Physician, Feed Thyself…

All this medical food blogging has gotten me to thinking about the similarities between chefs and doctors.

What is the same

1. They’ve got the whites and the chef’s hat, we’ve got the greens and the caps and masks.

2. Both require intensive training with a clear hierarchy of ascent.

3. The chef and the surgeon are captains of their respective ships – the kitchen and the OR.

4. Skill with sharp instruments is necessary for both professions.

5. We both work long hours, including nights and weekends.

6. If we both do our jobs right, our clients walk out feeling better than when they walk in.

7. We have JCAHO, they have Frank Bruni.

8. A knowledge of organic and biochemistry is essential in both cooking and medicine.

9. Medicine and the culinary arts have many aphorisms and truths: For example, “If you hear hoofbeats, it’s a horse, not a zebra.” and “The oven can wait for the cake, the cake can’t wait for the oven”.

10. Classic texts: We have Williams Obstetrics, they have Lourousse Gastronomique.

11. Clogs. We love ’em.

What is not the same:

1. Doctors should not take care of family members, but chefs should (and do) cook at home

2. They don’t have to worry about malpractice.

3. They cause food poisoning, we cure it.

4. Iron Surgeon? Nah, it’d never fly…

5. We only talk about food (“A fibroid the size of a grapefruit”).

6. We call a thymus a thymus. They call it sweetbreads.

7. We call it fatty liver disease and treat it with a low fat diet and exercise. They call it Fois gras and treat it like a delicacy.

8. Let’s see…Clients leaving restaurants pay a $20 co-pay and their dining out insurance picks up 80% of the reasonable and customary cost of their meal? Hmm…

Category: Second Opinions, Food

Meat Loaf – I Can See Paradise by the Oven Light

Ain’t no doubt about it, this meat loaf is doubly blessed – mushrooms flavor both the meat and the gravy. Because I am beginning to look like our friend Meat Loaf over there, I started Weight Watchers today, and thus have no intention of blowing an entire days points on dinner by actually making this particular meat loaf tonight. But I had mentioned it in a previous post, and a reader has requested the recipe, so here it is.

Although this is not Irene’s only meat loaf recipe, it is a particularly interesting, if not a bit fattening, one. She’s got another good meat loaf recipe in her short-lived blog Cooking with Grandma. Maybe you guys can convince her to restart her blog. The world needs her recipes. Until then I will continue to leak them to you through my blog. (Carl Rove, step aside.)

MEAT LOAF
Oliver Clark’s from the New York Times
With variations by Irene

3 cloves garlic
2 tbsps. olive oil
2 medium onions
1 red pepper
salt and pepper
5 oz. fresh mushrooms
1 lb. Ground beef
1 lb. Ground pork or sausage meat
½ cup matzo meal
1 tsp. Dijon mustard, heaping
1-1/2 tsp. Old Bay seasoning
1/3 cup Parmesan cheese, grated
3 tbsps ketchup
1 tbsp. Mayonnaise
2 tbsps. whipped cream cheese
½ cup chicken or beef broth
2 eggs, lightly beaten
¼ lb. Bacon

Ingredients for gravy:

2 small cans tomato sauce (8 oz. cans)
5 oz. fresh mushrooms, sliced
1 tbsp. Sugar

1. Preheat oven to 350 degrees.
2. In food processor, coarsely chop garlic, onions and red pepper.
3. Saute garlic, onions and red pepper in 1 tbsp. Olive oil. Take out.
4. Coarsely chop mushrooms in food processor. Then saute in 1 tbsp. Olive oil until they give up their liquid. Take out. Place in large mixing bowl with garlic onions and pepper. Sprinkle all with salt and pepper.
5. Stir the whipped cream cheese into the warm vegetables until the cheese melts.
6. Add all remaining ingredients except the bacon.
7. Toss lightly until well mixed but do not overmix.
8. Shape into loaf shape in baking pan.
9. Lay about 8 half strips of bacon on top of loaf just to cover.
10. Pour 2-8 oz. cans of tomato sauce alongside of the loaf.
11. Bake for 1 hour. Turn bacon to brown other side.
12. Slice another 5 oz. fresh mushrooms and add to tomato gravy and return to oven for 20 minutes.
13. Remove meat loaf to serving platter. Let rest 10 minutes while preparing gravy.
14. Pour tomato/mushroom gravy into saucepan. Add 1 tbsp. Sugar. Skim fat from surface and keep warm.
15. Slice meat loaf. Serve gravy separately.

Yield: 4 to 6 servings.

Category: Food

In Search of the Perfect Scone

SCONES 007

Perfect scone update – I found it!

Chocolate chip scones have pretty much replaced chocolate chip cookies as the thing my daughter Natalie and I bake together. This is a good thing, I believe, for several reasons. First, less sugar and fat. Second, much quicker and an easier clean up. Third, only one baking time, as opposed to cookies where it’s in and out, in and out, onto the cooling racks, and then we tend to burn half of them because we lose track of the time. Finally, we love to drink tea, and scones are pretty much perfect with tea, although they also pair quite nicely with a tall glass of cold milk.

Still, I am not entirely happy. For, although I have tried at least four different recipes, I have yet to make the perfect chocolate chip scone.

