Screening for Colon Cancer – CT Scan vs Colonoscopy

A study published in today’s JAMA comparing CT scan to colonoscopy for detection of colon polyps and cancer in high risk individuals found that CT scan slightly underperformed colonoscopy, especially in folks with GI bleeding. But overall it did pretty well.

Of 1103 participants, 937 were included in the final analysis: 373 cases in the family-history group, 343 in the group with personal history of adenomas, and 221 in the FOBT-positive group. Overall, CT colonography identified 151 of 177 participants with advanced neoplasia 6 mm or larger (sensitivity, 85.3%; 95% confidence interval [CI], 79.0%-90.0%) and correctly classified results as negative for 667 of 760 participants without such lesions (specificity, 87.8%; 95% CI, 85.2%-90.0%). The positive and negative predictive values were 61.9% (95% CI, 55.4%-68.0%) and 96.3% (95% CI, 94.6%-97.5%), respectively; after group stratification, a significantly lower negative predictive value was found for the FOBT-positive group (84.9%; 95% CI, 76.2%-91.3%; P < .001).

In an accompanying editorial it was suggested that the slightly lower rate of cancer detection with CT may be more acceptable to folks who have to have repeated studies because of high risk (with the multiple studies making up for the decreased detection rate of an individual study), and especially for those high risk patients who would choose to have nothing rather than undergo the colonoscopy.

With the majority of individuals in the United States who meet criteria for colorectal cancer screening and surveillance not undergoing recommended procedures, an imperfect test that has a lower risk profile and greater acceptance among patients seems to be an appealing solution.

In other words, if it’s a choice between nothing and a CT scan, the CT scan is reasonable. But the colonoscopy is better.

Although I am not a gastroenterologist, I did have a colonoscopy last week. The prep was one of the more difficult things I’ve done, but the procedure itself was nothing. I’ll probably have to have another in 3-5 years due to family history, and will choose the prep and colonoscopy over a CT anytime.

New York for the Locals – Movie Night in Bryant Park

Summer Monday nights in New York City are best spent having a picnic in Bryant Park while watching the movies.

Especially if you have teenage daughters and they have friends.

And especially if they all come over to your apartment after school and make chocolate chip cookies, and your husband is finished school for the year so he is home to make great baguette sandwiches and the pouring rain stops and the sun comes out just as you leave the office at 6:30 pm having seen 24 patients and still every chart is closed and every phone call returned and you stroll in the door, change into warm clothes because who would have thought it could be so cold in June, grab blankets, umbrellas (just in case) and bags of food and head to the F train, emerging a few minutes later at Bryant Park where even though the lawn is closed because it is still wet you find great seats and even tables not far from the screen and even though it spritzes a bit just before show time, the sky clears again and they are showing the Sting, it doesn’t get any better than this does it and hey, we’re drinking Newman’s Own Lemonade it must be a sign and my God they are both so handsome which one would you choose if you had the choice, I’d choose Robert, not me, it’d be Paul every time, remember that time we saw him on the street, what a loss he is gone, but what a wonderful movie this is and what delicious sandwiches and cookies these are and can we do this again next week, they are showing Breaking Away?

Mozarella and Tomato Sandwiches (Makes 8 sandwiches)

2 long sourdough baguettes ( We get ours from Gourmet Garage)
16 oz fresh mozarella, sliced
2 tomatoes, sliced
Fresh Basil
Olive Oil
Salt and Pepper
Cut the baguettes lengthwise. Drizzle olive oil on both halves. Lay the mozarella and tomato slices along two of the halves. Top with basil leaves, salt and pepper. Top with the other two halves. Cut each baguette sandwich crosswise into 4 individual sandwiches. Wrap tight for travel.

Serve with fresh olives, leftover pesto pasta and chocolate chip cookies.

_______________________________________________

This is the first post in a special TBTAM Post series. (Shhh! Don’t tell the tourists…)

An Al Fresco Lunch for Al

Al and Darcy in the garden

Al’s last words to me before he hung up his cell phone to join his wife Darcy on board the plane to New York were – “We’re expecting a delicious lunch – I’m thinking maybe something drizzed or reduced?…”

My big brother may be able to pilot a 747, but he can barely make oatmeal, and wouldn’t know a reduction if it was dripping from his nose. But he loves that others know how to cook, and he loves to eat what we love to make for him. Introducing Al to new foods is second in fun only to turning him on to interesting new movies – I sealed my reputation on the latter count when I got him to rent John Sayle’s “Lone Star”, and since then he revels in calling up to tell me about a “Peggy Movie” he has just seen. So I was psyched for Al’s visit and the chance to make him a meal he would not forget.

