Close Encounters

What happens when the doctor and the patient run into each other outside the office, in the real world?

For RL Bates, a plastic surgeon, the encounters can range from “Hey, there’s the lady who did my boob job!” to desperate glances from patients who pray she won’t out them (or their new boobs).

Doctor Rob’s reactions vary depending on the patient – happiness and concern for those patients he knows and loves vs. the old “duck and cover”, reserved for those few patients whose over-familiarity breaches the boundaries of the doctor-patient relationship.

Rural Doc’s small town practice gives her ample opportunity to run into her patients, who she hopes will stick to conversation about food and gardening, and leave the medical questions for the office.

Though New York isn’t exactly a small town, you’d be surpised how often I run into my patients outside the office. The nature of my business means that most of my patients feel rather intimate with me, even if, in truth, we don’t know each other very well. So, no matter where I am, conversations with my patients (and, come to think of it, even with strangers at parties) tend to get pretty personal pretty quickly.

For some reason, I don’t mind. Maybe it’s because I hate small talk.

And though as a rule, I really do prefer the office, I have to admit that I’ve done more than one breast exam for a worried woman at a dinner party (in an empty bedroom of course), and even diagnosed preterm labor once at a baby shower.

One problem I do have is names. I’m horrible at remembering them. I can recite almost eveything about someone and still not be able to tell you a name. I’ve tried to train my husband to introduce himeslf and ask “And you are?…”, but more often than not I find myself searching for a name when I encounter a patient outside the office setting. And I am ever so grateful to those patients who anticipate this and re-introduce themselves when we meet on the street.

My Favorite Out-of Office Patient Encounter

A few years back, I happened to take my daughter to a kid’s musical where one of my patients, an actor, was playing a lead role. It had been a fun show, and my patient had been hilarious. After the show, we all lined up for autographs from the performers, who were sitting behind a long table outside the auditorium. The audience was mostly women and their toddlers, a very casual crowd.

My patient, still in costume, saw me and gave me a big “Hey doc!” Then she said, “Wait a minute. You probably don’t recognize me. Here, I’ll make it easier for you”, swept her feet up onto the table in front of her and spread out her legs.

“She’s my gynecologist”, she explained to her fellow performers, all of whom nodded in complete understanding.

Sunny with a Chance of Meatballs

So there I was, minding my own business, sitting in my car in front of a high rise apartment building across from Asphalt Green, waiting to pick up my daughter and her friend from softball practice.

It was a warm, beautiful summer afternoon with an amazingly blue, cloudless sky and a strong but warm breeze blowing in from the East River. Jonathan Schwartz was playing something by Nancy Lamott on WHYY, and I was trying to think of a 9 letter word meaning “commonplace”.

I don’t know what made me look up from my Sunday Times crossword. Maybe I was hungry.

All I know is that, at that moment, a large uncooked hamburger patty fell from the sky and splattered onto my windshield. Come to think of it, it didn’t really splatter much. It just sort of spread itself out there on the wipers in front of me.

No cheese. No bun. No fries. Just fresh, raw ground beef.

Now that’s what I call a heavenly burger.
______________________________________________________

Apologies to Judy and Ron Barrett for mutilating the cover of their wonderful children’s book.

Asian-Marinated Salmon


Irene’s recipe. Simple. Delicious.

Asian Marinated Salmon

salmon filets
Equal parts each soy sauce, rice wine vinegar, sesame oil and Asian fish sauce (1tbsp each per fillet, adjust accordingly)

Marinate salmon for 20 minutes. Broil (not too close, on 2nd shelf down from the broiler in our oven)10-12 mins till done. (Irene uses Mark Bittman’s broiling method, we just broiled ours up there.) Baste halfway through. Serve.

Shrimp Risotto

I’m going on record right now and telling you that this risotto is not only the best risotto I’ve ever made, it’s the best risotto I’ve ever eaten. I don’t know if it was the Tabachnik Chicken Broth I used or the fact that I finally figured out how not to overcook shrimp. I do know that I’ll be making it again. Soon. Maybe next week, when The Italians visit. That’ll be ballsy of me – serving Risottos to the Romans.

