connectivity

Food Friday: The Travel Food Tour

Food always factors greatly in my traveling. First, I am concerned about healthy snacks that are allowed on the plane. It ends up being nuts, chocolate, and dried meats like jerky. I buy fruit, veggies and drink as soon as I get past security. 

On the plane I either get a club soda with a splash of cranberry juice, or a bloody mary mix with no alcohol: a Virgin Mary. 

For layovers, I like to keep it light but ethnic. My favorite in Salt Lake is the Greek place, since I seldom get this kind of food. In Seattle, it is Asian of some kind, usually Japanese or Chinese. 

 Once to my destination, I had the good fortune to be hosted some lovely people who came originally from the south of India. She, a Biology professor at Stanford, and he an engineer with a company, they were both a bit older, and had freedom in their schedule. They used this time in some part to putter around in a lovely cottage garden that they both maintained. Big sweet oranges were falling off the trees, while diverse peppers, tomatoes and strawberries decorated their respective bushes. 

We shared similar sensibilities in everyday foods, which took my worries away. Additionally we went out a couple times, once to a traditional Indian restaurant and ate family style. It was so much fun since each new dish was a discovery. The second time we went to a old style steakhouse with clients. The dinner was spiced with political conversation. 

The most amazing use of food was at the conference itself. I laughed when I saw the schedule. As there were not one, but two or three breaks between breakfast and lunch. Tables were set all over the place amidst and some times in auditoriums. The food at morning break might be poached pears, or filled croissants. Lunch was often salmon with several vegetables. Mid afternoon, tea with something on the sweet side was served, from strawberry shortcake to cups of fresh fruit. Fruited ice water was everywhere. 

All of this abundance encouraged a relaxed attitude. People sat with each other ate short frequent meals or servings. Before long another session would be called, and then another break, so it kept people mixing in a very genial fashion. The food was entertaining as well as delicious, so it was an instant conversation starter, fostering very positive feelings.

Finally my travels usually include some exotic purchases. This time I headed to an Indian grocery store which we lack, and picked up some very fresh spices. Small and light, they were easy to bring home. 

I have long advocated that my patients pay more attention to their food. If you do, you will enjoy it more and it will be of a better quality. This fits my vision that enjoyment of good food, good social life and good health go together. 

  

 

 

 

 

Wellness Wednesday: Stanford Medx 

I just knocked something off my bucket list. 

Stanford Medx is a multi-day conference on innovation in health care. The conference is akin to it’s older and more popular cousins TEDx and TED, programs which are available online to everyone and which deal with topics in technology, entertainment and design, really all the big issues. 

Medx brings together people interested in moving medicine to a new and better place. It’s themes are people, technology and design. I would like to share with you some of the material that I encountered and the people that I met, together with a few images. 

On Wednesday my first day, I travelled. It is always an entertaining shock to change biomes so quickly, going from the alpine to the sonoran in little more than a couple hours. From cool pine I went to warm eucalyptus. After getting settled, I attended presentations and a workshop at the D school - The Design School on the Stanford Campus. There I met designers, architects and medical people all coming together to make buildings, objects, and even procedures which would make getting medical care more effective and pleasant for patients and caregivers. I met a women who is involved in renovating the Women’s and Children’s hospital at Stanford, just as I am at my hospital. I also met the grandson of Charles and Ray Eames who reviewed principles of design though a survey of his grandparents’ work. I also met the mother of an unexpectedly premature baby who had struggled with expressing colostrum. She had, as a result, developed a clever and inexpensive device to modify existing pumps to make them more effective. We expect its use to become widespread. 

Day two was a workshop on shared decision making. This was meant to be decision making between anyone and anyone else: doctor-patient, doctor-nurse, and family member to family member. Shared decision making was a key theme which dovetailed into one of the main themes of the conference, EVERYONE INCLUDED.

Decisions from the top down can be problematic, and partake of hierarchy. Hierarchy for its own sake is to be banished from medicine. Effective communication, and therefore better results, satisfaction and even safety grow out of shared decision making. This was amply explained an demonstrated across all the varied content of the conference.

Communication needs more than clarity. To be optimal, it is two way, and involves empathy. EMPATHY was another key theme echoed over and over again. As physicians, engineers and designers, we must employ empathy in all our thinking. We need to ask the patients and the users for input at all stages of development. Such a process creates more user satisfaction and better results. 

On day two, we partnered up. Our group was composed of the professionals I mentioned, but also of special “ e-patient scholars”. These were medically sophisticated patients with serious chronic medical conditions who could speak to us about their long experience in the medical system. They were there to help us see through their eyes. I was paired with an older woman in a wheelchair with end stage MS and lupus. Since I have lupus we exchanged notes about that. But it was her MS that was making the critical problems. She spoke about her end of life plan. Even so, she was as pleasant and sparkling as a person could be.

On days three four and five we had presentations from morning until evening, often rapid fire. That is when the conference really took on a life of its own. The conference designers were smart. They had substantial breaks every hour or two, and provided food, and tables, and encouraged everyone to live tweet the conference. The session to break ratio was optimally dialed for stimulation and interaction. All the speakers made themselves accessible, so not only did you hear these phenomenal stories, you met the phenomenal people. Bread was broken and contact information was exchanged. 

Key themes were as follows: 

  • open medical data, especially genetic data
  • open research data 
  • the quantified self 
  • gamification of healthy lifestyle goals
  • getting patients, doctors and researchers together, often through the internet
  • patient education, often self education, through apps and the internet
  • collaborative and integrative medicine
  • collaborative end of life planning

A lot of this came together under the topic of PRECISION MEDICINE. This means care tailored to one's precise condition, down to the genes if possible. It also means giving exactly the right amount of medical care, not too much, and not too little. It also means care tailored precisely to the patient’s wishes. Finally it means oversight so that care dollars are used optimally. 

By far the most stunning presentation was that of Dr. Lucy Kalanithi, the widow of Dr. Paul Kalanithi, Stanford neurosurgeon who wrote “ When Breath Becomes Air”. Her presentation detailed the reality of love and connection despite suffering and death in a way that I have never imagined. Her presentation had more power than any I have ever heard. I recommend the book. 

Besides being stunned, I was also charmed. I got to meet so many delightful people who were also talented beyond measure. The same people were uniformly willing to share their insight and experience. Noteworthy among these was Dr. Wendy Sue Swanson, Seattle Mama Doc. She is a Pediatrician, mom, and writer extraordinaire. Check out her website, blog, and book " Mama Doc Medicine".

It was also great to meet Dr. Kyra Bobinet, who shares my interest in helping patients realize their goals in fitness, nutrition and health in general. She told me that everything she knows is in her book, " Well Designed Life". I didn't believe her but I can't wait to read it. 

Medicine is moving forward folks, and you will want to come with it. Medicine needs your input to be what it needs to be. Monitor yourself. Get your health data. Try to connect with your caregivers. Tell your story. Listen and see an alternative point of view. Have a discussion.  This is the basis of the future of medicine, medicine 2.0. 

Not nearly everything from the conference is uploaded, but a Stanford MEdx youtube channel exists. Check out the link below and I know you will be inspired. 

https://www.youtube.com/channel/UCK1chhgXNHf7iB5mlqzXODA



 

 

Food Friday: Feeding the Recovering 

Last week on Food Friday we looked at "Feeding the Unwell". We talked about patients who were quite ill or in the early post op phases. This week we will go on to pleasanter things and talk about the time frame when patients are feeling better, but still are unable to cook healthy attractive food for themselves. 

