London 6 – An (Almost) Perfect Day in London

If you are in London on a cold, sunny Saturday in early January, then this is where you must go and what you must do (and in this order) –

1. Visit the Portobello Road Antique Market

Get there early, say by 9 or 10 am, to beat the crowds. Take the tube to Notting Hill Gate and follow the flow of people – you’ll find it, it’s not far.

Today, we’re only doing the antique part of the market. (If you want to give it a whole day, you can do the whole thing. It’s fun. ) This means you will need a plan. The plan is to do the right side of the road first, then when you hit the green market stalls, you’ll know you are at the end of the antique section of the market. Turn ’round and head back up the other side – it is the better side, with gallery after gallery filled with stall after stall of antiques.

Make sure that you walk through each and every market or gallery (and there will be many…)

Enjoy looking at all the wonderful antiques and talking with the dealers, who have time to talk since it is very cold today and the market is not as busy as usual. There is so much to see. Do your best to see it all.

Do not buy a pith helmet. But do take a picture of it, even though they don’t seem to want you to.

When you start to get tired, have a coffee and a sit at the downstairs cafe with the dealers at the Admiral Vernon Antique Market .

Make sure to find one or two things that you love, and buy them. (I happen to love old African and Asian antiques, so I got a wooden statue from Tonga and an old ceremonial cloth from Bali, but you should get what you like).  Sadly, you will not be able to buy everything you want, including that nifty ceremonial headdress, because some things are just too big to take home on the plane.

Keep walking, and looking, and sometimes buying.

By now, you are getting a bit peckish. Have a sausage or a crepe at one of the many stalls lining the market. Even so, you will still have to stop at the Hummingbird Bakery.

There, you can get two cupcakes for later, because you know you will want them at some point. (We got Nutella and Carrot cake cupcakes, but you should get whatever strikes your fancy.)

You are almost done. Just another block or two of wonderful things to see. The crowds have gotten much thicker, just in time for you to head on. If you like, you can stop and get some shoes or second hand clothes on the road back to the tube stop.

No time to stop at Arancina , but what a cute little cafe! (Hmm, next time maybe you should have lunch there instead of a sausage…)

Take the tube to Charing Cross Station and walk to Trafalger Square.

2. Trafalger Square and the National Gallery

The steps of St Martin in the Fields provide a great place to watch the crowds. Stop downstairs below the Church and get tickets for tonight’s concert. (Don’t worry – the rest of the tourists will be at Jersey Boys or Spamalot – You will be able to get tickets at the last minute.)

Now head into the National Gallery . Check your bags and coat – you’re tired! (Don’t worry – there are plenty of places to sit while looking at the paintings.) Wander through the galleries, using the museum’s map to find your faves. It’s almost like a treasure hunt! Make sure you see the Camara Obscura in the same room with Vermeer’s paining of the Girl at the Piano.  And Van Gogh’s Sunflowers. And the Gaughans. And the Renoirs. And the Cezannes….

Oh yeah, and the gift shop….

3. Dinner and bronze rubbings at St Martin’s Crypt

Now you are really tired. But that’s okay – we’re done walking for today. Head back over to St Martin’s Crypt. Do a brass rubbing. Visit the gift shop. And have dinner in the Cafe in the Crypt . A little odd, perhaps, supping over gravesites, but hey, this is London and the food is fine. (By the way, they also have lunchtime concerts in the crypt if you decide to come at a different time.)

When you’re done, head upstairs for your concert.

3. Concert at St Martin in the Fields

If you are lucky, it will be a chamber concert of violin music by Mozart, Vivaldi and Bach. Or something equally as wonderful. The kids read their books and sketch while you listen to the music.  It gets very cold at intermission when they throw open the doors to the outside so you may want to head downstairs for a cup of herbal tea and those cupcakes you bought earlier. Or perhaps you already ate them. Oh well…

Do you like that wacky stained glass window? It’s been called  “a gynecological” rendering. I guess they’re referring to the vaginal-type light filled opening in the middle. I like it. Very futuristic for such an otherwise simple old church.  Here’s a better photo .

4. The way home

You’ve had a wonderful day and an even more lovely evening.

Do NOT ruin it by refusing to speak to your husband because you are cold and want to take a cab home and he wants you to take the tube. And definitely do NOT refuse to help him find the tube stop on the map because you are still mad and since he’s Mr Subway Guy he should know where the tube stop is, right? If you do do these things, then you must offer a make-up kiss on the subway home. Don’t worry – It will work.

However, if I were you, I would instead do what we did the night before and take a long double decker bus ride home.

Then it will have been a perfect day.

Portobello Road

London 5 – New Year’s Eve Dinner

We celebrated with a dinner and terrace firework watching at our apartment in London (Thanks again, Val – Don’t forget to come to our place soon!). We picked up provisions earlier that day at the Borough Market. The fact that we were going straight from the market to the theater limited our purchases to non-perishables, so we chose to make a mushroom risotto the main course, with assorted cheeses and dried meats for appetizers. I think we did pretty well under the circumstances.