Shrimp Risotto

This is based on a recipe I found at Epicurious, with a few tweaks based on both necessity and invention. Irene made it after I did, and I’m incorporating her modifications as well. The trick is not to overcook the shrimp, and then, just before serving, to cut them up into small pieces and add to the risotto so that every bite has a wonderful bit of moist, plump shrimp in.

I added shrimp shells and clam juice to the stock for added flavor. As for the fresh herbs, parsley is standard, the others are optional. Don’t be afraid to make it if you don’t have fresh thyme or basil – the dish is still fabulous without them. If the weather is warm, I add the lemon juice to lighten up the risotto. But if it’s cold outside, leave it out and go for the warmth.

4 cups canned low-salt chicken broth
8 oz clam juice
3/4 cup dry white wine
2 tbsp olive oil
2 tbsp butter
1 tbsp minced garlic
1/4 teaspoon dried crushed red pepper
1 pound uncooked large shrimp, deveined but still in shells
1 small onion or 2 shallots, finely chopped
1 sweet red pepper, finely chopped
1 tbsp chopped fresh thyme leaves (optional)
1 tbsp chopped fresh basil (optional)
1 1/2 cups arborio rice or medium-grain white rice
1 tbsp lemon juice (optional)
2 tablespoons chopped fresh parsley
Salt and pepper to taste

Peel shrimp, reserving shells.

In a medium saucepan, combine shrimp shells, chicken broth, clam juice and 1/4 cup of the wine. Bring to a boil and reduce to a low simmer for about 10 minutes.

Meanwhile, heat 1 tbsp olive oil and 1 tbsp butter in a skillet. Add 2 tsp minced garlic, 1/2 tsp salt and crushed red pepper, then shrimp. Saute until shrimp barely begin to turn pink (only a minute or so- this is the critical part so pay attention..). Add 1/2 cup wine. Simmer until shrimp are just barely cooked, another minute or so. (Don’t overcook!) Drain shrimp and reserve the liquid. Use a few tbsp of the chicken broth to get all the goodness out of the skillet and add to the reserved shrimp liquid.

Remove shrimp shells from the broth using a slotted spoon. Turn the broth down and keep warm.

Melt 1 tablespoons butter and 1 tbsp olive oil in heavy large saucepan over medium heat. Add onion, chopped red pepper, thyme, basil, 1/2 tsp salt and remaining 1 teaspoon garlic; saute until onion is translucent and pale golden and peppers are softened, about 6-8 minutes. Add rice and stir till it is toasted and opaque, about 3-4 minutes. Add reserved shrimp liquid and a 4-6 oz ladleful of stock and cook till evaporated. Continue stirring and continue 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. (You probably won’t have any leftover stock, but if you do, freeze it and use another time.) Turn heat way down and hold for just a few minutes while you cut the shrimp up ito bite-sized pieces (about 4 per shrimp).

Stir lemon juice, shrimp and parsley into risotto. Season risotto to taste with salt and pepper and serve immediately with chopped parsley for garnish.

I’m So Winning this Contest

I actually got my act together to submit an entry to the Bulwer-Lytton Fiction Contest this year! (Last year, as faithful readers may recall, I forgot about the contest till after the winners were announced.)

The contest challenges entrants to compose a very, very bad opening sentence to an imaginary work of fiction.

Here’s my entry. I did my best to combine food, medicine and bad imagery.

It was sometime during the soup course, an appallingly flocculent vichyssoise populated with a Mexican strain of E. coli that would declare war on his large intestine later that night just after he rolled off his new bride and reached for a cigarette, that Max admitted to himself that his explosive declaration of love for Muriel during cocktails had been the catharsis of his remaining feeling for her, which could only mean that, once again, he had married too quickly.

The Bulwer-Lytton Fiction Contest honors the memory of the author who penned that infamous opening line which begins – “It was a dark and stormy night.”

It was a dark and stormy night; the rain fell in torrents–except at occasional intervals, when it was checked by a violent gust of wind which swept up the streets (for it is in London that our scene lies), rattling along the housetops, and fiercely agitating the scanty flame of the lamps that struggled against the darkness.”
– Edward George Bulwer-Lytton, Paul Clifford (1830)

It’s still not too late for you to do some bad sentence writing. Although the contest has an official April 15 deadline, official means nothing to these people, and, according to the contest website, “The actual deadline may be as late as June 30.”

