TBTAM Does Italy – Part Last. Three Memorable Meals in Maratea

Il giardino di Epicuro

Il Giardino Di Epicuro is a family-owned restaurant in Massa de Maritea that serves food made from ingredients that, for the most part, the owners grow themselves. They also cure their own meats.

Fernando calls the restaurant “the Philosopher”. If so, the philosophy seems to be that of Horatius, whose famous quotation adorns the walls. (Translation – “Eat, drink…there is nothing else beyond that.)

The night we eat at the Philosopher is a quiet one, so the owner himself takes our orders, or rather tells us what to order, in a gruff but lovable way that adds to the ambiance of this find of a restaurant.

Best part of the meal? Hands down, the Chickpea noodles. I have to learn to make this…

Other highlights? Gnocci with truffles

the homemade grappa

and standing outside onto the vine covered patio looking at the moon while the kids play in the garden.

Ristorante Vincenzo a Mare
Located in Port Maratea, Ristorante Vincenzo a Mare has a lovely, vine-covered porch overlooking the port. Fernando tells us he chose it, “so we can look at Fabrizio’s boat”. He and Fabrizio have reason to be proud of that boat. They brought her back to life with a new motor in a two-day long adventure that at one point had them stranded on the sea a windless hot afternoon with no sunscreen.

The menu at Vincenzo a Mare is handwritten, a charming touch that only added to the ambiance of a wonderful meal. The food is fresh and delicious, especially the snapper up there, which though bony, is exceedingly flavorful and well-spiced.

But the best part of the meal? The lesson Fernando gives us in Italian table manners. Here, I’ll let him show you, as he explains how to do Scarpetta or “The little shoe”.


Double click on arrow to view video.

Beach Party Maratea

For our last night in Maratea, Fernando has the perfect dinner suggestion, this time a beach party. Fabrizio, Emily and I take the boat into the Porta for pizza as the setting sun shines through gathering evening clouds.

Fernando supplies the beer, and Diego brings his ipod and speakers. By the time we arrive with the pizza, it is growing dark, and the fire is blazing.

Party may not be the best word for what we are doing, for we don’t really drink much, and the families talk softly as we listen to the music and watch the Sea. I take a brief dip at the water’s edge, and come back to find everyone starting to fall asleep. Time to put out the fire and head back to our hotel.

There is no more perfect a way to end a perfect vacation.

TBTAM Does Italy – Part 7. Maratea

We spent the last part of our vacation in Maratea, a lovely town about 2 1/2 hours south of Naples at the southern end of the Campagna Region of Italy. The area is like the Amalfi Coast without the crowds, the prices or the tourists. Italian families come here year after year to summer, as do Wanja’s friends Fernando and Martina, who generously allowed us all to tag along their annual vacation.

Maratea is really three towns. First, there is Porta Maratea, which is at sea level.


Then there is the main town, or Centro Storico, nestled on the mountainside 1,000 ft above the Porta.

It has a square,

a mermaid fountain,

charming little alleys

filled with restaurants,

shops

and galleries,

and a bakery called Iannini that sells the most amazing cookies I have ever eaten.

The old town is Maratea Superiore, which sits atop Mt San Biago above cliffs so steep that the road extends out from the rock walls to allow cars to make the climb. (Photo blatantly stolen from Europe for Visitors)

Overlooking the town is the Statua del Redentore, or Christ statue, seen up there on the left. Our kids did not want to visit the statue, being freaked out by the urban legend that the statue had the face of the dead young man in whose memory it had been built.

We three families split ourselves between 2 apartments at Pianeta Maratea, a Catskills-like resort in the hills, complete with pools and a nightly teen disco

and the rustic but lovely Hotel Illicini, a cluster of well-appointed but simple adobe huts along the Mediterranean Sea.

Here, we could choose to sit in the shade on the upper beach just outside our room

along with the salamanders,

or walk down a short path to the lower beach for a swim.


We could also join Fabrizio on his sailboat,

or take the shuttle bus to the larger public beach, which has two cafes, changing areas and kayaks to rent.

One afternoon, we took the kayaks out along the coast, and the bravest among us swam into a hidden grotto. This, my friends, was everything a vacation should be.

“But what”, I hear you asking, “do the Italians eat at the beach?”

I’ll tell you what they eat. They eat Friselle.

Friselle with Tomatoes, Olive oil and Capers

Friselle are hard, double-baked bread from Puglia. We soften the Friselle by dipping them into the sea and …

Wait. Let’s ask Wanja to explain it, she does it so much better than I.


Double-click on arrow to start video (Sorry it’s sideways…)

Opening a Restaurant is Like Having a Baby

Shuna, whose blog Eggbeater is one of my regular reads, is blogging the day-to-day life of a pastry chef in a new restaurant soon to open in the Bay Area. Leaving out pertinent details like the name and location of this exciting new venture, she tells us…

I am like a pregnant woman who wants to keep it a secret until I feel like I’m out of the woods

Wish I could be there for the delivery…

I Love Technology!