Appetizers from Borough Market

The cheeses are Spenwood, a goats mild cheese made by Anne and Andy Wigmore in Eisely, and  a Gorwydd Caerphilly made by the Trethowan Family in Wales, both purchased at Neal’s Yard Dairy. (Click the cheese names for more info about the cheese makers.) The wonderful Balsamic Fig Sauce comes from Apulia Blend. I don’t know the name of the stall where I bought the salamis, but they were delicious.

And how about those cheesticks? They’re called “Red Leicester Cheese Straws” and they’re from the Flour Power City Bakery stall at the Borough Market. Like air they are. Look how light – What I’d give for that recipe…


Mushroom Risotto with Thyme

For this entree, I used mushrooms and herbs bought at the Wild Mushroom Company in Borough Market. The recipe is a basic risotto, with a few additions such as thyme and mushroom stock.

4 tbsp butter
2 tbsp olive oil
1 lb assorted mushrooms, sliced thin (I used chantarelles, cepes from South Africa and button mushrooms from France)
1 medium onion, diced small
2 cloves garlic, chopped fine
2 tbsp chopped fresh tyhme
1/2 cup white wine
2 cups risotto rice
4 cups chicken broth
1 cup mushroom broth (I used a dried mushroom stock cube, but you can make your own from dried porcinis, straining the stock before using and chopping the porcinis to add to the mushrooms)
1/4 cup grated parmesan cheese
1/4 cup chopped fresh flat-leaved parsley
Salt and pepper to taste

Combine the broths and heat to boiling, then turn down to a low heat to keep warm.

In a large heavy pot (I use a le Cruset French Oven), melt 1 tbsp butter with the olive oil over medium high heat. Add the chopped onion and saute till soft and translucent. Add the mushrooms, garlic and thyme and saute, stirring frequently, till the mushrooms give off their water and just start to brown. (About 10 minutes).Add the rice and stir, cooking for 2-3 minutes till it is opaque. Add the wine and stir till evaporated (about a minute).

Now turn down the heat a tad and begin adding the hot stock to the rice, a laedful or two, and stir. Continue stirring and adding the stock a ladleful at a time, waiting until the liquid is absorbed each time before adding more, until the rice is tender and creamy yet still a little al dente.

Remove from heat. Stir in the remaining butter, then the parsley and parmesan cheese. Season with lots of fresh ground pepper and a little salt. Serve with a side green salad and sauteed root veggies (recipe follows).

Sauteed Root Vegetables with Salsify

I discovered Black Salsify at the Wild Mushroom Company at Borough Market. The propietor suggested I treat it like a root vegetable, so that’s what I did, combining it with a few gorgeous carrots, leeks and fennel I found at the same place.

Salsify is sometimes called “Goat’s Beard”, which I suppose describes what the small roots look like coming off the end of the stalk. (This is black salsify – there are other types as well.) Salsify is also called  Oyster Plant because of it’s flavor when cooked. In this dish, that flavor did not come through, probably because of the stronger flavors of the carrots and fennel that accompany it. I’ve seen recipes for sauteed salsify with apple, and if I ever find salsify again,  that’s the recipe I will try.

You need to peel salsify before cooking it, after which you keep it in water with a little lemon juice to prevent it from turning color before cooking it.

1/2 lemon
Large bowl of cold water
3 salsify roots, peeled and julieened
2 large carrots, peeled and julienned
1 large leek, halved lengthwise, rinsed, sliced again lenghtwise and the into 2-3 inch strips
1 medium fennel bulb, sliced into thin strips 2-3 inches long

Squeeze the lemon into the cold water. Peel the salsify, then julienne. Keep in cold water till ready to cook, then drain and blot dry before cooking .

Slice the leek lengthwise and rinse well in cold water. Drain. Cut across the length, and then again lengthwise. so you have strips about 2-3 inches long.

Melt butter in heavy skillet. Add carrots, fennel and salsify, and saute over medium high heat till just softened. Add leeks and continue to saute till soft and veggies start to brown. Season with salt and pepper and serve.

London Diary 4- Borough Market

If you are lucky enough to have a kitchen while visiting London, you must visit the Borough Market for provisions for a great meal. On second thought, even if you don’t have a kitchen, you still have to visit. You’ll have to be content with just eating the fabulous food from the stalls or surrounding cafes.

Think Union Square Greenmarket mixed with Reading Terminal Market, add in the ever-chiming bells of the Southwark Cathedral and the hum of the trains heading over London Bridge overhead and you’ll get an idea of what a marvelous experience a visit to London’s Borough Market can be.

Our first stop, Neal’s Yard Dairy.

Neal’s Yard sells cheeses from farms all over the UK. Because many of the farms are too small for a cheese-making operation, Neals has their own aging rooms at their central warehouse. Every cheese is labelled with the name of the farm and its owners from whence it came. I purchased the Spenwood and Caerphilly.

On to the Wild Mushroom Company, where our main course is inspired.

and where I found these babies:

and saw some beautiful fruits and veggies.

This is salsify, which the stall keeper tells me is a tasty root. I’ll try it!

