Cheese-Stuffed Eggplant

He’s actually a pretty darned good cook, the man that I married.

Last Saturday Mr TBTAM whipped up a little din-din using recipes from Nick Stellino’s cookbook Mediterranean Flavors. This little gem of a cookbook features flavors and recipes based on the cuisines of Italy, Greece, Turkey, Spain, North Africa and the Middle East. Stellino’s recipes are beautifully written, with clear, easy-to-follow instructions that leave nothing in doubt, making them suitable for even the most novice of cooks. (The recipe that follows is my abbreviated version of Stellino’s instructions.)

Dinner also included Tunisian Chickpea Soup (recipe another day) and green salad with a lemon vinaigrette. Friend Annette supplied dessert, a gorgeous fruit tart from the Food Emporium under the Queensboro Bridge.

Let’s just say that by the time we were all done, the eggplants weren’t the only thing stuffed….

Cheese-Stuffed Eggplant
These actually taste very light, and are wonderful as an appetizer, side dish, or if you are vegetarian, a main dish. The only change in this recipe is to use Kosher instead of regular salt, so I increased the quantity a bit.

4 Japanese Eggplant
1 tsp Kosher salt
2 tbsp olive oil
6 tbsp grated Parmigiano Reggiano
4 tbsp goat or ricotta cheese
1/4 tsp black pepper
1 egg, separated
1/4 cup Italian breadcrumbs
2 tbsp oil-packed sun-dried tomatoes
1 head roasted garlic
2/3 cup chicken stock

Cut the eggplant in half lengthwise, leaving skins attached. Score flesh with a sharp knife, but don’t cut through the skin. Rub cut surfaces with 1/2 tsp salt. Place eggplant halves cut-side down on paper towels and drain for 15 mins.

Preheat oven to 400 degrees Fahrenheit. Brush cut surfaces of eggplant with olive oil and place cut side down on 18×13 inch non stick baking pan. Bake for 15 mins. Cool for 15 mins.

Gently scoop the pulp from the eggplant, leaving skins intact for later. Put pulp in food processor, and add 2tbsp Parmesan, goat or ricotta cheese, remaining salt, pepper, egg yolk, bread crumbs, sundried tomatoes and roasted garlic. Pulse till just mixed, about 30 secs.

Whip egg whites till stiff. Fold into the eggplant mixture with a rubber spatula. Fill the reserved eggplant skins with the eggplant mixture, mounding slightly. Place in a 9×13 inch baking dish and pour chicken stock around them. Sprinkle eggplant halves with the remaining Parmesan cheese and bake at 450 degrees Fahrenheit for 30 mins., until golden brown. Cool for 5-10 mins. and serve.

Stellino serves them on a small bed of tomato sauce. We just had them as they were – delicious.

Dove Does it Again

This time it’s a video called Onslaught, which shows the images of the female body that young girls are bombarded with by the media.

It’s part of Dove’s Campaign for Real Beauty. I like the message.

Can’t say I use the soap, though, being a gal who goes for the more squeaky clean feel. And in the end, it’s really all about selling soap, isn’t it?

If you didn’t see their first video called “Evolution” here it is. I thought it was even more powerful than this new one.

Thanks for California Now for pointing me to these videos.

Dove Does it Again

This time it’s a video called Onslaught, which shows the images of the female body that young girls are bombarded with by the media.

It’s part of Dove’s Campaign for Real Beauty. I like the message.

Can’t say I use the soap, though, being a gal who goes for the more squeaky clean feel. And in the end, it’s really all about selling soap, isn’t it?

If you didn’t see their first video called “Evolution” here it is. I thought it was even more powerful than this new one.

Thanks for California Now for pointing me to these videos.

Will a Hysterectomy Make You Fat?

No, according to a British study published in this week’s Maturitas. Removal of the uterus, with or without removal of the ovaries, is unlikely to lead to weight gain.

The investigators used data from two British prospective health studies that enrolled over 6,000 women born in 1948 and 1956 and followed them longitudinally throughout their lives.

Although women who had a hysterectomy had higher BMI and waist circumference in middle age than women who had not had this surgery, this was because they were already heavier to start with, not because they had had a hysterectomy. After surgery, these women merely continued on their previous trajectory of weight gain, as did their same-sized cohorts who had not had the surgery.

