Eight Random Facts Meme

Tagged by Dr Rob on this one. I need to tell you eight random facts about myself. Okay, here goes:

1. The first car I ever owned was a ’64 Valient. You know, the one with a slant 6 engine and manual stick shift on the column. My uncle found the car for my Dad, who bought it for me for $150 so I could drive to my after school job at Kresges. The summer I was a day camp counselor, the kids I drove in the car were embarrassed to be seen in it, which made me love it even more. I kept the car till I moved to New York after college, at which point my friend Shari (The one who slept with Robbie)’s boyfriend offered to keep it for me and basically trashed it.

2. When I was 10, I won a spot on a bus trip to Washington, DC with Wee Willy Weber’s Cartoon Club.

The only parts of the trip I remember are the baloney sandwiches Wee Willy’s wife made for us and the catacombs. I think they are under a church somewhere in DC. (The catacombs,I mean, not the baloney sandwiches…)

3. I sing.

Anything and everything. I took voice lessons for 2 years with the most amazing teacher, Nancy Evers, but stopped because I really didn’t have time. I still practice with my tapes before choral rehearsals and I think my voice is even better than when I was taking lessons. If you are reading this – Hi Nancy! I miss you!

If money were no object, I would quit my job tomorrow and do music. Not that I don’t love what I do, because I do love it. But you have only one life, and there are so many other things to be done… Do you think American Idol will ever raise the age limit? Because if they do, I’m there, baby!

4. I had Hepatitis C. (Type 2b)

I took the pegintron-ribavirin treatment a few years ago. The treatment sucked, but it worked.

5. I have bitten my nails my whole life,

but recently realized that sometime in the last few years, I stopped biting them. Why is that? Do you think this means I will stop overeating soon as well?

6. I do this voice…

My sisters and I can do this duck voice – well, R really invented it, and she taught it to the rest of us. I’ve morphed it into a little kid voice. I can stratify my boyfriends by whether or not they liked the little kid voice. (Mr TBTAM likes it.)

I stopped using the voice for a while shortly after giving birth – the enormity of the responsibility made it seem so childish. But of course it came back. Now I find the voice quite helpful whenever my kids are being mean to me, at which point I cry out – “You haffa’ to be nice to me! I’m your MOM!” It generally works, because they really like the little kid voice.

7. I am allergic to cats and most dogs.

I hate this, and it has ruined many an evening at a friend’s house for me. I used to hate my Dad for not taking us places because they had cats (he was also allergic), but now I understand.

8. I hate Disneyworld.

(So sorry to those of you who love it…) I think my feeling was crystallized the day I was standing waiting for the shuttle bus at the Swan Hotel and there was Muzak coming out of the bushes next to the bus stop. My feeling about this matter do not seem to be shared by the medical meeting organizers, and so I have been to Orlando now 4 times.

But enough about me. Tell me about you.

I don’t know who’s left who hasn’t been tagged on this one, so if you haven’t, consider yourself tagged by me and give us the facts, just the facts…

Keeping Your Fertility Options Open

What do you do when you’re 35, have 3 kids and for various reasons have run out of acceptable contraceptive options? You have a surgical sterilization, that’s what.

But here’s the question – who gets snipped, the male or the female member of the couple? I almost always advise that the male should be the one.

It’s not personal, guys. It’s because vasectomy is a brief office procedure performed under local anesthesia, compared to a tubal ligation, which is an intra-abdominal procedure performed under general anesthesia. A no-scalpel vasectomy can be performed in as little as 7 minutes, with exceedingly low rates of complications.

“As a couple,” I usually say, ” “Your safest option is a vasectomy”.

But a patient recently objected to the idea of a vasectomy, because it was really her decision to stop having children. Hubby would have kept on going if she had been willing.

“If anything ever happened to me, I would want him to be able to have more children,” she said.

Now this was a woman who had already had several C-sections. Neither she nor her huband liked the idea of her having another surgical procedure. What to do?

“Have him freeze some sperm before the vasectomy”, I said. “That way he may still be able to father children in the future if anything ever happens to you.”

