So anyone who knows me knows that I preach the gospel of rice cooker cooking. I bought my rice cooker from Amazon as a "Christmas Gift to myself" my first year of medical school. Forking out more than a hundred bucks on a kitchen appliance seemed a little crazy at the time, but it was one of the best investments I have ever made. I use that thing every day and sometimes twice a day and you will see how and why with my style of cooking.
Nothing beats cooking beans in a rice cooker, because you can soak and cook in basically one step. Soak overnight, then use the timer function to cook and they'll be done in the morning. Or, soak all day and use the timer for the beans to be ready and waiting for you when you come home from work!
I finally hit up the farmer's market last week after weeks of absence, mostly due to bad timing and a demanding schedule. Luckily, the bounty still abounds and I bought some gorgeous heirloom tomatoes and crisp, tender kale. Combining kale to homegrown collards in the recipe below was twice as nice, but you could use one or the other. The black-eyed peas stick to your ribs. Add extra water for a yummy broth to slurp up after a cool walk in the woods.
Green Leafies and Black-Eyes
1 Tablespoon Extra Virgin Olive Oil
1 onion, diced
1 garlic clove, minced
1 bunch kale, collards or both cut chopped finely into little threads
4oz dry black-eyed peas, already reconstituted and cooked (or two cans ready-made)*
2-3 large tomatoes, chopped
2 cups veggie broth (or water + broth cube)
1.5 tsp. Cajun seasoning
1 tsp. paprika
3-4+ Tablespoons hot sauce such as chili-garlic, or Tabasco if you prefer
dash salt
Saute the onion and garlic over medium heat for 5-7 minutes until sweaty and smelly. Add the kale, a dash of salt and stir. Cook for 5-10 minutes until the kale is nice and wilted. Add the beans and broth. Cover. Cook 10 minutes. Add the tomatoes and cook another 10-15 minutes. Add the seasonings, stir, and turn off the heat but keep the lid on and let flavors combine. Taste for final flavor adjustments.
Rice cooker method: Truth be told, the last time I made this recipe, I did it all in the
rice cooker on "slow cooker" mode. I sauteed the onion and garlic in
the oil first, then added everything else at once (sans spices). It
turned out splendidly. I actually made this over my lunch break if you
can believe it, and added some leftover squash for color and substance.
* To have thicker Green Leafies and Black Eyes, smash about half a cup of the beans with a fork before adding them to the pot. The pulverized beans will add some creamy texture and a little complexity to the dish. You can always add more water if you want it soupier. Happy slurping.
Tuesday, September 27, 2011
Tuesday, September 20, 2011
Coronary Artery Disease: a rite of passage?
For the past 4 weeks, I have spent my days (and frequently, my nights) working up patients young and old for heart problems on the coronary care unit. Most of these problems are related to coronary artery disease, the three word phrase synonymous for gunk in your arteries that causes heart attacks, strokes, and chest pains. Having people present with chest pain to hospitals is so common in America that we have become incredibly efficient with algorithms with how to stratify risk and treat patients depending on chemical blood markers, EKG, and clinical symptoms.
If symptoms and tests are concerning enough, the patient gets sent to the "cath lab" which doesn't contain any Bunsen burners, but does has fancy xray equipment that specially trained cardiologists use to visualize the coronary arteries. That is, after they consent the patient regarding risk/benefits of this invasive test (including the risk of losening a plaque in the process, releasing it into the blood stream and causing a stroke, which--though rare--did happen to a patient of mine this month). Once inside the lab, the masked cardiologist drapes the patient and him/herself with layers of sterile blue and inserts a wire up through an access point (usually an artery in the arm or leg) and inject dye. The xray takes a multiple images of the dye flow through the arteries and the patterns coalesce like a movie. Cardiologists examine the films of the dye pattern filling (or not filling) the main arteries and any auxiliary arteries over a period of just a few seconds. They repeat the same film over and over, much like conspiracy theorists watch the grassy knoll tapes of JFK's assassination. There are standard angles to capture in 2D a moving and dynamic 3D organ. However, the interpretation of these films is where precision and art meet. Cardiologists are trained for an additional three years after their internal medicine residency and in so doing learn to interpret "lesions" as they call them (read: plugged arteries) and where TIMI flow III exists (read: blood flow isn't compromised). But where an angle of an artery is bent or there is blurred filling pattern, one cardiologist might see constricted flow and another may see free flow. To make it more complicated, the cardiologists have to make sure that the compromised vessel is the one causing the pain, as patients with severe disease can have many vessels that are partially occluded and it is important to try and address the one that is most likely the culprit. "If it aint broke don't fix it" as they say, but when everything looks broke, it's sometimes hard to assess which is the most broken.