But what would I serve? Could I top that meal Joe and Rachel put together for Al’s birthday in Athens a few years ago? No – that would be impossible. (I think it was the wine…) Plus, we had to be at my daughter’s show by 2 pm. It would need to be something simpler.

I called Rachel to brainstorm. I had, after all, these freshly made toasted breadcrumbs. What about crab cakes said Rachel (she makes a mean crab cake…)? No, we decided – the crumbs would take a back seat to the crab. Perhaps roasted tomatoes? Too early in the season for the good ones. I had a recipe for Apple tarts that used bread crumbs – but the afternoon was going to be too warm to serve dessert.

Then I remembered that great pasta Irene had told us about, and that Paul had made a few months back. It’s light and flavorful, perfect for a summer Sunday afternoon. Go for it, said Rachel.

The weather was perfect. We ate in the garden. I served the pasta with a side salad of Mesclun greens tossed with lemon vinaigrette, a small plate of marinated artichoke hearts and sun dried tomatoes (from Costco), and some cold fizzy lemonade with mint. We didn’t exactly drizzle anything, and nothing got reduced, but there were those amazing breadcrumbs to sprinkle, and the lemonade was great. Most importantly, Al loved it.

And I love my big brother.

Spaghetti with Fried Egg and Roasted Peppers

This recipe is from Mark Schwartz, from his book Naples at the Table, via the New York Times. (Hat tip to Irene.) The original recipe is for 12 ounces of spaghetti, but I adjusted it for a full pound and upped the eggs just a tad. I was tempted to add an anchovy or two, and will the next time I make this delicious pasta.


Timing is everything in making this dish. You can roast and slice the peppers and prepare your ingredients ahead. Preheat the oven and start your pasta water boiling when your guests arrive. Then about 10 minutes before serving, do the rest. Pass the breadcrumbs and Parmesan for guests to sprinkle atop their pasta. This dish reheats beautifully the next day.


3 red peppers
1 1/2 tbsp capers
1 1/2 large garlic cloves, chopped
1/3 cup finely chopped parsley
salt
pepper
1/4 cup + 1 tbsp coarse bread crumbs
6 tbsp extra virgin olive oil
16 oz spaghetti (#10)
5 eggs
Extra toasted breadcrumbs
Grated Parmesan cheese
Roast the peppers on a cookie sheet under the broiler, turning them so they char evenly on all 4 sides. Remove to a brown paper bag to cool, then peel them over a large bowl, saving the juices and discarding the stem, seeds and skins. Slice into 1/4 inch strips and set aside. Turn the oven down to 350 degrees fahrenheit.
Combine the peppers, garlic, capers and parsley in a small baking dish. Season with salt and pepper, top with the breadcrumbs and set aside.
Preheat the oven to 350 degrees fahrenheit and start some salted water boiling for the pasta in a big pot. Just before the water boils, drizzle 3 tbsp olive oil over the red peppers and place in the oven, where they will bake for 10 minutes. Meanwhile, add you pasta to the pot and cook till al dente, scooping out some of the pasta water about halfway through and setting it aside.
Meanwhile, heat 3-4 tbsp olive oil in a saute pan over medium heat. Crack the eggs into the oil and fry until the whites are set but the yolks are still runny. (This is the hard part to get right – don’t overcook the yolks!). Remove from the heat.
Drain the pasta and put into a large warm serving bowl. Toss in the fried eggs along with the cooking oil the pepper mixture, and the pepper juices, using the forks to break up the eggs and allow the yolks to make a sauce as they cook up a bit in the hot pasta. Add some pasta water if the sauce is too thick. Season with salt and pepper and serve, passing the cheese and breadcrumbs to sprinkle on top.
Fizzy Minted Lemonade


Make lemonade by heating 1 cup water and 1 cup sugar with the juice of 4 lemons in a medium saucepan till the sugar melts. Pour into a large 2 quart pitcher with 4 cups cold seltzer, lots of chopped fresh mint, and ice to the top. Refrigerate for 30-40 mins and serve. (If you’re lazy, buy a can of frozen lemonade and make it with seltzer instead of water. Add mint and serve.)

I’ll Never Buy Breadcrumbs Again

Inspired by this wonderful video by Gourmet executive food editor Kemp Minifie, I decided to make my own breadcrumbs. I made mine exactly as Kemp did, except that I used my Kitchen Aid food processor instead of a blender – it did a beautiful job.

All I can say is – I’ll never buy bread crumbs again. Stay tuned for a great recipe for using these breadcrumbs.