Let’s wander some more, shall we?

Boar Pie, anyone? No? How about pheasant?

Okay, then how about some Ostrich Salami? Try it! It’s French!

No? Okay, we’ll just get some more mundane pork salamis. And balsamic-fig syrup to serve with the cheeses. (Can you visualize tonight’s appetizer plate yet? Wait till you see the cheese sticks I got!)

Hungry yet? Let’s have some freshly made fish curry. (It tasted great!)

We’ll try to be good and pass up the truffles.

But maybe just some dried fruit and chocolate covered nuts for the Theater later…

We need to make a matinee, so there’s not enough time for bread and jam at the Monmouth Coffee Shop. (Put it on the list for next trip).

Unfortunately, the Market had only limited hours and not all the stalls were open on New Year’s Eve, plus the Raclette Guy was off. But you can see more photos and get more info about the market by browsing the links below.

Tomorrow’s post – What we made with what we bought…
_________________________________________________________

Borough Market Links

The best of Borough Market  (according to Enrica Rocca)
Borough Market Website
Borough Market Vendor Map
London Eater has has a Two Part post on Borough Market.
Great pics from Not Another Big Menu
A nice Flicker Set of Borough Market photos
Liz does the Borough Market

Using the FRAX in Clinical Practice

This post is in response to Jane Brody’s recent NY Times article on the FRAX fracture risk calculator. FRAX is a clinical decision tool devised by the World Health Organization that allows physicians to account for the myriad of risk factors, including bone density, to determine a patient’s risk for osteoporotic fracture.

Now about 20 years into the practice of medicine, I have evolved from what they call an “early adopter” of new drugs, through a time of cautious use of new drugs, to what I am now – highly skeptical of most new medications and suspicious of Big Pharma, medical thought leaders and anyone else trying to “educate” me about a disease. I am also disappointed in my medical societies for failing to cut the ties between themselves and industry, but hopeful that we are slowly but finally starting to emerge from of an era of industry-dominated health care and into a time of patient-centered medicine.

Case in point – Treatment of Bone Loss.

I used to prescribe a fair amount of medication for treatment of bone loss, having fallen victim, I am ashamed to say, to the Big Pharma’s commandeering of medical education on Osteoporosis, with all the so-called experts telling us all that Osteopenia was a treatable medical condition rather than an arbitrary research category. (The story is one that should go into the Hall of Shame for medicine, and I encourage you to follow the link to NPR’s fabulous article about it.)

These days, I prescribe meds much less often for bone loss. With the help of the FRAX fracture risk calculator, I’m able to determine which of my patients with osteopenia are at significant fracture risk and require treatment (very few, it turns out) and which ones can be adequately managed with lifestyle, calcium and vitamin D (most).

I’ve been using FRAX for almost two years now, and find it to be an extremely helpful and objective tool. With it, I can calculate a person’s risk for fracture in the next 10 years. Then, using the WHO or National Osteoporosis Foundation guidelines for treatment, I treat only those with risks high enough to warrant medication. (I’ve also been screening for and treating vitamin D deficiency in a large number of women, giving me a non-pharmacologic treatment option for bone loss that is welcome by my patients.)

FRAX is not an entirely perfect tool. For instance, FRAX does not account for high risk medication other than steroids. For women taking drugs such as aromatase inhibitors, therefore, I fudge the FRAX by checking off the “steroid use” box. It’s not a perfect fix, but it’s not a bad one, either. Another fracture risk assessment tool called QFracture is under investigation as an alternative that may address some of FRAX’s limitations.

Despite its limitations, FRAX is a more than adequate tool in my clinical practice. I find sitting down with my patients and doing the FRAX together serves as great education for them and brings us together into the realm of joint decision making. I do the FRAX with them when they come in to have a vitamin D level checked – that’s a test I do routinely in women with low bone mass before deciding on any course of management. The FRAX only takes a few minutes to do, and my patients can take a print out of the results home along with their bone density results.

My major issue with the FRAX is that it seems to be a proprietary site. The FRAX tool is not integrated with any medical record system that I know of, which means I have to head to the FRAX site every time and enter information that already resides in my chart. This, I believe, limits use of the FRAX use and I would encourage the WHO to find ways to integrate FRAX into online EMR systems. Integrating FRAX results into bone density reports would also go a long way to increasing the use of this important clinical decision making tool. (I believe the NOF has made recommendations to radiology practices on how this should be done.)

By the way, in the NY Times article, Jane Brody describes FRAX as a “controversial” tool. I have not seen any controversy over its use. The National Osteoporosis Foundation appears to have embraced FRAX (actually, it was from them that I first learned about FRAX). The controversy lies in deciding if and when to treat bone loss. Like the mammogram controversy, the question is one of balancing potential harm (in this case, side effects of medication) with benefit ( lowering of fracture risk).

London Diary 3 – The Food so Far

As much as I wanted this visit to be a gourmand’s tour of London, my kids refuse to have their eating itinerary dictated by Mom’s must-visit restaurant list. They value spontaneity and self-discovery above all else in their dining experiences. As long as they are in on the choice, they will love the meal, whether we eat at a local hole-in-the-wall with a family-run kitchen or a tourist trap Italian eatery in Covent Garden.

