Feet First |
|
|
“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler Email Dr. Alice
Sites I Like
Useful Links Area Codes Zip Codes A Handy Temperature Converter Body Mass Index Calculator The Mailbox Locator Current Events With Attitude Instapundit Ace of Spades Coalition of the Swilling Weather Sites California Regional Weather Server NOAA Weather BBC Shipping Forecast Gastric Blogs What I Cooked Last Night Eggton Red Kitchen The Cheap Cook Traveler's Lunchbox Archives 10/01/2002 - 11/01/2002 11/01/2002 - 12/01/2002 12/01/2002 - 01/01/2003 01/01/2003 - 02/01/2003 02/01/2003 - 03/01/2003 03/01/2003 - 04/01/2003 04/01/2003 - 05/01/2003 05/01/2003 - 06/01/2003 06/01/2003 - 07/01/2003 07/01/2003 - 08/01/2003 08/01/2003 - 09/01/2003 09/01/2003 - 10/01/2003 10/01/2003 - 11/01/2003 11/01/2003 - 12/01/2003 12/01/2003 - 01/01/2004 01/01/2004 - 02/01/2004 02/01/2004 - 03/01/2004 03/01/2004 - 04/01/2004 04/01/2004 - 05/01/2004 05/01/2004 - 06/01/2004 06/01/2004 - 07/01/2004 07/01/2004 - 08/01/2004 08/01/2004 - 09/01/2004 09/01/2004 - 10/01/2004 10/01/2004 - 11/01/2004 11/01/2004 - 12/01/2004 12/01/2004 - 01/01/2005 01/01/2005 - 02/01/2005 02/01/2005 - 03/01/2005 03/01/2005 - 04/01/2005 04/01/2005 - 05/01/2005 05/01/2005 - 06/01/2005 06/01/2005 - 07/01/2005 07/01/2005 - 08/01/2005 08/01/2005 - 09/01/2005 09/01/2005 - 10/01/2005 11/01/2005 - 12/01/2005 12/01/2005 - 01/01/2006 01/01/2006 - 02/01/2006 02/01/2006 - 03/01/2006 04/01/2006 - 05/01/2006 05/01/2006 - 06/01/2006 06/01/2006 - 07/01/2006 08/01/2006 - 09/01/2006 09/01/2006 - 10/01/2006 10/01/2006 - 11/01/2006 11/01/2006 - 12/01/2006 12/01/2006 - 01/01/2007 01/01/2007 - 02/01/2007 02/01/2007 - 03/01/2007 03/01/2007 - 04/01/2007 04/01/2007 - 05/01/2007 07/01/2007 - 08/01/2007 08/01/2007 - 09/01/2007 09/01/2007 - 10/01/2007 10/01/2007 - 11/01/2007 11/01/2007 - 12/01/2007 12/01/2007 - 01/01/2008 01/01/2008 - 02/01/2008 02/01/2008 - 03/01/2008 03/01/2008 - 04/01/2008 06/01/2008 - 07/01/2008 07/01/2008 - 08/01/2008 08/01/2008 - 09/01/2008 09/01/2008 - 10/01/2008 12/01/2008 - 01/01/2009 01/01/2009 - 02/01/2009 02/01/2009 - 03/01/2009 03/01/2009 - 04/01/2009 04/01/2009 - 05/01/2009 05/01/2009 - 06/01/2009 06/01/2009 - 07/01/2009 07/01/2009 - 08/01/2009 08/01/2009 - 09/01/2009 09/01/2009 - 10/01/2009 10/01/2009 - 11/01/2009 11/01/2009 - 12/01/2009 01/01/2010 - 02/01/2010 02/01/2010 - 03/01/2010 03/01/2010 - 04/01/2010 04/01/2010 - 05/01/2010 05/01/2010 - 06/01/2010 06/01/2010 - 07/01/2010 07/01/2010 - 08/01/2010 08/01/2010 - 09/01/2010 10/01/2010 - 11/01/2010 01/01/2011 - 02/01/2011 02/01/2011 - 03/01/2011 03/01/2011 - 04/01/2011 04/01/2011 - 05/01/2011 05/01/2011 - 06/01/2011 06/01/2011 - 07/01/2011 07/01/2011 - 08/01/2011 08/01/2011 - 09/01/2011 01/01/2012 - 02/01/2012 02/01/2012 - 03/01/2012 04/01/2012 - 05/01/2012 08/01/2012 - 09/01/2012 09/01/2012 - 10/01/2012 01/01/2013 - 02/01/2013 02/01/2013 - 03/01/2013 03/01/2013 - 04/01/2013 09/01/2013 - 10/01/2013 09/01/2014 - 10/01/2014 10/01/2014 - 11/01/2014 12/01/2014 - 01/01/2015 02/01/2015 - 03/01/2015 03/01/2015 - 04/01/2015 05/01/2015 - 06/01/2015 06/01/2015 - 07/01/2015 10/01/2015 - 11/01/2015 12/01/2015 - 01/01/2016 07/01/2016 - 08/01/2016 09/01/2017 - 10/01/2017 04/01/2018 - 05/01/2018 12/01/2018 - 01/01/2019 11/01/2019 - 12/01/2019 12/01/2019 - 01/01/2020 01/01/2020 - 02/01/2020 04/01/2020 - 05/01/2020 05/01/2020 - 06/01/2020 07/01/2020 - 08/01/2020 01/01/2021 - 02/01/2021 02/01/2021 - 03/01/2021 03/01/2021 - 04/01/2021 04/01/2021 - 05/01/2021 05/01/2021 - 06/01/2021 05/01/2022 - 06/01/2022 06/01/2022 - 07/01/2022 07/01/2022 - 08/01/2022 08/01/2022 - 09/01/2022 09/01/2022 - 10/01/2022 10/01/2022 - 11/01/2022 11/01/2022 - 12/01/2022 12/01/2022 - 01/01/2023 
|
Sunday, July 26, 2020
Crack Chili Con Carne So I acquired a tenant some time back who thinks my chili is truly awesome. Any time I make it, I freeze most of it and she will devour it over the next few weeks. I thought I'd post the recipe here. If you will allow me a detour into pedantry, chili basically means some type of stew or liquid flavored with chilis. (Chiles? However you spell it, you know what I mean.) Chili con queso: with cheese, chili con carne: with meat. Technically, I suppose meatless chili would be chili con frijoles though I have never heard that term used. At some time in the past few decades, however, chili con carne was shortened to simply "chili," in the assumption that the dish is going to contain meat. My chili is not gourmet in the slightest. It's made with ground beef, not chunk or stew beef, and the base recipe is the 1:1:1 of one pound meat, one 1-lb can tomatoes (technically we now have 15-ounce cans, but whatever), and one 1-lb can of beans. I'm sure it sounds pretty pedestrian, but allow me to suggest a few choices which can add up to a significant improvement in the final product. Beans: I go with either small red beans or pink beans, though you can use pinto or black beans if you like. Do not drain the