When the interventionalist (which is what the wire-inserting cardiologists are called) feel comfortable with determining a certain vessel could be causing the chest pain and EKG changes they place a stent (think a mini- culvert to keep open the vessel) or blow up a mini balloon (angioplasty) to open up the vessel and improve blood flow. After a stent is placed, patients must take a drug that prevents the stent from clotting or occluding for at least a month and generally a year, called Plavix. If you don't take Plavix or can't afford it at $200/month, you might not be a candidate for a stent at all. I have seen patients who, because they couldn't afford the Plavix, don't get a stent. (It went generic briefly a year or two ago, but the pharma company that makes it quickly fixed that!)
When there is disease in many of the main vessels, interventionalists usually don't bother placing a stent and simply call the cardiothoracic surgeons, as that patient has likely bought a ticket to have his/her chest cracked for open heart surgery. At that point, the surgeon will harvest certain veins (usually a leg vein) to "bypass" the occluded blood vessels in the heart (think taking an alternate route during a traffic jam). He/she can also use existing artery closer to the heart, depending on how many vessels are needed. That way, even if the native artery eventually occludes with plaque, the patient will have the alternative route for blood flow. CABG (coronary artery bypass grafting) can buy people many years, but it's not without it's own risks, months of recovery, and I haven't even talked about the fist fulls of medicines patients are sent out with...whether they get a cath or surgery or are medically managed (some people who have heart attacks don't get caths or CABG).
So... it was a typical day last week. We had a patient, who was actually known personally by my very kind and dry-humored attending physician (fancy name for grey-haired boss) who had been experiencing heartburn-like symptoms (read: chest pain and he should have known better) for months. He finally went in to be checked out and after a catheterization due to ongoing chest pain, was found to have multi-vessel disease. Pop quiz students: what does he get next? That's right: surgery consult. In breaking the news that the patient would need surgery, my attending physician was trying to soften the blow as best he could to this stoic, professional man who did not want surgery. In doing so said, "You know, by a certain age, CABG is a rite of passage when you are an American."
I almost swallowed my teeth. No. No it's not. Voting at age 18 is a rite of passage...getting your driver's license and driving with the radio up so loud your ears hurt is a rite of passage ...even unsolicitously receiving your first edition of the AARP magazine at age 49 is a (not warmly received) rite of passage as an American. But CABG, far and away, is preventable. If you look at the risk factors for coronary heart disease, they are almost all modifiable: high blood pressure, high cholesterol, diabetes (which is 90% type 2 and related to obesity and diet), smoking. Only family history is the non-modifiable risk factor, which, when people do have it (defined by someone in your family having a heart attack before age 55) is a major player, but not the only player. When someone is having chest pain, we don't want to blame the victim at least in the time of crisis when he/she is facing a major operation and a brush with death. But for the rest of us who never want a CABG, and for those who don't want a cath or surgery again, we CAN change the course. (I'll site some literature on the subject...next time...as this will be an ongoing topic)
And so, I continue to believe in healthy living, more than ever. Not in a punitive way because I'm afraid of dying. Everyday I work in the hospital I become more aware that I will die. But because it makes me happy to take care of my body and feel good doing so. Day by day. And ok, I admit it: I'm more than a little scared of having a wire stuck up my heart!