Fortunately, we’ve eaten well for the most part. While I wouldn’t make a special trip just to eat at any of the following places, if you find yourself in the neighborhood, you won’t go wrong to stop in. (I’m leaving out the Covent Garden eatery – you’re on your own in that neighborhood. Good luck.)

Our local spots here in Putney Bridge include –

The River Cafe. A throw-back restaurant with a family-run kitchen, original tile walls, formica table tops and home-cooked food. Has a Barney Greengrass kind of feel, without the lines and with immigrant Brits behind the counter (The cook, an older gent, seemed to have some sort of French accent). If you go in for retro dining, as we do, this place may well be worth a special visit.

Cafe NuNu. An adorably funky little place with a casual hippie feel and excellent croissants (not so easy to find in London). Think East Village 10 years ago. Dinners look interesting, in an early Moosewood kind of way – though it is not vegetarian, you get my drift.

Gourmet Burger Kitchen – a fabulous slightly upscale burger joint chain, where one can have a cappucino or glass of wine along with one very delicious burger. They’re all around town.

Other places we’ve eaten –

Preem & Prithi. We had a very good and reasonably-priced meal at this well-known Bangli curry house on Brick Lane. I finally tasted (and loved) Masala Dosa and discovered coconut chutney, a condiment I shall have to have again. Unfortunately, Brick Lane has gotten very touristy since we last visited it over 15 years ago, and I don’t think I’ll go back. Next time, we’ll head to Southall for a more authentic London-Indian experience.

Westminster Arms. The kids, starving after our tour of Westminster Abbey (Jeremy Irons’ narration of the self-guided audio tour is itself worth the visit), insisted we eat at the first place we passed on our way to the Churchill War Rooms (a must-see). Which was how we found ourselves eating lunch at the tourist-packed Westminster Arms, where I am amazed to report that I had the best sausage and onion sandwich I have tasted. Really. And I want to go back and have another. Right now.

Borough Market.One thing I did insist upon was a visit to the Borough Market to shop for ingredients for dinner on New Year’s Eve, a holiday we always celebrate at home rather than by going out to a restaurant. Despite my disappointment that a fair number of stalls were closed and the Cheese Guy was off for the holiday, the Market was well worth the visit. And it’s own blog post.

So stay tuned for photos of dead pheasants, a recipe for mushroom risotto and everything you ever wanted to know about salsify.

London Diary- Day 2 – Music Underground

Want to perform for tips in the underground? Want to avoid a fine? Apply for a licence, audition before a panel of judges, and get on the schedule. Now you’re an offical underground “Busker”. (That’s the word for street performers here. It derives from a Spanish word meaning “to seek”.)

Nice stuff.

London Diary, Day 1 – The Little Things

One of the most enjoyable things about traveling, aside from seeing the sights and meeting the people, are the little things that make life in a different country feel, well – different.

Those wacky electrical outlets.

That cool radiator in the bathroom. (Could it also be a towel warmer?)

The electic tea kettle.

The under-counter washer-dryer combo, which would be perfect in my tiny NYC kitchen. (Although it takes 2-3 hours to finish a very small load of laundry.)

And the built in wine racks in the fridge.

These are the little joys of travel that make every minute special. Minutes that in our normal lives pass us by as we make that morning cup of coffee the same way for the thousandth time, turn on the shower, half-asleep, or absently swipe a metro card while heading onto the subway.

You don’t swipe cards here, by the way. You touch them to a sensor.

And did I mention the practically empty ladies room at intervals (that’s London-speak for intermission) at the theater tonight?

Actually, that’s not a little thing. That’s a really big thing.

A Tale of Three Cakes

For almost two weeks now, I’ve been playing with the recipe for this Devil’s Food Cake with Mocha Frosting. My daughter Natalie had requested the cake for her birthday, having remembered it fondly from a family dinner earlier this year. The recipe, from my mother in law Irene‘s old Kitchen Aid Mixer booklet, looked straightforward, and included exact mixer speeds and times for beating at each step. Making it, I figured, would be a piece of cake.

Cake #1

The first time I made the cake, other than using extra-large eggs (the only ones we had in the fridge), I followed the recipe instructions exactly, including sifting the cake flour before and after measuring it. I ended up with a very large amount of fluffy batter which overflowed two 9-inch layer pans as it rose into deliciously moist but structureless layers that split when I took them from the pan. I cemented the cake together with frosting and served it at Natlie’s birthday bowling party – the kids loved it.

I, on the other hand, was not so pleased. This patched-up mess was not up to my usual standards. I needed to try it again.

Cake #2

Assuming that the problem had simply been the too-large size of the eggs, I made the cake again 3 days later for Natalie’s birthday dinner, this time using large eggs. I was surprised to once more end up with an unusually large volume of batter. Having learned the hard way just how well burned cake batter sticks to the bottom of the oven, I got smart and used 10 inch pans this time. The final product was yet another very moist but very crumbly cake that literally fell apart as the girls and I lay the top layer onto the bottom. Laughing, we patched it up as best as we could. It looked a bit sad, but tasted great.