beans.The starch in the bean liquid will help thicken the chili. Tomatoes: diced fire-roasted for preference, and I also add a small can of tomatoes and green chilis (the best known brand in the States is Ro-Tel). Don't drain the tomatoes, either. Additional liquid: Rinse the cans with a small amount of water and add that in. In addition, I use beef broth. Beer is an alternative (at least a small amount) and some cooks add coffee. Flavorings/spices: This is where you can get creative. I dice an onion and two cloves of garlic and cook these after the meat is browned and drained. Then add the meat back in and add the beans/tomatoes/Ro-Tel and the beef broth. Now, keep in mind that chili powder also is a thickening agent. Standard prepared chili powder consists of pulverized dried chilis, oregano and cumin and often paprika. You can also purchase powders of individual chilis such as ancho chili, but I go with the old tried and true. What I like to do is to start with pouring in some chili powder - I really don't measure but I would estimate 1.5 to 2 tablespoons - and then add in varying amounts of oregano, paprika, garlic powder (yes, on top of the garlic), maybe some celery salt, cumin and a little cayenne. Depending on what is available and my whim, other options would be crushed red pepper or hot sauce. And if you're going for that gourmet touch, a small amount of cocoa powder or bitter cooking chocolate can be added, though I've never tried that either. Be sure to taste as you go. Don't forget the salt, though with the sodium in the canned vegetables you may need less than you think. Once all this is in, I bring it to a boil, lower to a simmer and let it go for at least an hour. Don't let it go at a hard boil, because the beans are already cooked and they will fall apart. Lastly, another authentic touch if you want to thicken your chili is to take a small amount of cornmeal, mix it in a cup with some water or liquid from the chili until you have a smooth, loose slurry, and stir it into the chili. You should not use a lot, maybe a couple of tablespoons of cornmeal, and it will need to cook for 20 minutes or so. You can serve with diced onions, grated cheese, sour cream if you like. You can also put chili on baked potatoes or cooked rice, or even on spaghetti. Warm leftovers and toss with romaine or iceberg lettuce, corn chips and cheese and you have taco salad. Enjoy. Labels: Ingestion Tuesday, July 21, 2020
Thoughts Before Work My parents' 60th wedding anniversary is this week (my sister reminded me yesterday; I ordered a cake for pickup and she has taken care of the flowers). We will have a little Zoom meeting to celebrate after Dad gets back from his visit to the cardiologist. Yesterday I was on the receiving end of a telephone appointment - for my parents, not for me. With the primary care doctor on the phone I reviewed their medications, blood pressures and symptoms. I also have to talk to them about completing an advance directive form (not the most pleasant conversation I've ever had). This is a weird way to live. I veer between doing nothing and being booked with patients all day long. Later this week I plan to go back into the office to see patients in-person for the first time since February. I suppose you could call this a working retirement. I have to pay for my own benefits now, and that comes expensive; but the ability to say "no" to work when I feel like it makes it all worth it. Here in the US there is a growing drumbeat of resistance against the ongoing lockdown orders. I have no objection to wearing a mask, but I am concerned about all the small businesses that are at their last gasp because they aren't being allowed to open. This stressful atmosphere, added to the fact that this is an election year, combine to create a fertile support system for conspiracy theories and accusations. I'm about ready to give up Twitter, because I just get angry every time I log on and start reading. I do wonder whether there was a similar atmosphere in the time of the Spanish flu, post WWI, a time of even greater social upheaval. My mother once told me that her father was prevented from enlisting in the Army due to the flu, but she has very few details. It's too bad; I would have liked to know more. At any rate, it's time to start work. It's been good to start blogging again; it gives me time to get my thoughts down without the constant background static that comes with other social media. It does have a calming effect. Labels: Random Thoughts, The Doctor's Life Friday, July 17, 2020
