HPV Vaccine – Defining the Limits

In a study published today in JAMA, HPV vaccination did not improve clearance of HPV 16/18 in women ages 18-25 who were already infected with the virus.

our results demonstrate that in women positive for HPV DNA, HPV-16/18 vaccination does not accelerate clearance of the virus and should not be used for purposes of treating prevalent infections.

In this study, conducted in Costa Rica, 41.3% of women were infected with HPV at the time of study enrollment. Just another reminder of how common this virus really is.

What do these results mean for patients? If a woman already has an abnormal pap or infection with HPV, vaccination will not be useful in treating her current infection. However, until we have a test to determine which of the 40 HPV subtypes our patients are infected with, vaccination may still be reasonable in such women for preventing future infections with types 16/18/6/11.

The CDC currently recommends vaccination before sexual debut as the most effective means of preventing HPV infection. The older a woman is, the greater the chance she will already have been infected with HPV.

Don’t Misread the Hype

The hype over the HPV vaccine may be misleading, leading some women to believe that the vaccine will make them immune to all HPV infection. Products like the HPV thong (seen below) do little more than promote this misunderstanding.

To be correct, here’s what that thong should look like…

Remember that the currently marketed vaccines only target 2 of the 12 known strains of HPV that cause cervical cancer. Pap smears are still critical in screening for cervical cancer and detecting precancerous lesions before they become life-threatening.

And now back to our regularly scheduled blog….

Olive trees, Rome
Sorry for the uncheduled blog break. I was catching up at the office (payback for vacation), unpacking (I moved my office 3 days prior to vacation), and dealing with Mom’s illness (she’s doing much better, thanks Dinosaur Doc for listening).

Now where was I? Oh, right – Rome. Of course, we did the tourist-thing. You know, the Mouth of Truth,

the Forum,

and the Colliseum (Fabulous tour by Steve of Angel Tours)

But by far, the best part of visiting ancient Rome was having a picnic under the olive trees on the Palatine Hill.


Wanja packed “turtle rolls”

onto which we piled fresh mozarella, tomatoes and basil, henceforth known as a “Palatine Sandwich”.

On Sunday, we rented bikes at the train station and rode out along the Appian Way, (which is closed to traffice on Sundays) to the Catacombs. Highly recommended, and a new bike path within the city made it even easier. Then to the Spanish steps and the Trevi Fountain. Sorry, no photos, but here’s a little clip of the Trevi Fountain scene from La Dolce Vita…

As much as we loved touring Rome, my favorite times there were when we hung out with the locals in Trastevere. Like the hour or so we spent sitting at a bar at the Piazza San Cosimato, a favorite neighborhood gathering place.

The Piazza has long been home to a local vegetable market, but until recently was also Trastevere’s unoffical parking lot and home to drug dealers. That all changed when the Piazza was redesigned by Lorenzo Pignatti as a modern gathering place for the residents of Trastevere and their families.

Although the Piazza is a bit of an anachronism in this ancient part of Rome, it works. The market is thriving and children play safely in the playground while their parents sit and drink coffee or wine at the nearby bars. Which is exactly what we did.

Now if we had had this at our neighborhood playgound in NYC, my kids would have been there every evening. Heck, I’d be swinging on those swings myself..

The market in Piazza San Cosamo is a bit quiet these hot summer days, but that doesn’t mean the fruits and vegatables are not just as gorgeous as in the high season.



If, like us, you are in Rome in late July, you will be just in time for Festa de’Noantri. The festival starts with the procession of the statue of Vergen del Carmine, who is taken from her home in church of Sant’Agata and paraded through the streets of Trastevere to San Crisogono, where she will be on display for eight days while Trastevere parties.



Unfortunately, we will miss the rest of the Festival, because we are heading to the beach, with a stop in Villetri along the way.

TBTAM Does Italy, Part 6 – Vinci and Lucca

Vinci

We sleep late yet again (When will we recover from our jet lag?) and hit the road hours later than we had planned. Today’s road trip will take us first to Vinci, the home of Italy’s favorite son – Leonardo da Vinci. Until this day, we never realized that Leonardo’s last name means “from Vinci” – Duh!

Natalie wonders: “Does that mean everyone in this town has the same last name? Or is it just the famous ones? And if I ever get famous, will I be called ‘Natalie from New York City’?”

These are very good questions that I cannot answer. Fortunately, Wikipedia can.