Check the rules and tips before submitting. Read last year’s winning entries for inspiration. Sentences may be any length, but try to keep it short- at most 50-60 words (That’s the hard part, and I failed there…) And if you do submit, post yours and then send me the link and I’ll put it here. Or write your sentence in the comments section.

I dare you. (sung) My writing’s worse than yours…..

Grand Rounds 4:36

Grand Rounds is up this week at Parallel Universes, a blog by Dr Emer, a Filipino physician “trying to balance his time between medicine and blogging”. Given that this is Dr Emer’ss 5th time (!) hosting grand rounds, it seems the scale, at least this week, is tipped in the favor of blogging.

Head on over for some great reading.

Manhattanhenge 2008

Okay, fellow new Yorkers. It’s that time again. Time to stand in the aisles of the skyscraper canyons of our fair city and worship the sun gods as they shine crosstown at sunset.

Yes, it’s Manhattanhenge! Those magical days of the year when the setting sun aligns itself perfectly with Manhattan’s crosstown streets in the same way that the rising sun aligns with Stonehenge at the summer solstice.

This year, Manhattanhenge is May 29/30 and July 11/12. Happily, the weather report calls for sunny skies on the 29th with sunset at 8:18 pm.

Here’s this year’s email announcement I received today from Neil DeGrassi, the founder of Manhattanhenge:

Dear Museum Community,

It’s that time of year again…. MANHATTANHENGE 2008

What will future civilizations think of Manhattan Island when they dig it up and find a carefully laid out network of streets and avenues? Surely the grid would be presumed to have astronomical significance, just as we have found for the pre- historic circle of large vertical rocks known as Stonehenge, in the Salisbury Plain of England. For Stonehenge, the special day is the summer solstice, when the Sun rose in perfect alignment with several of the stones,signaling the change of season.

For Manhattan, a place where evening matters more than morning, that special day comes on Thursday, May 29h this year, one of only two occasions when the Sun sets in exact alignment with the Manhattan grid, fully illuminating every single cross-street for the last fifteen minutes of daylight. The other day is Saturday, July 12th.

These two days give you a photogenic view with half the Sun above and half the Sun below the horizon — on the grid. The day after May 29th (Friday, May 30th), and the day before July 12 (Friday, July 11) will also give you Manhattanhenge moments, but instead you will see the entire ball of the Sun on the horizon — on the grid. My personal preference is the half-Sun.

As you may know, had Manhattan’s grid been perfectly aligned with the geographic north-south line, then the days of Manhattanhenge would be the spring and autumn equinoxes, the only two days on the calendar when the Sun rises due-east and sets due-west. But Manhattan’s street grid is rotated 30 degrees east from geographic north, shifting the days of alignment elsewhere into the calendar.

Note that any city crossed by a rectangular grid can identify days where the setting Sun aligns with their streets. But a closer look at such cities around the world shows them to be less than ideal for this purpose. Beyond the grid you need a clear view to the horizon, as we have over New Jersey. And tall buildings that line the streets create a kind of brick and steel channel to frame the setting Sun, creating a
striking photographic opportunity.

True, some municipalities have streets named after the Sun, like Sunrise Highway on Long Island and the Sunset Strip in Los Angeles. But these roads are not perfectly straight. And the few times a year when the Sun aligns with one of their stretches of road, all you get is stalled traffic solar glare temporarily blinds drivers.

So Manhattanhenge may just be a unique urban phenomenon in the world, if not the universe.

Note that a couple of years ago, an article in the New York Times identified this annual event as the “Manhattan Solstice”. But of course, the word “solstice” translates from the Latin solstitium, meaning “stopped sun,” in reference to the winter and summer solstices where the Sun’s daily arc across the sky reaches its extreme southerly and northerly limits. Manhattanhenge comes about because the Sun’s arc has *not* yet reached these limits, and is on route to them, as we catch a brief glimpse of the setting Sun along the canyons of our narrow streets.

IMPORTANT: For best effect, position yourself as far east in Manhattan as possible. But ensure that when you look west across the avenues you can still see New Jersey. Clear cross streets include 14th, 23rd, 34th. 42nd, 57th, and several streets adjacent to them. The Empire State building and the Chrysler building render 34th street and 42nd streets especially striking vistas.