Just testing out my new Verizon Air Card, and I am pleased as punch to say that it works! I am blogging this while driving on Rte 78 in New Jersey. Well, technically, my friend Andy is driving, but the point is I AM FREE, UNTETHERED AND ON THE ROAD, BABY, AND I AM SURFING THE WEB AND BLOGGING AT 70 MPH!

Damn, life is good…

NY Attorney General Questions Insurer’s Health Care Ranking Methodology

NY State attorney general Andrew Cuomo has come out against the use of claims data for ranking doctors.

In letters to Aetna and Cigna, Cuomo questioned the insurers’ use of claims data to rank specialists. According to Cuomo, claims data does not contain complete information and can skew rankings. He also criticized the insurers for failing to disclose the accuracy of the rankings and said insurers “have a profit motive” to recommend physicians who cost less but might not be the most qualified. Cuomo asked Aetna and Cigna to provide details about the criteria they use to rank doctors, how the insurers measure a physician’s performance and what incentives are used to steer patients to or away from providers.

He’s right. Here are just a few of many examples of how use of claims-based ranking data was found to be erroneous for docs in our institution:

  • A woman who is rubella immune comes to see an ob-gyn for her third pregnancy. The doc is dinged by the insurer for not doing a rubella titer, since no claims were submitted for this test. The fact was that the patient already had immune titers in her prior two pregnancies and did not need this test done a third time.
  • The insurer claimed a doc did not refer for BMD testing. It had already been done the prior year when she was covered under another insurance plan
  • Insurer claimed no pap was done. It was done, but for some reason a bill was never submitted by the outside lab.

It’s as if Zagat decided they were going to rate restaurants by looking at the bill…

Abortion Politics and Mini-Storage – Strange Bedfellows?

That’s a real billboard up there, one that’s creating a lot of controversy here in Manhattan. I happen to like it, although I wonder how I’d feel if the other side started putting up similar ads.

Manhattan Mini-storage ad’s have been raising eyebrows for some time now. Previous billboards have had such slogans as:

“Your closet’s so narrow it makes Cheney look liberal”

“Your closet’s scarier than Bush’s agenda.”

And my personal favorite –

“Your closet’s so shallow, it makes Paris look deep.”

What do you think? Should Manhattan Mini-Storage be allowed to mix politics and advertising?
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(Photo from Gothamist)

Caring for Our Aging Parents – Lessons from Italy

Our visit to Italy included a brief overnight at Fabrizio’s family home in Velletri, a town in the Alban Hills about an hour outside of Rome. Fabrizio, Wanja and the kids come every weekend to this lovely old villa, and not just because they want to escape the heat in Rome.

You see, Fabrizio’s Dad has Alzheimer’s disease. And though he has a nurse who stays with him during the week, Fabrizio comes to stay with him most weekends, a duty he shares with his sibs who live nearby. They feed, shave and bathe their Dad, and most importantly, watch to be sure he does not wander off, as he has done on more than one occasion.

I am moved, not just by Fabrizio’s personal attention to his Dad, but by the family’s acceptance of this lovely childlike man in their midst. His dad joined us at the dinner table, and although he did not speak, he smiled a lot. Like a small child, he was taken from the table when he was finished, and sat on the nearby sofa while we finished dinner. Then off to bed early, Fabrizio holding his hand as he led him upstairs to his room. No apologies were made to us, no complaints. My children did not skip a beat. Fabrizio’s Dad was simply part of the family, just the way he was.

This sort of loving acceptance is exactly what NY Times writer Denise Grady writes about this week in an article entitled, “Zen and the art of Coping with Alzeimers“.

If Dad wants to polish off the duck sauce in a Chinese restaurant like it’s a bowl of soup, why not? If Grandma wants to help out by washing the dishes but makes a mess of it, leave her to it and just rewash them later when she’s not looking. Pull out old family pictures to give the patient something to talk about. Learn the art of fragmented, irrational conversation and follow the patient’s lead instead of trying to control the dialogue.

Basically, just tango on. And hope somebody will do the same for you when your time comes. Unless the big breakthrough happens first.

Along with acceptance, my friends express an unquestioning belief that care of their parents is just another part of life. Wanja tells me stories of friends in similar circumstances doing much the same for their parents as Fabrizio does for his dad.

“We don’t have nursing homes here,” Wanja tells me. “This is just what we do.”

She’s right. Italy has few nursing homes, and in almost all families, care of aging parents happens in the home. Acccording to a 1997 survey of nursing home care in 10 countries:

Italy has a national heath care system with universal coverage, modelled on the UK’s National Health Service [20]. There is, however, a major difference, in that no provision was made for the long-term care of elderly people. There is no uniform policy and there are literally hundreds of local solutions to meet the needs of elderly people… in Italy the care of elderly people is almost exclusively the concern of families.

The need for good home care in Italy has created a huge market for caregivers in Italy, a need that apparently is being filled in large part by Ukranian caregivers. It’s a patchwork of a solution to a growing problem, as the average life expectancy in Italy rises and families with two working parents struggle to keep their parents at home.

And it speaks of a nation that still has the family at its center.

Though our stay in Villetri was brief, it has left an indelible impression upon me. As I watch my own parents aging, I can only pray that if the need ever arises, my sibs and I can care for them with the same grace that my dear Italian friends have shown in caring for their Dad.

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