The illegitimate son of a notary, Messer Piero, and a peasant girl, Caterina, Leonardo had no surname in the modern sense, “da Vinci” simply meaning “of Vinci”: his full birth name was “Leonardo di ser Piero da Vinci”, meaning “Leonardo, son of (Mes)ser Piero from Vinci.”

Leonardo’s birthplace is a small town surrounded by olive groves and rolling hills not very far from Florence. The centerpiece of the original Renaissance town is the castle, which has been transformed into il Museo de Leonardo da Vinci.

The museum is dedicated not to Leonardo’s art, but to his machines – construction machines, optic instruments, fabric looms. They’ve built quite a number of Leonardo’s machines to his exact specifications, including his bicycle and flying machine. This is just a great little museum!

The kids are actually interested, and we learn how a rack and pinion works, how simple machines can be used to lift large stones with little effort, and how ball bearings reduce friction. This is the physics of everyday life, the stuff I love to explain to the kids. And to see daVinci’s actual notebooks and drawings is magical.

A short hike to the top of the tower is mandatory and we are rewarded with gorgeous views of the surrounding countryside.

A quick sandwich in town and we hit the road again. Next stop, Lucca.

Lucca

The walled town of Lucca is a moderate sized city-within-a-city located not too far from Pisa. Earthen ramparts surround the entire inner city, and auto traffic is limited within its walls. No longer necessary for protection, the ramparts are essentially a 3 mile long city park, filled with tourists and locals of all ages bicycling, running or just strolling hand in hand.

We decide to rent bikes and join in the fun.


After about an hour of riding, the views of the town from the ramparts begin to tempt Mr TBTAM and I, who want to head down into the town to explore.


But the kids are enjoying the ramparts too much to come down, and we give in to them and take a break from touring. Emily starts a watercolor of this scene…

but before she is finished, a nearby church chimes the hour, and she must put away her paints so we can get the bikes back by 8 pm.

We have planned things wrong – Lucca deserves more than a day, and now we must leave it unseen except for these wonderful walls. We debate staying over, but have train tickets back to Rome tomorrow, so it is not possible. And so we head back to Florence, once again promising to return to Italy and see all the things we have missed on this trip.

Tomorrow – A litle more of Rome

TBTAM Does Italy – Part 5, Road Trip to Siena

Our Italian hosts head back to Rome, leaving us on our own for a few days. Although we will miss them, we are excited about tackling this country ourselves. We decide to drive to Siena for the day.

Driving in Italy is not for the faint of heart, or for those who can’t drive stick. Thankfully, we are neither. We rent a cute Alfa Romeo, grab a map and go.

Unfortunately, few of the Italian roads have names or rte numbers, so getting anywhere is a challenge. We get lost, and find ourselves on the Autostrade to Pisa. This is actually fortunate, since we will become detoured tomorrow in this very area and will know how to get back to Florence because we were lost here today.

We decide to take rte 22, that green road up there that looks like a straight shot between Florence and Siena. We figure that the 40 kilometer or so drive will take at most 2 hours.

Boy were we ever wrong. The road, which starts out flat and straight, is soon winding its way up into the mountains. The views are breathtaking, but so are the turns. Natalie, the Carsick Kid, does beautifully, but that is because we are driving so slowly, which for some odd reason seems to annoy those in the cars behind us. We only stall on a hill twice, leaving the Italian drivers behind us laughing hysterically. Oh, well…

Panzano in Chianti

We stop in Panzano in Chianti, a small town about halfway to Siena, hoping to visit Mario Cecchini, the famous Butcher. But his shop is closed today, the young boy mopping the floors tells us. So we decide to have lunch at Oltre il Giarndino, a lovely restaurant in a stone house just a few steps away from the small town square.

We sit on a large terrace shaded by Wisteria and other vines, overlooking the valley. The ravioli ricotta e spinaci al burro e salvia (ravioli in sage butter) is the best I have ever had in my life – how do they make it so light?

A quick gelato for the kids, then back to the road. We take a wrong turn out of town, and find ourselves up amidst the vineyards. A roadside shrine provides a good spot to turn around and head back to the highway towards Siena.

As we make the turn, an old lady glares out at us from between her curtains. I can almost hear her muttering, “Touristsi…”

Siena
Siena is a medieval city built on a mountaintop in the heart of Tuscany. The heart of the city is restricted to pedestrians, giving it almost a Disneyworld kind of feel. But this is a real town populated year-round and having a vibrant shopping district, a strong arts culture, and a twice-yearly horse race around the Piazza del Campo.