Arrive a half-hour earlier than the times given below.

MAY
Half Sun on grid: Thursday, May 29 — 8:17 p.m. EDT
Full Sun on grid: Friday, May 30 — 8:16 p.m. EDT

JULY
Half Sun on grid: Saturday, July 12 — 8:25 p.m. EDT
Full Sun on grid: Friday, July 11 — 8:24 p.m. EDT

Downloadable Image of the July 2001 “Manhattan Sunset” as it first appeared in 2002 among the photo-essays of “City of Stars,” Natural History magazine: http://research.amnh.org/users/tyson/ManhattanSunset.php

As always, keep looking up,

-Neil deGrasse Tyson
Department of Astrophysics & Director, Hayden Planetarium
American Museum of Natural History
Central Park West at 79th Street
New York, NY 10024
http://research.amnh.org/users/tyson

Now get out there, you big Apple Druids, and give the sun gods their due!
__________________________________________________

Image from Wikipidia Commons

How to Pay Less for Birth Control

Most of my patients are spending way too much money on their hormonal birth control. At close to $50 a month, contraception can eat up as much as $600 a year. Sure, compared to the cost of raising a child, $600 is peanuts. But what if I told you that you could get the same protection against pregnancy for less than $100 a year? That’s a savings of $500 that you can put in the bank, or use to pay off your student loans or credit card bills.

So get smart and start saving money on birth control!

1. Go mail order.

Stop refilling every month at the local Duane Reade or CVS, and go mail order. Did you know that if you use your insurer’s mail order pharmacy, you can get a 90 days supply of birth control pills for a single co-pay? Not only do you save money, but you don’t have to worry about finding a 24 hour pharmacy on a Sunday night when you run out of pills, because you’ll have a 90 day supply in stock all the time.

You’ll need to think ahead, since it can takes up to a week to get your pills in the mail. Solve this problem by asking your doc to write you two prescriptions – a one month supply with 12 refills to keep at the local pharmacy for emergency refills, and a 90 day supply with 3 refills for mail order.

If you don’t know what mail order pharmacy your insurer uses, check you insurance card – it’s usually there. If not, ask Human Resources at your job.

2. Go generic.

Most pills are available in cheaper generic forms that are just as effective and available at much lower cost. If your current pill does not come in generic, ask your doctor if changing to pill that comes generic would be a problem for you. In my experience, a significant proportion of patients can find a generic pill that they will be just as happy with as their brand name.

Check your insurer’s website for a list of preferred generics. Print it out and bring it to your next appointment. Ask your Doctor to see if changing to a pill from that list would be appropriate for you.

3. Get your pills at Walmart, Target or Kroger.

That would mean changing to generic Sprintec (Ortho-Cyclen) or Tri-Sprintec (Ortho-Tricyclen), but at a low cost of $9 a month, it may be worth a try. Ask your doctor if it makes sense for you. (more info here)

4. Get your pills from Planned Parenthood

Even though recent legislation has limited their ability to purchase pills cheaply, Planned Parenthood’s prices may still be cheaper than the pharmacy.

5. Ask your partner to share the cost.

It takes two to tango, so let’s go, gentlemen – Ante up!

6. Take your pills the same time every day, and don’t miss a pill.

After all, if you’re spending money on birth control, don’t take it properly and end up with an unplanned pregnancy, then you’ve wasted your money, right?

7. Use pre-tax dollars for birth control.

If you know you’ll be spending a given amount every year on your pills, put that amount aside in a health savings account with your employer and save on taxes while preventing unplanned pregnancy.

8. Join Planned Parenthood’s Birth Control Now Campaign.

Keep birth control prices low for college students and low income women.

9. Remember birth control pills are used for more than just birth control.

If your insurance won’t cover family planning (and shame on them if they don’t), ask your doctor to submit a letter of medical necessity to your insurer for your use of your pills for treatment of menstrual cramps, acne, or menstrual irrregularities if that’s another reason why you use them.

10. Your turn

Got any other ideas on how to save money on contraception? Share it in the comments section.

Media Blather Interviews TBTAM

I was interviewed this week by David Strom, tech journalist and host of Media Blather.

We “blathed” about blogging, technology in medicine, Michael Moore and Eva Peron. (When’s the last time you read those two names together in the same sentence?)