And that’s what they did.

Sperm Banking Before Vasectomy

Sperm banking before vasectomy is not a guarantee of future fertility, since frozen and thawed sperm may be less viable than fresh sperm. Overall, pregnancy rates using cryo-preserved sperm are about 50% lower than with fresh sperm. Assisted reproductive technologies such as intracytoplasmic sperm injection (ICSI) may improve these odds.

How long can frozen sperm be saved? Well, pregnancies have been reported using thawed sperm that have been frozen up to 21 years!

Sperm banking is not terribly expensive, with costs of about $500 per year. Sperm should be frozen and thawed as a test prior to vasectomy to see if they survive storage. And experts advise banking multiple samples in two separate sperm banks as insurance against lab accidents.

When weighed against the option of vasectomy reversal surgery, hedging your bets by sperm banking before getting snipped seems a reasonable option.

A word of caution, though. Urologists who perorm vasectomy generally advise that vasectomy be reserved for men who are really sure they want no more children.

In other words, if are considering banking some sperm because you’re not sure if you will want children in the future, then consider the possibility that you may not be ready for permanent sterilization.

I am not a Paparazzi

Dear Paul Newman:

When you looked up as you were getting into your car outside of the NDI performance on Monday night, I’m fairly certain that you saw me. And I think you noticed that I was holding my cell phone up in front of me. So I’m pretty sure that you think that I took your picture.

Which means you now think I’m the kind of person who takes pictures of celebrities with their cell phone.

But really, Mr Newman – Do you mind if I call you Paul? – Really, Paul, what I need you to know is that I did NOT take your picture. I swear, I didn’t.

I know you don’t read my blog, but if you did, you would know that if I had taken your picture it would be up there. But it’s not. See?

I am, after all, a New Yorker. And we New Yorkers pride ourselves on the fact that the great ones can walk amongst us unrecognized. They are, after all, no better than we are…That didn’t come out right, did it? What I meant to say was that we just want you to feel comfortable…

So, do you believe me?

I really hope you do. Because if we ever run into each other again, I would hate for you to hate me because you think I’m one of those people who take pictures of you with their cell phones.

Because I didn’t. Really.

Sincerely Yours,

TBTAM

Trojan’s Ad Needs to Evolve

Trojan has mounted (oops – Freudian slip?) a new ad campaign urging young men to be sexually responsible by using a condom every time they have sex. The mantra : It’s time we evolve. From their website:

Sex itself isn’t an unhealthy thing that needs to be policed or demonized; it’s a natural expression of our humanity. Using protection consistently and correctly is a critical component to managing one’s sexual health.

Trojan claims they are trying to break down the predjudice that condom use automatically mean promiscuity. From today’s NY Times:

“We have to change the perception that carrying a condom for women or men is a sign they’re on the prowl and just want to have sex,” said Linda Kaplan Thaler, chief executive of the Kaplan Thaler Group, the New York advertising agency that created the “Evolve” campaign.

Unfortunately, Trojan seems to be sending that exact message with their ad. Set entirely in a bar, with a cute little ditty of a tune beneath it, the ad shows men, portrayed (literally) as pigs, on the prowl trying to pick up a series of girls, all of whom seem to be alone at the bar. None of the pigs are successful. But then, one pig heads to a vending machine and buys a condom, at which point he is transformed into the cutie that he really is, and gets the girl.

Message? – Carrying condoms will get you laid.

Fox and CBS are refusing to air the ad. I’m not sure why – this ad is no worse than what they are showing 24-7 on their stations already. I say air it and let’s get this conversation going.

Trojan – Bad start, but at least it’s a start. Keep trying – I’ll be watching. And so will millions of young men. See if you can find a way to reach them in a way that doesn’t cheapen women or promote promiscuity. You’ve got some brilliant advertising folks working for you – I’m sure they can help you figure it out …

Help Me Plan My Trip to Italy

We are heading to Italy in July, and all I’ve done so far is make our plane reservations. We are flying into Rome and visiting friends there, but the rest of the trip is up for grabs. We are thinking it would go something like this –

  1. Rome for a few days
  2. Train to Florence
  3. Stay in Florence as a base, take day trips by trian or car to Pisa, Siena, San giomani (where else?)
  4. Back to Rome for another few days? (We fly back from Rome) To the beach maybe? Someplace else near Rome that is worth seeing?