Feral Cat Land Here we are on another tour of my neighborhood, one of my frequent morning walks. Today we embark on an east-west walk, rather than north-south. I start out heading south on the big boulevard I mentioned in my previous post for a block or so, then make a ninety degree turn and head east. This neighborhood is nice and quiet, a bit on the exclusive side, and becomes more so as you head further east away from the boulevard: The reason being that all the streets in this section dead end at the local movie studio. Once upon a time this area used to be farmland until it was purchased in the 1920s by Twentieth Century-Fox. The surrounding neighborhood was sold off to become housing and what is now known as Century City, but the studio remains, an island of Hollywood commerce in the middle of Westside suburbia. I like to check out the homes in the neighborhood as I walk along. The styles and sizes of the houses vary. Some are still the one-story ranch type homes that were originally built here but many have been renovated and are now much larger (read: taller). In this area, if the homeowner wants to enlarge the house there is nowhere to go but up. The newer homes are two, sometimes even three, stories and really are too large for the lots they are built on. Many are starkly modern and, to my mind, not very attractive when compared to the Olde California mission or classic ranch styles of their smaller brethren. Some front yards are drought proofed with cactus and gravel; some are tangled webs of rose bushes and overgrown grass with winding paths of brick or stepping stones glimpsed when you crane your neck or venture onto the driveway (with caution, at 5:30 am). There are a few north-south cross streets here which run between the two defining east-west streets of the area. They are lined with apartment buildings, most of which are new and look fairly nice. As I approach the terminus of my walk, however, there are a few holdout buildings which are older and shabbier - the chief of which is a faceless two story building, which could best be described as a single block of stucco dotted with a few minimalist windows. It is surrounded by a blasted patch of dry earth which likely has not seen water since the last rain months ago. As I plod up to the dead end of the street the side of the stucco block is enlivened by a small side porch lined with potted plants and an oil-stained driveway on which usually lounge two wary cats. Welcome to Feral Cat Land, the most exclusive amusement park in Southern California. Population: two cats and me. As per my custom I chirp to the cats, which either ignore me or give me a shocked look and disappear. The attraction of Feral Cat Land, other than the cats, is a battered pickup truck several decades old painted teal blue and bearing the International Harvester logo. The truck is a fixture on this street: it's always there every time I come here. Based on my (minimal) online research, it dates to about 1951. By the time I reach this part of my walk I usually lean on it and pant for a while. Feral Cat Land is bordered by a tall wrought-iron gate edged by two impressive Art Deco-styled concrete pillars, painted white. The pillars are topped by two lovely, elaborate street lamps which burn bright in the predawn twilight. If you look more closely you will see a placard on the gate which states that, per municipal code, you can't go through the gate without permission - although you can peer through at the little bungalows by the gate (probably administrative buildings) and a large filming stage looming in the background. Occasionally a golf cart will zip across the parking lot. This is the closest most Angelenos who are not employed by the entertainment industry will ever get to a studio or film set. I always linger here for a minute or two, wondering what it would be like to slip through that gate. The whole matter-of-factness of the location fascinates me: six inches on one side you're looking at a rundown apartment building and feral cats; six inches the other side and it's Movieland! If you turn away from the gate and walk north you will find several similar streets dead-ending in similar pillars, marking the borders of the studio. It's rather like traveling from Main Street U.S.A. to Tomorrowland in the Kingdom of the Mouse. Except here, Tomorrowland is strictly off limits. Labels: Los Angeles, Random Thoughts, The Doctor's Life Monday, July 13, 2020
Architectural History: The Apartment House As with all of Los Angeles, the buildings here are constantly being renovated or torn down and rebuilt. An architectural historian would probably have a field day identifying the styles and dates of the various apartment complexes lining this street. The appearance of the buildings gives most of the clues you need. First, the size: are they two stories, or three or four? Do they extend for half a block, or are they only one or two units wide? The design of parking spaces alone would be enough, in most cases, to tell you when the place was built. The newest buildings have underground parking accessed by an automatic gate; the older ones have parking slots on the ground floor of the buildings, which may have garage doors or be open to the street. Most tenants of this type of building park their cars on the driveway apron extending onto the sidewalk, because everybody knows