In unadjusted analyses there was a difference of 1.18 kg/m2 (95% CI: 0.64, 1.74) in mean BMI and of 2.72 cm (1.45, 3.99) in waist circumference at age 44–45 years between women who had undergone hysterectomy and those who had not in the 1958 cohort, and differences of 0.76 kg/m2 (−0.05, 1.57) and 0.34 cm (−1.58, 2.26) at age 43 years and 0.81 kg/m2 (0.14, 1.49) and 1.45 cm (−0.15, 3.05) at age 53 years in the 1946 cohort. These differences attenuated and were no longer significant after adjustment for pre-hysterectomy BMI and confounders. There was no strong evidence of variation in associations by oophorectomy status, timing, route of or reason for procedure. (italics mine)

Such is the value of longitudinal objectively measured data. Although previous cross sectional and cohort studies have shown weight gain after hysterectomy, none of these controlled as well for pre-hysterectomy weight, and none had the kind of objective measure of pre-hysterectomy weight used in this study, where subjects had nurse visits for measurement of weight and other vital signs throughout their life.

It is known that menopausal women begin to shift their weight to the middle, and that hormone replacement prevents this change. In this study, however, hormone replacement only accentuated the difference in BMI between women who had hysterectomies and those who did not. We do know that obese women have more hot flashes than thinner women, and perhaps they ended up using more HRT. That’s just a thought on my part.

Some other thoughts

So, women who were heavier to start with end up with more hysterectomies.

Although this study did not address the question, one has to ask – why? What is it about higher weight that leads to hysterectomy?

One factor could be that obesity raises the risk for endometrial cancer. Other risk factors for endometrial cancer are diabetes, hypertension and lifelong irregular menses such as those experienced by women with polycystic ovarian syndrome, all conditions linked to obesity. Obesity is also associated with higher rates of uterine fibroids and prolapse of the uterus, two common causes for hysterectomy. In the study reported here, women having hysterectomies for reasons of fibroids and prolapse had higher BMI’s, while those with cancer had lower BMI’s.

It was interesting to me that women born later in this study had less hysterectomies by their mid 40’s than their older counterparts, suggesting that they and their physicians were finding ways to avoid surgery to treat their conditions. Indeed, we now have a number of good non-surgical interventions for fibroids, so that less women should have to have surgery for this indication as time goes on.

Unfortunately, this study also showed that women of lower socioeconomic status had higher rates of hysterectomies, making me wonder if they had access to the kinds of treatments throughout their reproductive life that could have prevented their surgery.

Bottom Line

If you are deciding whether or not to have a hysterectomy, concern about weight gain related to the surgery does not appear to be important factor in your decision-making. That leaves you more time to really talk to your doctor about what your options are and what’s best for you, surgery or not.
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Venus at the Mirror and Three Graces. Paul Rubens (1577-1640)

My Latest Addiction – Gertie’s Artichoke Tapenade

No, it’s not drugs or alcohol. It’s Gertie’s Artichoke Tapanade, and I got mine at Costco.

This stuff is incredible – a simple mix of artichokes, olive and safflower oil, green olives, key lime, vinegar, salt and spices. 29 calories for 2 tbsp, 2.5 grams fat (no trans fats) and 0.3 gm fiber per serving.(That’s 1 point for you WW fans)

Makes a great party appetizer served with baked pita triangles or crackers, but I’m trying to figure out how else to use it – maybe on pasta?

Here’s a recipe that sounds similar…

Grand Rounds: Volume 4, No 8

From the Saguaro Desert in Arizona comes this weeks grand rounds, hosted by none other than Dr Anonymous, who is becoming less and less so given his photo over there. So stop on over for this week’s best of the medical blogosphere.

While you’re there, be sure to check out the post from Dr Bongi’s blog Other Things Amanzi. Dr Bongi is a general surgeon from South Africa, and his blog is always a great read.

Give a Laptop, Get a Laptop

One Laptop Per Child, an organization that is building and distributing laptop computers to children in the developing world, is offering a free laptop for every one you donate.

This is the first time the revolutionary XO laptop has been made available to the general public. For a donation of $399, one XO laptop will be sent to empower a child in a developing nation and one will be sent to the child in your life in recognition of your contribution. $200 of your donation is tax-deductible (your $399 donation minus the fair market value of the XO laptop you will be receiving).

It’s a great little laptop – built around a Linux operating sytem, rugged enough to resist the wilds of Africa and the dangers of your kid’s commute to school. Best part? The screen is visible in sunlight.

The Give one, Get One Offer runs till November 26. I ordered mine today. My daughter is ecstatic, and I hope some kid in Africa will be too.

Why not order yours?

Butternut Squash Soup with Fried Sage Leaves

A visit from Mr TBTAM’s sisters on a crisp fall day called for a great soup, and what could be better than butternut squash soup? Serve it with a green salad and warm bread.

Butternut Squash and Apple Soup with Fried Sage Leaves

This recipe is a modification of the pumpkin bisque recipe from the Professional Chef, with a bit of advice from Irene. The fried sage leaves as my addition.