I had two theories this time. One was that I hadn’t let the cakes cool enough before moving and frosting them. The other was that perhaps my oven was slow. I couldn’t imagine any other reason for the high batter volume and fragile final product.

Cake #3

A night at my mother-in-law Irene’s home and a promise to bring dessert to Christmas dinner provided me one more chance to get this cake right. After all, Irene had given me the recipe – surely she could help me figure out what I was doing wrong.

I explained to Irene that I had followed her recipe exacly, only varying the pan sizes. “Exactly?” she asked. Yes, I replied, including sifting the flour twice. Why wasn’t my cake as nice as hers?

Turns out Irene hadn’t actually followed the recipe she had sent me.”I never sift my flour”, she told me.”That’s how my mother taught me.” And as for the beating times, well, they were too long as far as she was concerned.

Now it all made sense. By sifting it the first time, I was likely ending up with less flour after measuring. Sifting a second time aerated the ingredients even more, as did beating for the long periods of time noted in the recipe. No wonder the batter was so fluffy. It was half air!

So Irene and I made the cake together. We did not sift the flour, and our beat times were about half that which the recipe advised. We ended up with exactly enough batter for two 9 inch pans, and this time, I let the cakes cool completely before removing them from the pan. The layers were denser than their predecessors, but still very light, and although a fair amount of crumbs graced the lower edges, the layers held together beautifully.

And finally the cake looked as wonderful as it tasted. Pretty enough to earn a crown of bittersweet chocolate shavings. And a doily.

Rich Devil’s Food Cake with Mocha Frosting

The quantities are straight from the Kichen-Aid booklet, with a single addition of expresso powder for added flavor. If you don’t use a Kitchenaid Mixer, ignore the speed numbers and use an approximate corresponding speed on your own mixer. (1 is low, 10 is high). If you make it, let me know how it turns out.

3 squares unsweetened chocolate
¾ cup hot water
¾ cup butter
1 tbsp instant expresso powder
2 cups brown sugar
3 eggs
2 ¼ cups UN-sifted cake flour
1 ½ tsps baking soda
¾ tsp. baking powder
¾ tsp. salt
¾ cup buttermilk
1 ½ tsps. vanilla
Bittersweet chocolate shavings (optional topping)

Combine chocolate, expresso powder and hot water in a small saucepan. Cook over low heat, stirring constantly, until chocolate melts and is smooth. Set aside until mixture cools.

Cream butter in bowl for 1 minute at speed 6. Add sugar and beat at speed 6 for 1-2 minutes. Stop and crape sides of bowl using a rubber spatula. Turn to Speed 4 and add eggs, one at a time, beating after each addition till just incorporated, about 30 seconds, scraping the bowl when needed. Add cooled chocolate. Turn to Speed 4 and beat about 30 seconds. Stop and scrape bowl.

Sift together cake flour, baking soda, baking powder, and salt; set aside. Combine buttermilk and vanilla. Turn to Speed 2 and add 1/3 flour mixture and bea till incorporataed, just a few seconds. Still beating, pour in 1/2 the liquid, then another thirdflour, the second half liquid, and finally the last third of the flour, beating as little as possible until just combined, stopping and scraping the sides when needed.

Pour batter into two greased and floured 9 inch round cake pans. (Before flouring, cut a nine inch round of waxed or parchment paper and place on greased bottom of pan. Then grease the paper and flour pan.) Bake at 350 degrees for 25 to 30 minutes. Cool in pans 10 minutes, then invert pans on wire rack, remove waxed paper and let cakes cool completely before icing with mocha frosting. Sprinkle the top with bittersweet chocolate shavings.

Mocha Frosting

¾ cup butter
1 tbsp instant espresso or coffee granules
1 tbsp. Hot water
1 tsp. vanilla
3 ½ cups powdered sugar
4 tbsps heavy cream

Dissolve coffee granules in hot water. Set aside until cool. Place butter in bowl. Turn to Speed 6 and cream for 1 minute. Do not overbeat or it will melt. Stop and scrape bowl. Add cooled expresso and vanilla to butter. Cream 30 seconds. Stop and scrape bowl

Add powdered sugar, ½ cup at a time, beating 30 seconds after each addition. Stop and scrape bowl. Add cream and beat on Speed 4 for 2 minutes, until fluffy. If frosting is too soft, refrigerate for a while before frosting cake.

Place 1st layer on cake plate upside down and frost. Place 2nd layer on top and frost top and sides.