Listening to the interview, I was struck at what a nice voice and manner David has. It was really a fun interview for me, and I hope he had a good time too.

Thanks, David!

Menopause Defined

A reader commented in my recent post that she was just a tad insulted when her doc implied that she was “in menopause”.

“Menopause! I had the period from HELL last week!”

She then goes on to wonder just what the difference is between menopause and peri-menopause, and asked that I address these definitions for her and her friends, because they are all a bit confused.

Happy to oblige, Sea Spray. The reason you’re confused is that it’s, well, confusing. Not to mention the fact that the terminology around menopause has recently changed.

But let’s see if I can make it simple.

Menopause

By definition, menopause is the date of the final menses. But you don’t get to call it your final menses until 12 months have passed with no intervening bleeding. Then, you get to look back and say “That was the date of my menopause!”. Of course, it’s a bit anti-climactic at that point…

If you have what you think is going to be your last period, and then you bleed again in the subsequent 12 months, then the clock resets at that new bleeding episode and we start the 12 month countdown all over again.

As to what to call yourself, you are not “menopausal”. You are either in your reproductive years, peri-menopausal or post-menopausal. The chart below may help you understand these terms.

Postmenopausal

Once it has been 12 months since your last menses, you are officially post-menopausal.

So what are you in that year while you are waiting to find out if that was your last period? You are peri-menopausal.

Perimenopausal

You are perimenopausal from the time from when you first start having variation in your menstrual cycle length to one year after the last menses. Other terms for the perimenopause are “menopause transition” or “climacteric”.

For some women, perimenopause is very short. For others, it encompasses a good deal of their forties and early fifties.

Hormonally, the perimenopause is characterized by fluctuating hormone levels and rising FSH levels. Cycles can range from textbook normal to skipping months at a time to occurring every few weeks. PMS can worsen. Periods can become very heavy and erratic. Mood swings can be problematic. Breast tenderness can be a bitch. And you can have hot flashes even while you are still having menses.

A simple way to remember the perimenopause is this – “Perimenopause is hell”.

Reproductive years

This one’s easy. It’s the years from menarche to the onset of the perimenopause.

The problem with this term is that it implies that the perimenopausal years are not reproductive. Tell that to the woman who gets pregnant in her perimenopause. Which definitely happens, by the way, so use birth control till you are post menopauseal.

What about the word Premenopausal ?

By definition, you are premenopausal for your whole reproductive life, until your final period.

Premenopausal is not really a helpful word, because it not distinguish the perimenopausal years. But it can occasionally be used to describe all those women out there who are still menstruating.

What about the word Menopausal?

When docs use that, they usually mean perimenopausal.

What does Menopause really mean?

The use of the last menstrual period as a defining moment in a women’s life is really an artificial construct based on the only outwardly measurable event we have marking the decline in ovarian function – the last episode of bleeding.

But it’s not like the ovaries give up the ghost at the final period. Many women’s ovaries keep chugging along for quite some time after the last menses, but in general cycling in an increasingly erratic fashion that is characterized by a lack of ovulation, absence of bleeding and lower and lower estrogen levels over time.

But this continuing ovarian function can make the perimenopause and early post-menopausal years a bit less predictable than some think. Not infrequently, my post-menopausal patients will complain of episodes of breast tenderness or PMS, and swear they are going to get a menses, but then nothing comes. And some women, even after 12months of amenorrhea, will occasionally have a full blown normal menses.

Take me, for example.

My Post-Menopausal Period

Just last month, a full 14 months since my last period, I had a miserable 3-4 weeks of bloating, breast tenderness, crankiness and a 5 pound weight gain, along with a pleasant little blip in libido, followed by a whopping migraine the likes of which I had not had for months, followed by a week long episode of vaginal bleeding.

Officially, this was an episode of post-menopausal bleeding. Not something to be ignored, since post-menopausal bleeding can be an early sign of uterine cancer. So I had a sonogram, which was normal. I didn’t have uterine cancer. It was, simply, a period. Just my ovaries popping up to say “We’re not dead yet!”

It’s all normal, because menopause is really a period of time, not a magic day. An episode of transition that can last for days, weeks, months and even years.