Nutritional requirements are increased while recovering. In particular, nutrients and protein needs are particularly increased, similar to that for pregnancy. There are other special needs. For example, the need to avoid constipation is key. Those recovering from surgery or whose mobility has been limited are prone to constipation, and this can be a significant source of discomfort. Strategic food choices can help avoid this. 

Those who are recovering may have had antibiotics. They may benefit from probiotics such as yoghurt, kefir, sauerkraut, and kombucha. 

Appetite is often diminished in the recovery period. Foods need to be especially appealing and tailored to the patient’s preferences. It also is best to foster a small frequent meals type schedule. 

Between all this, you as the caregiver or helpful friend have several options: 

  • Bring freshly made food which can be portioned out over time.
  • Bring frozen food which can be heated up.
  • Bring ziplock freezer bag “ Kits” of food for use in slow cookers or fast cookers ( pressure cookers like InstantPot) which the patient might have. 
  • Make sure the patient has enough healthy handy beverages. Consider herb tea, probiotic Kombucha, milk if tolerated and lightly sweetened drinks. 
  • Bring frozen “smoothie kits” containing yogurt or kefir, fruits, and veggies. 
  • Use the secret weapon of some wholesome sweets, .i.e. dark chocolate, or a slice of fruit pie to kickstart a recovering person’s appetite. 
  • Use the secret weapon of salty foods like pickles, salsa or sauerkraut to induce someone to drink more water. 

 

Here are some of my Pinterest Boards with recipes which may inspire you. 

Instant Pot Tips and Recipes

Paleo Nutrition

 

Pick dishes with ample protein, fruit, veggies, and fiber. Include healthy fat such as avocado, nuts, olive or coconut oil. For specific information on these, see below: 

Protein

Fiber

Healthy Fat

Smoothies

 

Here are some tips to make your culinary caregiving experience more manageable and satisfying. 

  • Visit your patient first to see how she really is doing. 
  • Make sure you know her allergies, intolerances, preferences and level of hunger. 
  • Check in regarding who else will be helping, and whether someone else has organized a meal schedule. 
  • Organize a meal schedule yourself using Google Docs or another method of your choice. 

 

Your patient will not just be well fed; She will have the pleasure of seeing you and the knowledge that you care.  

Wellness Wednesday: The Importance of Neighborhood

Right now I am in the middle of something big with my neighborhood. We are rallying and banding together to prevent the development of a huge water bottling plant in our agricultural and research oriented riverside neighborhood. Yeah, I know ! Outrageous isn’t it ? More on that later. 

I am learning what good people I have around me. I have truly been blessed. My neighbors are educated, considerate, flexible, and well spoken. They are from old to young. They come from a variety of economic and social backgrounds. They have a wide range of politics. But one thing’s for sure, we have some shared values. Those include feelings of stewardship for good soil and our pristine aquifer. 

It goes deeper. I have a sense of having a neighborhood of people who would help me if I had a flat tire. I have seen random busy people stop their cars to help shoo someone’s cows back into a pasture. I would never worry about my kids walking to school. But not everyone has these types of advantages. 

A Rand foundation report called “ Neighborhoods and Health”  indicates the following:

“ Just as conditions within our homes have important implications for our health, conditions in the neighborhoods surrounding our homes can have major health effects. Social and economic features of neighborhoods have been linked with mortality, general health status, disability, birth outcomes, chronic conditions, health behaviors and other risk factors for chronic disease as well as with mental health, injuries, violence and other important health indicators."

reference:

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf70450

Did you know, for example, that heath habits or disease habits are contagious ? That’s right, things like obesity, smoking, or on the other side, jogging and gardening are contagious too ? Neighborhoods can influence health in this way. 

Even the physical layout of a neighborhood can have its effects. Are there sidewalks, playgrounds and good lights ? A “ bad neighborhood” where it is not safe to walk or play outside severely constrains people’s ability to be active. It keeps people inside with the shades drawn, and bad behaviors like drinking can potentially go unchecked because there is no social accountability.  Such a lonely hostile environment greatly contributes to people’s stress, and of course stress truly contributes to many disease processes. 

Green spaces in neighborhoods turn out to be especially important. These serve as places to congregate and places to play. They also expose people to nature in places where it may be scarce, and research tells us that exposure to nature is beneficial to health in specific measurable ways. Please see my 2015 post on Nature and Health HERE. I remember being delighted with the particulars of what I unearthed when I did the research for this post. 

Here is a strange, wondrous and reproducible statistic:

An increase of ten additional trees on a city block on average, increases self reported health equivalent to a $10,000 annual increase in income or being 7 years younger. That’s right, adding ten trees to your block will add seven years to your life, at least from your perspective. The health they are talking about here is “cardiometabolic conditions” such as heart disease and diabetes. Several studies have tried to determine how this works. It seems to start by getting people outside, more active, with lower stress and lower blood pressure. More green space also seems to help reduce aggression and crime. 

What about the food environment of a neighborhood ? Is there local food ? Is food grown and sold ? Are there bars, grocery stores or convenience stores ? There is such a thing as a “ food desert” and I don’t mean dessert. A food desert is place which has nowhere to easily get healthy affordable food. The food environment has a huge obvious effect on food choices and health. 

Have you ever heard of a Ciclovia ? A Ciclovia is a open street programs that closes major roads to motor vehicles so they can be used exclusively by bicyclists and pedestrians. Ciclovias are being studied in large urban centers like Los Angeles in an effort to increase physical activity and sense of community in urban areas. 

What about sense of community ? What does that do ? This goes back to my original description of our neighborhood. It involves trust. There is trust and accountability in the continuity of these neighborhood relationships. Dan Beuttner, in his book Blue Zones, speaks of the decade-spanning friend groups of Japanese women, the “ moai” and their role in promoting the extreme healthy longevity of these women. The trust and connection of these long relationships provide a basis for the best things in life, such as celebration. 

These neighborhood relationships also uphold us when the going gets tough. I can remember nearly 27 years ago, I was between med school and residency, when I was pregnant with Forest. I had preterm labor and was put on bedrest. I was living in this same rural neighborhood, but in a tiny aging cottage which has since been torn down. I had a four year old, and my husband worked long days. Neighbors I barely knew, from newly married young women to aging matriarchs arrived with casseroles and pies. When it snowed, the drive just got plowed. These people became friends, and some have since passed. But their kindness left a permanent mark. 

In my search of Pub Med, which is the US National Library of Medicine at the National Institutes of Health, I found a fairly recent article stating “ The study of neighborhood health effects has grown exponentially over the past 15 years. “ Do not think for a minute that this is not real science nor that there are not real monetary and human resources being devoted to it. 

Neighborhoods affect the physical and mental health of their constituents. One study from the Archives of Psychiatry introduced me to some useful terminology as they highlighted the effects of neighborhoods on health. “ Concentrated disadvantage” was strongly associated with mental health problems for children. On the other hand, collective efficacy (the ability of neighbors to work together) and organizational participation mediated the effects of concentrated disadvantage on the effects of children. 

My neighborhood is demonstrating collective efficacy and organizational participation at its best. We have got our Facebook and Twitter pages for our cause and a great many of us plan to show up at the County Commissioners’ Office  to register our thoughts on the matter. I anticipate the group will bring some scientific and oratorial firepower to bear. 