I’m hoping some of you have done this trip before and can help me out. I don’t trust the rest of those people out there on the web..

Any suggestions? Hotels you loved in Florence? (I need to move on this one yesterday..) Restaurants in Rome or Florence or Tuscany? Places to see (and avoid)? Great web sites that you used for your trip? ?

You should know that I HATE being a tourist and I know that I will have to deal with this in Florence, which, from what I read is like Disneyworld. So any suggestions as to places off the beaten track or how to avoid the crowds will be appreciated. In that vein, are we nuts to even go to Tuscany? Should we head to some other region or city within striking distance of Rome?

Any and all suggestions are welcome.

I promise I will be blogging the trip so I can “pay it back” to the blogsophere.

THANKS, GUYS!

Life Imitates Art

Pont Neuf, Wrapped.
Christo and Jeanne-Claude, 1985

Queensboro Bridge, Wrapped
NYC Department of Transportation, 2007

Ovarian Cancer Symptoms

Gilda Radner, who died of ovarian cancer at the age of 42,
had symptoms for months before her cancer was finally diagnosed.

The American Cancer Society and the Society for Gynecologic Oncologists have issued a consensus opinion outlining the symptoms of ovarian cancer, and more importantly, urging women and their doctors to consider ovarian cancer in the differential diagnosis when these symptoms present.

What are the symptoms? They are vague and all too common – bloating, pelvic or abdominal pain, early satiety, and urinary sympotms such as urgency and frequency. But, when present and persistent for more than 2 weeks and less than 1 year (or in the case of urinary symptoms, persistent after treatment for a UTI), one must consider ovarian cancer in the differential. And consider it early, because this is one cancer that won’t wait around while you exclude everything else.

For almost 2 decades now, this is exactly how I have been practicing. As I’ve said before, I don’t hesistate a second before performing a pelvic ultrasound in women with any of the symptoms listed in the consensus statement. I happen to be pretty good with a vaginal ultrasound probe, and I have an amazing gynecologic radiologist to whom I can refer.

Despite this, in all these years, after performing or referring for thousands of sonograms (and not a few ca125 tests) in what I believe is an optimally aggressive screening approach for ovarian cancer in symptomatic women, I have yet to diagnose a single case of early ovarian cancer. Of the 5 or so cases (it is, after all, not a common cancer), all but one presented to me at stage 3 or more. That early tumor was a borderline cancer, and she would have done well no matter what I had done.

I wish I could say my aggressive management of symptoms has impacted ovarian cancer mortality. It’s certainly reassured a lot of frightened women and found quite a bit of benign disease. But ultimately, I just don’t think it has made a difference in terms of ovarian cancer outcomes.

Maybe it is because my patients with ovarian cancer ignored their symptoms for too long before coming in to see me. If so, then publicizing this consensus statement may make a difference. I certainly hope that it does. And despite my reservations about my practice’s efficacy, I’m not changing what I do, because at this point, there is nothing else I can do. It’s what I have to do, and what my patients deserve.

What we really need is a good early ovarian cancer screening test for asymptomatic women. (No, it’s not the Ca125 test.)

Or better yet, how about a pill to prevent ovarian cancer? Oh, wait a minute – we already have that. It’s called the Birth Control Pill.

_______________________________________________________________

Here’s the Consensus Statement:

Historically ovarian cancer was called the “silent killer” because symptoms were not thought to develop until the chance of cure was poor. However, recent studies have shown this term is untrue and that the following symptoms are much more likely to occur in women with ovarian cancer than women in the general population. These symptoms include:

  • Bloating
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Urinary symptoms (urgency or frequency)

Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies. The frequency and/or number of such symptoms are key factors in the diagnosis of ovarian cancer. Several studies show that even early stage ovarian cancer can produce these symptoms.