Last Saturday, because Irene and Marvin left behind some buttermilk on their recent visit, Natalie and I decided to try buttermilk scones. Here’s the recipe we used, barely modified from a very nice web site called Baking Sheet. The scones in the picture looked pretty perfect to me, and I liked that the recipe only makes 4-6 small scones. Although they apparently freeze well, scones are best eaten the day they are made, so a smaller quantity seemed better to me.

Buttermilk Scones
1 cup flour
1 tsp baking powder
¼ tsp baking soda
1/8 tsp salt
2 tbsp sugar
3 tbsp butter, cold and cut into small pieces
5 tbsp buttermilk
1 tsp vanilla
1/4 cup chocolate chips

For topping:
1 tbsp buttermilk
1 tbsp coarse sugar

Preheat oven to 400F. Line a baking sheet with parchment paper. In a large bowl, combine flour, baking powder, baking soda, salt and sugar and whisk to combine.

scones 001

Rub butter into the flour mixture with your fingers or a pastry cutter until the mixture resembles very coarse meal.

scones 002

Mix vanilla into buttermilk and add to the dry ingredients.

scones 003

SCONES MIX

Add chocolate chips. Turn out dough onto lightly floured surface, knead a very little and form dough into a disc 1 inch thick. Cut the dough disk into 4-6 wedges using a knife or a pizza cutter.

scones 004

Brush with 1 tbsp buttermilk

SCONES 005

and sprinkle liberally with coarse sugar.

CONES 006

Place on baking sheet and bake at 400F for 15-18 minutes, or until lightly browned. Let cool for a few minutes before serving.

The end result, shown at the top of this post, was quite tasty. Everyone, including Natalie and her friend, enjoyed them immensely. But I was a bit disappointed in the texture. It wasn’t light enough, I thought. So, I decided to try again.

Most scone recipes I’d seen that originate in the UK called for Castor sugar, which is a very fine sugar. I figured that since scones originated in England, they might be onto something. I didn’t have any superfine sugar, but I read you can make your own using a food processor, so that’s what I did.

I also decided to add an egg to the recipe to see if that made a difference. Some scone recipes have an egg, others don’t. I wasn’t sure why, but I read in Harold McGee’s On Food and Cooking that in baking, eggs act as leavening agents because they expand while they cook.

So back I went to the kitchen, and whipped up another batch of scones using these two modifications – the superfine sugar and the egg. Confirming my belief about the superiority of scones over chocolate chip cookies, they were into the oven in less than 10 minutes. And here was the result:

SCONES 008

Here are the results of the two recipes side by side (with egg on the left, without on the right):

COMPARESCONES

To be honest, I really couldn’t see or taste much difference. My husband Paul thought the ones with an egg tasted better, but that may have been because they were still warm when he tried them. Don’t get me wrong. Both scones were quite tasty. But they were heavier than I’d like, and a little more cakelike than I expected. I decided to do a little more research into the scone-making process, so that I could better choose a recipe next time.

There are many scone recipes out there. What seems to be common in all of them is flour, leavening (baking powder, soda or both), sugar, butter and a liquid. According to the very well-written Joy of Baking Newletter on scones, the ratio of liquid to dry ingredients is 1:3. The liquid can be cream, milk, or buttermilk. Interestingly, eggs are not a consistent ingredient of scones.

According to the CIA’s The Professional Chef, one makes both scones and biscuits using a “rubbed dough” method, similar to that used in making pie crust. Dry ingredients are well-blended, either by sifting or whisking together. Shortening is chilled and then rubbed into the dry ingredients to create layers. The Professional Chef actually recommends putting the butter back into the fridge after cutting it up, so that it remains hard until you actually use it. It is extremely important not to let the fat melt and mix evenly into the rest of the ingredients; thus the liquid must also be very chilled.

The best results are achieved by working the dough as little as possible. This means that after adding the liquid, you only mix the dough enough so that it is a “shaggy mass”. Some recipes call for rolling and cutting the dough, but the traditional method for scones is to just knead the dough slightly, pat it into a flat circle and cut it into triangles.

As for the leavening agent, most recipes call for baking powder. When buttermilk is used, however, baking soda is also added. I did a little reading in McGee on the difference between baking powder and baking soda. Without getting too much into the chemistry, the acidity in the buttermilk causes the baking soda to react and start bubbling right away (I felt it as I was working the dough). The problem with baking soda is that the reaction is short-lived, and if you don’t work quickly enough after adding the liquid, is over before the real baking starts. Baking powder, especially double acting baking powder, has two different ingredients that have different rising reaction times. The first reaction occurs on addition of the baking powder to the batter, the other later on at higher temperatures that occur in the baking process. I also found that you can test your baking powder and soda for freshness. I did both, and mine were fine, so that wasn’t my problem.

So, now that I am an expert on scones and baking, I have the following insights into why the scones I made last Saturday were still a little far from perfect (though not that far…):

1. We didn’t have the butter or the buttermilk cold enough
2. We worked the dough just a little too much (I thought the “shaggy mass” was a shaggy mess and kept working the dough. Now I know that a shaggy mass is just what I am aiming for.)
3. I think we cut up our dough into too many scones, so they may have overcooked due to the higher ratio of surface area to middle.
4. I think more baking powder is called for. I’ve checked dozens of scone recipes. The ratios of flour to leavener vary greatly, but some definitely call for more that what I used.