Which Reminds me of a Joke

A woman goes to her gynecologist for a check up. “Doctor”, she complains, “There are pennies coming out of my vagina.”

“Take this medicine”, says the doctor, “It should stop the problem.”

Two weeks later, the woman is back. “Well, the pennies stopped, but today I found a nickel.”

“Let’s increase the dose”, says the doctor, and writes her a new prescription.

Two weeks later, she’s back. “Now it’s dimes”, she complains.

The doctor reaches for his prescription pad.

“But doctor,” cries the woman. “What is wrong with me?”

“Nothing,” he says. “In fact, it’s completely natural. You’re just going through your change.”
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For information on Menopause, see

 

Cartoon copyrighted and used with permission from cartoonstock.com.

Chart from Straw (Stagng of reproductive aging workshop). J Clin Endocrinol Metab. 2007 Aug;92(8):3060-7. Epub 2007 Jun 5.

A Quartet of Salads for a Choral Gathering

For the past few years, Mr TBTAM and I have hosted my Choral group’s annual end-of-season party. It’s one of my favorite days of the year. I take off work and spend the day cooking, with NPR and the dog for company, and the sun streaming in my kitchen window.

This year, I made Irene’s chicken with Pauls’ barbecue sauce and a quartet of salads. The group supplemented with wine, appetizers, desserts and more side dishes. Usually we eat on the roof, but the weather was cooler than we expected, so we only did drinks and appetizers upstairs, then dinner downstairs. After dinner, we listened to a recording of our recent concert at Lincoln Center. Was that beautiful singing really us?

Thanks to Martin Rutishauser, our choral director, for an amazing season and for what was for most of us, the opportunity of a lifetime – a chance to sing at Lincoln Center. And thanks to all my friends in the chorus for another great year of music and friendship.

A Quartet of Salads

All four of these salads can be made ahead, and make a great addition to any party plate.

Creamy Potato Salad with Lemon and Fresh Herbs

This recipe is straight from Epicurious, and one of the best potato salads I’ve ever had. There are so many flavorful herbs that I think one could get away with non-fat mayo in this recipe and no one would be able to tell.

3 pounds baby red potatoes
3 tablespoons unseasoned rice vinegar
3/4 cup mayonnaise
3 medium green onions, thinly sliced
1 celery stalk, cut into 1/3-inch cubes
1/4 cup chopped fresh parsley
1/4 cup chopped fresh basil
2 tablespoons chopped fresh dill
11/2 teaspoons finely grated lemon peel

Bring potatoes to boil in large pot of water. Reduce heat to medium-low and simmer until potatoes are tender, about 17 minutes. Drain; let stand until cool enough to handle, about 20 minutes.

Cut potatoes into 3/4-inch pieces. Place 1 layer of potatoes in large bowl; sprinkle with some of vinegar and salt and pepper. Continue layering potatoes with vinegar, salt, and pepper. Add all remaining ingredients; toss. Season with salt and pepper.

Cucumber Salad (Sorry, no photo)

This is a family standard that Mr TBTAM usually makes, but I did it myself this time.

6 large cucumbers
1/2 medium sweet onion
1 cup white vinegar
1 cup water
1/2 cup sugar
1 tsp salt
1/2 tsp pepper
Fresh dill (optional)

Peel cucumbers, slice lengthwise and using a teaspoon, scrape out the seeds. Then slice crosswise into thin slices using a knife or, if you have it, a mandolin. Slice the onion into think slices and then in half across so they are not too long. Mix together in a large Pyrex bowl.

Meanwhile, mix vinegar and water in a medium saucepan, add sugar and bring to a boil. Cool slightly and then pour over cucumbers and onions and mix gently. Salt and pepper. Cover and place in fridge overnight.

Best made a day ahead.

Rice and Lentil Salad ala’ Ottolenghi

This is a slight modification of a Wild Rice Salad from the website of Yotam Ottolenghi, the UK’s vegetarian sensation. (Hat tip to 101 Cookbooks for introducing me to this amazing chef.)

I substituted an Indian rice and lentil blend called Delhi Durhbar for the wild rice. You could use really any lentil or rice mixturein this salad. The original recipe also calls for fresh rocket, an herb that I could not find. So I used an herbal salad green mix from Gourmet Garage instead.