that if you park in the garage your car will be blocked by another car and you'll never be able to move it. The detailing of older buildings often gives information about the decade in which they were built; buildings from the Fifties and Sixties will have fancy detailing known as "dingbats" - in fact, the nickname has transferred to the buildings themselves. More information, and a nice photo, are here. (Love those garage doors.) In older buildings, more time and effort was spent on windows; you may see French windows, bay windows or windows curved to fit the corner of a building rather than those Bauhaus-inspired flat atrocities. Scattered around town, a few complexes dating from the 1940s still survive which can be identified by their auto-court design (garages in the back) and curved corners echoing Art Deco streamlining. Light fixtures and paint color are also good indications of when a building was constructed. Seventies buildings are noted for their dark wood detailing, overall blocky and squarish design, and globed light fixtures. Sometimes you'll see some wrought iron detailing as well. Everything built after 2000 has that awful Tuscan-inspired pinkish ocher stucco and white trim. Eighties buildings tend to be a little more froufrou - the architectural equivalent of big hair and shoulder pads. There is one building I pass on my walks which is painted blue with fancy metal detailing on the balconies; for whatever reason, it reminds me of a French chateau. The buildings I truly love are the garden apartments, which are slowly dying off. They are being torn down and huge, efficient hivelike buildings are appearing in their stead. One such building directly behind me was torn down over the past few weeks; nothing is left of it but dirt and the concrete stairs at either side leading up to the back of the property. In a garden apartment the living space lines the edges of the lot, with a narrow path leading into a central garden space shared by the tenants. Granted, it isn't the most efficient use of real estate but there is a peace and graciousness to these spaces that will be sorely missed when all of them are gone. Our local architecture conservation group is fighting to save some of them, but it is an uphill battle as developers have no compunction about rewarding our City Council with cash, cash, cash for getting their plans approved. I will try to post soon about one of my other favorite neighborhood landmarks that I visit on my walks. Labels: Los Angeles, The Doctor's Life Friday, July 10, 2020
Cake or Death But I seem to be entering that part of the life cycle in which you're surrounded by death. Patients I have known for years are dying. My trainer has lost both parents in the three years we've been working together, and another trainer I work with occasionally is about to lose his mother to breast cancer. A close relative of mine has metastatic lung cancer. My parents are reasonably stable - for the moment - but the question is for how long; they're both in their eighties. Several friends of mine have lost parents or other family members recently. I guess what I'm saying is it would be nice to be offered some cake for a change. Labels: Random Thoughts Thursday, July 09, 2020
In Which Dr. Alice Enriches an Orthodontist He's a nice fellow, if a little too prone to making tooth-related puns. Such as, "If you don't treat this it'll come back to bite ya!" Sigh. But he was recommended by my regular dentist, whom I have been seeing for years. He certainly has a lovely office and I'm pretty sure I just made his next month's rent payment for him. Very well organized, everyone masked and hand sanitizer everywhere. They have incredibly fancy equipment which allowed my teeth to be scanned and a mold visualized in less than five minutes. No more biting into a concrete filled mold and fighting gag reflex for what feels like forever. There is something to be said for the twenty-first century after all. In related news, this afternoon I drafted a query to the administrators of my medical group about my lack of remuneration for the past five weeks. I'm still working there as an hourly employee now that I have retired (semi-retired, I suppose, is more accurate) and had to fight the temptation to email "WHERE MY DAMN PAYCHECK AT" instead of substituting something more diplomatic. Well, I can't spend money on a vacation this year due to the Virus, so I may as well spend it on my teeth instead. I go back in about a month for my first fitment. Labels: Science, Technology, Twenty-First Century Crap Tuesday, July 07, 2020
Virtual Medicine My group uses a video program which is part of our electronic medical record system, as well as an alternative which is simpler to use called Doximity. (We can also use FaceTime or Zoom, but these systems are discouraged because they don't have the same privacy protections as the other two options.) Mostly they work well, but there are issues from time to time.
