Age Before Beauty

There was shocking and disturbing news at the recent American Stroke Association conference-strokes rates have risen dramatically between 1994-5 and 2006-7 but only in the younger populations!  While there are many explanations for the data (51% rise in 15-34 year old males, for example) but certainly in part, this is related to the obesity crisis coming home to haunt.  Strokes are sad because:

1. Even with early warning signs and advanced medical therapeutics, strokes remain devastating in terms of quality of life-they less often kill than maim
2. Stroke rates can be dramatically impacted by lifestyle decisions-obesity, smoking, sedentary lifestyle, etc.

This study should serve as the shot across the bow-we can no longer ignore the dangerous health trends in this country-a FAST FOOD NATION is doomed to egregious health outcomes, stroke being a prime example.  Each one of us has to commit to trying to live healthier lives and help others to do so as well,

I have long been an exercise enthusiast and have been proud of my locavore/healthy cooking style.  Nonetheless, like many 50-somethings, found my weight had crept to dangerous levels.  I have made further adjustments and am proud to say, have dropped 25 pounds over the last 6 months.  But then I decided to take an even greater step and try to turn my new awareness to greater purpose.  I have set a challenge in both of my offices related to sustainable weight loss.  I decided that as a physician I have to both walk the walk AND talk the talk.  I hope everyone will try and think of at least one thing you can do in your own life or for those you love to help reverse these dangerous trends.

First Post: A Recipe for Health

Happy 2011 to all.  I thought I would share a recipe I recently created as part of our holiday celebrations that is quick, easy, delicious and healthy.  Certainly a good way to start the year!

Fregola with sauteed spinach and shrimp

1/2 c Fregola
1 pound spinach, cleaned and chopped
1 leek, sliced
1 red pepper, diced
1 garlic clove, minced
6-12 shrimp, shelled
1 c. stock or bouillon
olive oil

1.  Cook fregola in stock until tender but not mushy.
2.  While the fregola is cooking, prepare the vegetables.
3.  Warm olive oil in sauté pan.  Add leek and red pepper, cook until soft.  Add garlic and then spinach.  Cook just until spinach wilts.
4.  Add shrimp to vegetables and cook just until color turns to pink.  Add a little of the stock (bouillon) to create some sauce.
5.  Add fregola and toss.  Salt and pepper to taste.

Obviously there are many variations on this...you can add fresh or dried herbs for more flavor, eliminate the shrimp or substitute some sausage...onion can stand-in for leek...to make it extra festive, you can drizzle the final salad with crispy leeks...Try it my way or make it your own.

To a healthy 2011 for all.

Neurosurgeon Foodie

Last week I was finishing up my pre-operative routine with a lovely woman suffering from a recurrent brain tumor when she stopped and inquired whether she could ask a strange question.  I know this patient and most of her family well so I figured, sure, why not? I nodded and she continued-I was seeing my podiatrist the other day and I told him I would soon be having brain surgery. He asked who my doctor was and when I mentioned you he grinned and said, "She makes the best butternut squash soup I have ever tasted."  I laughed and my patient continued, he wants to know how much heavy creme you use?  Now I could really smile, "None, and it is all vegetarian, too."  Her extended family immediately asked for details.  For them and for any of you who may want to enjoy this fall favorite of mine, here is the recipe.

BrainDame's Butternut Squash Soup

1 medium butternut squash
1 medium to large white onion (peeled and diced)
1 tbs cumin (toasted and ground)
1 tbs aleppo pepper
1-2 quarts good vegetable stock or bouillon
Salt and pepper to taste

1. Cut squash in half lengthwise and place face down on greased pan, bake at 350 until flesh soft.  Cool.
2. Scoop seeds out of squash (save if you want to roast them), then scoop flesh away from skin and save pulp.
3. In a large sauce pan, sauté onions in small amount of oil until soft.
4. Add toasted cumin and pepper and stir.
5. Add prepared squash pulp and cover with stock.
6. Simmer for at least 15 minutes.  Adjust seasoning.
7. Puree soup (in pot with hand held device or in blender) and adjust consistency with additional stock if desired.

Enjoy!

Autumn High

The cool air assaults me as I step outside

The dogs lope gracefully in anticipation

The sun glints against the coloring leaves

Some trees already ablaze in glory

The trail is firm and welcoming

The dogs throw caution and romp

Light filters and flickers through thinning leaves

Our feet crunch on already fallen

Apples crisp and pears, too

Cider bracing and sweet every morning

Still produce in great abundance

Meals a treasure like no other time

My autumn high

Taste of Summer

I found this recipe for the perfect quick pickling sauce and wanted to share it! The result is close to the taste of those great veggies you get in  good Thai restaurant.   It is a perfect way to use those extra cucumbers, carrots, onions (and probably zucchini!) that are coming into season. Use the final product alone, as garnish for meat/fish, as a component in a complex salad...the uses are endless.  I like using any leftovers on my lunch sandwhich-YUM!  I usually double or triple the recipe because it is so easy and then I have a ready supply on hand.

Pickling Juice

1 cup water
1/2 cup rice vinegar
1/2 cup plus 2 tablespoons sugar
2 tablespoons Kosher salt
1 whole clove
1 teaspoon mustard seeds
1 teaspoon black peppercorns
1 teaspoon fresh ginger
1/2 jalapeno pepper, seeded and chopped (any hot pepper will do, more or less to taste)

Combine all the ingredients and simmer for 5 minutes or until the salt and sugar dissolved.  Cool, strain and store until ready to use.


To Pickle:
Slice a red onion (thin)
Warm 1/2 cup pickling juice (in pot or microwave).
Add onion and steep for 30 minutes (more is fine).
Strain and reserve liquid for reuse (I find it is good for 2-3 times then I discard).

My Dinner Conversation

The Place and Time: Lyon, May 2010
Setting: Dinner Meeting at Brassier Nord, a Michelin star chef's local digs
Players: Neurosurgeons from France, England, German, and me (USA)
Theme: Medical systems: What works and doesn't
(Preliminary Info: All sitting at the table are pretty tops in field)

On a recent lecture tour in France, I sat back and listened to a remarkable discussion revealing the mixed assessments of physicians of mixed how successful their own medical delivery system worked-for both themselves (physicians) and themselves (patients).  Highlights:

Germany: Two tiered system.  Everyone must have insurance, responsibility is on individual (not employee), if you can't pay you get it anyhow, and if you earn enough you can opt out and get "private insurance."  Biggest catch for patient:  Once you opt for private, there is no going back!  Biggest catch physician: Little motivation for innovation, working hard, etc when on straight salary.

France:  Subtle two tiered system, everyone insured by state, private insurance allowed for upgraded service.  Increasing numbers opt private leaving the public system in tailspin.  Biggest perceived challenge: "fraternity" not fair that some have better than others! For doctors-the allure of the dollar is strong so they would rather spend their time in the private sector.

UK: Once the quintessential socialized system, now two-tiered and highly regulated.  Also crunched by work hour restrictions on house staff resulting in both workforce and competency issues.  Patient challenge:  wait times.  Physician challenge: highly regulated and little opportunity for creativity.  Leading edge of outcomes/quality assessment that I've encountered.

The US is entering a period of transition for our medical system.  There is so much propaganda flying around about the failings of other systems.  This dinner conversation proved many important things to me.  First, certainly no medical delivery system is perfect and effecting positive change in any system is excruciatingly slow.  Delivery of medicine is ever more complex, time consuming and less remunerative for physicians.  However, no one will argue that maintaining the status quo is just not a viable option.