We stop for a drink on this sweltering hot day. Looks like the birds in the Fonte Gaia (“Fountain of Joy”) had the same idea…

Mr TBTAM and Emily climb the Tower of the Pallazzo Publico while Nats and I tour the rooms inside. The frescoes there are amazing, and we are quite taken with Ambrogio Lorenzetti’s enormous fresco “Allegory of Good and Bad Government”, which encompasses an entire room.

We lean in close to look at the detail on the strangely prophetic Bad Government frescoe….

There is a jazz school in Siena, and they are recruiting students at the Pallazzo. I check out the brochure, but there is no course in scat singing. Too bad, I might have stayed on for that. But students of jazz are everywhere in this town.


(Double-Click player for a little Siena Street music.)

We stroll and shop, the it’s on to the Duomo, which goes on record as my favorite church in Europe.

I love everything about it – the zebra striped columns,

the floors

and the ceilings.

But the Duomo is closing, and the sun is setting. We need to get back on the road to make it to Florence before it is too dark to read the poorly lit road signs on the autostrade. So we head back down to the car, strolling a little more slowly than we should, vowing to return someday soon for a longer visit to this lovely town.



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Frescoe images from Web Gallery of Art

In Defense of the Hysterectomy


First of all, let me go on record as saying that I have no vested financial interest in whether or not women have hysterectomies, since I confine my practice to surgical procedures that I can do in the office.

Second, let’s get our terms straight. A hysterectomy is removal of the uterus. Removal of the ovaries is called an oophorectomy. While it is true that sometimes both procedures are done at the same time, one must be careful to speak of these procedures separately, because they have different indications and different outcomes.

Okay, now that we have that settled, let’s talk.

It is estimated that in 1999, the last year for which we have data, there were some 600,000 hysterectomies performed in the United States.

Is that too many hysterectomies? I’m sure it is. Are there unnecessary hysterectomies being performed? I’d bet money on it. Are there non-surgical options for many of the conditions we use hysterectomy to treat? You bet there are.

But this does not mean that hysterectomies are bad operations.

That’s not what the HERS folks think. They want to see hysterectomies abolished. They tout data from uncontrolled studies and surveys to prove that hysterectomies lead to everything from decreased libido to impaired sexual function to obesity. And that anything other than a hysterectomy is better than the hysterectomy. The media don’t always help the discussion, especially when the only data they quote is the uncontrolled survery data from HERS. It’s all so simple for them. Hysterectomy = Bad. Anything else = Good.

What they do not tell you is that when it is indicated, a hysterectomy can save lives, restore sexual function, eliminate bleeding, resolve pain and improve the quality of life overall. But no one talks about the positive aspects of the surgery.

And no one talks about the many, many women out there who are suffering from heavy bleeding, pain and reduced quality of life because they have been led to believe that hysterectomy is a bad operation. They may spend years trying every other option under the sun so that they can avoid the dreaded operation that might give them back their lives. Some will make it finally to menopause with their uterus intact, but will have lost those years to pain and bleeding in return. Others will eventually give up the good fight and have the dreaded hysterectomy. And the most frequent comment I hear from these latter patients is this – “Why did I wait so long?’

It’s true. When hysterectomies are performed for indicated conditions, and when women make a well-informed decision to have the surgery, they tell me they would make the same decision over again.

This has not been my experience with my patients who have had myomectomies, the favorite surgery of the HERs foundation.

I have had more than a few patients regret their decision to have a myomectomy when, less than 5 years later, they are back with new fibroids larger and more symptomatic than their previous ones. “Why didn’t I just have a hysterectomy then?” they will say, or more disturbing to me “Why did I let everyone talk me out of a hysterectomy”?

Look, if you are 25 and have fibroids and haven’t had your kids yet, then absolutely a myomectomy is the operation you most likely will want. The surgery carries risks, but these pale for most women compared with the thought of not being able to have children.

But women who are done childbearing, and are taking the time out of their busy lives to have major surgery, should at least be given the opportuity to consider having the operation that will solve the problem forever – a hysterectomy.

As to the long term effect of hysterectomy, there are a number of well-done prospective studies showing that removal of the uterus alone does not impact sexual function. In fact, if reserved for women who really need it, sexual function in my practice experience, is often improved.