Women who have these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist. Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early stage diagnosis is associated with an improved prognosis.

Several other symptoms have been commonly reported by women with ovarian cancer. These symptoms include fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities. However, these other symptoms are not as useful in identifying ovarian cancer because they are also found in equal frequency in women in the general population who do not have ovarian cancer.

Thinking Blogger Award

Many, many thanks to fellow bloggers Dr Wes and KatieZ , who nominated me for a Thinking Blogger Award. It’s an honor to be a recipient of this award, and I am proud to display it on my sidebar over there.

But the best part is that I get to give the award out to 5 other blogs that make me think. And so, without further ado, I award this prestigious award to (drumroll, please…)

The Well-Timed Period. An incredibly interesting, opinionated and comprehensive blog about anything and everything contraceptive.

Enter the Circle: My friend Linda writes an insightful, brassy and funny blog. She’s also into the whole women’s empowerment thing and runs something called the Moon Lounge, yet remains completely normal.

Bardiac: Of course.

Celebrity Cosmetic Surgery: Just checking to see if you’re still reading. Well, it does make me think I’ll never get plastic surgery…

Aetiology: Everything a science blog should be.

If you’ve been tagged, here are the rules. And thanks to the awardees for your contribution to keeping my brain alive.

Grand Rounds 3:38

Jacob M Gershberg . Images from the NLM History of Medicine Webpage

Grand Rounds is up over at Dr Val’s Blog. It’s a nice edition – succinct and well-organized, with a short and long version. Plus, she included a post of mine that I hadn’t even submitted! Thanks , Dr Val! My favorites from the lot:

Kerri meets a sympathetic Barista:

Damn you, Starbucks. Just when I’ve thought I’m beyond your caffeinated claws, you reach back out and gently bring me back in.

Type-B Premed captures a slice of life in the ER that will tear your heart out.

“You’re sure?” Upon hearing the news, a perfectly manicured hand raised to her mouth to hide her trembling lip…

Dr Rob explains the genetic difference between men and women. Hilarious!

Many scientists believe that the feeling by many women that jeans make them look fat comes from the fact that there are more genes in a women’s body, and this is actually a cry for help from the chromosomal level.

Now head on over for the weekly best of the medical blogosphere!

Grand Rounds 3:38

Jacob M Gershberg . Images from the NLM History of Medicine Webpage

Grand Rounds is up over at Dr Val’s Blog. It’s a nice edition – succinct and well-organized, with a short and long version. Plus, she included a post of mine that I hadn’t even submitted! Thanks , Dr Val! My favorites from the lot:

Kerri meets a sympathetic Barista:

Damn you, Starbucks. Just when I’ve thought I’m beyond your caffeinated claws, you reach back out and gently bring me back in.

Type-B Premed captures a slice of life in the ER that will tear your heart out.

“You’re sure?” Upon hearing the news, a perfectly manicured hand raised to her mouth to hide her trembling lip…

Dr Rob explains the genetic difference between men and women. Hilarious!

Many scientists believe that the feeling by many women that jeans make them look fat comes from the fact that there are more genes in a women’s body, and this is actually a cry for help from the chromosomal level.

Now head on over for the weekly best of the medical blogosphere!

The Knife Sharpening Guy

This is fifth in a TBTAM special series called I Get it on the Streets. Links to the next post in the series are at the end of each post. Enjoy!

On any given Sunday, if you live in New York City and have your windows open, you may hear a clanging noise coming from the street below. If you do, drop whatever you are doing, run to your kitchen, grab your knives and head downstairs as fast as you can. Because Mike the knife sharpening guy will be there with his truck ready to give your steel a new edge.

That’s right – A mobile cutlery grinding service. A time-honored tradition that still exists in some US cities , unchanged from what I imagine it was years ago, when aproned housewives and the cooks of the rich listened for the clanging bell and headed downstairs, gathering around the truck to grab a few minute’s gossip with their neighbors as the cutlery man sharpened their knives.