We can always resort to telephone visits, but the group strongly emphasizes video visits when possible. The amount of data you can get on a video visit is obviously greater than on a phone call - you can check the patient's appearance as well as their surroundings (are they dressed neatly, disheveled, short of breath, pale?) And to be honest, reimbursement for video visits is better than for telephone visits. These days that is no minor issue. The clinic has reopened but patients continue to be reluctant to come in. Certainly not all patient issues can be addressed via video, but I would say that overall this system has worked well. My biggest problem with telemedicine is that I need a chair with better back support. After sitting at my desk for four hours straight it's almost impossible to move... Oh, and edited to add that it's really special when you realize after a four-hour shift that you've been interacting with patients all the while you have a big food stain on your shirt. On the up side, though, you can work barefoot and wearing shorts because no one can see you below the waist. So there's that. Labels: Medicine, Technology, Twenty-First Century Crap Saturday, July 04, 2020
Thoughts on Fan Fiction Fan fiction, for those who don't know, is a term for writings or artwork based on a preexisting work, written by fans of said work. The work in question could be a film, a television show, literature, radio program, comic strip or even other works such as video games. Fanfic has been around for decades and first really made it into the public eye with Star Trek, I believe. Fans of the show wrote stories about the characters which were collected, mimeographed and stapled into fanzines and then mailed to subscribers. Nowadays fan fiction is published on websites (the two best known are Archive of Our Own and FanFiction). Traditionally fanfic has not been highly regarded; if you say the phrase "fan fiction" most people will either be unaware of what you are talking about or will cringe in revulsion. There are reasons for its poor reputation. Unfortunately, although some fan fiction is well written the genre as a whole has a reputation for bad writing. Consider the term "Mary Sue." The original Mary Sue was the main character of a Star Trek fic, a Starfleet cadet who wound up on the Enterprise somehow. She was depicted as impossibly gifted and accomplished, although the story contained no scenes showing her doing anything which would justify this portrayal. Readers expecting Kirk and Spock got Mary Sue, plus main characters basically drooling over her and how amazing she was. The author of the story was named Mary Sue Something-or-Other, and the story was immediately recognized as nothing more than wish fulfillment. It was reviled by other fans and "Mary Sue" is now used as shorthand for this type of character. But there are other reasons for the critical view of fan fiction: often it is simply viewed as derivative and lacking in imagination since it is based on other works. "Create your own characters!" critics will cry. "Do your own thing!" Everything above pretty much describes what my opinion of fan fiction used to be... until I started writing it. I blame Season 5 of 24 for starting me on this hobby. Every season of 24 had loads and loads of characters and enough subplots for three other shows. Some of the subplots were more compelling than others. I got drawn into the Season 5 saga of the First Lady and her stalwart bodyguard Aaron Pierce, who were investigating the web of intrigue surrounding the President... as well as developing a relationship of their own. It may sound cliched but in the hands of two gifted actors, Jean Smart and Glenn Morshower, it worked incredibly well. Some of the online 24 commenters were also fans of these characters. We formed a discussion group and several members began contributing stories about them. I was coaxed into writing an initial story and then found that I could not stop. It was just too much fun, as well as being good writing practice. The next thing I knew I was embarked on an epic story that took me two years to write and ran to over 100,000 words. What's good about writing fan fiction? If you want to write, it's a good place to start because it allows you to concentrate on plot, dialogue and settings. The beginning writer does not have to focus on creating characters because readers familiar with the source work know who the characters are; that work has been done for you. Original characters can be created one at a time and allowed to interact with established characters. You can also get critiques and suggestions from other writers (this is called "beta" (noun or verb). If you want your story to be beta'd before you publish it you can request input on it. Most critiques I have seen are supportive. With this kind of practice writers can become successful: "Fifty Shades of Grey" started as fan fiction of the "Twilight" series; the author changed the controlling vampire character to a controlling billionaire character. I won't claim it's great art, but the author sold tons of books and got a movie deal, so there you go. What isn't so good about fanfic... for me this divides into two categories: stylistic errors and terrible plot ideas. The style stuff is usually pretty basic: misspellings and grammar mistakes such as changing tense from paragraph to paragraph, or even sentence to sentence. Using quotation marks erratically, a more common mistake than you'd think, drives me nuts. Sentence fragments may or may not be a problem, especially if these occur in dialogue; they can add realism and an informal tone, if that's what you are aiming for. Terrible plot ideas: Oh, God, don't get me started.