Is hysterectomy the only option for the conditions I listed above? For most benign conditions, the answer is absolutely not. But it is an option, and a very viable option. For many women, it is their best option.

Hysterectomy deserves consideration and discussion as much as any other procedure. To label it as being bad, or to try to convince women that they should not have this surgery is as much a disservice to women as performing an unnecessary hysterectomy.

Thanks to Kevin, Md for pointing me to the Time/CNN article on hysterectomy.

TBTAM Does Italy – Part 4

After gorging oursleves on prosciutto and ham and scomorza, we headed out to visit Tempio Maggiore, the only Synagogue in Florence. Definitely worth the trip, and far from the tourist crowds. Moorish design, gorgeous. Security was tight, and they gave the girls shawls to cover their shoulders for the tour. Sorry they forbade cameras inside, but here is a web site with good pics. We learned the fascinating history of the Jews in Florence and met a nice man from Crown Heights who thought Diego was Jewish and offered him his Tallis.

Beautiful Oleander growing on a wall across from the Synagogue, and everywhere we went throughout this country. Given how oleander grows here in this hot sunny climate, I am wondering if it would do well on my rooftop, and consider sneaking some cuttings through customs, but reconsider and plan to check it out when I get home…

On to the Iffizi. As with the Metropolitan in New York, I think the best time to visit the Iffizi is the end of the day. We got our tickets for 6:00 pm, which left us plenty of time to see the galleries, catch a gorgous sunset…

and close the rooftop cafe with drinks.

Dinner is a pizza with anchovies.

More strolling. gelato for the kids, then home to Boga Pinte.

The grafitti catches my eye tonight, and I find myself thinking that it is much more artistic here than in Rome. Or perhaps it is just that the Iffiizi has me seeing art everywhere….



Tomorrow – On our own in Sienna and Vinci

TBTAM Does Italy – Part 3. Mercato Centrale, Firenze

The Mercato Centrale (Central Market) in Florence is filled with a seemingly endless array of vinegars, cheeses, meats, fruits, vegetables, all stunningly gorgeous, fresh and wonderful, in surroundings a bit prettier and a little more self-conscious that I’d expected.

But I’ll let the photos speak for themselves…





Vinegar tasting bar

These were the best sun dried tomatoes I have ever had.



Here’s what we made with what we bought.

Ricotta, arugula and sundried tomato sandwiches

Ricotta cheese
Sundried tomatoes
Arugula
Salt (only if tomatoes are not salted)
Good bread
Olive oil

Cut bread into clices. Spread ricotta on bread. Top with tomatoes and arugula. Drizzle olive oil. Salt only if tomatoes are not salted already.

Figs wrapped with Proscuitto

Fresh figs
Prosciutto Crudo

Cut figs in half. Wrap with Prosciutto. Eat.

Cooked Scamorza Cheese

Cut the scamorza cheese in half lengthwise. Place in a preheated pan for a few minutes till soft, warm and bubbly. Eat immediately.

When do you eat scamorza? Well, it could be a second course at dinner. Or, according to Wanja, you keep it around at all times, “And when you get home late on Sunday night and you’re hungry and too tired to cook anything, then you make yourself a scamorza.”

TBTAM Does Italy – Part 2

Florence

The high speed train from Rome to Florence takes under 2 hours, and Wanja packed us sandwiches for the ride. We walked from the train station in sweltering heat down the narrow, treeless streets of Central Florence to our apartment on Borga Pinte.

Tucked away behind the tall stone walls are apartments, gardens, schools, hotels, you name it. It all seems so very secret. So it should come as no surprise to you that behind the unassuming door of our building was this entryway…

Go through that gate and down the hallway…

And you are in the main garden!

Our apartment is a modern renovation on the ground floor…

and has a small private garden.

We rented the partment through a European site called Hidden Italy. I highly recommend it.

The best part about staying in an apartment vs. a hotel is discovering the little things that make life abroad different from home. For example, the Italians dry their dishes in a cupboard above the sink lined with open-grated shelves. Now you see ‘em…

Now you don’t!

But enough domesticity – on to Florence.

This is the Duomo. It was closed by the time we arrived, but open for Mass, so we decided to attend the Mass in order to see the place. We were a rather motley crew – one ex-Catholic, one Jew, 2 Quakers, and 2 kids raised without a formal religion. No one seemed to mind.

We liked the Fake-David in the Piazza near the Iffizi Galleries. The lines were too long to see the real one.