1 large onion, diced
2 stalks celery, diced
3 cloves garlic, minced
3 tbsp butter
1 really large butternut squash (or two medium squash) , peeled, seeds removed and cut into 1 inch cubes
3 apples, peeled, cored and cut into 1 inch cubes
4 cups vegetable stock (or chicken stock)
2 oz cup white wine
1 tsp minced ginger
Salt and pepper to taste
30 fried sage leaves for garnish

Melt butter in a saute pan, and saute onion, celery and garlic.

Add squash and apples, saute a minute or so, then add vegetable stock. If needed, add a bit more stock or water so veggies are just covered.

Bring to a boil, then turn down heat and simmer, uncovered, until tender, about 30 minutes or so, stirring occasionally.

Meanwhile, bring the wine to a simmer in a small pot. Add the ginger, remove form heat and steep until cooled to room temp. Strain.

Let the soup cool slighty, then puree in batches in food processor. Return to pot, reheat and stir in the wine. Season with salt and pepper. Pour into bowls. Garnish with sage leaves.

Fried Sage Leaves

30 sage leaves
Flour (optional)
4 tbsp olive oil
Kosher salt

Rinse the sage leaves and allow to dry. Dust lightly with flour (optional) Heat the olive oil in a small pan. Add the sage leaves and fry for about 30 seconds. Remove with a slotted spoon and drain on paper towels. Salt before serving.

Cervical Cancer and Birth Control PIlls

A recent meta-analysis has confirmed that use of birth control pills slightly increases the risk of cervical cancer. But before you stop your pills, take a deep breath, relax and read further.

Because the risk is really small. How small? Well, if you live in a developed country (meaning you have access to Pap smears), use of the pill for 10 years increases your chance of having cervical cancer from 3.8 per 1,000 to 4.5 per 1,000.

Remember that the real cause of cervical cancer is not birth control pills. It’s infection with the Human Papilloma Virus (HPV).

But estrogen metabolites of the pill may make your DNA more susceptible to changes induced by the HPV virus. The pill can also make the glands of the cervix more exposed to infection by the HPV virus. The other big factor may be that women taking the pill may use condoms less frequently, thus making them more likely to get HPV.

The good news is that once you stop the pill, the increased risk of cervical cancer goes away. That means that when you get older and don’t need birth control, you won’t be paying the price for your decision to use pills when you needed them to prevent pregnancy.

Bottom line – limiting your number of sexual partners and getting pap smears regularly are the most important things you can do to prevent cervical cancer. There is also a vaccine to prevent HPV, but remember that it only protects against 2 of the 12 subtypes of HPV that cause cervical cancer, so it’s not a panacea.

And remember, the pill cuts the risk of ovarian cancer, a protective effect that lasts up to 20 years after you stop the pill. It also reduces your risks of endometrial cancer. And keeps your menstrual cycles shorter, lighter and less painful. Not to mention it prevents pregnancy.

A Gynecologist’s Perspective

I’ve been a practicing gynecologist for 20 years now. In that time, I can remember only 1 case of cervical cancer in my private practice, in a woman age 60 who was completely cured with a hysterectomy. (The cancer was so small they could not find it in the hysterectomy specimen because I had removed it all with my office biopsy.)

I recall many more cases of cervical cancer from my residency, most during my oncology rotation, and all in women who had not had pap smears in years. I remember vividly the woman who presented to the ER bleeding from a large cancer on her cervix. She had not seen a doctor since giving birth to the last of her 7 children, who was now 25 years old. I don’t think she ever took birth control pills.

On the other hand, I’ve lost count of the number of unplanned pregnancies that have occurred among my patients, and the number of my patients who have had abortions for an unwanted pregnancy.

Given this experience, I see no reason for woman to stop taking the birth control pills because of concerns about cervical cancer.

I can think of only one situation where I might tell a woman to stop the pill for this reason. That is the rare patient with recurrent cervical dysplasia and persistent HPV infection that does not clear. I had one such patient, and I changed her to the progesterone-only pill. She is doing well.

Garbage In, Garbage Out

Two of our finest docs were recently down-graded from premium status by a major insurer for providing sub-par care. Specifically, the insurer claimed that not enough patients seen by these docs got routine screenings with pap smears and mammograms.

I was asked to help review the data that led to this down-grade in designation for these docs. Here’s what we found –

Of the 209 instances where the insurer claims that patients did not receive either paps or mammograms according to recommended screening guidelines –

  • 191 received these services, and we had documentation to prove it.

  • 5 saw a different doc in our system, but had the services in question

  • 1 was referred for a mammogram, never went, and has not been back to the doc in 3 years.

  • 7 never saw any of our docs

  • 5 have not been back to see the doc in 2-3 years, and at their last visit, had the services.

      • This, my friends, is how insurers measure quality.