I found a recipe that claims to be an “authentic” scone from Devon, England, and that calls for a full tbsp of baking powder plus 1/2 tsp soda per cup of flour! It will be the next recipe I try. I’ll let you know how it turns out.

In the meantime, if anyone has any better insights, or can help me out in finding the perfect recipe, please feel free to comment. Because I am definitely on a mission here.

Next : Still Searching for the Perfect Scone…

Caegory: Food

Thai Salad Swings Both Ways

This particular evening, I was in the mood for Thai Beef Salad. But my eldest daughter is a vegetarian – I knew she wouldn’t eat it. So I decided to make two versions of the salad – one for the Carnivores (with beef), and one for her (with tofu). As it turns out, we all loved the tofu, Carnivores and Veggies alike. So the meat eaters mixed some of the tofu into our salads along with the beef. Luckily, this still left enough tofu for my Daughter the Veggie to take some salad to school for lunch the next day. And it tasted just great.

Thai Salad Both Ways

One of my all-time favorite recipes is the Thai Beef Salad from the Frog Commissary Cookbook. The Commissary was Steven Poses’ cafeteria-style gourmet restaurant cum wine bar/bakery that, along with its upscale companion The Frog, led the Philadelphia Restaurant Renaissance in the 1970’s. Some wonderful restaurants opened in those years in Philly, and put the town on the map forever as an amazing place to dine out. The Frog, Astral Plane, The Aspen Café, Judy’s, The Blue Moon, The White Dog, Jack’s Firehouse – Mr. TBTAM and I have fond memories of many wonderful meals at these great restaurants, some of which are still around today. (Not to mention Le Bec Fin…)

The Frog Commissary Cookbook features Poses signature dishes from his two vanguard restaurants. It is one of those cookbooks of mine whose pages are stained and torn, whose cover has long since come off its bindings, and whose recipes I return to again and again. The recipes are an eclectic mix of East and West with great appetizers, dinners, soups and amazing desserts and party food. The carrot cake recipe alone is a national classic. Poses designed all the recipes in an apartment kitchen, not a professional kitchen, and every dish is worth making.

The original recipe calls for already-cooked beef, so I’ve modified the recipe to include how I cook the beef and tofu for this salad. I didn’t have scallions, so I used red onion. My daughters ate up the cucumber before I could add it to the salad, and the bean sprouts were not fresh enough at the market, so you don’t see them in the photo. Otherwise the recipe is the same as the original.

Spicy Peanut Dressing
½ cup unseasoned rice wine vinegar
1/3 cup corn oil
1 tsp salt
1 tbsp sugar
¾ tsp minced garlic
½ tsp crushed red pepper flakes
1 ¼ tsp soy sauce
1 ¾ tsp Thai hot sauce or Tabasco
1 ¼ tsp minced fresh ginger
2 tbsp lime juice
1/3 cup coarsely chopped salted roasted peanuts

Whisk together all ingredients (except the peanuts). Refrigerate. Add ¼ cup peanuts to the dressing just before mixing with salad. Reserve the rest to sprinkle on top (see below).

Beef or Tofu
1 ½ pound sirloin beef (don’t slice it till after you cook it) or 1 block tofu (cut into 1 x ¼ inch strips before you cook it)
Peanut or vegetable oil
2 tbsp Salt
1 tbsp pepper
1 tsp ground fennel (I wanted to add some ground star anise, but didn’t have any)

Combine salt, pepper and fennel.

Beef: Rinse beef and pat dry. Rub in a little oil, and the spice rub. Heat 1 tbsp oil in saute pan till hot over med-high heat, then add beef and cook, about 8 mins. per side, till rare. Remove to cool a bit, and cut into 1 ½ x ¼ inch strips.

Tofu: Sprinkle spice rub over tofu slices. Heat 2-3 tbsp oil over medium high heat. Add tofu, and saute, turning once after about 4-5 minutes. Cook till nice and crispy on both sides. Remove to drain on paper towels.

Salad
2 medium-large cucumbers, peeled, seeded, and sliced into ¼ inch thick crescents (about 2 ½ cups)
¼ pounds snow peas, semmed, blanched 20 seconds
½ pound bean sprouts
1 ¾ cup julienned red peppers (about 2 medium)
2 cups finely slice red cabbage
1 cup thinly slices scallions (I used red onion)
Romaine leaves
½ cup chopped salted roasted peanuts

For the beef salad: Just before serving, combine the beef, the cucumbers, snow peas, bean sprouts, peppers, cabbage and scallions with the dressing. Plate the romaine. Arrange the salad ingredients atop. Sprinkle with the remaining peanuts. Serve.

For the tofu salad: Just before serving, place the tofu on a flat plate or low bowl and pour a little of the dressing on top to flavor them. Combine the cucumbers, snow peas, bean sprouts, peppers, cabbage and scallions with the rest of the dressing. Plate the romaine. Arrange the salad ingredients atop, tofu slices last. Sprinkle with the remaining peanuts. Serve.