COMMENTS

  1. Surgeon in my dreams says: EditThey look sooooo good!!Reply
  2. rlbates says: EditCan almost taste them!Reply
  3. Anonymous says: EditSo we made the cake today for a late holiday celebration, following your modifications to the original recipe. Used my new Cuisinart stand mixer which I am still getting used to. The cake turned out fine. Make that “very fine.” I added 7 tbsp of cocoa to the icing and another tbsp of coffee (after looking at a Saveur No. 62 recipe for Fudge Icing). It was so good that it will become our House Chocolate Cake. Thanks for your research and the recipe. Rural ObGynReply
  4. kacee says: EditI was having a similar problem (cookies and cakes too light-textured) a few years ago and traced it to my switch to White Lily flour from Gold Medal or Pillsbury. White Lily is popular for biscuits in the South. However, all your cakes look scrumptious! Our favorite family birthday cake is BHG’s Best-Ever Chocolate Cake topped with Mackinac Island Fudge ice cream.Reply
  5. Shell says: EditLooks super yummy! Maybe I’ll try it once I purchase a mixer =)Reply

Diet Update, a New Resolve and a Cheerio

I’m down 33 pounds and holding. Just barely.

Folks are starting to notice, which is nice, and I really should buy new clothes. But I have no time right now to shop. Plus, I really don’t want to reward myself just yet. I’m not being good enough right now.

Dinners with friends, Thanksgiving and Christmas have given me excuses to slack off just enough to maintain, but not lose significantly more weight for over a month now. And the cold weather has stopped the long weekend bike rides that were giving me the exercise I needed.

Although I dropped below the snore threshold about 20 pounds ago, I cleary have not yet passed the point where reflux and hiatal hernia symptoms disappear. Smaller meal sizes on my food delivery program have helped my symptoms somewhat, but they remain bad enough that I finally went for an endoscopy and upper abdominal songram last week. Despite the fact that all was okay, I’m annoyed at myself. Because if I had just stayed a little more true to the diet and exercise plan, I might have dropped below the reflux point by now and saved myself and the US healthcare system an expensive medical procedure. Now I am determined to get a move on with this weight loss.

The encouraging news in this regard is that we’re heading off to London for a week (the girls can’t wait!), and if my tradition of always losing weight on vacation holds, I expect to a few pounds thinner when I return. Just in time to start off the New Year with another push downward on the scale.

Expect upcoming posts from across the Pond.

Happy Hanukkah (or is it Chanukah?)

It’s that time of year again, Folks. Time to take the Menorah off the bookshelf and the electric frying pan out of the closet. It’s Hanukkah!

Or is it Chanukah? I never know which spelling to use. But I do know the story of Hanukkah.

Many years ago, it is said, in the land of Judea, there was an evil Syrian king named Antiochus IV who set out to destroy the Jews and their religion. Some say Antiochus may have been taking advantage of an ongoing struggle between orthodox Jews and their reformed Hellenic counterparts, who were seeking to assimilate into the Greek culture that had come to dominate the land after the time of Alexander the Great. Under Antiochus, Jews were persecuted and brutalized by the Greeks, and their temples taken over by Hellenic priests.

Finally, the Jews, led by a man they named Judah the Macabee (“The Hammer”), rose up against Antiochus, in a war whose inciting event was the killing of a Hellenic Jewish sympathizer by a more traditional Jew. The war lasted 25 years, and ultimately, the Macabees were victorious over Antiochus’ forces.

After one of the decisive final battles of the war, the Macabees returned to Jerusalem and set about to rededicate their temple. The Macabees built a new candlabra (menorah) and lit it. While there was only a day’s worth of holy oil for it, the lamp stayed lit for a full 8 days until a new supply of oil could be gotten. And that is the miracle of Hanukkah.

Today, Jews, Orthodox and reformed alike, celebrate Hanukah by lighting the menorah – one candle each night for 8 nights, each candle lit by the central candle called the Shamash. To remember the miracle of the oil, one eats foods cooked in oil. Hence, the venerable fried potato pancake, or Latke. (Also donuts.)

The Irony of Chanukah

I love Chanukah, probably mostly because I love lighting our Menorah. (We got it the year our oldest daughter was born.) And even more than lighting candles, I love latkes. And getting together with friends and their children for parties.

But it saddens me to think that our family traditions are really based on the outcome of a religious war fought centuries ago between the Greeks and the Jews, possibly even between factions of the Jews themselves. That a bloody war can give us such wonderful family traditions is testimony to what centuries of light, songs and good food can do to eradicate the memory of war and adversity.

Someday perhaps we will have a food we serve to celebrate the time when man stopped waging war against his fellow man in the name of religion. What kind of food would it be, do you think?

It would need to be a food that melds the culinary traditions of all the world’s religions and peoples. A wonderful stew, perhaps, that marries the warmth of the potato with the meat of the sacrificial lamb and wine, along with the olives of Greece and the spices and fruits of Africa and the Middle East, served from a communal bowl and eaten with a flat, soft unleavened bread. We would invite our friends from every religion we knew to share it with us, sitting around a table lit by candles, perhaps on a cold night near the winter solstice. The more different religions represented at our table, the more we would all be blessed.

I can only hope to see that meal, and that world, in my lifetime.

Until then, at least there will be Latkes. (Here’s our recipe.)

Sausage, Peppers and Onions

This is a family standard that Mr TBTAM and I have been making for years. It’s a variation on the classic Italian sausage and peppers that are usually served on a roll. We increase the tomatoes and serve it over pasta or rice rather than in a roll. A fast and delicious meal for a cold winter evening. You can make it healthier with turkey sausage, but why would anyone want to do such a thing?