Homemade Toasted Bread Crumbs
If you buy bread, and you’re like me, you’re probably wasting bread. I can’t tell you how many pieces of leftover bread I’ve thrown out over the years. Well no more. Save your leftovers or heels of the loaf in the freezer and use them to make bread crumbs. These crumbs store well in the freezer, but taste most amazing if used right away. You can toss a few fresh basil, oregano or parsley leaves before processing in if you want herbed crumbs.

Leftover Bread, cut or torn into pieces
Salt
Olive oil
Preheat oven to 350 degrees fahremheit. Place bread into food processor. Pulse till coarsely ground.
Spread the crumbs evenly out on a baking sheet and bake till golden brown – about 15-20 minutes – stirring them a bit about halfway through to assure even browning. Pour into a large bowl and toss with about 2 tbsp olive oil and salt and fresh ground pepper to taste.
_____________________________________________________
Gourmet Magazine’s Test Kitchen website has more great videos. No subscription is needed.
Cooks Illustrated also has great instructional videos, but they require a paid subscription.

Gas House Eggs

Gas House Eggs were a real favorite in my family while growing up. Eggs fried in a nest that you make by punching a hole in a slice of bread. The name is a common American mispronounciation of the term “Gasthaus”, but apparently these eggs are known by a dozen or more different names around the world

The best part of this breakfast is the small bread round that you cook alongside the egg. In my family, we called that part the “Ding-Ding”. That’s because we kids thought it looked like the Holy Host, and “Ding! Ding!” was the sound of the bells that rang whenever the priest raised the host for us to see during Mass. My kids have never been to a Mass, but they still call it a Ding-Ding.

Gas House Eggs

For each serving, you will need –

1 egg
1 slice bread (I used country white, but it’s just as good with whole wheat)
Butter or olive oil (I use olive oil these days, but butter tastes great…)
Salt and pepper to taste

Using a shot glass (who has shot glasses anymore?) or small jar top, punch out a hole in the center of each slice of bread.

Heat oil or melt butter in fry pan. Add bread to pan. Break the egg into the hole.

Add the Ding Ding to cook alongside the egg, flipping it halfway through so both side get nice and browned. Cover and cook till egg is cooked and bottom of bread is browned and crisp. (Flip the egg for once over If you like the yolk a bit more cooked.) Salt and pepper to taste. Serve hot.

If you cooked your gas house egg just right, the bottom will look something like this –

Call it what you like, I call it delicious!
___________________________________________________
More Reading on Gas House Eggs

Mrs Goundo’s Daughter

Don’t miss the Washington DC and New York City premieres of this documentary about one couple’s journey to obtain asylum in the United States in order to save their daughters from the horror of female circumcision.

Mrs. Goundo’s Daughter is the sensitively told story of a Malian mother’s fight for asylum in the US to protect her two-year-old from female genital cutting. To stay in the US, Goundo must persuade an immigration judge that her US-born daughter, Djenabou, will suffer this procedure if Goundo is deported. In Mali, where 85 percent of women and girls experience clitoral excision, Goundo and her husband are convinced they would be powerless to protect their daughter from her grandparents, who believe all girls should be excised. The film bridges Goundo’s two worlds, expertly interweaving scenes from Mali of girls preparing for an excision ceremony and scenes from Philadelphia where those who have survived the procedure share their stories.

Kudos to my good friend Janet Goldwater and her fellow filmaker Barbara Attie for once again taking on the issues of women in their documentaries. Previous films from these two include Motherless, the story of men and women who lost their mothers to illegal abortions, I Witness, the story of the Pensacola Florida abortion clinic bombings and Rosita, the story of a Nicaraguan family’s struggle to obtain an abortion for their 9 year old child, impregnanted during a rape.
____________________________________________
Mrs Guondo’s Daughter is being shown at Silverdocs/AFI Discovery Film Channel Festival in Washington DC on June 17 (12:30 pm) and June 20th (12:30 pm), and at the Human Rights Watch Film Festival in NYC on June 21 (7 pm), June 22 (4pm) and June 23 (9pm).

City Bird

>

The kids were out, Mr TBTAM was downstairs grading final exams, and I figured I was going to be spending a rainy Friday evening alone in my room. Turns out I had wonderful company till sunset.

Any bird lovers out there who can tell me what kind of bird my garden guest was? (You can’t see the bird in this video – but I was hoping someone knew bird calls and could figure it out that way…)

Oprah – I’m not a doctor, but I play a really bad one on TV

In their Newsweek Cover story whose link is entitled “Why Oprah’s Health Advice Can make You Sick“, writers Pat Wingert and Weston Kovsova have finally broken the cone of mainstream media silence that surrounds Oprah, letting everyone else in on the dirty little secret that we doctors have known for some time now – Oprah is practicing bad medicine without a licence.