It turns out that bad neighborhood environments generate their own vicious cycle and good neighborhood environments generate an even stronger virtuous cycle. Understanding this dynamic gives people a handle on how to make things better, no matter where they are starting from. 

How do you make things better ? Twenty two years ago I purchased an unconventional poster to decorate my office. It was shrink-wrapped, and backed in cardboard. When my practice got going, we had it framed and glassed. I still see its message every day. It is by an artist named Karen Kerney, and I will share it with you through an Amazon link. It is titled, “ How to Build Community”. It is for everyone who does not yet have a nice neighborhood to live in. It was ahead of its time. The folk wisdom it contained has now been largely validated by the science on neighborhoods and health.  I hope you enjoy it. 

Wellness Wednesday: How to Visit Someone in the Hospital 

On first glance this seems self-explanatory. However, a few tips may make things easier. 

If you are uneasy about visiting the hospital, figure out why. Are you afraid of embarrassing the patient ? Do you not like hospitals ? Do you fear illness yourself ? Figure out your reasons and decide if they are reasonable. Remember that the visit is for the benefit of the patient, and that it is an act of care. People in hospitals can very easily feel isolated, as though everyone else is out there living life to the fullest…but them. 

Call beforehand. Based on circumstances, call the patient, her significant other, or perhaps the nursing station of the ward that she is on. Find out the visiting hours, if there are any, and whether or not a visit is appropriate. When you call, ask if the patient needs anything from home or from the store. Sometimes little things can make a big difference, i.e. gum, or their iPad. 

Consider bringing a small gift of your own. However, when considering gifts of or drink, make sure you know the patient’s dietary limitations. In the hospital, dietary restrictions are common, such as during the time before and after surgery, or stroke. When considering flowers, make sure they are permitted. Some units cannot have them because of infection risk. If the patient can do things to pass the time, consider bringing activities that he or she will like, such as card games. 

When you arrive, check in at the nursing station and with the patient’s nurse. Wash your hands. Once in the patient’s room, it is important to suss things out. It may be a time for visiting and joking, but it also may be a time to just be present in silence. Either way, it is a comfort. Even without a lot of conversation, just being there is very beneficial. On the other hand, patient’s still like to hear about what is going on in their friend’s lives as they would normally. If the patient is too tired to read, they might like having the paper read to them. Do remember that hospitalized patients are almost always tired. Watch carefully so that you do not stay too long, to that there are so many guests that the patient feels overwhelmed. 

Do not ask prying or personal questions about the patient or the illness. If the patient wants to talk about them, be a good listener. Even then, do not pry. Do not ask the nurses, doctors or other staff about the patient’s condition. They are not permitted to discuss the case without the patient’s permission, and asking right then might be uncomfortable. 

When you are there, consider offering material help to the patient or to her helpers. She may need kids shuttled, dogs walked, or lawns mowed. You could even offer to set up a google doc or some equivalent to coordinate the helpers if the need is extensive. 

Consider helping your friend after they transition back to home. Getting around will not be the same even if they are stable enough for discharge. Plus, hospitalized patients get a lot of attention to help them through. To have that come to a screeching halt upon discharge would not be all that fun. Connection, not isolation, is essential to healing. 

Most major religions, certainly Judaism and Christianity, include visiting the sick as a formalized duty. It represents the best of society, and embodies compassion. The secret is, it blesses the visitor as much as the visited. 

Wellness Wednesday: Back to School 

Parents all over the world are experiencing one of the biggest transitions of the year: back to school. Whether you have grade schoolers, high schoolers or kids bound for the university, it is bound to have a big effects on your routines of daily life. And that in turn, has effects on your health and the health of the family. 

Summer can be a relaxing time when people are more physically active. Or it can be hectic with guests, vacations, and the routines can go out the window. Take a moment to assess your summer. Determine how you would like to capitalize on the transition back to school. 

For families with kids of any age, getting back on a good sleep wake schedule is key. Start at least a week early. Get back on a good meal and snack time schedule. You should be on that schedule anyway ! 

Sit down with kids of any age and go over their school supplies. Let kids have as much independence as possible in picking their supplies. These are important expressions of individuality. 

For university students, sit down and discuss finances. Establish a realistic budget regardless of where the money is coming from. Make sure they know how to balance a bank account and look up any card balances. Discuss expectations well in advance. 

For school clothes, don’t go crazy. Start by asking kids to tidy up their room and go through their things. Younger ones will need help with this, but let them do as much as they can by themselves. Encourage them to get rid of as much as they can, but go through it later yourself for things you might need to keep for younger children or other kids whom you know. Establish a habit of giving to Goodwill, and likewise, regardless of your finances, teach kids that it is reasonable to check second hand stores for things they might need. This should be given a air of boho environmental cachet, as well as frugality. After that, establish a budget and go shopping, but just get basics until your child reinvents themselves again for that year. 

Make it easy for kids to stay organized. Have an area such as a mudroom with hooks and cubbies for kids to put their things. Additionally, each child, whether large or small should have a desk area of their own if at all possible, even if they have to share a bed. This can be organization central for them. Consider having a family wall calendar, so everyone can see what family activities are coming. 

Teaching kids early on to have a routine will save them tons of stress. There are routines for sleep, eating, exercise, homework, after school activities, family time and play. Teach kids by example. Make sure you have good habits yourself. Then everyone will have a productive, low stress, enjoyable school year. 

 

Food Friday: Campfire Cooking 

Summer is in full swing and this is the weekend to be out by a campfire. That is because the weather is fine, the nights are mild and the Perseid meteor shower is coming. 

Cooking on a fire is truly gratifying from a five senses point of view. The crackling fire is beautiful, the smell is delicious and the taste is unmatched in the kitchen.

It is hard not to be relaxed by a fire. You just can’t rush it. If you try, you’ll literally get you or your food burned. 

Those unfamiliar with fire making need to start by checking their local agencies regarding fire regulations. These my vary by your season and location. You may need to go to a public park or a campground. Or you may need to use a barbecue. Whatever you do, keep it simple and friendly, since that is part of the charm. If possible, give each person some hands on responsibility for their food. 

How is food on the fire cooked ? Well for starters, the same rules of food safety apply over a fire. Keep cold food cold and hot food hot. Check the link below for more details on that. Meanwhile, consider all the ways you can cook over a fire: 

  • Food goes on skewers and is set on a grill.
  • Food goes directly on a grill. 
  • Food is placed on skewers and held over the fire.
  • Food is cooked in a pan on a grill. 
  • Food is cooked in a Dutch Oven in coals. 
  • Food is cooked in foil packets or in its own skin in coals. 

However you cook it, the same rules of safe cooking apply. You must ensure fire safety and food safety. Make sure you have a source of water and that you are not at risk of losing control of your fire. Make sure you have all the right tools so that you will not be tempted to use your hands and burn yourself. Regarding food safety, you must stack the deck in your favor to make sure all foods are thoroughly cooked and yet not burned. Some of you will recall that black char contains unhealthy chemicals. More on that in the link below.

http://drginanelson.com/drginablogs/2015/6/11/food-friday-healthy-barbecue-grilling-and-picnics?rq=barbecue

How can this be accomplished ? 

  • Precook foods that take a long time. 
  • Cut foods into easily cooked piece sizes. 
  • Do not mix short and long cooking foods in one packet. 