Chocolate Butter Cookies

I know, I know. It’s a whacky idea for a blog – sort of culinary gynecology. I didn’t plan it that way, I swear. It just sort of evolved this way. You can use the categories at the right to find the medical posts if you don’t like to read about the food. Don’t worry – you won’t hurt my feelings (much).

Anyway, on to the cookies…

On this visit, Irene also brought us some of her famous homemade cookies. She makes amazing cookies, having honed her skills over the years making beautiful holiday cookie platters for Marvin’s office staff. On any given day, you will find one or more rubbermaid containers of cookies in one of her kitchen freezers, cookies arranged carefully on wax paper layers, often a masking tape label on the side.

This particular cookie is an adaptation from a recipe in Cook’s Illustrated Magazine. Irene gives us a yearly gift subsciption to Cook’s, and I highly recommend it to you.

Chocolate Butter Cookies

20 tablespoons unsalted butter (2 1/2 sticks), softened to cool room temperature
1/2 cup cocoa powder (Cook’s recommend Dutch-processed as best) (about 2 ounces)
1 teaspoon espresso powder
1 cup sugar (7 ounces)
1/4 teaspoon table salt
2 large egg yolks
1 tbsp vanilla exract
2 1/4 cups unbleached all-purpose flour (11 1/4 ounces)
Chopped nuts (hazlenuts, almonds and pistachios mixed)

1. Adjust oven rack to middle position; heat oven to 375 degrees. Melt 4 tablespoons butter in medium saucepan over medium heat. Add cocoa powder and espresso powder; stir until mixture forms smooth paste. Set aside to cool, 15 to 20 minutes.

2. In standing mixer fitted with paddle attachment, mix remaining 16 tablespoons butter, sugar, salt, and cooled cocoa mixture on high speed until well combined and fluffy, about 1 minute, scraping sides of mixing bowl once or twice with rubber spatula. Add yolks and vanilla and mix on medium speed until thoroughly combined, about 30 seconds. Scrape sides of bowl. With mixer running on low, add flour in three additions, waiting until each addition is incorporated before adding next and scraping bowl after each addition. Continue to mix until dough forms cohesive ball, about 5 seconds. Turn dough onto counter; divide into thirds and roll into logs, 2 inches in diameter and about 12 inches long. (Correction: Roll it in the nuts before you chill it. The nuts will adhere better. Thanks, Irene.) Chill until very firm and cold, at least 1 hour.

3. Roll the chilled cylinder of dough into chopped nuts. Slice cookies 1/4 inch thick and place on parchment-lined baking sheets.

4. Bake until cookies show slight resistance to touch, 10 to 12 minutes, rotating baking sheet halfway through baking time; if cookies begin to darken on edges, they have overbaked. Cool for 5 minutes, then, using spatula, transfer cookies to wire rack; cool completely.

Doing the Work that Has To Be Done

I was asked by a colleague the other day if I would be willing to head the medical advisory committee of which I am currently a member. The committee is part of a large organization whose mission includes provision of family planning services. As chair of the committee, I’d have some additional responsibilities, and would have to start attending board meetings for the organization, in addition to the twice yearly advisory committee meetings I already attend.

I don’t like to spending evenings away from family, and try to limit outside responsibilities as much as possible. I never go to drug company dinners, resent my boss for making me join our local medical society (which has monthly dinner meetings), and aside from my voice lesson and choral rehearsal (which I combine on the same night once a week) have no outside evening activities. I told my colleague that I’d think about it and get back to her, because I didn’t think it was nice to say no right away. I promptly forgot our conversation.

A few days later, I was privileged to listen to an esteemed gynecologic oncologist give a lecture about his life’s work. Amidst his tales of the lab, the operating room and the chairman’s office, he told us stories of the old days before abortion was legal. In those days, the hospital wards were packed with septic abortion patients. He told us how many lives they saved by not waiting for cultures to diagnose clostridial sepsis. They used to mix the patient’s secretions with milk right there in the ER, and look for bubble formation (clostridia is a gas forming bacteria). He told of how he stayed up all night long in the ICU with women who had attempted self-abortion with lye, only to have them die in the morning despite all his efforts. And although he had enormous responsibilities in his specialty, he served for years on the board of his local Planned Parenthood. “It was just something I felt I had to do”, he said. “I hope you never live to see the things I saw”.

That same night, I learned that South Dakota has passed a law that outlaws abortion under any circumstance.

Today, I emailed my colleague that I would accept the position.

According to the Alan Guttmacher Institute, in 1962 alone, nearly 1,600 women were admitted to Harlem Hospital Center in New York City for incomplete abortions, which was one abortion-related hospital admission for every 42 deliveries at that hospital that year. In 1968, the University of Southern California Los Angeles County Medical Center, another large public facility serving primarily indigent patients, admitted 701 women with septic abortions, one admission for every 14 deliveries. (AGI also source for graph above)

Category: Second Opinions

Shrimp Louie Salad, Mac & Cheese

Every couple of months or so, my mother-in-law Irene, the Greatest Home Cook in the World, visits us. She and her husband Marvin never arrive without the Blue Cooler. And in that cooler they carry, along with Irene’s special cereal, Marvin’s buttermilk and a few tasty leftovers from their fridge, the ingredients for the dinners Irene has planned for us during her stay. These are often supplemented with items bought by us from the short shopping lists that Irene phones up ahead of time.