TBTAM Family Sausage, Onions and Peppers

Olive oil
1 lb sweet Italian sausage
1 red pepper, cut into strips
1 green pepper, cut into strips
1 large onion, sliced
4 cloves garlic, chopped
1 tsp dried or 1 tbsp chopped fresh oregano
1 tsp fennel seed
1 tsp dried basil or 1 tbsp pesto
1 large can diced tomatoes
Salt and pepper to taste
1 tsp sugar
1/4 tsp red pepper flakes
1/4 cup red wine

Heat a bit of olive oil in a big heavy skillet on the stove top. Cook the sausages, turning to brown them slightly, over medium high heat till just done, about 7-10 mins. Remove to a paper towel to drain.

Toss the onion and pepper with some salt and pepper in the same pan and cook till soft and smelling delicious, about 5 mins or so. Add the garlic, oregano, fennel seed, basil and cook another few minutes. Add the tomatoes, wine, sugar and hot pepper flakes, stir and cook a few minutes.

Slice up the sausages and add them to the pan. Cook for 20-30 minutes, till the sauce is reduced a bit and the flavors meld. Meanwhile, cook your pasta or rice.

Season again with salt and pepper before serving. Serve over cooked pasta or rice.

Ghostbusters

Everyone knows it goes on. Big Pharma either solicits or creates scholarly review articles that paint its drug in a favorable light, attributing the writing entirely to a prominent thought leader in the field.

But this article in today’s New York Times exposes the process in a way none has before, following the production of a review article from it’s first inception in a Wyeth stratgey meeting to the hiring of a ghost writer and the correspondance with the attributed author, its rejection by a peer review journal and final publication in a throw away.

Most of us docs know that the articles in throw aways are slanted towards Big Pharma’s agenda, and if we read them, do so with that in mind. But some of these ghost-written articles make their way into peer-review journals. One could argue that the peer-review process should weed out the artciles that are not medically correct. But what if the peer reviewers have conflicts similar to those of the supposed author?

Oh, what a tangled web we weave…

Thank you, Bruce

For the past few days, my brain has been stuck in high gear. Nothing particularly is wrong. Everything is fine, actually. But I’ve been unable to relax. You know what I mean – Shoulders and neck are like a board, songs are running through your head and you can’t get them out, food sticks in your throat on the way down and you just cannot relax. Deep breathing only works for a few seconds. Sleeping just makes your neck hurt even more, and when you wake up, that same damned song is still stuck in your head. (I love that song, really, but enough already…)

Then, this morning, while walking to work, I slipped on my IPOD headphones and clicked on Bruce Springsteen’s Thunder Road.

Within 30 seconds, I could feel my shoulders relax in a way they had not done in weeks. My step lightened. My breathing deepened. My head cleared. And that damned song became nothing but a memory.

I sighed.

Four hours later, I was still feeling great.

It wasn’t the first time Bruce had come through for me

When I was in labor with my first child, I came very close to having a C-section. The baby’s head was up at -1 station and I had been pushing for almost two hours but getting nowhere. At that point, we turned down the epidural so I could feel what I was doing. And I put on my Walkman with a tape for Born to Run blasting at almost full volume. Within 3 pushes, Emily was born.

What is it about music that can literally transport us to another place? And what is it about Bruce?

I don’t think it’s just me. When I was in grad school, my roommate, who was always neat but never cleaned our apartment, cleaned it one day because a friend who was visiting happened to put on my Born to Run album. “You always play that album when you clean”, she later explained. “As soon as that song started, it was like I couldn’t help myself. I grabbed the vacuum and off I went.” She had never cleaned before, and was never to again. But that day, Bruce put her into a place where nothing was more important to her than making that place shine like there was no tomorrow.

I don’t know if I’ll ever understand it

But I’m sure as heck going to remember it. And in the future, if I ever find myself stuck in a place and can’t get out, I won’t wait so long to call on my man Bruce.

What music does it for you?

Take Your Bladder Back from Pfizer

For years now, Big Pharma’s approach to drug marketing has been to first promote disease awareness and then sell you their drug for the disease you never knew you had until they told you about it. HPV testing and vaccination are textbook examples of an extremely successful use of this marketing approach. (With a little mandatory vaccine regulation thrown in for insurance.)

But what if we could combine disease awareness with brand name recognition by actually renaming the disease with your drug’s brand name? Better still, forget disease recognition altogether. Cast an even wider net and tie your brand name to the symptoms of the disorder. Who cares if other diseases might have the same symptoms? You’re going to own that symptom, and then, like a rancher with a roped calf, brand it.

That, in essence, is what Pfizer is doing with their Detrol Ad campaign.

The Detrol Ad Campaign

Detrol is a drug that is FDA-approved for treatment of overactive bladder (we docs like to call it detrusor instability). The hallmark symptoms of overactive bladder are urinary frequency and urgency. Pfizer calls these symptoms “that gotta’ go feeling”.