      TBTAM’s Recommends – An Equal Music by Vikram Seth

      The best novel I’ve read this year is An Equal Music by Vikram Seth. It is the story of a violinist in a string quartet who reunites with his one true love, a gifted pianist with a tragic secret, 10 years after their relationship ended. The violinist wrestles with his own inner demons even as he tries to reclaim his love, hold onto his violin, make a living and stay united with his quartet.

      This one of those books you want to read slowly, savoring every word. It is a journey into the inner world of music and the mind of the musician, narrated by one who is passionate about every note he plays. It was all I could do to keep myself from jumping up and heading to the music store to find a recording, any recording of the pieces descibed.

      “This book needs a soundtrack” I told my husband when I was about halfway through the book. “I’m dying to hear this music.” Then I looked on Amazon – There is a soundtrack!

      Buy this book. Buy the soundtrack. Read, listen and enjoy.

      jUST A sUGGESTION

      dEAR mR gATES AND mR jOBS –

      i LIKE YOUR COMPUTERS A LOT. bUT i HAVE ONE SMALL SUGGESTION.

      nEXT TIME YOU DESIGN THE KEYBOARD – cOULD YOU MAYBE PUT THE caps lock KEY SOMEWHERE FARTHER AWAY? mAYBE AT THE TOP OR SOMETHING? oR NEXT TO SOME LETTER i DON’T USE SO MUCH? mAYBE NEAR THE Q?

      bECAUSE WHERE IT IS, i MUST HIT IT AT LEAST 50 TIMES A DAY. aND i CAN’T THINK OF THE LAST TIME i NEEDED CAPS LOCK, CAN YOU?

      tHANK YOU FOR YOUR ATTENTION.

      sINCERELY,

      tbtam

      Kiddush Quiche (say that 5 times fast….)

      The Hebrew word Kiddush means a prayer recited at the beginning of the Sabbath or holiday, but can also refer to a reception held just after services, often in conjunction with a Bar Mitzvah. Food at a Kiddush tends to be light or sweet fare – salads, fish, bagels, wine, cakes.

      We hosted a Kiddush at our home last month for our friend’s son on the night before his Bar Mitzvah. In this process I discovered that hosting a friend’s party is much less stressful that hosting your own, especially when they bring most of the food, which in this case included a varity of cakes and fruit, the most amazing of which was the chocolate flourless cake from the Silver Moon Bakery. Because the timing of services made me worried that some of the guests may not have eaten dinner, I added cheese to the menu of sweets and decided to make a quiche.

      It was a good decision – the group pretty much devoured everything. And what a great group it was – the kids all got along well, and we adults re-connected with old friends and made some new friends, too.

      Thanks to our dear friends for allowing us to play such a special part in this important event.

      Leek, Red Pepper and (chicken) Sausage Quiche

      I modified a recipe for leek quiche I found in the Professional Chef, and used my own pie crust recipe. Obviously, our friends are not Kosher, but if you are, skip the meat in this quiche.

      1 recipe Pate Brisee
      2 large leeks or 4 small ones, thinly sliced
      1 red pepper
      1 clove garlic
      butter or oil
      salt
      cayenne pepper
      1 1/4 cup half and half
      3 eggs
      4 oz grated cheese (I used Fontina, you could also use Jarlsberg)
      2 tbsp fresh thyme, chopped
      2 sausages (I used Applegate Farms organic pre-cooked chicken-apple sausages), diced

      Prepare the crust

      Make the Pate Brisee dough, roll it out and fit into a 10-inch tart pan. Partially cook it by either lining it with foil and adding pie weights, or setting a slightly smaller pie pan inside it. Bake at 425 degrees Fahrenheit for about 15 minutes till set. Then remove the foil and weights or smaller pie pan, prick the bottom with a fork and and bake another 5 minutes. Take out and let cool before filling

      Make the Filling

      Heat a small amount butter or oil in a saute pan. Add sausages and saute quickly over high heat to brown. Remove from pan to paper towels to drain. Lower heat to medium high and saute leeks, peppers and 1 tbsp thyme until leeks start to soften. Add garlic and saute a few minutes more. Season with salt, pepper and a pinch of cayenne. Remove from heat to cool.

      In a medium sized bowl, whisk eggs and half and half together. Stir in the grated cheese and the second tbsp thyme, season with salt, pepper and cayenne.

      Assemble and Bake

      Spoon the filling mixture into the tart crust. Add the egg mixture gradually, stirring carefully with a fork to distribute the filling ingredients evenly.

      Set the quiche on a sheet pan and bake in preheated oven at 350 degrees Fahrenheit for 40-45 minutes until set ( a knife blade inserted into the center comes out clean) and lightly browned.

      Serve warm or at room temp.