I long ago gave up feeling insulted that Irene feels the need to bring food along or plan the meals for her visit with us. I love her cooking too much, and just enjoy both their company and their food. Every once in a while I do put my foot down and insist that she let us feed her, but mostly I just join in and chow down. And what better treat than to walk in the door from work at the end of a long day, and find Iene in the kitchen, Marvin and my husband Paul setting the table, the kids happy and the smell of garlic in the air? If there is a heaven for working mothers, this is it.

This particular night, my in-laws were headed to see “The Odd Couple” with my kids, so dinner was “a quick meal”. Shrimp salad like no shrimp salad I’ve ever had before, and a test run of the latest macaroni and cheese recipe from the NY Times, served with garlic bread. (Susan, no comments please, you’re just jealous you weren’t here to eat it.)

Irene’s Shrimp Louis Salad

This recipe is based on the classic Crab Louis Salad, the origins of which are not entirely agreed upon, but which seems to have been created sometime at the turn of the 20th century in a restaurant on the West Coast. Some say it is named after King Louis XIV who was known for his enormous appetite. It is always pronounced Loo-ey. (Let’s sing it together, shall we? Louie, Louie…)

Irene uses Trader Joe’s frozen shrimp, which are really delicious. She keeps them in her freezer at all times. (One of these days, I will do a post about her two, count ’em 2, kitchen freezers and what’s in them… ) The amounts and proportions of ingredients will really depend on how many people you are serving and what you like, but do keep her proportions of the shrimp and celery, and obviously the dressing and artichoke recipes are made as written.

Ingredients
Shredded romaine lettuce
1 ½ pound cooked shrimp, cut into bite sized pieces
3 stalks crisp celery, cut up
Some sliced scallions
Louis Dressing (recipe follows)
Marinated artichoke hearts (recipe below)
Cherry tomatoes
A few hard boiled eggs, cut into quarters
Black olives
Cucumber, peeled and sliced
Red onion, slivered (salted or not, your preference)
Slices avocado
Lemon or lime wedges

Toss the shrimp and celery together with just enough Louis dressing to hold it together, really just a little. (You’ll serve more dressing on the side late, so keep it light at this point.)

Plate the lettuce on a large serving platter. Heap the shrimp salad in the middle. Arrange everything else prettily. Scatter scallions atop everything. Serve with lemon wedges and Louis dressing on the side.

Irene’s Louis Dressing
1/3 cup French vinaigrette Dressing (Made using the ingredients below)
– 1 ½ tbsp Dijon
– 1 tbsp Worcestershire
– 1 tbsp honey
– ¼ cup olive oil
– salt and pepper to taste
1 cup mayonnaise
¼ cup chili sauce
1 tsp Worcestershire sauce
¼ cup sweet India relish
1 tbsp minced scallions

Mix well.

Irene’s Marinated Artichoke Hearts
Trader Joes again, this time a bag of their frozen artichoke hearts. (Manhattanites, take heart – a Trader Joes is coming to Union Square, finally!)

Put artichokes in just enough water to cover, with some chopped garlic and a little olive oil. Simmer till most of the water is evaporated and artichokes are tender. Add 1 to 1 1/2 tbsp champagne vinegar, and salt and pepper to taste. Cool before using.

Creamy Macaroni and Cheese (adapted from the NY Times)

Julia Moskin wrote a really nice article in the NY Times recently about her search for the ideal mac and cheese recipe. This was one of the ones she made. Some minor changes were made for this meal. Irene left out the butter and the extra cheese for the top, and baked it in a 9 by 12 glass baking dish instead of a smaller pan as called for in the original recipe. This change in pans results in lots of the crispy top and bottom of macaroni and cheese that is my favorite part of the dish. It was still quite rich, and I’m going to make it myself sometime soon using a little less cheese.

1 cup cottage cheese (not lowfat)
2 cups milk (not skim)
1 teaspoon dry mustard
Pinch cayenne
Pinch freshly grated nutmeg
½ teaspoon salt
¼ teaspoon freshly ground black pepper
1 pound sharp or extra-sharp cheddar cheese, grated
½ pound elbow pasta, uncooked.

1. Heat oven to 375 degrees and position an oven rack in upper third of oven. Use 1 tablespoon butter to butter a 9×12 inch glass pan.
2. In a blender, purée cottage cheese, milk, mustard, cayenne, nutmeg and salt and pepper together. Reserve ¼ cup grated cheese for topping. In a large bowl, combine remaining grated cheese, milk mixture and uncooked pasta. Pour into prepared pan, cover tightly with foil and bake 30 minutes.
3. Uncover pan, stir gently, sprinkle with reserved cheese and dot with remaining tablespoon butter. Bake, uncovered, 30 minutes more, until browned. Let cool at least 15 minutes before serving.
Yield: 6 to 8 servings

Category: Food

Another So-Called “Teen” Pregnancy

She’s 16 and 9 weeks pregnant, having come to the resident’s clinic this afternoon complaining of bleeding after intercourse 2 days ago. The baby is fine (very cute on sono, we all agree), but it’s clear by her exam that she has a rather severe infection of her cervix, most likely due to Chlamydia. On further questioning she admits to having been treated for Chlamydia not too long ago.