Mike’s been sharpening New Yorker’s knives and scissors in this truck for years, having learned the trade from his father, who outfitted the truck before Mike was born. Mike remembers riding with Dad when he was as young as 5 years old. Now Dad is gone and Mike works fulltime in the DA’s office and has a grown son of his own. But he and his son still take the family truck out on weekends, driving from their home in Brooklyn over to Manhattan to sharpen knives, mostly on the Upper West Side. Word on the street is that they provide great service at a low price.

Today was the third time I’d seen Mike’s truck, but unfortunately I’ve never been able to get my knives to him. Once he was even in front of my building, but I was late for something or other and could not take the time to run upstairs for the knives.

I suggested that perhaps getting a web site and publishing a schedule would help folks like me to get him our business. But Mike didn’t seem interested in changing a thing. After all, he’s not in this business for the money. It’s really just an excuse for he and his son to spend some time together and keep the family tradition alive. But they did promise to head over to my neighborhood sometime soon.

I’ll put my doorman on the lookout for the truck, and ask him to buzz me next time Mike comes by. Hopefully, I’ll be home.

Or maybe I should just start carrying my knives around with me….

Hash Browns

Mr TBTAM makes a mean batch o’ hash browns. Some people call them home fries. I call them delicious. They’re great with fried eggs for breakfast, or cooked up with some roast beef for dinner (we call that hash). To make it healthier, use olive or canola oil.

The best way to be sure you have will be able to make home fries is to serve baked potatoes for dinner. Cook a few more than you’ll need, and you’ll have the makings of a great breakfast tomorrow.

Mr TBTAM’s Hash Browns

3 baked potatoes, skins on, diced
1/4 cup diced onions
1-2 tbsp vegetable oil
Salt and pepper

Ketchup and/or hot sauce

Heat a frying pan till nice and hot. Add enough vegetable oil to coat the bottom well and heat.

Add potatoes and lower heat to med high. Let sit about 3 minutes or so till bottoms of potatoes are browned. Add onion. Toss. Cook, watching carefully and turning only when the bottoms are browned, about every 3 minutes or so. After most of it is browned, you can toss a bit more frequently to prevent the onions from burning. The trick is not to turn too often and to let the potatoes brown before turning them, otherwise you end up with mashed potatoes.

Season with salt and pepper, remove from heat when perfect and serve immediately with ketchup and/or hot sauce.

Operation Garden Storm

The Aphids are back, and the annual struggle for control of my garden has begun.

I thought I’d gotten them all last year. But the evil-doers re-grouped and set up winter training camps in the soil of my containers, where they indoctrinated a whole new crop of young fighters. This spring they attacked with a vengeance, spreading their evil venom throughout my pristine garden, curling up my honeysuckle flowers and causing their leaves to drop, even threatening to swarm the day lilies before the first bud had even opened.

To make matters worse, the bastards have enrolled their allies in the axis of garden evil, the wooly adelgids, to infect my evergreens.

Wisconsin Department of Natural Resouces Website
These insurgents hid in the old growth of my evergreens, beneath the bright green canopy of spring’s eruption. So that it was not until I trimmed the bushes back last week that I saw the tell-tale white cottony honeydew and dropping yellow leaves. It made me sick, I tell you. Sick.

But if these terrorists think that they can take control of my garden, they are wrong. Dead wrong. Because I’m taking them on with everything I’ve got. This, my friends, is war.

Phase 1 – Targeted Strikes

First, I bring out the garden hose. Nothing like a good strong spray to knock those buggers off the plant and onto the ground. Although this picture makes it look random, I actually use precision targeting, getting in close and hitting every infected flower or leaf I find. If there are too many aphids on a limb, I take the whole limb out. Sure, I’ll sustain some collateral damage, but it’s necessary for the survival of the entire plant. Then it’s on to…

Phase 2 – Organic Weapons of Mass Destruction

That’s right, I bring out the Neem Oil and insecticidal soap. These oils are safe to use yet highly effective, basically smothering the soft bodied aphids. The soap emulsifies the oils, making them more effective.