1 cup Delhi Dunbar mix
2-3 ounces by weight peeled dry roasted pistachios
5 ounces by weight soft dried apricot, soaked in hot water for 5 minutes
1 small bunch of mint, leaves picked
2 cos, loosely packed mixed mesclun salad herbs
3 spring onions, roughly chopped
Zest and juice of 1 lemon
2 tbsp olive oil
1 large clove of garlic
Kosher or sea salt and freshly ground pepper

Cook the rice and lentils according to directions. Coarsely chop the pistachios with a large knife. Drain the apricot and coarsely chop them too.

In a bowl mix the rice, apricots and pistachios. Add the rest of the ingredients, toss well and season with salt and pepper to taste.

Green Bean Salad with Mustard Vinaigrette

Another recipe modified from Ottolenghi. I increased the proportion of beans to onions, substituted basil for chervil and plated it on a bed of baby spinach.

1 lb trimmed French beans
1 small red onion, chopped
2 tablespoon capers
2 tablespoon tarragon leaves, chopped
2 tbsp basil (or parsely or chervil or dill)
1/2 bag cleaned baby spinach leaves

Vinaigrette
1 small garlic clove, crushed
2 tablespoons Dijon mustard
1 tablespoon cider vinegar
¼ cup olive oil
Salt and pepper

To make the vinaigrette, put the mustard, garlic and vinegar in a mixing bowl. Slowly add the olive oil while whisking until you get a thick dressing. Taste and season.

Blanch the beans in boiling salted water for 4 minutes. Refresh and drain.

Arrange the spinach leaves on a large platter or flat bowl. Mix the beans with the rest of the ingredients in a large bowl. Toss with vinaigrette and pile onto spinach. Serve.

Eva Peron, Cervical Cancer and the Pap Smear

Eva and Juan Peron, October 1951 (Image from Wikipedia)
Fat Doctor writes that she can never think of Argentina without thinking of the music from Evita, the musical that was inspired by the life of Eva Peron.

When I think of Argentina, I too, think of Eva Peron. But there’s no musical accompaniment. Just sorrow.

Because I can never think about Eva Peron without thinking about cervical cancer, Pap smears and HPV. And the tragedy that was Eva’s death, and the deaths of so many women from cervical cancer.

Eva died from cervical cancer in 1952 at the young age of 33 years. Although George Papanicolaou invented the Pap smear in 1942, this life-saving test was not widely used in Argentina until the 1960’s. Thus, Eva’s cancer was at an advanced stage when it was diagnosed after she began having vaginal hemorrhage.  She received radiation treatment to control the bleeding, probably right around the time of that photo up there, and then a radical hysterectomy in November 1951. Despite treatment, the cancer progressed rapidly and she succumbed to it just 8 months later.

Don’t be surprised if you did not know that Eva had cervical cancer

She herself never knew. Her diagnosis was kept from her at her family’s request, and the public never told, even after her death. The subterfuge was so extensive that when they brought in an oncologic surgeon from Memorial Sloan Kettering to perform a radical hysterectomy, he never met his famous patient until she was asleep under anesthesia, and Eva never knew that her surgeon was anyone other than her own doctor.  It’s an amazing story of paternalism and politics.

Eva’s husband, dictator Juan Peron, also lost his first wife to cervical cancer at 28 years.

Did Peron carry a particularly aggressive strain of HPV, the virus that we now know causes cervical cancer, and unknowingly transmit the infection to both his wives?  Or did Evita contract HPV elsewhere, having been sexually active with multiple partners from the young age of 15?  We will never know for sure.

What we do know today is that Evita’s death due to cervical cancer would likely never have happened if she had had a Pap smear. This simple test, in which cells from the cervix are collected with a brush and examined microscopically for abnormalities, can detect precancerous changes up to 10 years before cervical cancer develops. Ten years during which developing lesions can be treated before they become cancerous.

This week is the 125th anniversary of the birthday of George Papanicolaou, the inventor of the Pap smear.

Happy Birthday, George. If there is a heaven, you are surely in it. And thank you for your wonderful Pap smear – one of the most effective cancer screening tests ever created

If only Evita had had one.

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For more reading about Evita see –

For more information about cervical cancer, pap smears and HPV see these sites –