Here is my modest album of campfire recipes on my Pinterest: 

https://www.pinterest.com/drginanelson/campfire-recipes/

Truthfully, I am not much of a recipe user anymore. Dutch oven recipes are like crock pot recipes but take less time. Foil packets for grilling are pleasing single serving mixes of fruits vegetables and meats cut small and generally marinated with a basic vinaigrette or butter. Grilled food is similar, but more lightly dressed so as not to burn, and placed on a skewer or on a grill directly. Oh and, if Pinterest is any indication, everything is wrapped in some sort of bacon.  Dessert and treats are less familiar to me, although I have made nice s’mores with good chocolate in my day. Even more intriguing are fruits dipped in marshmallow cream or doughs wound onto skewers and roasted directly over the fire, things I have yet to try. 

About the real dessert: the Perseids are an annual meteor shower, my favorite. It is generated as we pass through the tail of the comet Swift -Tuttle. The shower comes out of the northeast, and as the name suggests, out of the sky in the region of the constellation Perseus. If you are not familiar with the night sky, I recommend getting an app to help. I have had several such apps, but right now am using SkySafari, the cheap version. With it, you can point your screen of your device ( phone or tablet) at the sky and see the same segment of virtual sky, but WITH LABELS ! This year the Perseid forecast is for 200 meteors per hour, which is at least twice the typical average. This is because, this year earth orbit is nearer to the center of the comet tail than usual. 

So take advantage of this good fortune and check out the beauty of the summer sky. And get back to the primitive pleasure of sitting around the fire with friends and family to eat good food and relax. 

 

Food Friday: Family Dinner

It’s summer and the kids are home. Why not take advantage of their company and get serious about some awesome family dinners ? Sounds like fun, right ? But it’s much more. According to a considerable body of research on the subject, family dinners are important to well being. (Reference: thefamilydinnerproject.org)

Family dinners are associates with the following findings: 

  • Better academic performance 
  • Higher self esteem
  • Greater sense of resilience 
  • Lower risk of substance abuse 
  • Lower risk of teen pregnancy 
  • Lower Risk of depression 
  • Lower likelihood of developing an eating disorder 
  • Lower rates of obesity 

Let’s think about why. 

 

The family dinner is a testing ground for the performance of a family group as a team. And yet, pulling it together to make a family dinner is not all that hard. It is within most every person's or every family's reach. Engineering the family dinner is an exercise destined for success. Most people are grateful when someone makes them something to eat, no matter how simple. It is a primal act of caring, usually free of strings, that one person does for others. Thus a dinner is easy to produce and easy to accept. 

Children and teens can and should help prepare the dinner, even if is just setting the table. They learn preparation and cooking skills, and they learn to pitch in. They also learn that if they don’t pitch in, they will stand out. 

The family dinner is a time when most families put aside conflict, since conflict at the dinner table just doesn’t work. The ritual and the food cause us to make a deliberate change in our behavior for the better. We cease to be isolated individuals and come together to make something more, a family or a even a social group. Thus, it is very hard for someone to be lonely at the table. At the table, it is graphically obvious that you come from somewhere, and that you have a place. 

Our family table has extended into the adulthoods of our children and to the younger cousins and their friends. We are very lucky in that regard. Most of them have gone off to college and have come back, bringing spouses, girlfriends, friends and grandchildren in tow. They have each developed family table specialty skills. Echo bakes and is an award winning amateur chocolatier. Forest is lately enamored of our Instant Pot, a cool pressure cooker, which enables you to make impressive meals with little planning or tending. Geri does veggies and my son in law does smoked meats and salads. Vale is smoothie man. Hanna my niece is a cake decorating expert. They are all serious students and professionals, but they have all come to be serious foodies too.

Stepping back, I see that no matter what their fancy, the whole thing is one big shared hobby, and when we do food, everyone is pretty happy. A happy hobby. Moreover, while it was simple and easy when they were little, they have, on their own, leveled up, as the gamers say. They relish the acquisition of skills needed for their culinary hobbies, and that gives them social confidence. Finally, they relish the presentation of their dishes to others. The “ breaking of bread” has always been a bonding experience and in a family this is nothing but good. 

Think about all this this summer, when your kids are around more, and hopefully you have a little more time. All you have to do is start something fun in the kitchen. Put your heart into and it and invite others to join in the process of creation. It will take on a life of it’s own.  

Wellness Wednesday: Reclaim your Summer ! 

Setting Summer Goals 

I write this post as the beginning of summer approaches. I look forward to each summer as though I were a school child with a summer break instead of a physician with a steady job. All the same it is a special time, when children are more available, and when people are happily vacationing. We get an especially big dose of this spirit since we host guests in a vacation rental. They remind us of what summer is all about: excitement family, relaxation and adventure. 

To make sure you get all you can out of the summer, I suggest you plan. I suggest this since I am doing the same thing for myself right now. 

No matter your job, no matter your income, you should make sure to refresh yourself in this most sparkling of seasons. 

 

 

 

 

Here’s how.

1. Make a list of your summer goals. Make sure to include your goals in the following areas:

  • Fitness- Set realistic SMART goals for fitness. Make sure to incorporate active summer sports into these goals. Likewise, plan ahead to get fit before that big hike, so you can enjoy it best. 
  • Nutrition and Culinary- Make dishes you want to cook, eat and share, especially with fresh summer produce.
  • People goals- Who do you want to see this summer ? Make time for reconnecting. 
  • Project goals

Home improvement, garden, artistic- Take a summer themed classes, like water colors. Do some gardening. I believe everyone should garden, even if it is a nice tomato pot on the porch. 

Activities- Take advantage of the out of doors and the company of your kids. 

Staycations and Vacations - You can make time special right where you live, or strike out on the trail, for all day or all month as your circumstances allow. 

2. Consider making use of a wall calendar that comprises the whole summer. Block out the time so your goals are realistic.  Leverage your available technology to communicate and coordinate with others in your group of family and friends. 

3. Document your summer so you can best enjoy your memories later. Use photo, video, journalling, paper and mixed media scrapbooking or even digital scrapbooking. 

 

No matter your job or responsibilities,

summer is not just for kids.

Reclaim your adult summer !

The first day of summer is June 21st.

Make it your best yet.

Wellness Wednesday: How to Tell if You’re a Workaholic

Most people say they are busy. But are they ? Americans are famous for being workaholics (fully 25 % of us). How busy is too busy ? 

I would like to present my thoughts on the issue. Then I would like to present some other sources which are more authoritative.

It is important to understand what is not too busy. If you work full time, but have no time to work out or see your spouse, and yet you have time to game, watch TV or get a professional pedicure, you are not too busy. 

You are not too busy if you find that working at your desk leads to hours of randomly surfing the web or checking social media. You can only assess yourself once you have cut all the unintended time wasting from your life. If you are mindfully watching a film, or checking specific things in social media for a few minutes, that is fine and does not count as time wasting. 

So let’s say you have optimized the way you work and spend your time (a topic for another day). Let’s say you have reviewed your schedule and have decided that everything on it is important and nothing can be cut. Then you have met the “ inclusion criteria” and can ask yourself these questions: 

  • Am I getting less than 7 hours of sleep on a regular basis ? 
  • Do I feel a constant sense of frustration at not getting things done ? 
  • Do I lack time to work out for 30 minutes per day ? 
  • Do I lack time to eat three healthy meals and snacks ? 
  • Am I getting sick too often ? 
  • Is the quality of my work getting lower and lower ? 
  • Am I neglecting important relationships ? 