Of course, if I had gotten off my winter couch-potato ass in February, I could have sprayed a dormant oil then and I wouldn’t have this problem now. Sort of like if the FBI had gotten their act together a little earlier we wouldn’t be in this mess now…

Phase 3 – Take out the Collaborators

Then it’s time to get the ants. Ants, you see, farm the aphids for the honeydew and proteins that the aphids secrete. In return, the ants protect the aphids against other bug predators. (Sort of like the Taliban and Saadam…)

I take a mutipronged approach to the ants. First, I use landmines – Diotomaceous Earth (DE). DE is the fossilized remains of the shells of one-celled plants called diatoms that inhabited the earth’s oceans millions of years ago. Large deposits of DE can be found all around the world in areas where oceans once existed. DE looks like a fine white powder. But look more closely, and you’ll see that it’s like microscopic scrap metal, whose shards cut and break the ant’s limbs as they move past them.

Photo credit: Univ of California Dept of Paleontology Website

DE is safe to use, but I wear a mask that I fashioned out of paper towels as I spread DE around the base of my plants on a hot, windless afternoon. Die, you bastards, die!

Next, just in case the ants make it past the DE, I wrap my tree trunks with tanglefoot, a sticky substance that both repels and traps the ants and keeps them off the trees.

Finally, I plant deterrents at the base of the at-risk plants. From what I have read, ants hate spearmint.

Phase 4 – Special Ops

After I have done all I can do, after I have been covered in water from hosing and smell of neem oil, after I have scrubbed the tanglefoot off my hands, after the DE has had a few days to do it’s nasty work, and after enough time has passed to lull any remaining aphids into complacency, than, and only then, do I call in the Special Ops Unit.


(Double click on the arrow to view video)

That’s right, the labybugs. These babies have been training their entire life for this mission. One adult ladybug will devour up to 1000 aphids a day!

I purchase one bag of 500 ladybugs at my new favorite Garden Center, Hicks, out on Long Island. Then, under cover of night, I creep outside, and after hosing down the leaves of the plants, open the mesh bag of ladybugs and sprinkle the brave fighters over the honeysuckle bushes, the day lilies, the apple trees and the evevergreen boughs.

Of course, the biggest question is, will they stay? They did! Next day, they’re still there on my evergreens chomping away at the adelgids. I declare victory – for now.

Phase 5 – Post War Strategy

I may have won this battle, but this administration isn’t resting on its laurels. The insurgents are still out there, and I’m going to weed them out with weekly Neem spraying. And next February, come what may, I’m doing a dormant spraying.

This is one occupying force that’s not leaving.

Welcome to My Blogroll!

A much belated welcome to my blogroll to the following blogs that I have been reading for some time now.

Midwife with a Knife – A blog by an energetic fellow in Maternal Fetal Medicine. Brings back so many memories (good and bad) from my training days. And she’s a fellow foodie and chef! Commenter Hillary, an aspiring gynecologist and foodie, suggests that we all open a birthing center and B&B. Not a bad idea…..

Sugar and Ink – A pediatrician who, like me, started her blog as a food blog. She just recently began to reveal her medical self to the world.

Suddenly… Sudan: A riveting blog by a Canadian doc with medicins sans frontieres stationed in Sudan. Written in lower case, in a style that somehow reminds me of Camus.

today a boy came from “far away” to the hospital, accompanied by his father. his leg was full of holes from an infection that had festered for two weeks. he was thin from it, all angles. I lifted his leg off the bed to look at the other side, and it came apart at the knee.

last year, I went camping with my friend jehan. we paddled for hours to find our own lake. we set up camp, and the next day, in my hammock, after a cup of strong coffee, I ate a plum for half an hour.

Surgeon’s Blog: I re-discovered Dr Sid Schwab’s blog when I hosted Grand Rounds recently. He just finished publishing a nine-part series called “Operation: Deconstructed”, where he takes you through every step of a colectomy, from preop to dictation. If you’re a patient, you’ll come away with an understanding of How Doctors Think as good as any recently published book will give you, and we physician readers will learn something new in every post.

Dr Smak: Just discovered this rural family physician via a well-written comment to a recent post of mine. She’s a fellow gardener and has a nice bookshelf over there at her site. Stop on by….