Because the truth is, some of what Oprah promotes isn’t good, and a lot of the advice her guests dispense on the show is just bad. The Suzanne Somers episode wasn’t an oddball occurrence. This kind of thing happens again and again on Oprah….She has the power to summon the most learned authorities on any subject; who would refuse her? Instead, all too often Oprah winds up putting herself and her trusting audience in the hands of celebrity authors and pop-science artists pitching wonder cures and miracle treatments that are questionable or flat-out wrong, and sometimes dangerous.

Oprah’s embrace of the Woo-Woo factor in health hasn’t served either herself or her viewers. By giving her stage over to wackos like hormone-crazy Suzanne Somers and anti-vaccine nut Jenny McCarthy, while treating legitimate medical authorities as nothing more than naysayers, Oprah has behaved irresponsibly and abused the huge power that the American TV viewing public has bestowed upon her as the Queen of the daytime talk show.

Oprah’s Response

Oprah’s response to the Newsweek article is self-serving and disingenuous. She hides behind what she calls the ‘intelligence” of her viewers to sift through the crap she presents them to find what’s right for them.

For 23 years, my show has presented thousands of topics that reflect the human experience, including doctors’ medical advice and personal health stories that have prompted conversations between our audience members and their health care providers. I trust the viewers, and I know that they are smart and discerning enough to seek out medical opinions to determine what may be best for them.

I believe my viewers understand the medical information presented on the show is just that—information—not an endorsement or prescription.

Not an endorsement or prescription, Oprah? Like the woman you took to your doctor for a “hormone makeover” after touting the miracles you experienced from those same hormones? That non-endorsement?

Drs Northrup and Oz – Not just innocent bystanders

Wingert and Kosova also take on Christian Northrup, Oprah’s menopause Guru, for her new age medical opinions that are just plan bad advice. Northrup recommends iodine supplementation, unnecessary in almost anyone, and soy, which actually interferes with thyoid hormone absorption. Worse still are her theories about the causes of thyroid disease.

As she explains in her book, “in many women, thyroid dysfunction develops because of an energy blockage in the throat region, the result of a lifetime of ‘swallowing’ words one is aching to say.

When it comes to menopause, Northrup is on safer ground, in my opinion. Her book is by and large medically correct in terms of menopausal treatments, and thankfully, she does not package HRT as anything other than what it is – a pharmacologic treatment with risks as well as benefits. But any little credibility Northrup has is squandered by her failure to challenge Suzanne Somers’ outlandish claims about HRT, and her willingness to appear side-by-side with Somers in forums such as the Oprah show, giving tacit approval to the wholesale marketing of bioidentical hormones as the fountain of youth.

Like Northrup, Dr Oz sat by unquestioning while Suzanne Somers and Dr Hall have spouted incorrect medical information.

One could argue that Oprah is the victim of bad advice from these two doctors, whose need for her endorsement has led to their unwillingness to challenge her in public. But I disagree. What would happen if Dr Northrup Or Oz were to actually argue with Suzanne Somers on Oprah’s show? I’ll tell you what – they’d get relegated to a seat in the audience along with the rest of the good doctors who dare to speak the truth to the emperor. Oprah would find some other quack to sit next to Suzanne Somers while she spews her fallacies. Don’t kid yourself. This is, after all, the woman who gave the entire CDC a whopping 30 second written statment in response to Jenny McCarthy’s anti-vaccine nonsense.

No, Oprah is no victim here – she is utterly in control.

Should Dr Oprah be Sued for Malpractice?

I think it’s time Dr Oprah deals with what every other doctor in America has to deal with – a malpractice case. In fact, I’m shocked that someone hasn’t sued her by now for an adverse outcome related to a treatment she has touted (or in the case of vaccines, advised them to avoid). Here’s one suit she may have narrowly avoided –

In March 2007, the month after the first two shows on The Secret, Oprah invited a woman named Kim Tinkham on the program. She had been diagnosed with breast cancer, and her doctors were urging surgery and chemotherapy. But Tinkham wrote Oprah to say that she had decided to forgo this treatment and instead use The Secret to cure herself. On the show, Oprah seemed genuinely alarmed that Tinkham had taken her endorsement of The Secret so seriously. “When my staff brought this letter to me, I wanted to talk to her,” Oprah told the audience. “I said, get her in here, OK?” On air, Oprah urged the woman to listen to her doctors. “I don’t think that you should ignore all of the advantages of medical science and try to, through your own mind now because you saw a Secret tape, heal yourself,” she said. A few weeks earlier, Oprah could not say enough in praise of The Secret as the guiding philosophy of her life. Now she said that people had somehow gotten the wrong idea. “I think that part of the mistake in translation of The Secret is that it’s used to now answer every question in the world. It is not the answer to all questions,” she instructed. “I just wanted to say it’s a tool. It is not the answer to everything.”