We strolled the streets, stopping to buy sandals, watercolors and other small things.

Dinner was at a rather touristy place near the Ponte Vecchio, a meal during which the waitress ran out of the kitchen screaming when a large bird flew in. The food itself was non-descript, save for a single dish – Pecorino cheese served with honey and pears. We decided then and there to make it ourselves the next day. (recipe below)

We stumbled upon a concert by the Santa Barbara Choral Society in the Chiesa San Stephano al Ponte Vecchio.

The entire first half of the concert was accompanied by a solo bird singing along somewhere in the eaves of the church! The highlight of the concert was Lux Aeterna, a modern choral piece by Morten Lauridsen that I had never heard before.

To get a little sense of the experience do this – Close your eyes, imagine you are in a church in Italy and listen to this excerpt. (Requires real player, give it a second to load.) You will understand why my face was covered in tears by the end of the piece.

After the concert, it was gelato and a leisurely walk home. At night, many of the stores outside the tourist areas shutter up, giving the place a bit of an eerie feeling.

But don’t be frightened. Madonna is there on almost every corner watching out for you…

The restaurants are still open…

And there is plenty going on behind those walls. One evening, we walked past an open door, and looking in, saw that the whole neighborhood was in a large coutyard watching an old movie being projected on the walls!

Tomorrow – More Florence (and more recipes)…

Pecorino Cheese with Honey and Pears

1 wedge good pecorino cheese – Goat’s (oops I mean sheep’s) milk is best
1 pear, not too soft
Honey
1 Tiny sundried tomato (Or a small piece of dried pepper if you are daring)

Place honey in a small bowl for dipping, Garnish with a small sundried tomato or pepper.
Cut cheese into small wedges. Core and slice pear. Dip cheese or pear into honey and eat. Hmm…

TBTAM Does Italy – Part 1

To see Italy through the eyes of those who live there is to truly experience that country.

It is the difference between standing in a café stranded by the lack of language and knowing that you order one way when sitting at a table and another when standing at the bar, and never cappuccino after noon. The difference between getting lost on the Autostrade and knowing that the road you are driving on took years to build because each kilometer had to be contracted separately with the Mafia family assigned to it. The difference between wandering around the Palatine Hill with a tourbook in the sweltering heat and having a picnic there. Between feeling like an outsider and belonging.

And so first, I want to thank our dear friends Wanja and Fabrizio for hosting us during this trip and our new friends Martina and Federico for making us feel as if we belonged in their wonderful country.

Now on to your visual trip through Italy, complete with a recipe or two. First stop…

ROMA

Our friends live in Trastevere, which means “Across the Tiber”. Trastevere is Rome’s Left Bank, and is a vibrant neighborhood that has been gentrified from its seedier predecessor. Graffiti still abounds, but the area is safe and like New York, there are people out till the late hours. Visitors tend to stick to the same main streets, which can be very crowded at night. But just stray off the beaten path by a single block, and it is peaceful. Needless to say, we felt right at home.

For this one night stay we split up between Wanja’s apartment and that of their friends in Monte Verde, which is on one of Rome’s seven hills. The apartment came complete with terrace garden, great views of the city and a four flight walk up. There was an air conditioner, but we did not discover it until the next morning. Oh well, what’s another bath or two when the tubs are deep enough that the water covers your shoulders while you read.

Now that we’re settled, how about a walking tour through the cobblestone streets of Trastevere? (Since I am contemplating painting my living room orange, you will see a lot of orange buildings in these photos…)

The Piazza Santa Maria Trastevere is the heart of the neighborhood, and until recently, it was where all the school kids hung out at night, till the cops had them move on to another Piazza.

Check out the floors in the Church of Santa Maria Trastevere…

Even though I no longer am a practicing Catholic, I light a candle for my Mom whenever I visit a church. Here, we also wrote a request to St Anthony to take away Mom’s post-herpetic neuralgia. We tucked our paper in near the top, hoping this would get her priority attention.

Piazza Navona. They used to fill it with water and reenaact naval battles there.

Speaking of water, there are freely flowing fountains everywhere. The Romans are very proud of their water, which rivals New York’s in terms of taste. You can cup your hands under to get a drink,

or do as the Romans do, plug the bottom and and lean in for a sip from the top.

We all share a few bites of a pizza Blanca (pizza dough without sauce), sandwiching a few slices of meat.