 

If you met the inclusion criteria and you answered yes to any of these things, you should consider thinking about whether you are overcommitted. These would be the relevant endpoints for me, after 54 years of living with, working with and being an overcommitted person. 

WEBMD

http://www.webmd.com/balance/features/are-you-a-workaholic?page=2

This article places workaholism in its psychiatric context. It is a compulsion to go work, combined with discomfort when not working. So it is much more than working hard, or working a lot. They site signs like trouble delegating, thinking about work while on vacation, or neglecting one’s nonworking life. They indicate that cognitive behavioral therapy and support groups can be helpful. 

US NEWS 

http://money.usnews.com/money/careers/slideshows/17-signs-you-might-be-a-workaholic/2

This feature described signs you might be a workaholic. Noteworthy signs including having no hobbies, working through lunch every day, coming to work when sick, being accessible to work all the time, and consistently overbooking. 

The WORKAHOLICS ANONYMOUS site is a real eye opener. 

http://www.workaholics-anonymous.org/10-literature/24-twenty-questions

Surprises in their list of 20 questions include "Do you regularly underestimate how long something will take the rush to complete it ?” This is a more in depth read and I recommend it. 

FORBES 

http://www.forbes.com/sites/deborahlee/2014/10/20/5-signs-you-might-be-a-workaholic/#430847d833d1

Forbes showcases a very worthy article about work-life balance, citing some interesting statistics including the following : "Americans put in more hours than workers in other wealthy countries and are more likely to work nights and weekends.” They alsogive an introduction to Bryan Robinson’s book “ Chained to the Desk”, which is available on Amazon. 

The follow up articles in the same series 

http://www.forbes.com/sites/deborahlee/2014/10/20/6-tips-for-better-work-life-balance/#5ae8fd25dbc9

details 6 tips for a better work like balance. The two tops which appeal to me the most are “ Letting go of perfectionism” and “ Limit time wasting activities and people”. 

SCIENCE DAILY

https://www.sciencedaily.com/terms/workaholic.htm

This site highlights some more surprising aspects of workaholism including the observation that workaholics lose track of time. They also highlight some chilling aspects of workaholism including the problem in Japan, where early death related to workaholism has its own word, karoshi. We all know that workaholism takes a huge toll on mental and physical health, but death by karoshi is hard to fathom. 

I am going to strive in the next few weeks to make my posts more brief. I will feature more outside sources. It is my hope that these posts will be easier to write and easier to read. This is one step I will be taking toward a better work like balance. 

Send me your thoughts on the matter. I would love to see what you think. 

 

 

 

 

 

 

Food Friday: Cookbooks

Todays's post is the last in a series of 4 posts about cooking inspiration. It is about cookbooks. As I survey my wide ranging cookbook collection, I can see that they sort themselves into a few key categories: 

Reference Material- These are books that encyclopedically categorize a small category of foods or ingredients, ie. The Spice Bible.  

Do it Yourself Cookbooks- These are books which have recipes and methods for making that which we commonly think of as " store bought" stuff.  These books often collect food preparing techniques which are in danger of being lost from the general population. How many of you know how to make crackers, cheese, pickles or ice cream ?   i.e The Home Creamery by Farrell Kingsley. 

Cookbook travel- These books explore a region dish by dish. They are often noteworthy for their fabulous photography.  i.e. My Paris Kitchen by David Lebovitz

Health related cookbooks- These are focused on foods, dishes and menus which have health benefits. There are many such books claiming this feature, but not all actually have it. I have included a few which I think have genuine health benefits.  i.e. The Autoimmune Paleo cookbook by Mickey Trescott, NTP. 

Coffee Table Cookbooks-  These books are typically large format, and magnificently photographed. They are sumptuous tomes which are meant to be works of art in and of themselves. Example: Culinaria, eds. Andre Domine, and Michael Ditter

Chef Based Cookbooks- These feature one famous chef who gives presents their unique recipes but also their versions of the classics, i.e. Mastering the Art of French Cooking, by Julia Childs. 

Category Cookbooks- These are cookbooks which focus on a particular category of cooking, i.e. The Essentials of Roasting by Williams Sonoma. 

Comprehensive Cookbooks- These are cookbooks which aspire to cover everything comprehensively, ie. The Best Recipe, by Cooks Illustrated. 

Here are some homegrown photos of my cookbook shelves as they are tonight. 

My personal favorites shift every few months. Right now, I am biased toward the health related cookbooks since I believe more and more that one can make healthy food delicious. We understand more than we ever have about food science and human nutrition, and many well educated and creative writers are producing excellent cookbooks by marrying this information with their skill and taste in cuisine. 

I also believe that once you taste healthy food from well written recipes, that you will not be able to go back to ordinary unhealthy food. 

With this in mind, I am going to plug one cookbook series and two particular books by different authors as my top choices at this time: 

The Jonny Bowden series on The Healthiest Foods

Paleo Takeout by Ross Crandall

Nom Nom Paleo Food for Humans, by Michelle Tam and Henry Fong 

I love all the online recipes and sites. But sometimes, the large glossy photos and thoughtful prose in a traditional paper cookbook is uniquely satisfying. Paper cookbooks also permit annotation. I can tell you all of mine are written in, with dates, who I made the recipe with, and any modifications I saw fit to make. 

Take a walk on the culinary wild side, and read a good cookbook. Better food is pleasant step toward better health. 

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

Zika Virus was front and center at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG) this last week. Hospital protocols are being developed to handle Zika affected births. Additionally, research continues into the the way that the virus affects babies, some utilizing the placenta. 

The annual ACOG meeting also presented a medical legal panel which presented evidence that latest cluster of TRAP (targeted regulation of abortion providers) laws were not based on medical indications. Many such laws are introduced under the auspices of medical necessity, where the available medical literature does not indicate such. It seems to me that abortion opponents should be truthful about promoting pieces of legislation based on their moral and religious views, and not medical science, for which there is none. 

In Brazil, where Zika virus is rampant, abortion is illegal, even for anomalies. Recently, evangelical politicians there have introduced stricter penalties there for those who illegally are found to have aborted a baby with microcephaly. There are nearly one million illegal abortions in Brazil each year. The number of women who are hospitalized for complications from these illegal abortions is ten times the number of women who are not. 

Oklahoma just passed a law making it illegal to have an abortion. It is a felony there, punishable by up to three years in prison. Physicians performing abortions would have their medical license revoked. 

And no matter where you stand on the issue of abortion, it comes as good news that abortions in the US and other developed countries have significantly declined since the 1990s. In my experience, abortion is a tough decision for people and is fairly hard on women. 

Also in the good news department, new research in JAMA (Journal of the American Medical Association) indicated that exercise wards of a variety of different types of cancer, even in those who smoke or are obese. There is a 20 % risk reduction for about 13 different types of cancers including esophagus, lung, kidney, stomach, endometrium and others. 

And in some news which I consider to be outstandingly good news, a panel at ACOG has generated a strong statement of consensus that 39 weeks is the optimal time to delivery a baby.  They have stated that there is little to gain and considerable to lose thereafter. We Ob/Gyns are committed to practicing evidence based medicine, and so I have managed patients according to the existing algorithms of the day supported by the best available evidence at the time. But, as my 22 years of practice have ticked by, I have had a stronger and stronger hunch about this 39 week point. Now there is finally a high level consensus about it. The presentation was so strong the the 63% opposed to the consensus before the talk turned into a 81% for the consensus by the end of the meeting. Inductions at 39 weeks had a lower complication rate than previously appreciated, and the C section rate did not increase. 