“Did your boyfriend get treated?”

No, he didn’t. He told her that his doctor told him he didn’t have Chlamydia, so he didn’t need to be treated. This of course, cannot be true, because we treat anyone potentially exposed. Which means that her boyfriend did not go to a doctor – he basically lied to her.

He’s 21, the FOB. That means “Father of the Baby” in OB chart-speak, although I could think of a similar acronym that might be more appropriate. He also sleeps with his other baby’s mother, who is 15. She has a 3 month old baby girl.

I ask my patient why she still sees this guy, if she knows he sleeps with another girl. “He’s my baby-father”, she says. “So when I get the urge, he’s the one I go to.”

So this means they all have chlamydia – her, her baby-father, and her baby-father’s other baby-mama. I tell her this, and ask to consider whether she really wants to continue sleeping with him.

And although our former surgeon general was forced to resign for suggesting that teens be taught about masturbation, I take my chances and tell her that there are other things she can do to satisfy her urges that don’t involve exposing herself and her baby to serious infection. I don’t know if I got through, but I hope so.

We treat her infection, talk to her about getting her partner treated, send some labs, talk to social work and make her a follow-up appointment. Her baby is due the end of September.

According to the Alan Guttmacher Institute, fathers of babies born to teens are often significantly older than their female partners. It is estimated that, among girls who have given birth to a child by age 15, 39 percent of the fathers are between the ages of 20 and 29.

Category: Second Opinions

Pasta con le Sarde ala Chita Rivera

pasta and chita 2

In a recent post, in which I basically trashed the recent research on Calium supplements, I noted that the current recommendation is for women to get the majority of their calcium intake from food sources. I decided to take my own advice and made Pasta with Sardines, a classic Sicilian dish. Sardines are a great source of calcium – 4 oz has 300 mg of elemental calcium, a full 1/3-1/4 of the daily recommended requirement for most women.

I planned to make this dish on Saturday, hoping for an early dinner and a nice evening at home with my family. Late that afternoon, all plans for a leisurely dinner were quashed. Around 4 pm, we found out that Chita Rivera’s show “The Dancer’s Life” was going to close in 2 days, which made our tickets for Tuesday night obsolete. My husband had rushed to the box office to see if he could get tickets for the closing night show on Sunday. He returned instead at 5:15 with 4 tickets for that very night! Fine, we figured we’d eat a rushed dinner at 6:30 or so, and still have time to get to the theater at 8. We set to work together in the kitchen, my husband cutting up the veggies while I deboned the sardines.

About halfway through our preparations, the phone rang. My younger daughter’s friend was calling to see why my daughter wasn’t at her house for the special sleepover they had planned (and that we had thought was the following weekend). Now we had an extra ticket! Calls were frantically made to find a friend of my older daughter to accompany us to see Chita. My husband took my younger daughter to the sleepover while I finished the sauce and put it in the fridge to hold. By then it was past 7.

My older daughter’s friend’s father graciously drove us all to the theater. In usual New York fashion, we got stuck in traffic at 54th and 6th. So we jumped out of the car and ran through the freezing night the remaining 6 blocks to the theater, cursing ourselves for not taking the subway, stopping only to warm ourselves on a subway grate (now we knew why the homeless slept there.) We just made the curtain.

We returned after the show to cook the pasta and eat our dinner, in relaxed European style, at 10:30 pm. Luckily, the sauce kept beautifully.

Was it worth all the running around? You bet. Chita was amazing! Singing and dancing for 2 hours at the age of 72! And do you know that her left leg was broken in 12 places in an automobile accident in 1986? Now that’s a woman who must get enough calcium!

Pasta con le Sarde

Most recipes for Pasta con Sarde (and there are probably as many recipes as there are cooks in Sicily) call for anywhere from 1 to 3 8-10 oz. cans of sardines in oil. The recipe on which I based this dish comes from Mario Batali, who calls for 3 pounds of whole fresh sardines! I like sardines, but not that much, so I used about 9 ounces. If I make this again, I will also add a can of anchovies in oil.

2 lbs fennel bulbs, greens removed and reserved, bulb cut into sticks.
9 oz whole fresh sardines
flour, for coating
1-1/2cups extra-virgin olive oil
2 medium onions, minced
3 cloves garlic, minced
1 (28 oz) can whole tomatoes with juice, pulsed a few times on the food processor to chop
3 tbsp pine nuts, lightly toasted
3 tbsp raisins, soaked in a little white wine
salt and pepper to taste
7 saffron strands
1 lb dried bucatini (also called perciatelli, basically thick spaghetti with a hollow center)

In a hot skillet, add olive oil and saute fennel until caramelized. (Next time I’ll add the onions at this step and carmelize them too. )

Remove the heads of the sardines and pull out the backbones and entrails. (You don’t need to do this if you decide to use canned sardines instead.) Select a few sardines for garnish. Chop the rest of the sardines for the sauce, set aside.

Season the flour with salt and pepper, and dredge the selected unchopped sardines in it. Heat 1/2 cup olive oil in a small saucepan until it starts to smoke. Cook the flour-coated sardines in the oil until a light golden brown, about 1 minute on each side. Using a slotted spoon, remove the sardines from the pan and set them aside to drain on a paper towel.