Let me turn the subject to my bias in favor of plot. Many of the works I read rely on romantic scenarios between characters and have little or no plot, another reason I will give a thumbs down judgement on a piece (mental judgement only; I don't post negative reviews). I love lots of plot, and subplots make me really happy. I am heavily biased in favor of Gen (for general) fics for this reason. Usually Gen fics contain little or no romance, or at least the romance is not the focus of the piece. My 24 fic did have romance between the main characters, but this was well-established in the show and I spent a lot more time on my plot, which involved the unwinding of a major political conspiracy. Going back to the ever popular idea of slash fiction (gay romance between characters): The authors do have a point. It's true that there are not a lot of LGBTQ heroes in pop culture, even today. My response to that is to write some original new ones. It makes a lot more sense to me to create original characters to fill a need rather than to radically change a well-established character. Another motive for writing, if I am honest, is positive feedback. A complementary review on something I have written is an ego boost like no other. As I tend to write about works that are not so well-known, I don't get that many of these but I certainly enjoy them when I do. Reading fanfic is like panning for gold, basically. The good stuff requires a search but it's there. If you have a favorite book, TV show or film it's worth doing a website search (see the sources above); you may be pleasantly surprised at what you find. Labels: Pop Culture, Random Thoughts Tuesday, May 19, 2020
Variations on a Theme I've never been a fan of eggs Benedict. For one thing, I don't really like poached eggs - I prefer them either scrambled or hard boiled. For another, I find them awkward to eat. Have you ever tried to cut an English muffin with a knife and fork? English muffins were made to be bitten. A plain toasted buttered English muffin is truly heaven on its own and should not be loaded down with a drippy egg. And for yet another, you have to get your Hollandaise sauce ready to go before you can begin the rest of the recipe (and good luck with poaching eggs if you've never done it before). For my money, this is truly a restaurant meal if you want to indulge. And yet I find the concept interesting because the basic recipe yields itself to so many other approaches. The variety of what you might call Benedictine egg dishes is truly impressive and makes good reading, even if you have no intention of making them yourself. As I was writing this piece it occurred to me that the egg McMuffin is in fact a low-rent twist on the idea of eggs Benedict. You're welcome. Eggs Sardou, while by no means low calorie, is an interesting vegetarian twist on the idea. Artichoke bottoms sub in for the English muffin, and they are topped with creamed spinach... then the egg and Hollandaise. This one I would eat. Then you have eggs Hussarde - similar to Benedict, but incorporates a slice of tomato on top of the ham/Canadian bacon, and is served atop a red wine sauce with onions, mushrooms and minced ham. Wow. You won't need to eat for the rest of the day. I found a recipe from an inventive chef blogger titled Eggs Benedict Cumberbatch, served on a slice of sauteed polenta instead of an English muffin, with arugula and Parmesan on top instead of Hollandaise. This sounds awfully good; extra points if served to you by Mr. Cumberbatch himself. Sling some asparagus on top of your muffin and you have Asparagus Eggs Benedict. I was somewhat disappointed that this variation did not have a fancy name attached. New Orleans, known for its rich and fancy French based cuisine, is a true haven for Eggs Benedict and all its variations. Brennan's restaurant, which has been around for more than 70 years, seems to be very well known for these dishes. Should you find yourself there and wish to up your cholesterol count, this is the place to go. I think that I will need to practice my Hollandaise sauce skills before attempting any of these myself. Labels: Ingestion Wednesday, April 22, 2020
Insomnia "I'm having trouble sleeping" is one of the most common complaints I hear from patients. This is understandable, as up to 25% percent of the American population reports occasionally not getting enough sleep (though it seems like more to me). However the percentage suffering from the true definition of insomnia is smaller, about 6 percent. Per the DSM-5 definition, insomnia patients feel impaired from lack of sleep during the daytime; symptoms last at least a month; and are not associated with other medical conditions, substance use or other sleep disorders (restless legs syndrome would be a good example of this). Certainly sleep issues are seen most often in the elderly but insomnia can hit at any age. Recently while sorting through a bunch of stored papers I found a literary quarterly published by my university which I had saved for some reason. The theme was "All Night Long" and at least two of the pieces dealt with insomnia... it could have been more, possibly three or four. (These were written by people in their late teens and early twenties, mind you, and they were complaining of insomnia!) There are plenty of factors other than age, however. Sleep problems are often connected to lack of physical activity, especially these days when so many people work sedentary jobs. Daytime naps are also not a good idea as they relieve physical fatigue just enough to make it difficult to fall asleep. And irregular sleep patterns, such as working nights or sleeping late, can also ruin a good night's sleep. I empathize with patients as a fellow sufferer. I have had insomnia most of my life, to the point that if I sleep through the night I almost feel cheated. My nighttime awakenings are my "me time," when I ponder my work schedule, to-do lists and various deep thoughts. Certainly I need sufficient sleep to function, at least six hours. Back when I was a medical resident I realized that I was usually very depressed the day after being on call. It took a surprisingly long time for me to figure out the connection between my mood and lack of sleep. The basic recommendations:
And now we come to the crux of the matter... the request for sleep medication. Many insomniacs resort to the antihistamine diphenhydramine (AKA Benadryl in the US) as it is sedating and readily available. Not to mention that if you have allergy-related postnasal drip at night, it will solve that problem as well. Pretty much every nonprescription sleep medication is a combination of diphenhydramine and either acetaminophen or aspirin. Does it work? Yes, as I can vouch from firsthand experience; I have used it myself. However it can interact with other medications and has side effects, most often associated with the elderly population, who of course are the ones most often requesting sleep medication.