While Oprah did the right thing and brought that woman onto her show to tell her to get to a conventional doctor, are there women who missed the follow up recant? How about those women out there taking hormones without being advised of their risks, or failing to vaccinate a child who subsequently becomes ill from a vaccine-preventable disease?

Maybe some clever lawyer will see dollar signs in Newsweek’s cover and get a class action suit going on behalf of Oprah’s viewers whose trust she has betrayed. After all, those are some deep pockets there at Harpo Productions.

I wouldn’t hold my breath.
____________________________________________________
Previous posts about Oprah on this blog

The medical blogsosphere take on Oprah

The Prospect Park Bike Loop – Bet You Can’t Do Just One…

My newest fave place to bike ride is Prospect Park in Brooklyn.

Prospect Park is to Central Park as Brooklyn is to Manhattan. (Well, was – before some parts of Brooklyn got almost too hip for themselves.) Same great Olmstead bones, just as beautiful but a little less polished and manicured, even a bit tousled in places, filled with real folks doing real things, all of it less like a movie set and more like real life.

The Park is flanked by Grand Army Plaza and Park Slope in the north, the Botanical Garden and Brooklyn Museum of Art to the east, and the south? well, between 3 and 8pm on Sundays, that’s the best part of all, as musicians gather in Drummers Grove to strike the beat of a Caribbean/African drum to drive you on your way as you bike the 3.35 mile loop just one more time…

As far as a work out, the Prospect Park Loop is a good one. Heading South from Grand Army Plaza (that’s counter clockwise on the loop) are some lovely downhills on the Western slope mixed with a few straight stretches and strategically placed water fountains.

The south loop is flat and skirts the lake and then heads north again at Drummers Grove. (Careful – there’s a short stretch at the bottom where cars are still allowed on weekends.) Then the road heads on a wonderful uphill – Wait- Did I just say wonderful uphill? – I did, and it is! A moderately long, nicely curving hill with a low mid section for relief before heading up the bit steeper upper section that plateaus out just as you are starting to think that your legs might be hurting but is never too steep to stop the conversation. Ending with a rolling north section that energizes you for just one more loop around….

Go ahead – Try it. You’ll want to do at least two, and maybe even three loops as we did – it’s that much fun. Maybe combine it with a trip to the Brooklyn Museum or Botanical Gardens, or with lunch in Park Slope, or if it’s Saturday, a visit to the Farmer’s Market at Grand Army Plaza. Better yet, if it’s Sunday, grab an early dinner from the Caribbean food carts at Drummer’s Grove and enjoy the music before heading home.

I can’t think of a better way to end a weekend.

______________________________________________

Suggested Links

Vitamin D Deficiency and Bacterial Vaginosis – Causality or Guilt by Association?

Bacteria-coated vaginal epithelial cells in Bacterial Vaginosis

In a recent study sure to get a lot of media play, researchers have found an association between low vitamin D levels and the vaginal infection called bacterial vaginosis in pregnant women.

Bacterial vaginosis (or BV for short) is the most common vaginal infection in women, and in pregnancy has been linked to premature labor and delivery. Despite this, interventions to diagnose and treat BV in pregnancy have had only modest impact, and then only in the subgroup of women with a history of previous preterm birth.

The results of this study, if confirmed in larger trials, would suggest that vitamin D deficiency may be the cause for bacterial vaginosis in pregnancy, and that supplementation of this vitamin might be worth investigating as an intervention to prevent preterm birth.

It’s an interesting idea, but just a hypothesis at this point. Although the study is well-done, it does not prove causality. Both BV and vitamin D deficiency are incredibly common conditions, both in pregnant and non-pregnant women. To find them together in the same patient would not be unexpected given their relatively high frequency in general. (In this study, almost half the women had BV – that’s a very high incidence.)

On the other hand, the researchers did find a dose-response relationship between vitamin D levels and BV incidence, and that would support a real effect rather than mere association. Interestingly, vitamin D deficiency has also been linked to periodontal disease, another condition that is found to be associated with preterm labor and delivery.

The most intriguing aspect of this study lies in the fact that all three conditions – vitamin D deficiency, preterm birth and BV – occur more often in African American women, individuals whose darker skin requires longer sun exposures to convert vitamin D to its active form. Preterm labor in this group has been especially hard to explain because this increased risk is independent of socioeconomic status. Could Vitamin D deficiency in African American women be the common factor that explains this increased risk? Wouldn’t it be neat if correcting that deficiency were to prevent preterm labor and delivery?