In the skillet with the caramelized fennel, add the onions and cook about a minute. Add the garlic and cook a bit. Add raisins, tomatoes, pine nuts and saffron. Season, to taste, with salt and pepper. Bring the sauce briefly to a boil and then lower to a simmer. Add the reserved sardines and cook, stirring occasionally with a wooden spoon, until the sardines have broken into pieces and are thoroughly mixed into the sauce, about 10 to15 minutes. If the sauce appears too thick at this point, add a little of the pasta cooking water.

Bring 6 quarts of water and 2 tablespoons of salt to a rolling boil. Add the bucatini and cook until tender but still al dente. Drain the cooked pasta into a large serving bowl, add 3/4 of the sauce and stir to combine. Top with the remaining sauce and the fried sardines.

This pasta tastes best if allowed to sit for several minutes, soaking up the flavors of the sauce, before it is served. Keep the pasta covered during this waiting period, then garnish with reserved fennel fronds.

Category: Food, Second Opinions

Birth Control as Art

TBTAM the gynecologist was just a little overcome when she read this in a recent post by MegSpohn, who was describing the arts scene in Denver.

“Have you seen “Invesco Field at Mile High?” Looks like a diaphragm that has Jumbo-vision and seats thousands. We also have some weird public art outside the Convention Center that’s kind of a giant, rusty, coiled spring, which of course reminds me of an I.U.D. that someone left out in front of the Convention Center.”

Now that’s a girl who’s in touch with her inner-gynecologist.

OBS Housekeeper’s Favorite Corn Muffins

My sister, the Obsessive-Compulsive Housekeeper, commented the other day that cooking was notoriously absent from by so-called food blog of late. (Hello – It’s called a day job…?) She put herself up as an example for me by lauding her recent foray into the kitchen to make corn muffins. In doing so, she heaped high praise on this recipe from the Heathcote Tavern in Scarsdale, NY.

So, OBS housekeeper, I’m going to make your muffins. Being a doctor, I will doctor it just a little by adding in some of last summer’s corn from my freezer.

Preheat oven to 375 degrees. Grease well a standard 12 muffin tin. Gather your ingredients. (I read recently in Cook’s that Arrowhead corn meal makes the best corn muffins. Actually, the best corn meal I ever used was fresh stone ground from Phillipsburg Manor, a working 19th century farm we visited in the Hudson Valley. Since I didn’t have that, I’m using what’s in my cabinet.)

In large bowl, mix 1 1/2 c. all purpose flour, 1 c. cornmeal, 1/2 c. sugar, 1 tbsp. baking powder and 3/4 tsp. salt.

Stir in 1/2 cup of melted butter (1 stick). (This step I didn’t understand. I would have expected to mix the melted butter in with the other wet ingredients, as if making pancake batter. But I decided to try it the way it was written. Maybe someone can explain for me why this method might be better or worse than the standard method.)

In small bowl whisk 2 large eggs, 3/4 c. Milk, 2 tbsp. Honey, and 2 tbsp. Maple Syrup until mixed.

Stir egg mixture into flour just until combined. Batter will be lumpy.

Thaw some of this summer’s leftover corn from your freezer and add it to the batter.

Spoon batter into muffin cups.

Bake for 20-22 minutes, or until a toothpick comes out clean. Amazingly, OBS Housekeeper, this is exactly the amount of time it takes for you to fill the sink with soapy water,

and transform the kitchen from this:

To this:

Oh, and the muffins were delicious.

Calcium Confusion From the WHI

In yet another media “bombshell” from the Women’s Health Initiative and the New England Journal, we are now being told that calcium isn’t as good as we thought in preventing fractures. (See study here.) Moreover, women who take calcium supplements have higher rates of kidney stones than women who don’t. And once again, the media is off and running…

No problem. I can handle this one with my hands tied behind my back…aiebpqiwuy756435yh 46ty2w4… Oh, sorry, I forgot that I can’t type with my nose. Let me get my other shoe off, I’ll use my toes. Okay, are you ready? ‘Cause here we go…

First, let’s talk about the intervention studied by the WHI : Approximately 36,300 women nationwide were randomly assigned to placebo or 1000 mg/day elemental calcium combined with 400 IUs/day of vitamin D. The primary outcome was osteoporotic hip and other bone fractures, with colon cancer as a major secondary outcome. Overall, women assigned to take calcium supplements had no less osteoporotic fractures than those taking placebos.

What???? Oh, wait. I understand. When they looked at women who actually took the pills as advised, there was a 29% reduction in fractures.

So, what they seem to be saying is this – telling women to take calcium and vitamin D doesn’t prevent fractures. Sort of like telling my kids to brush their teeth to prevent cavities – it only works if they actually do it. OK, I’ll buy that.

The statisticians don’t like to hear this. They prefer the purity of an intent to treat analysis, where the only valid comparison is what goup study participants were assigned to, not what they actually did. As a clinician, I alswys have trouble with intent to treat analysis – I tend to want to drill down and find out why. I would argue that this is as valid as the intent to treat.