The gelato looks delicious,

as does the apricot torte…

But it’s too hot to eat anything else but fruit.

The Pantheon was not really as crowded as this photo makes it appear. We strolled right in.

The top of the Pantheon is open, but the floors are slanted so the water runs away from the center when it rains.

Wanja’s daughter’s school is across the street from the Pantheon. Can you imagine looking out your window during class and getting an eyeful of ancient Roman History every single day?

Speaking of school, Italian kids get real food at lunch. There is no institutional food. Only fresh pasta, meat, salad or veggies and fruit, home made by the school cooks. Apparently the best school food in Italy is in Modena.

Back for a nap and a bath (loving that tub…), then out for dinner to Corallo, a restaurant in Centro (the center) near Piazza Navona.

Tables from the restaurants flow out into the narrow cobblestone streets on these hot nights, and we eat bathed by street lamps and serenaded by passing vespas. We had pastas and a delicious fennel-orange-peach salad with shrimp.

Italians care very much where their food comes from, and eat it in season. They are suspicious if they are offered food that they know is out of season or not grown in the region. So, when we were offered artichokes, which are in season near Rome in June and August, our friends knew they were not local. Indeed the waiter admitted that they were from Brittany.

After dinner, we wandered back to Trastevere, stopping at Tre Scalini for gelato (supposedly one of the best places for gelato in Rome), and strolling along the banks of the Tiber for the Estate Romana (Roman Summer) Festival.

This is one of the many summer evening activities around the city for visitors and those poor Romans who haven’t yet gone to the seaside to escape the heat.

What we did not do, and should have, was go to Isola Tiberina, where you can have a drink or eat while reclining Roman style on pillows or rugs on the inclines.

Tomorrow, it’s off to Fierenze (Florence)

Fennel, Orange and Peach Salad
Here’s a recipe we came up with and made the following night.

Fresh fennel
1 Blood orange
1 peach
Fresh basil leaves
Olive oil
Salt and pepper to taste
Pesto

Shave the fennel thinly (It should look like a thinly sliced onion). Place into a large bowl. Peel and section the orange; core and section the peach. Add both to bowl. Make sure you get any extruded juice, it serves as the “vinegar” for your salad. Scatter fresh basil on top. Add a small amount olive oil, and salt and pepper to taste. Serve with a dollop of pesto on the side.

Greetings from Italy!

Just a little something to tempt you…..

No internet access all week, and now just for a few minutes. Promise to post much, much more sometime soon. Ciao!

Passport Help!


Okay, so we are leaving for Italy on Saturday night. We applied for our passport renewals in MARCH. My youngest daughter’s passport is still in process.

We have done everything we know to do. We had to wait until 14 days prior to our travel date to begin the rush process. Since then, we have called daily. We cannot get an appointment at any of the passport offices within 200 miles. We called the office of Carol Maloney, our state rep,and her guy in her office has been on the phone with the passort processing center in New Hamphshire on a daily basis for us every day this week. Every time he calls us back, it is the same news “Not ready yet. But they have moved your request up to urgent”.

So I am putting it out to the blogosphere…

I’m praying that someone in the passport office in New Hamphire reads my blog and can see it in their heart to help us.

Or someone reading this blog knows someone in the passport processing center in New Hampshire. Or knows someone at the state department. Or is someone really, really important who can get my daughter’s passport processed for us tomorrow.

In the meantime, we are heading up to Norwalk Connecticut so that we can get online at 5 am tomorrow in hopes that we can get an appointment and get a passport. I will be checking me email continually, so if you can help, please email me at tbtam@rcn.com.

THANKS, whoever you are!

UPDATE: 9am We are in line at the passport office in Norwalk. They could not be nicer. We got here at 6am and were 2nd in line. However, it is clear that they are triaging by urgency of travel and passport status, so we are hopeful. The mantra seems to be “We will help you”. Here’s hoping…

UPDATE:
We have a passport!

Thanks to all of you for your great suggestions, you are so wonderful. And thanks most of all to the wonderful folks at the Norwalk Passport Center, who treated everyone there like human beings, always had a smile and a kind word, and know how to handle a crowd, triage and move the work. Everyone of them embodies what a civil servant should be.

BOTTOM LINE: IF YOU LIVE IN THE NEW YORK METRO AREA, AND YOUR PASSPORT APPLICATION IS BEING DELAYED AS WAS OURS, AND YOU NEED A PASSPORT WITHIN 2 WEEKS, GO TO NORWALK.