Then there are the natural options: Camomile tea, valerian and melatonin. Also meditation. I recommend all of these options, but you can always identify a hardcore insomniac by the death glare they give you when you suggest melatonin. Also melatonin is not recommended for pregnant women, and the jury is out on valerian and pregnancy (I have seen articles saying both that it is OK and that it should be avoided).
And then there are the prescriptions. Sleep specialists recommend not using benzodiazepines (aka "nerve pills") for sleep, even though they work. They are also potentially addictive, and sudden discontinuation after years of heavy use can cause lifethreatening withdrawal. (A favorite saying of addition specialists: Narcotics withdrawal makes you wish you were dead; benzodiazepine withdrawal makes you actually dead.) It's easy to develop benzo tolerance with regular use, meaning you need to keep increasing the dose to get the same effect.
Non-benzo hypnotics are considered safer, and generally are. However, we still don't recommend using these on a nightly basis as development of drug tolerance is still a problem with this group. Examples of these drugs include zaleplon and eszopiclone. Keep in mind that any sedative, no matter which drug group we are dealing with, is dangerous to mix with alcohol or other sedation. In the elderly sedatives can cause confusion and they also increase the risk of falls and injuries.
Sleep specialists recommend not prescribing these medications; however, we live in the real world and I do prescribe sleep medication, because sometimes you just need it. When I do, I always emphasize that it should not be used nightly and I track patients' refill requests to see how often they are using it. I suggest using it not more than three times per week, to prevent the problems of relying on the drug and developing tolerance.
Not to mention that patients are missing out on the benefits of searching your soul and making to-do lists at three in the morning.
Labels: Medicine, Random Thoughts Thursday, April 16, 2020
Quarantined? Try a Mystery Series
So I've been passing time locked down at home reading (mostly mysteries) thanks to the LA Public Library and their wonderful ebook collection. Check to see if your library will allow you to download ebooks onto your Kindle or other e-reading options. If you have a library card, you probably can.
Mysteries are the most flexible genre I have come across. The detective can be a professional or a talented amateur, of any gender/sexual orientation/race/era/country/profession. Subgenres could include suspense, espionage, historical, procedurals, scifi, romance and the detective who has a cat that helps them solve crimes (I particularly loathe this group).
For research purposes I can recommend the website Stop, You're Killing Me if you're looking for something that might sound interesting. This site lists mysteries alphabetically by author and by detective, as well as listing the many books nominated for awards for the last several years. I've found several interesting reads this way. You can also try TV Tropes for suggestions, particularly the historical mysteries page.
The books I've been reading recently include:
The Judge Dee series, historical mysteries/procedurals set in China during the Tang dynasty and based on a real-life judge. They are written by a Dutchman named Robert Van Gulik who made a lifelong study of China and Chinese culture, and lived there for many years... they're classics of the historical mystery genre. The descriptions of criminal trials are particularly interesting. Highly recommended.
The Midnight, Texas series by Charlaine Harris. Southern goth (her specialty, apparently; she's better known for the Sookie Stackhouse mysteries, which I have not read). These are set in the town of Midnight, Texas, literally a wide spot in the road. Populated by a vampire, a witch, a psychic, a couple of angels... you get the idea. I'm not big on the supernatural mystery genre but these are pretty good.
The Miss Julia series, by Ann B. Ross. Set in a small North Carolina town, Miss Julia is a recent widow who one day is confronted with her late husband's illegitimate child. As a good Presbyterian and one of the most proper ladies in town, this is a bitter pill for her to swallow but in true Southern lady fashion she deals with the issue and winds up taking the boy and his mother into her home. Julia is tough as nails and not always the kindest person, but the way she bonds with her husband's son is quite believable and I love the scenes with the two of them. The town manages to hide quite a few secrets, financial and otherwise, and Miss Julia goes about ferreting them out.