A benefit was also seen to calcium supplementation in the over-60-years-old crowd. Gee, that makes sense too. I wouldn’t expect to see a big difference in fractures in the under 60 crowd, because that group doesn’t get many fractures. And if someone in that age group is breaking her hip, I’d have a strong suspicion there’s something else going on other than just age. Like maybe anorexia or smoking or an overactive parathyroid gland or malabsorption, to name a few possibilities. No amount of calcium is going to fix that. Hmm…So far, it sounds like calcium is doing exactly what I’d expect it to do.

But that’s not what CBS News says. Their headline? “Calcium, Vitamin D Assumptions Shaken.” Why? Because the big groups analysis showed no benefit to calcium, that’s why. And do you know why? Because the women who received placebo were allowed to take calcium and vitamin D supplements on their own! That’s right. Here it is, right out of the WHI press release: “Since participants were not restricted from taking personal calcium or vitamin D supplements, they had a relatively high calcium and vitamin D intake at enrollment and intake rose even higher during the trial so the impact of study supplementation may have been muted.”

What the researchers are telling you is that since they didn’t control the very intervention they were studying, their results might not be right.

Oh, and one more confounding issue. They also did not restrict the use of Fosamax-type drugs in either group, so about 15% of women ended up on these fracture-preventing meds during the course of the study. This means that most likely the women at risk for fractures in both groups were already taking a more effective medication than just calcium and vitamin D.

Are you getting all this?

Now, let’s talk some more about the WHI’s intervention – namely, giving all women the same dose of calcium, regardless of what amounts they may have been getting in their diet.

You know what? This is not the way we doctors recommend that women take calcium.

Here’s the recommendation of the National Osteoporois Foundation and the American College of Obstetricians and Gynecolgists: “Food is the best source of calcium; however, most Americans do not have enough calcium in their diets. Fortunately, calcium-fortified foods and calcium supplements can fill the gap, ensuring that the daily calcium requirement is met. The amount needed from a supplement depends on how much calcium is consumed from food sources.”

Hmm…I don’t see any recommendation that every woman be given 1000 mg of calium as a supplement daily. Gee, I wonder what might happen if women were to take calcium supplements without taking into account their dietary sources? Maybe they’ll get too much calcium. And what can too much calcium cause? (Let’s shout it out together, shall we?) KIDNEY STONES!

Oh, wait, wait… I forgot to tell you about the vitamin D dose studied – 400 IU daily. Unfortunately, it’s too low. The current recommendation is 800 IU daily. (And not 600 IU as the NY Times says.)

Quick take

And there you have it, folks. The WHI researchers designed an intervention that doesn’t match current medical recommendations, failed to adequately control the intervention they were studying, and then used their results to question the very medical recommendations they didn’t follow. Yet despite this, they did manage to get some results that make sense if you understand what really happened.

Fortunately, Gina Kolata at the New York Times understands it. Here’s her headline: “Big Study Finds No Clear Benefit of Calcium Pills”. That just clears it all up for everyone, doesn’t it? And this from Forbes: “Calcium, Vitamin D Won’t Protect Older Women From Fracture.” The fact that it was the older women who actually did show a benefit is irrelevant to the headline. No wonder we’re all confused.

Here are the current recommendations for calcium and vitamin D (click here). I wouldn’t change a thing.

Mrs. O’Leary Milking Daisy by Norman Rockwell
 _________________________________

Comment : define_me
February 16, 2006
Maybe I should aim to get my first publication with the New England Journal of Medicine…hehehe

Comment: Anonymous
February 17, 2006
Between the calcium and fat study, the headlines should read: Impossible to do prospective food study; massive waste of money and time. Conclusion: retrospective food studies, or even large population studies (Japanese on traditional diet v. American diet) are clearly the best information we’ll get—and far cheaper.) I’m not even going to think how many children could be fed and vaccinated, or how much prenatal nutrition could be paid for with the 415 million from the fat study…

Comment: Guinness_Girl
February 17, 2006
That’s all I have to say. Wow

Food Blogger Paraphernalia

The best thing about a new hobby is that it gives you a reason to buy new stuff, and I love buying new stuff. Here’s what I got last weekend:

A tripod so that I can take better pictures of my food. The salesman tried to talk me into a $180 clamp that the professionals use, but I went for the $25 cheapo portable tripod. I tried it for the valentine’s day photo, and I think he was right about that clamp – you need it for the overhead shots. But I still like the little one, mainly because it is cute.

New dishes. My own dishes are green, and although my friend Rachel graciously loaned me a white bowl for a recent post, it was clear that I could not continue to rely on my neighbors for dinnerware. Fish’s Eddy is having a close out sale at the B’way and 77th Street store, so I headed there last Saturday and I now have a great collection of single plates and bowls to enhance my food shots. (Just no room to store them…)

A Clamp-on Light. Well, technically I didn’t buy the light, my brother-in-law did. But I did start using the light in the kitchen this weekend, because we have no over-the-stove light to work (and photograph) by. Suddenly, I can see what I am cooking. Amazing!

Now I just have to get back into the kitchen. The problem with a day job (and a family) is it leaves no time for cooking…

Category: Food

Happy Valentine’s Day!

This week’s Grand Rounds is up at Intueri.org. You must get over there and check it out. She’s made the posts into personal ads looking for love. Brilliant!

Hugs and kisses to you, dear reader. Have a great day.

Category: Considerations and Second Opinions