The vaccine rate for HPV (Human papilloma virus) has been low in this country. However, it is more than it has been in last years, and the rates of high risk HPV disease are decreasing. To really stamp out cervical cancer, we need to achieve the so-called “herd immunity” conferred by near universal vaccination. 

More good news…. In 2010, 16 % of Americans were uninsured. In 2015 this dropped to 9.1 % of Americans. Of course this is related to the ACA, the Affordable Care Act. Of course this has a cost. But, as a physician, I would like to remind the non-medical public that it is much cheaper for the taxpayer to pay for early prevention of illness and pregnancy than to pay for delayed treatment of illness and unintended pregnancy. 

Stay tuned for more breaking news from the work of Obstetrics and Gynecology next week on Medical Monday. 

 

Food Friday: Food Inspiration, Part 1 of 4 

I love food. I love healthy food. But sometimes I need food inspiration. I would like to turn to my four big sources of food inspiration: 

  • food websites
  • cookbooks
  • food in literature 
  • food movies 

This week we will touch on food websites. 

First and foremost, there is Pinterest. This is a free online general pinboard where you can create your own page full of albums and “pin” items from anywhere in the internet or from Pinterest itself. It is your all purpose infinite online scrapbook collection. More often than not, it is my first stop when searching for a specific recipe. Sometimes I just need inspiration and will just scroll through my own extensively curated food albums. It takes about 5 minutes for me to go from unmotivated to excited when I check Pinterest. 

Other general resources are food.com, foodnetwork.com, and epicurious.com. Of these, epicurious is my favorite. That is because it is a knowledge rich site. Sure, it has gorgeous  graphic design and photography. Additionally, it is well organized and is geared to someone who truly wants to learn to cook well. There are numerous tips, tricks and educational resources. There is also a free membership, and this enables readers to collect their favorite recipes on the site. Epicurious is a site I have used for years, but apparently it won a Webby award in 2015 for best site in the food and drink category.

AmericasTestKitchen.com and CooksIllustrated.com get the highest marks for being instructional, but they lack the high style and visual appeal of epicurious.com. If you want to understand technique, or the science behind cooking, go here. 

Saveur.com deserves mention as an old and fascinating resource. The magazine has been one of my favorites for many years. Saveur is distinguished by its philosophy of setting food into it’s cultural and geographic context. Reading Saveur is a good bit of culinary armchair travel. To introduce you, check out their page on the best culinary blogs of 2015: 

http://www.saveur.com/saveur-blog-awards-2015-voting-closed

I should say that there are many beautiful websites and blogs out there which I will not showcase. That is because I am going to try to highlight sites which feature healthier cuisine. Many of these are vegetarian or vegan. I will include them, since current evidence based guidelines recommend we consume more plant based foods. However, I will also feature Paleo sites, which I believe are even better. 

The Paleo movement is amusingly misnamed since it has little to do with what Paleolithic people (cavemen) ate. The Paleo diet is devoid of grains and legumes (beans, soy and the like) , as well as modern processed foods and sometimes even dairy. There are many versions of the Paleo diet. At its worst, it is trendy nonsense. At its best, it is allergen free, and rich in healthy animal proteins, healthy fats, and  nutrients and fiber from fruits and vegetables. 

A new favorite for me is Paleo Magazine. A good place to start is their list of the top 10 Paleo Blogs on the Web: 

https://paleomagonline.com/top-10-paleo-blogs-on-the-web-2014/

My favorite on the list is Nom Nom Paleo.

I would also like to mention an important site on Paleo food which goes into a fair amount of medical science. This is

thedomesticman.com

It’s young author Russ Crandall had a life threatening bout with autoimmune disease. The Paleo diet helped in his recovery. He is medically literate and goes to some length in his books to explain the connection, which is that in some people, the Paleo diet can help reduce intestinal hyperpermeability and inflammation. 

I am going to conclude with a couple other specific favorites. First is the “eat" section of Greatist.

greatist.com/eat

Their site is beautiful and evidence based. Finally, there is

theforestfeast.com.

For sheer beauty, you should go here.

 

I hope, from now on, the question “ What should we have for dinner ?" is a pleasure rather than a pain. 

 

Wellness Wednesday: Family and Social Support and Health

I have a pretty healthy family, and a pretty healthy group of friends. However, sometimes someone get sick or needs a surgery. I am always grateful and amazed at how people rally to help. At the same time, I think of my many patients who have to go it alone, even though they are not doing well. 

What is the relationship of social support to health ? It’s huge. I decided that if I write a blog post highlighting this interesting connection, that more people would connect with others in times of need. 

The most common form of social connection is marriage. Marriage is clearly associated with health. But there are some interesting particulars. Numerous studies over the last 150 years have noted this association. In more recent years, the association was questioned, on the hypothesis that perhaps healthier people marry. This turned out not to be true. In fact, unhealthier men were more likely to marry. 

If you parse the date further, the “ marriage effect “ is seen to be stronger as couples age. Moreover the effect is stronger for men than it is for women. Non married stable partners also have greater health than singles, however not as much as married people. There is not yet enough data to comment on whether same sex married couples share this health benefit of marriage. 

What are the particular mental and physical advantages associated with marriage and social support ? 

  • decreased depressive symptoms
  • better recovery from episodes of depression
  • lower heart rate and blood pressure 
  • lower serum cholesterol 
  • higher immune function 
  • reduced risk of Alzheimers 
  • better outcomes for hospitalized patients
  • decreased likelihood of chronic disease, disability, mental illness, and death

How do marriage and social support confer this improve effect on both mental and physical health ? There are several observations about those who are married, partnered or have good social support that seem likely to hold the answers : 

  • better social connectons
  • presence of companionship 
  • better emotional support 
  • better economic well being and more likely to be insured
  • more likely to keep medical appointments and get recommended screenings
  • more likely to take prescribed medications 
  • safer behaviors 
  • better nutrition 
  • more likely to get regular exercise

Dan Buettner in Blue Zones, identified social support as a principal correlate of extreme  longevity. He was focusing on groups of people around the world who lived healthy until past the age of 100. Regardless of place or culture, social support was key.

I think this is a powerful reminder for all of us to assess our our family and social connections. Are our relationships in good working order ? Those relationships may be more important than we realized. 

 

References: 

http://www.uniteforsight.org/gender-power/module1

http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-to-eliminate-cardiovascular-health-disparities/about/influences_on_health/family_social_support.html

http://www.economist.com/blogs/economist-explains/2015/01/economist-explains-0

http://www.webmd.com/sex-relationships/guide/relationships-marriage-and-health

http://www.health.harvard.edu/newsletter_article/marriage-and-mens-health

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/

https://www.bluezones.com/2014/03/blue-zones-history/

 

 

Wellness Wednesday: Healthy Architecture

Have you you ever noticed that you just feel good in some homes ? This might be because of the people who live there, or because of some happy memories. Or it could be the architecture ! It has been definitively shown that architecture influences our health and our sense of well being. In this post we will be examining what science and architecture say about healthy living space. 