The Shadow Walker, by Michael Walters, is (I believe) the first of a series featuring a Mongolian detective. It's a police procedural dealing with a serial killer. As one of the victims is a British national, a Chief Inspector from Scotland Yard is sent to assist with the investigation - the story is told from his point of view. I run hot and cold on procedurals, especially when serial killers are involved. I'm not a fan of violence porn. But here the focus is on Mongolia, a country focusing on modernization and moving out of the shadow of China, and it's really interesting.
While we're on the subject, if you like procedurals an old but good series is the Gideon series featuring Commander George Gideon of Scotland Yard. The series is written by J.J. Marric, which I believe is a pseudonym. They were published from the 1950s to the 1970s. Each book interweaves several crimes taking place in London, either in the planning stage or in progress, from a petty crook who's knocking off stores to a man plotting to kill his wife for the insurance money. Gideon holds an administrative role, so does not investigate all the crimes himself; but you see him pulling the strings, sending out his subordinates and discussing the cases with them. The books take place in real time, over a day or a week or so. They're fairly interchangeable, so you don't have to read them in order. Definitely worth a look.
Cozy series can be a mixed bag. There are way too many knitting/embroidery/bake shop/etc mysteries out there and a lot of them are really bland, with semigeneric main characters, or just badly written. However a series I've really enjoyed is the Noodle Shop Mysteries by Vivien Chien. Set in Cleveland in the Chinese-American community, Lana Lee is in her twenties and the manager of her family's noodle restaurant set in a large Asian shopping plaza. Who knew the death rate at the mall could be so high? But the characters are well-drawn and likable, and I can't stop reading these books. Also, the characters evolve from book to book, which is an important part of any series for me. This way you get a story arc that extends over several books and really makes the series more believable.
Lastly I'll recommend an urban fantasy noir series, the Nightside series by Simon R Green. They are set in the Nightside, part of modern day London. In the Nightside it is always three in the morning, the sun never shines, and anything goes. You can gamble, go to a bar that specializes in sadomasochism, run into a Greek god or two (or scarier things), get yourself a killer for hire. John Taylor is your classic trenchcoated detective with a murky background; his father is human, and no one seems to know who or what his mother is (was?). I've read the first several books in the series and she hasn't made an appearance yet. The series is leavened with humor and John's "gift" (he can find things with his mind) is well handled. He has to be careful how he uses the gift, because it can be used to track him and a lot of supernatural bad guys are after him.
And then there was that one series about a semiretired librarian who solves crimes in his home town... with a cat. Oh, all right. It's the Cat in the Stacks series, and it is somewhat flawed (IMHO) but readable enough. I've read three or four in the series but it is beginning to get a little tiresome for a few reasons. The narrator is a widower who moved back to Athena, Mississippi from Houston after his wife passed away. He is a pleasant fellow, but I am finding him somewhat bland; many of the secondary characters are more interesting, and that isn't good for the series. Our narrator works in tandem with the official detective of the city police, the only black woman on the police force, and it's implied that she has to take some crap from her co-workers; but, as with so much in this series, the details are never spelled out. Their initial interaction is prickly but they get along better over the course of the series. I'd like to see more of her and less of the narrator. The cat is Diesel, a Maine Coon cat which he takes everywhere with him, and of course everyone adores the cat. I wish I had a dime for every time a character says "What kind of cat is that?" or "I swear that cat understands everything you say!" It's that kind of series.
Oh, well, it passes the time. (As has this blog post.) Mystery series are a great deal of fun, in most cases, and if you do a little research you can find one that will suit you. Happy reading, and if you have a series you would recommend be sure to let me know.
Sunday, January 19, 2020
In Mourning This past week I lost a friend, the husband of my good friend V. Shortly before Christmas he became very ill and after several weeks in intensive care he passed away. He would have turned 62 today. R was an unassuming, yet fun and interesting, man. His interests included astronomy, woodworking, music (especially novelty music - his Christmas CDs have to be heard to be believed) and dogs. He dabbled in brewing his own beer. He was a wonderful father and was always to be seen at his children's soccer and softball games, acting as team photographer. He was proud of his Irish heritage and every St. Patrick's day he and V threw a huge neighborhood party. A hospitable couple, they made me welcome on summer weekends - I would drop by, bringing wine and appetizers, and R would fire up the barbecue after we swam in the pool. I will miss him very much; he will be missed by many. The funeral is in a week and I am sure the church will be full. Labels: Family, Random Thoughts 
|