If symptoms and tests are concerning enough, the patient gets sent to the "cath lab" which doesn't contain any Bunsen burners, but does has fancy xray equipment that specially trained cardiologists use to visualize the coronary arteries. That is, after they consent the patient regarding risk/benefits of this invasive test (including the risk of losening a plaque in the process, releasing it into the blood stream and causing a stroke, which--though rare--did happen to a patient of mine this month). Once inside the lab, the masked cardiologist drapes the patient and him/herself with layers of sterile blue and inserts a wire up through an access point (usually an artery in the arm or leg) and inject dye. The xray takes a multiple images of the dye flow through the arteries and the patterns coalesce like a movie. Cardiologists examine the films of the dye pattern filling (or not filling) the main arteries and any auxiliary arteries over a period of just a few seconds. They repeat the same film over and over, much like conspiracy theorists watch the grassy knoll tapes of JFK's assassination. There are standard angles to capture in 2D a moving and dynamic 3D organ. However, the interpretation of these films is where precision and art meet. Cardiologists are trained for an additional three years after their internal medicine residency and in so doing learn to interpret "lesions" as they call them (read: plugged arteries) and where TIMI flow III exists (read: blood flow isn't compromised). But where an angle of an artery is bent or there is blurred filling pattern, one cardiologist might see constricted flow and another may see free flow. To make it more complicated, the cardiologists have to make sure that the compromised vessel is the one causing the pain, as patients with severe disease can have many vessels that are partially occluded and it is important to try and address the one that is most likely the culprit. "If it aint broke don't fix it" as they say, but when everything looks broke, it's sometimes hard to assess which is the most broken.
When the interventionalist (which is what the wire-inserting cardiologists are called) feel comfortable with determining a certain vessel could be causing the chest pain and EKG changes they place a stent (think a mini- culvert to keep open the vessel) or blow up a mini balloon (angioplasty) to open up the vessel and improve blood flow. After a stent is placed, patients must take a drug that prevents the stent from clotting or occluding for at least a month and generally a year, called Plavix. If you don't take Plavix or can't afford it at $200/month, you might not be a candidate for a stent at all. I have seen patients who, because they couldn't afford the Plavix, don't get a stent. (It went generic briefly a year or two ago, but the pharma company that makes it quickly fixed that!)
When there is disease in many of the main vessels, interventionalists usually don't bother placing a stent and simply call the cardiothoracic surgeons, as that patient has likely bought a ticket to have his/her chest cracked for open heart surgery. At that point, the surgeon will harvest certain veins (usually a leg vein) to "bypass" the occluded blood vessels in the heart (think taking an alternate route during a traffic jam). He/she can also use existing artery closer to the heart, depending on how many vessels are needed. That way, even if the native artery eventually occludes with plaque, the patient will have the alternative route for blood flow. CABG (coronary artery bypass grafting) can buy people many years, but it's not without it's own risks, months of recovery, and I haven't even talked about the fist fulls of medicines patients are sent out with...whether they get a cath or surgery or are medically managed (some people who have heart attacks don't get caths or CABG).
So... it was a typical day last week. We had a patient, who was actually known personally by my very kind and dry-humored attending physician (fancy name for grey-haired boss) who had been experiencing heartburn-like symptoms (read: chest pain and he should have known better) for months. He finally went in to be checked out and after a catheterization due to ongoing chest pain, was found to have multi-vessel disease. Pop quiz students: what does he get next? That's right: surgery consult. In breaking the news that the patient would need surgery, my attending physician was trying to soften the blow as best he could to this stoic, professional man who did not want surgery. In doing so said, "You know, by a certain age, CABG is a rite of passage when you are an American."