A Picture Worth a Thousand Words

A literary project from Maria – She asked us to write a medically-related story, 1000 words or less in any genre, referring to the picture below. Here’s my submission. Thanks, Maria, for inviting me to participate.

The woman moved quickly through the crowd, weaving expertly between the carts and stalls of the marketplace, the sleeping child held close beneath her robes. She hoped to go unrecognized for just a few more precious hours before giving her child to the fate into which she had been born.

Had it not been for the Bronwin midwives she would surely have died giving birth to the infant. For 2 days and nights she had labored, the child pressed against her ribs with no sign of descent. They had broken her waters to no avail, and pressed her with herbal infusions, but the child would not come.

When the morning of the second day dawned, the elder midwife had been summoned. Wondera did not remember her face, only the smell of the burning weed she had passed over her swollen abdomen. The aroma was silken and light, and as the smoke entered Wondera’s nostrils, she felt it enter her forehead, flowing straight to the small pit which drove her labor. In that same instant, her lower womb relaxed and the upper womb embraced the breech, urging it into the birth canal as the mouth of her womb softened and spread wide to deliver the infant from between her legs into the arms of the second midwife. Then the elder midwife had pulled the weed away, and as the cold air of the room hit Wondera’s nostrils, her womb closed tight, the pain ascending and then withdrawing for a final time.

Afterwards, Wondera shook violently, unable to control the chattering of her teeth and the trembling of her limbs. They had washed her with warm water infused with chamomile, and she fell into a deep sleep from which she did not awaken until sunset. Only then did she ask to see her daughter.

As foretold, the child bore a mark gracing her right eye and cheek, passing over the bridge of her nose to tease the left eye at its inner corner. Even now, Wondera reached beneath her robes to brush the mark with her lips.

The mark was, she knew, the exact mirror of the one which graced the face of a male child born five years ago to a Mechabian woman. It was said that a male child born with a mark that crossed onto the other side of his face would grow to be the leader of the two tribes. But instead of rejoicing when the child had been born, the Bronwins had risen in jealousy against their Mechabian brethren, with the rallying cry. “No Mechabian shall lead us!” And so the Great War had begun, a war in which half the men of both tribes lost their lives, including Wondera’s husband.

In the fifth year of the War, the seers foretold that a girl child would be born at the next harvest, a girl child bearing a mark exactly mirroring that of the Mechabian prince. From these two children so marked would arise a nation of princes born of both tribes, who would bring peace, prosperity and unity for generations to come.

For the first time in five years, there was peace, as men came home from the battlefield to their wives, in hopes of fathering the child. And for the first time in history, families prayed for a female child. Mothers scanned their child’s face almost hourly, rejoicing with every new nevus, praying that it would spread in the right direction. Wondura had heard tale, true or not, of women who had taken burning charcoal to their infant’s cheeks, branding them. More likely, they had only rubbed the charcoal into their infant’s skin day after day, hoping that the pigment would stay and mark their child as the one.

When Wondera’s daughter had been born bearing the mark, the midwives feared that the child would be taken from her and so they had kept her hidden among them. This had been easy, since they lived in a small commune outside the village, and were rarely visited. For six months, Wondera and her child lived peacefully and happily in the commune. Wondera cooked and kept house for the midwives, who were called upon constantly to witness the many births that had been conceived among the Bronwin people.

But as the months passed and the prophesy remained unfulfilled, the men began talking again of returning to war. Wondera knew that the time had come to return to civilization and her daughter’s fate.

And so she made her way now through the marketplace to her family’s lodges. She had been away so long that she did not realize what day it was – the day of the harvest celebration. The village center was teeming with carts and people, the children running from stall to stall while young men and women danced through the square to the harvest songs.

Wondera strode quickly through the crowd, moving softly so as not to wake the child. But the child heard the music, and began to struggle in her arms to see its source. She grabbed at Wondera’s robes, pulling them apart and revealing her face to the light.

A murmur arose from the crowd.
____________________________________________

Four other bloggers also took Maria’s challenge. There’s some great writing in this bunch below…
– Intueri
– poeMD
– All Sounds to Silence Come
– Emergiblog

Total Inhibin – A New Ovarian Cancer Screening Test?

If researchers in Siena, Italy, are right, measurement of Inhibin, a hormone molecule produced by the ovary, could be an effective ovarian cancer screening test.