Vitruvius, a famed architect and engineer of the Roman Empire, note that three elements were required for a well designed building: health, comfort and delight.

Cleary these requirements go beyond household air and water quality, lighting, waste management, and nontoxic materials. They go beyond shelter, privacy and safety as well. 

The AIA or American Institute of Architects has utilized a set of design principles to inform architecture not only for homes, but for schools and hospitals as well. They are as follows: 

  • Safety
  • Social Connectedness 
  • Environmental Quality
  • Sensory Environments
  • Physical Activity
  • Access to Natural Systems. 

This means that besides being safe, homes need to provide a space for people to comfortably gather. They need to be designed in such a way as to foster good air and water quality in the home. They need to provide pleasant sensory experiences of sound, sight, smell and touch. They need to foster the ability to be active. Finally they need to include or be able to interface with nature. 

According to Robert Ivy, CEO of AIA, these criteria for health fostering architecture can go even further. He highlights the following design principles: 

  • Biophilia
  • Educational design strategies 
  • Light as therapy

Biophilia refers to our innate love of nature. It even alludes to the fact that exposure to the natural world has measurable effects on well being. This can mean we keep indoor plants. It could also mean we keep a small garden outside the kitchen door. Educational design, means that our physical spaces ideally foster learning. This may mean something as simple as including space for an aquarium,. Or, it may mean including bookshelves, a tool shop, or a lego table in a child’s room. Light as therapy is a proven factor. Daylight fosters recovery in the hospital and good emotions at home. Daylight is ideally part of every room in a building. 

Designing for wellness is important whether you rent, own or are building your home. Small but well informed changes in your living space can have significant effects on wellness. 

To learn more: 

http://info.aia.org/AIArchitect/2014/1121/aia-interactive/index.html?utm_source=http://info.aia.org/AIArchitect/2014/1121/aia-interactive/index.html#

http://www.ncbi.nlm.nih.gov/books/NBK44199/

http://www.webmd.com/women/features/25-ways-create-green-healthy-home

 

 

 

 

 

Food Friday: Our Passover 2016 Menu

Friday night is the beginning of the 8 day holiday of Passover. It commemorates the journey of the Hebrew slaves out of Egypt and into freedom. This passage can be seen on many levels: geographic, cultural, religious,  psychological, and, concerning our topic today, culinary. 

It is an archetypal story that the Jewish people have seen fit to memorialize and celebrate with the Passover Holiday. And, more than every other Jewish Holiday, it is celebrated with food. True, the Seder, or Passover celebration service has a beautiful and music-laden liturgy in a volume called the Haggadah, but the special food items eaten are written right into the text.

The ceremony begins with blessings over wine and candle lighting. The narrative proceeds to bring us into a desert land, into the fold of an impoverished and weakened people. Moses, with divine inspiration, invokes the plagues upon Egypt to persuade Pharaoh to let his people go. Finally the tenth plague, the death of the firstborn of Egypt breaks him, but he reneges, and the people are pursued by Pharaoh's chariots through the Red Sea, where they are delivered to freedom and the soldiers drowned. 

As the story proceeds, we at the table are permitted meager portions. We must wait patiently and hear the story unfold. We may dip bitter green herbs in salt water symbolizing the bitterness of slavery and the tears the people. Of course, everyone at the table is quite hungry by now, and we are reminded to remember the suffering of people everywhere, and even into the present. Fairly soon we can have a sip of wine. At last we are given the Matzah. It is a flat tasteless cracker made of flour and water. It is the closest thing to cardboard that you can actually eat. It has its appeals, but I think mainly from association to the festive family gatherings. It depicts a “ poor bread”, a bread made in haste, the bread of slaves on the run, the bread of people who can afford nothing else. Everyone eats some in ceremonial fashion, and often with a spread. But no ! It is a spread of pungent horseradish called Maror, again to symbolize suffering. It is traditional to see who can take the biggest bite and wince the worst. 

The rabbis must have known about being hangry, since right about then we are permitted also to spread Charoset on the matzah. Charoset is strange compared to typical American foods, one the hearkens to other lands and other times. . It is a paste made of fresh and dried fruit, perhaps citrus, spices and various nuts. It is mulled with sweet red wine. It can be made chunky or smooth, and can be delicious. It symbolizes the mortar for the bricks with which the slaves built. People make a sandwich of Matzah, Charoset, and Maror, as did the famous Rabbi Hillel centuries ago, since he taught that the bitter went with the sweet. 

Finally the meal is announced, and it is ritually begun with an elaborate blessing and a boiled or roasted egg. The egg is, of course, a symbol of new life. The entire “ Seder plate “ is presented. The plate is often very large and ornate, with special spots and labels for each of the ceremonial foods, including lamb and the ones already mentioned. As the meal unfolds in many courses, we are encouraged to recline and take our time, and to use pillows to highlight our status as free people.

Modern Seders make mention of various forms of oppression in modern times. In that spirit, the Seder is for passing on wisdom as well as celebrating, and elders at the table are meant to tell the young people what they have seen in their day. I can remember one Seder I attended with a friend as a young high school student. It was in Los Angeles in the 1970s. After the meal was largely finished, the elders started telling stories. I was brought to a table where several very old people had pulled up their sleeves. I could see numbers tattooed on their arms. I realized in silent horror that they were survivors of the concentration camps of World War 2. They spoke at length about what they had seen, and admonished us to never forget. These stories were tragic, but they encouraged us by saying, “Look at us now !” .

Indeed they were filled with joy and pride, in a grand ballroom filled with family and friends, dressed to the nines, and sitting before a splendid table with a spread fit for royalty. I will never forget it. 

So Friday when I make our small family Seder, I will think of them. Friday afternoon, however, I will think of all the things I have to prepare. To conclude, I would like to share with you my planned menu. For a Passover menu, it is one part traditional and one part eclectic, just like our family. I hope whatever your tradition, whatever your religion or lack of it, that you can celebrate with us in your heart. 

 

Passover Menu 2016 

 

The Wine: organic grape juice of course. 

 

Bitter herbs: Mixed greens to include arugula, mizuna, mustard greens spinach and kale for the sweet and bitter (with a citrus vinaigrette for later in the meal) 

 

Roasted eggs, deviled by my son in law if he has time. 

 

My own Charoset, featuring dried mango, golden raisins, dates, dried cranberries, almonds, orange juice and champagne, and spices. 

 

Home made matzah- very rustic and hot out of the oven. 

 

Horseradish - straight up no embellishment. 

 

Halibut and salmon terrine - My substitute for the traditional gefilte fish. 

 

Roasted carrot fries - yum 

 

Matzoh ball soup - A family favorite - essentially a chicken soup variation with these amazing smooth light dumplings called matzoh balls. Mix the matzoh meal (wheat crumbs essentially) with eggs and oil and let them sit in the fridge. You will drop them in broth later. Then you roast a couple chickens (done ! ) reserve the meat, make broth, then prepare a mirepoix. A mirepoix is a mixture of finely chopped carrots, onion, and celery, which together give wonderful aroma and taste to soup. Sauté the mirepoix in olive oiling a big pot, add the meat as well, with herbes de provence and pepper. Add broth over all of it, garnish with white wine, bring to a low boil, then drop in your formed Matzoh balls. It won’t take long until they are ready and rise to the top. Serve with matzah. 

 

Fresh fruit- I cannot serve a meal without fresh fruit. Any will do. Strawberries, watermelon, mango and blueberries tomorrow. 