Unfortunately, most things in medicine these days don’t present solutions that are so neatly packaged as this one. Not to mention the fact that BV was present in almost a quarter of the group with the highest vitamin D levels in this study, which would argue that something other than vitamin D is at play. So while it is intruguing, it is much too soon to jump on this bandwagon. But I will be watching the parade closely.

By the way, most prenatal vitamins carry about 400 IU of vitamin D. Emerging data are beginning to suggest that higher doses of vitamin D may be necessary, but this remains controversial. I am comfortable recommending vitamin D supplementation doses up to 800-1000 IU daily in my non-pregnant patients. These doses are safe, and in my experience, usually result in vitamin D levels in the mid 30’s ng/dl.(equivalent to the highest levels in this study). If you are pregnant and have questions about vitamin D, it’s best to talk to your doctor before going above current dose recommendations (200-400 IU daily).

Chicken with Artichokes, Sun-dried Tomatoes and Capers

I take absolutely no credit for this dish, but will accept thank you’s for the photo. Mr TBTAM created and prepared it, inspired by ingredients he found at Fairway tonight, with added ideas from recipes he found on the web.
He prepared this while I was off riding the Central Park loop after work this evening. By the time I got home, everyone had eaten and cleaned up, but they made sure to leave some out so I could get a good photo and a taste. I couldn’t eat more than that because I’m back on my food delivery diet (down 40 lbs total, thank you very much…) and I had my own meal waiting for me. But this was tasted so wonderful that I made Mr TBTAM promise that we could make it again this weekend when we will be away at the cottage and I will be off the delivery food (but still on a diet).

Chicken with Artichokes, Sun-dried Tomatoes and Capers

What makes this dish great is great ingredients. We used marinated artichoke hearts from Costco and the sundried tomatoes and capers are from Fairway Market. You can add some lemon juice to the broth/wine part, and some chopped parsely at the end if you like. We didn’t have any, so we didn’t. These are the amounts we used, but you can play around with the various ingredients to fit your taste – we love capers, but maybe you would use a little less, or cut back on the artichoke hearts, and so on.

3 chicken thighs
3 chicken legs
2-3 tbsp Canola oil
flour for dredging chicken
Salt and pepper
5 artichoke hearts, quartered
7 sun dried tomatoes, ,julienned
1/4 cup capers
1/3 cup chicken stock
1/3 cup white wine
juice of one lemon

Preheat oven to 350 degrees Fahrenheit.

Rinse chicken and pat dry. Season flour with salt and pepper in a flat bowl or plate. Dredge the chicken pieces in the flour, shaking off the excess.

Heat oil in a large oven proof skillet and brown the chicken on almost highest heat, 5 minutes per side. Put skillet in oven and bake for 20-30 mins till chicken is done. Remove chicken to a serving plate.

Pour off most of the excess fat from the skillet, place it back on the stove and add the stock, wine and lemon juice to deglaze the pan, scraping up the good bits with a spatula. Bring to a boil and cook down – it will thicken up nicely with the dregs of flour that are in the pan. Lower heat and add artichoke hearts, capers and tomatoes and cook for another minute or so. Pour over the chicken on the plate and serve.
______________________________
Recipes that inspired this dish

Proud Parent Moment, New York Style

Well. That was fun.

Eldest daughter won her high school’s drama award, which in this town means you get to go to the Drama Desk Awards ceremony with your parents and get your scholarship presented to you by Brian D’Arcy James, the star of the Broadway production of Shrek. Not to mention share your school auditorium stage with the likes of Harvey Fierstein, Liza Minelli, Stockard Channing, John Lithgow, Geoffrey Rush, Victor Gerber, Jane Fonda, Audra McDonald and Angela Landsbury (just to name a few).

Congratulations, honey – We are so proud!

The other moving moment tonight was seeing Laguardia alumnus and Pulizer prize winner Lynn Nottage return to her alma mater to receive the drama desk award for her play Ruined.

The most inspirational moment was when Angela Lansbury, age 83, danced across the stage to accept her award for best feature actress in a musical (Madame Arcady in Blythe Spirit), reminding us that age is just a number.

The gayest moment was a toss up between Carson Kressley’s monologue and when Cheyenne Jackson kissed James Donegan, the actor who spoofed him in Forbidden Broadway, full on the lips, saying “I always wondered what it would be like to kiss myself”.

The funniest moment was when Alison Janney, who won the award for best actress in a musical, slapped herself across the cheek to remind herself that she was in a musical, not a play.