In their ads, Pfizer barely mentions the term overactive bladder. They just show images of woman rushing to the bathroom, and then tell us about Detrol. Their icon is the little woman on the bathroom door, so that every time a woman heads to a public rest room, she will think of their drug. (See a typical ad on Ad Pharm Blog)

Of course, no good drug marketing campaign these days is complete without a website. With theirs, Pfizer is using every play from Big Pharma’s market-to-women playbook. First, female empowerment – “Get the help you deserve”. Next, the worry card – images that compare your overactive bladder to a healthy bladder (message – your overactive bladder is un-healthy), telling you overactive bladder “is never normal”, warning you that your symptoms “may lead to an accident” and telling you that “the less you gotta’ go, the less you gotta’ worry”. If you weren’t worried before, you sure are now. And will be every time you pee. Finally, the training – How to talk to your doctor about your bladder symptoms, or having The Detrol Discussion.

Leave it to Big Pharma to take a universal bodily function, turn it into something to worry about and sell you a drug for it.

It’s brilliant marketing.

And of course, I don’t like it.

Why not? For one, we all have to go to the bathroom. But since most of us women these days are also crazy busy, we often put off the deed as long as we can. Until we can’t anymore. Hence, that gotta’ go feeling. We don’t need a drug – we need to slow down our lives so we have time to go to the bathroom.

Not to mention the fact that the symptoms of urinary urgency and frequency are also symptoms of urinary tract infections, diabetes, uterine fibroids, early ovarian cancer and pregnancy. None of which are treated with Detrol last time I checked. Overactive bladder is a diagnosis of exclusion, only to be made after ruling out these and other underlying disorders.

But let’s suppose you’ve been cleared from all these and other conditions that can cause you to run to the bathroom. Taking a drug is the last thing you want to do.

Because there are so many other simple, inexpensive and healthier ways to address the problem. Detrol’s webpage lists these as things to do “in addition” to taking your medication. I say do them “instead” of taking medication.

Treating the problem without medication
  • Make time to pee. The first and most important thing to do is to take the time to go to the bathroom before it’s an emergency.
  • Get real about your fluid intake – what goes in must come out. How many of you have a big plastic bottle of H2O on your desk at work? Getting your recommended 8 glasses of water a day, and even more if you’re dieting? If you’re going to drink that much water, you’re going to be in the bathroom. That’s just the way it is. You don’t need a drug. Just some common sense. If you’re going to guzzle water on a long car ride, you’re going to need to take bathroom stops. If you’re ordering the liter diet coke with popcorn at the movie, don’t be surprised if you miss the good part because you’re in the ladies’ room.
  • If nighttime frequency is a problem, cut back on evening fluids. You can’t drink tea while watching Letterman and expect to make it through the night.
  • Drink enough water. While a lot of us are water guzzlers, some of you out there actually may not be drinking enough water. Your urine is concentrated, and that can be irritating to the bladder as well, especially if you’re also post-menopausal. So for you, the trick may be to increase your fluid intake a bit.
  • Cut back on the Starbuck’s Latte’s and Diet Cokes. Both caffeine and carbonated beverages can be bladder irritants, and caffeine is a diuretic. Put caffeine or diet coke habit together with an 8 cup a day water intake and you might as well just put your office in the ladies’ room, because you’ll be there more than you’re at your desk. Trust me on this. And it can be just as bad if you don’t drink enough water – now you’ve combined concentrated urine with a bladder irritant. You’ll go smaller amounts when you hit the stalls than the water drinkers, but you’ll still be there more often than you need to be.
  • See if other foods are bothering your bladder. Other foods that can irritate the bladder are chocolate, tomatoes and citrus fruits and juices. Maybe not for everyone, but maybe for you. If this is the case, simply eliminating or limiting these foods may be all you need to do to control your symptoms.
  • Try bladder training. Some of us have gotten ourselves into some bad habits when it comes to our bladders – running to the bathroom the minute we notice we have a bladder, jumping up out of bed 5 times before we fall off to sleep. But you can retrain it to hold out longer. It really is mind over body on this one.

What if these steps fail?

So let’s say you’ve tried everything up there and you’re still rushing to the bathroom. Maybe you’re even having occasional accidents. Your doctor has ruled out infection and other causes, and diagnosed you with irritable or overactive bladder. What can you do?

If you are post-menopausal, I usually first recommend a trial of low dose vaginal estrogen. (It’s an off-label use with some support in the literature.) For some women, this is all they need. If you don’t want to take vaginal estrogen or are not postmenopausal, then Detrol (or its generic) is definitely a treatment option, and it’s often quite effective.

Bottom Line

Urinary urgency and frequency are common symptoms in women. It’s important to see your doctor to rule out urinary tract infection (a very common problem in my practice) and other underlying causes. Once these things are ruled out, most symptoms can be controlled with simple changes in diet and fluid intake, along with some bladder training for more resistant cases, and if you are menopausal, a trial of vaginal estrogen. If these things fail, there are medications that can control symptoms, one of which is Detrol or its generic.

And as they always say, talk to your doctor.