS makes it better that Rachel does, I’m sure. It is absolutely delicious! Serves 6-8, but adjust accordingly for a crowd. You can make it in the morning the way OBS did for me, refrigerate till ready to serve, then reheat quickly on the stovetop and you’re ready to go! Goes great with cucumber salad. 

4 boneless, skinless chicken breasts
salt and pepper
Water to cover
1 medium onion, finely chopped
4 cloves garlic, finely chopped
1 1/3 cups barbecue sauce (You can use pre-made, or make Paul’s recipe)
1/2 cup apple cider vinegar
hot pepper sauce
6 ounces mild cheddar Cheese, shredded
8 rolls

Wash and dry chicken breasts. Season with salt and pepper and place in a heavy pot with the onion, garlic. Add just enough water to cover, then the barbecue sauce, vinegar and a few drops hot sauce (more or less to taste). Bring to a boil, then reduce the heat and simmer until the chicken is cooked through, about 15 minutes. Remove the chicken from the sauce and shred with two forks.

Boil the sauce, skimming occasionally, until reduced by half, about 15 minutes. Season with salt and pepper. Add the shredded chicken and heat through. Serve in a crock pot or casserole dish with the rolls and cheese on the side. Let guests assemble their own sandwiches. Enjoy!

DrugWatch.com = Ambulance Chasers

I don’t know about the rest of you medical bloggers, but I’ve been getting emails from folks who run a website called “DrugWatch.com”, asking for reciprocal links and promoting themselves as the go-to place for patients to get up to date info on medication safety.

Tucked into the website is this promise – “We will never accept advertising from the pharmaceutical industry”.

Right. Because the whole site is a front for a bunch of Orlando lawyers trying to sniff out potential clients for medication-related lawsuits against the pharmaceutical industry.

DrugWatch.com is sponsored by The Peterson Firm, LLC, which is licensed by The Florida Bar to practice law in the state of Florida. The Peterson Firm, LLC’s main office is located at 2317 North Wickham Road in Melbourne, Florida, 32935. If you indicate to your Patient Advocate your desire to speak with an attorney about your legal rights, he or she may recommend various law firms and recommendations may include law firms from around the country including The Peterson Firm, LLC. If you decide to retain The Peterson Firm, LLC for the handling of your legal claims, The Peterson Firm, LLC may utilize experienced co-counsel (at no additional cost) to assist in the prosecution of your claims. If a Patient Advocate-recommended law firm is retained, The Peterson Firm, LLC may co-counsel and assist with the prosecution of the claim at no additional cost to the client. The Peterson Firm, LLC handles cases on a contingency fee basis, and there are no costs or fees charged to the client unless a recovery is made.

Big Pharma has their disease awareness websites. Now the lawyers have their drug side effects awareneness websites.

And the game goes on….

Gorilla Opera

Flash Brindisi – Members of the Opera Company of Philadelphia break into song at the Reading Terminal Market in Philly.

Food and music together? It doesn’t get any better than that!

Spring Supper Salad – Scallops, Green Beans & Baby Reds on Lettuce with Miso Dressing

Perfect for a light meal after a warm Saturday afternoon biking the West Side Greenway Trail. Stop at Fairway on the way home for provisions, then eat al fresco with a cold beer. Ahh, spring!

Scallop, Green Bean and Baby Red Spring Salad with Miso Dressing

The dressing is modified from Museum Cafes & Arts, a little gem of a book of recipes from museum cafes illustrated with gorgeous prints of famous works of art.  The rest of the recipe we made up ourselves. Although I’ve listed the weights of the potatoes, scallops and beans we used, you should just buy what you think you need. The dressing will serve at least 6. 

1 lb small red potatoes
salt and pepper to taste (just a tiny bit – the dressing is salty)
3 tbsp canola oil
1 1/2 lbs large scallops
Fresh lettuce
1/2 lb green beans
Miso Dressing (recipe follows)

Wash and dry potatoes well. Don’t peel. Cut into half (or thirds, however you want, to uniform size) Toss with 1 tbsp canola oil and 1/4 tsp salt and pepper. Spread on a baking sheet and bake at 400 degrees, turning halfway, for about 30 minutes, or until browned and cooked. While the potatoes are cooking, make the dressing, wash and dry the lettuce. Steam the green beans over boiling water till warm, bright green and still a bit crisp. Drain and set aside. Remove cooked potatoes to a bowl and set aside while you cook the scallops.

Heat 2 tbsp olive oil in a skillet until very hot but not smoking. Add the scallops and sauté until nicely browned, about 3-4 mins. Turn to the other side and cook one more minute.

Arrange the greens on a platter. Arrange the scallops, browned side up, on the bed of greens. Scatter some green beans atop the greens and place the potatoes on the side. Drizzle dressing over the scallops, beans and greens and serve immediately. Serves 4.

Miso Dressing

I happen to love this dressing, but if it’s not for you, make my warm tarragon vinaigrette instead.

1 tsp sugar
1/4 cup white miso
2 tbsp rice vinegar
1 tsp wasabi paste
1 tsp fresh lemon juice
1/4 cup light soy sauce
1 teensy-weensy drop sesame oil (optional)
1 1/2 tbsp canola oil

In a small bowl, whisk together all ingredients except the canola oil. Gradually whisk in canola oil.