The only disappointing moment was when I realized that Audra McDonald, who presented several awards, was not going to sing. Actually, there would be no production numbers or entertainment other than the awards themselves. It was a very low key and low budget ceremony that felt, well, just about right for theater in a recession. As a result of this, and the fact that a fair number of award recipients (such as Elton John) were not present to make acceptance speeches, host Harvey Fierstein was able to congratulate us on the historic completion of an awards ceremony in under two hours.

Afterwards, in a real New York moment, we rode the crosstown bus where we had a nice chat with the President of the Drama Desk and the producers of Hair (who also won tonight – congrats ladies!).

Congratulations to all the nominees and winners of this year’s Drama Desk Awards, the prize that doesn’t care if your play is Broadway, off-Broadway or off-off Broadway, how big your audience is or how much money you bring in – if it’s great theater, it’s great theater.

And as for the rest of you – Get out there and see some theater! There are some amazing productions up this year.

I Love My New Lamps (and I love IKEA)

This is not a design blog, and I’m not plugging products for profit, but I just have to tell you about these 365+ Lunta lamps I got last week at IKEA. I am so in love with them!

These are incredibly solid, functional and most importantly for those of us with New York City apartments, they fit into narrow spaces. In my case, that’s next to the den sofa where my previous lamps’ shade dimensions precluded opening the closet door all the way. (Guess I’ll have to come up with another reason now for why that closet is such a mess…)

These lamps give great light, can officially handle up to a 100 W bulb (as opposed to me using the 100W even though they say don’t use anything higher than 75W and feeling nervous that I am going to blow it up or start a fire) and the switch (which is easily reached about halfway up the lamp) is also a dimmer!  With a price tag of $99 apiece, they out-function, out-style and outshine every other lamp I have ever bought, some which came at a much higher price tag.

Of course, all of this could just be me over-reacting to the fact that I no longer have to crawl next to the sofa to pull or put the plug out of or into the surge protector, which was how we were turning our previous lamp on and off since the switch broke over a year ago …

_________________________________________________________________________

UPDATE- We have had to replace each lamp once since I posted this, due to spontaneous shorting out of the bulb. We had the electrical outlet changed, use a surge protector and it still happened again. Our building insists it is a lamp issue and not an outlet problem. I have no idea which it is. If anyone else has had similar issues with these lamps, let me know. To Ikea’s credit, they replaced the first one free of charge, but we were on our own the second time. 

Ovaries – If they’re Normal, Leave them Alone


That’s what I’ve been telling my patients for years. And I will continue to say it after reading the results of a recent study comparing long term health outcomes in women whose ovaries were removed at time of hysterectomy for benign disease to those whose ovaries were left in place. The study found that women who had oophorectomy (removal of the ovaries) had an increased risk for death from cardiovascular disease. How high?

With an approximate 35-year life span after surgery, one additional death would be expected for every nine oophorectomies performed.

That’s a significant risk, I’d say.

As expected, women whose ovaries were removed had a lower risk of ovarian cancer, probably the most common reason some doctors give for removing normal ovaries at the time of hysterectomy. But this benefit was far outweighed by the cardiovascular risks conferred by removing the ovaries.

A surprising new finding in this study was an increased risk of lung cancer in women whose ovaries were removed. There is not obvious biologic reason for this, so it remains unexplained (and could be a statistical aberration).

The overall study findings were not surprising

Previous studies have found that removal of the ovaries confers increased risk of death from cardiovascular disease, which also occurs more frequently in women who undergo premature menopause. A decision analysis published in 2005 using data available at that time suggested age 65 as the cutoff for leaving the ovaries in place, since after that age, there was no added benefit. This more recent study suggests there should be no upper age limit.

What I found interesting in this study was that removal of the ovaries at the time of hysterectomy for benign disease did not appear to confer protection against future ovarian in women with a family history of ovarian cancer. This stands in direct contrast to well done prospective randomized data showing a clear benefit to prophylactic oophorectomy in this group. The authors suggest that their findings support a benefit from hysterectomy alone in preventing ovarian cancers, perhaps from a disruption of the influx path for potential carcinogens or changes in hormonal or triggering pathways. This would suggest that a randomized trial of hysterectomy without oophorectomy in women at high risk for ovarian cancer might be in order. (Currently, when prophylactic oophorectomies are done, the uterus is frequently kept in place.) It’s an interesting idea, but one that would need to be well-studied before suggesting anything other than current practice for these women.

Is there ever a reason to remove the ovaries?

Absolutely. If a woman has cancer of the ovary, the risk for death far, far outweighs any benefit to leaving the ovaries. (The exception is the young women with very early stage unilateral or borderline ovarian cancer – more limited surgery is generally offered to these women.)