 

Desserts: 

 

Always more than one. 

 

Coconut macaroons- some dipped in chocolate - Love ! 

 

Flourless or fallen chocolate cake - Need I say more ? 

Food Friday: Passover Food, Part One

This year the first night of Passover falls on Friday night April 22nd. This means the upcoming week will be one of preparing. Observant households are cleaned and cleared of all leavened (yeasted or raised) bread and grains, since for the entire 8 days of the holiday, they are not eaten. 

Passover is the biblical holiday of the Feast of Unleavened Bread. It commemorates the Exodus of the Hebrews from slavery in Egypt. It is celebrated by both Jews and Christians. Jesus famously celebrated the Feast of Passover at what is now called The Last Supper. It is important to me as Jew among Christians to highlight the fact that we share this common narrative of liberation and redemption. Passover is always fresh, modern and relevant. It is one of my favorite holidays because of these themes, and since it involves food and family. 

Passover is celebrated over an eight day period not at a synagogue, but at the dinner table. The story of the Exodus is retold at the table though the reading of a work of liturgy called the Haggadah, which is essentially a narrative recounting of the portion of the book of Exodus which chronicles the event.

Here is the real genius of the observance in my opinion: The series of dishes in the meal serve as illustrations for the major points in the story ! This serves to keep the attendants engaged and makes the elements of the story unforgettable. Our ancestors felt so strongly about instilling within us this story of freedom that they enshrined it in a festive meal. 

This post will cover the elements of the festive meal, in order, and their meanings. Next week we will look at modern recipes for the same. 

 

Historical Culinary Elements of the Passover Seder: 

 

 

1st cup of wine or grape juice              

To sanctify the day 

 

Karpas (green herbs)    

To announce spring 

 

Salt water for dipping     

To signify the tears of the people 

 

Matzah (unleavened flat bread)                          

made in haste for an urgent departure

 

Maror ( Bitter herbs) traditionally horseradish,

to symbolize the bitterness of slavery    

 

Charoset (chopped fruit, nut and spice mixture)

to signify the mortar with which the slaves built the cities 

 

2nd cup to signify redemption 

 

3rd cup to signify blessing

 

The festive meal beginning with a roasted egg to symbolize new life. A roasted lamb shank is included and lamb is often served to symbolize the sacrificial Paschal lamb. Typically potatoes are served since they are in season, and they are not a leavened grain. 

 

4th cup to commemorate acceptance

of the Covenant of Law 

 

The historical ingredients of the meal are a bit peculiar to work with but are imbued with meaning. Stay tuned next week for the delicious modern adaptations of these ancient dishes.

Food Friday: Easter Lunch Planning 

Sorry, for some reason this did not go out as planned.... so here it is ! 

Every year we have a sizable party for friends and family. Every year I try to include some traditional dishes, but also some things to surprise and delight. Right now I am letting you in on the menu planning process. 

This year, Passover does not coincide with Easter. Most years, it seems like it does. Since I am Jewish we do not have leavened bread on those years. However, this year, we will be able to. 

Last week’s Food Friday went over many of the traditional foods from around the world. Because Easter occurs so early in the spring, it is before crops are really coming in. Thus even the festive menus include foods made from preserved things, like cured meats and fish. But, when you think about it, dried wheat ground into flour is a preserved thing, and so breads are among the traditional dishes, especially if they contain dried fruits and candied citrus peel.

For our bread this year, I am looking forward to a traditional Russian Easter Bread made by one of my Russian friends. My mother in law usually brings lamb, which is herb encrusted. My daughter is quite the chocolatiere, and I am going to try to persuade her to make a batch of handmade chocolates in fanciful shapes on Saturday. We like to make bugs and butterflies from molds. Her husband is the salad expert and produces an extraordinary spinach salad with candied walnuts and sliced strawberries. I will handle the new potatoes, smoked salmon with cream cheese and pickles, and new asparagus. Also I cannot resist making a meringue cookie in honor of one of the great grandmothers in the family. For them I will use only the whites of the egg, and so will liberate numerous yolks. To utilize these, I will make lemon curd. I have discovered that just about everyone in my family loves it. Few here in the states eat it. It is more popular in Britain. It is a rich lemony spread made with butter, sugar, yolks and lemon juice. You can even make it with lime juice. People use it like jam. It is a beautiful sunny color. 

And that is quite enough for the cooked sweets, since there will be the egg hunt in the nearby forest. There will be lots of treasures, such as spools of thread, coins, buttons, ribbon and more, but there will also be candy. Some of the eggs will be wooden and painted, and some will even be stone. In the past I found some that rang like bells. They went to the permanent egg collection. 

Make no mistake these gatherings are for more than fun and food. They forge the social bonds we need to be happy and healthy. So regardless of your religious , political, familial or cultural affiliations,  get together and make something nice. Renew old bonds and forge new friendships. 

Welcome to my spring holiday table. I would love to hear about yours. 

 

 

 

 

 

Wellness Wednesday: Wellness While Gardening

Gardening does not strike anyone as a particularly dangerous pastime. However there are a few tips and one critical point I’d like to share on the subject. 

I have been a committed gardener ever since I got married 33 years ago. It has been a soul feeding pastime for me. Gardening has gone hand in hand with family time, from the hands on science education for our kids to our present day culinary pursuits. 

I have gotten sunburns, rashes, cuts, scrapes, slivers and mosquito bites.  I have gotten dirty and dehydrated. I have lifted too much. I have risked heat stroke and frostbite. Thank goodness I have not gotten any ticks. But these are the concerns at hand. If you check the CDC (Centers for disease control ,they cover the list of precautions that would have prevented all these ills, and I will recoup them dutifully here. But there are a couple surprises, and at the end, one BIG POINT. 

  • Your clothing and hat should protect against weather, insects, chemicals (even organic ones) sun and yes, dirt. Dirt is full of pathogens like various fungi, tetanus and toxoplasmosis. This is of special concern to those who are pregnant or have compromised immunity. Play in the dirt with gloves.  
  • Make sure your every ten year tetanus shot is up to date. 
  • Your skin should be protected by sunscreen or insect repellant as indicated. 
  • Your hands should be gloved no matter what. Did I mention the gloves ? 
  • Your eyes should be protected from flying debris and dirt. You are not pulling enough weeds if you do not have dirt flying toward your face. 
  • Have water with you and hydrate throughout the day. Dehydration happens faster than you think. 
  • Know the fertilizers and supplements you are dealing with. Read all labels and follow all directions. 
  • Know your equipment, and make sure it is in good working order. If you are using sharp objects or powered equipment, keep your attention on what you are doing and keep small children out of harm's way. 

Here is the BIG POINT, and I will plead with you on this. Use organic methods. Please. The whole point of gardening is to get closer to nature and to produce something wholesome you can eat. Please do a little reading, and welcome yourself into the immensely gratifying world of organic gardening. If there is one thing that will save the world, it might be this. 

I am not even going to begin to address all the safety concerns of gardening any other way, such as with conventional herbicides, pesticides, or fertilizers. It would take too long and it would be depressing. So, get yourself one of the many excellent organic gardening resources, like maybe a book, the internet, or maybe your grandmother.  It doesn’t matter if you do container gardening in the middle of a cityscape, or if you have a farm. Chose this life affirming hobby, and do it in a life affirming way. 

 

Stay tuned next week for another Wellness Wednesday.