In a study published this month in The Journal of Clinical Endocrinology and Metabolism, the researchers measured total Inhibin levels using an Elisa-based assay, comparing results in women with ovarian cancers to those of normals and those with benign ovarian tumors and other cancers. Total Inhibin levels were highly sensitive and specific in detecting ovarian cancers. When combined with Ca125 levels, the results were superior to either test alone. (See graph above).

The percentage of cancers detected at 95% specificity varied according to the histological subtype but was always improved by the combination of total inhibin and CA-125. In detail, the detection rate of all tumors raised from 84–87% with single markers to 99% with combined markers (P < .05). The addition of total inhibin increased the CA-125 detection rate for mucinous tumors from 14 of 17 (82%) to 17 of 17 cases (100%) without loosing specificity (95%). Remarkably, the detection rate of clear cell adenocarcinomas increased from 59–68% with single markers to 96% with combined markers (P < .05)

The next step is a large multicenter trial.

Inhibin has been on the radar as a potential ovarian cancer marker for some years now. The problem has been that there are various Inhibin molecules, and the different kinds of ovarian cancers make one or more of these in any combination. Most Inhibin assays are specific to one or more of the subtypes, which limits them in detecting all ovarian cancers. It seems that the total Inhibin assay used in this study may have worked so well because of its lack of specificity, making it more useful as a screening test.

What I found most exciting is that the inhibin assay used is one that is already commercially available, meaning that, if these results hold true, then we won’t have to wait very long to implement screening.

Stay tuned…

Get a Blog Already!

My friend Schruggling (whom you may know if you read the comments section of my blog) and my sister the OBS Housekeeper, both of whom clearly need to get back to work already, have created parodies of my blog. (That’s OBS’s up there) They thought they could just email them to me and have that be the end of it.

Well, Schruggling, it’s just the beginning. Enough already. YOU NEED TO GET A BLOG.

To that end, I have created your own blog for you. Here it is – I put up your parodies as your first posts, now it’s up to you.

For those of you who don’t know him, Schtruggling is a marketing VP for an unnamed internationally-based pharmaceutical company. He has lots to say, is extremely well-informed and very, very funny. So go to his new blog, give him some comments and see if together we can’t get him blogging on a regular basis.

As for you, OBS, I’ll deal with you another day..

Caprese Salad

How gorgeous is this? Who knew that my sister the OBS Housekeeper could make something so delicious and yet so casually arranged? Note that the mozzarella slices are not exactly the same size, and that the basil is scattered rather, shall we say, capriciously, and yet, there is a symmetry to the dish that pleases the eye. And of course the palate.

Did you know the OBS Housekeeper made this recipe up all by her little old self? Who knew she was so talented? I’m just a little verklempt here, give me a second….

Okay, now I’m fine. OBS wanted me to be sure I told you about the history of the Caprese Salad, which, in case you haven’t noticed, contains the colors of the Italian flag.

The History of the Caprese Salad

The Caprese Salad, or Inslata Caprese as we Italian affectionados call it, originated from the Isle of Capri in the Campagna region of Italy in the 1950’s. The traditonal Insalata Caprese uses cow’s milk mozzarella, tomatoes, and olive oil garnished with oregano and arugula. Elsewhere in Italy, basil is used as the garnish.

Tradition dictates that only olive oil be used in the Caprese Salad, but here in America, what do we care about tradition? We love balsamic vinegar, and so we use it.

OBS Housekeeper thinks I’m nuts, but I think the Caprese Salad was really invented as a homage to the big rocks of the Isle of Capri. They remind me of big mozarella slices. See?

The basil is the green stuff growing on the rocks. If you zoom in you can see it there on the big rock on the left.

Now, all that is missing are the tomatoes…

And there you have it! Thanks, OBS, for a delicious salad.

OBS Housekeeper’s Caprese Salad

2 – 3 large tomatoes
16 oz. fresh mozzarella
Lots of chopped fresh basil
Olive oil
Balsamic vinegar
Salt
Pepper

Use an apple corer to core the tomatoes. Slice them about ¼ inch thick. Drizzle olive oil over slices and set aside. Slice the mozzarella into slices about ¼” thick.. Layer the slices alternately on a plate or in a low dish. Drizzle olive oil and balsamic vinegar over top. Sprinkle lots of fresh chopped basil over all. Salt and Pepper entire dish. ENJOY!