Uterine cancer is also an indication for oophorectomy. Again, exceptions are often made in premenopausal women with early stage uterine cancers, and some of these women are being treated hormonally rather than with surgery. It will be interesting to see if anyone uses these study findings to recommend against removal of the ovaries in older women with very early stage uterine cancer.

I find the more difficult women to counsel are those having a hysterectomy for endometriosis with ovarian involvement, or for pelvic abscess or adhesions trapping a normal ovary and causing severe pain. For these women, the risk of continued pain and stress related to it, as well as the potential risks for additional surgery needs to be weighed against their risks for cardiovascular disease. The stress associated with chronic pain should not be minimized. For some of these women, removal of the ovaries may continue to be appropriate.

What if you’ve had your ovaries out?

It’s important to remember that oophorectomy is not the only modifiable risk factor for heart disease – diet, exercise, and treatment for underlying conditions such as hypertension and elevated cholesterol are just as important (and may be even more so). There is still an awful lot you can do to be sure you maximize your odds of beating heart disease as you age.

Oophorectomy is not the same as a hysterectomy

Hysterectomy is removal of the uterus. Oophorectomy is removal of the ovaries. Other than the risks associated with having surgery itself, hysterectomy alone does not confer an increase risk of mortality, and, unlike oophorectomy, does not increase long term heart disease risks. For many women, hysterectomy remains an important option for treatment of benign conditions such as uterine fibroids.
__________________________________________
Image from Wikpedia Commons

Family Brunch – Jewish Style

It’s a meal I never get tired of – the fish brunch. It’s the family meal you have when everyone gets together on a weekend morning, either for Mother’s Day (like today) or someone’s birthday, or just because you’re all in the same place at the same time.

I suppose every Jewish family has their version of the fish brunch, and this is Mr TBTAM’s family’s –

  • Nova (that’s the good lox)
  • Sable (if you’re lucky)
  • Whitefish salad
  • Creamed herring with onions (and/or chopped herring)
  • Cream cheese (plain or with chives, sometimes both)
  • Bagel (like fish, the plural is the same as the singular, and sometimes preceded by the word “the”)
  • Sliced tomato and onion
  • Kugel (homemade only)
  • Olives
  • Sometimes blintzes instead of kugel, but usually just kugel
  • Lots of coffee and orange juice.

In the past few years, we’ve added an amazing item to the meal – lobster salad from Sable’s. Of course, it’s not Kosher, but neither is Mr TBTAM’s family. And I’m telling you, the stuff is like heroin…

Today we also had Nancy’s homemade yogurt (excellent with the kugel) and ginger cake with whipped cream for her birthday. If it’s one of the kid’s birthdays, it’ll be the chocolate chip cake. And if it’s Mr TBTAM’s birthday weekend, they’ll be a sour cream coffee cake instead of the Kugel.  (One of these days I’ll have to post that sour cream coffee cake recipe…) A little fresh fruit is nice too.

How to make a fish brunch

You’ll need a supplier of fine fish. Sable’s and Russ & Daughter are our faves, but if we lived on the Upper West Side, it’d be Zabar’s or Barney Greengrass. If you’re in Philly, head to Abe’s & Sons. (Irene – feel free to add more recommendations in the comments.) If you decide to branch out and experiment with a new fish supplier, be prepared to discuss the relative merits of their whitefish salad compared to others you have known.

You’ll also need great bagels. For us, that’s H&H or Hot&Fresh Bagels or better yet, have Irene bring them up from Rolings Bakery in Philly. But bagels are a very personal thing, and you should buy the ones you love the best.

Finally, you’ll want to have a knock-’em dead recipe for Kugel. Make it that morning so it’ll still be warm when you serve it.

Serving the fish brunch

You’ll be serving everything except the dessert cake family style. Arrange the sliced Nova and sable nicely on a big platter. Warm the bagel in the oven and slice before serving them up in a big bowl. Cut the kugel into little squares and serve on a pretty plate. Serve the whitefish and lobster salads, herring and cream cheese in their plastic containers. (If it’s a special occasion, you can serve them in nice little bowls, but don’t get too carried away.) Bring out the coffee pot and OJ and call everyone to the table to eat.

Take your time eating, and be prepared to be asked repeatedly to pass something or other. Save some lobster salad for someone else.

Serve the birthday or coffee cake after you’ve finished eating, cleared the table and sat around drinking coffee for awhile. You’ll slice the cake up and serve everyone on a nice little plate. Have some more coffee

After the fish brunch

Clean up is easy. Put your dirty dishes in the dishwasher, wrap the fish well and distribute leftovers if anyone is heading out. If you’re still staying together for the afternoon, plan something nice to do together.

But don’t stray too far from a fresh water supply – you’ll be thirsty.