I almost swallowed my teeth. No. No it's not. Voting at age 18 is a rite of passage...getting your driver's license and driving with the radio up so loud your ears hurt is a rite of passage ...even unsolicitously receiving your first edition of the AARP magazine at age 49 is a (not warmly received) rite of passage as an American. But CABG, far and away, is preventable. If you look at the risk factors for coronary heart disease, they are almost all modifiable: high blood pressure, high cholesterol, diabetes (which is 90% type 2 and related to obesity and diet), smoking. Only family history is the non-modifiable risk factor, which, when people do have it (defined by someone in your family having a heart attack before age 55) is a major player, but not the only player. When someone is having chest pain, we don't want to blame the victim at least in the time of crisis when he/she is facing a major operation and a brush with death. But for the rest of us who never want a CABG, and for those who don't want a cath or surgery again, we CAN change the course. (I'll site some literature on the subject...next time...as this will be an ongoing topic)
And so, I continue to believe in healthy living, more than ever. Not in a punitive way because I'm afraid of dying. Everyday I work in the hospital I become more aware that I will die. But because it makes me happy to take care of my body and feel good doing so. Day by day. And ok, I admit it: I'm more than a little scared of having a wire stuck up my heart!
Friday, September 16, 2011
Date Balls
No smugness meant in this name...but it does cause guests to snicker. They are 100% delicious and there's nothing bad inside!
1/2 cup Walnuts (unsalted)
1/2 cup Dates
1/2 cup Almonds (unsalted)
1/2 cup nut butter (I use almond but you can use peanut, etc.)
1/2 cup cocoa powder
1/2 cup real maple syrup
1 tsp. salt
2 tsp. vanilla
1/2 cup shredded coconut (unsweetened)
Coursely chop walnuts in a food processor. Add the dates and chop until blended. Add the almond butter, syrup, cocoa powder, salt, vanilla and mix thoroughly. Blend in the almonds and mix until the almonds are chopped. The dough should be thick, not too sticky and consistently blended.
Using your hands, roll balls about the diameter of a quarter (or whatever size you wish). Place the formed balls on a cookie sheet covered with wax paper. Then, roll each ball in the coconut. Refrigerate. Best served cool but not cold. For coconut enthusiasts, add a couple extra tablespoons of coconut to the date mixture before you form the balls!
These things will knock your socks off.
1/2 cup Walnuts (unsalted)
1/2 cup Dates
1/2 cup Almonds (unsalted)
1/2 cup nut butter (I use almond but you can use peanut, etc.)
1/2 cup cocoa powder
1/2 cup real maple syrup
1 tsp. salt
2 tsp. vanilla
1/2 cup shredded coconut (unsweetened)
Coursely chop walnuts in a food processor. Add the dates and chop until blended. Add the almond butter, syrup, cocoa powder, salt, vanilla and mix thoroughly. Blend in the almonds and mix until the almonds are chopped. The dough should be thick, not too sticky and consistently blended.
Using your hands, roll balls about the diameter of a quarter (or whatever size you wish). Place the formed balls on a cookie sheet covered with wax paper. Then, roll each ball in the coconut. Refrigerate. Best served cool but not cold. For coconut enthusiasts, add a couple extra tablespoons of coconut to the date mixture before you form the balls!
These things will knock your socks off.
Friday, September 2, 2011
French Connection
What happens when I take the first three things I have in the refrigerator and blend with some seasonings? Something unreasonably tasty and darn filling for lunch. French lentils, the fiber-filled and protein-packed powerhouse fancy cousin-with-an-accent of the more dull (but still delish) brown lentil keeps its shape when you cook it. Some sources say that french lentils keep the flavor of the terroir of the region where they are grown (just like French wine--and lets face it: French people!). My palate is not that sensitive, however I do find their texture more crisp than other lentils and perhaps a bit fresher. The french often serve their lentils cold in salads like this one, though there is nothing french about this salad!
1.5 cups cooked lentils (3/4 c lentils cooked in 1.5 cups water)
1 fresh peach diced
1 cup purple cabbage chopped
3-4 tablespoons best quality balsamic vinegar
3 tablespoons toasted sesame oil
salt/pepper to taste
Serves two for lunch. More for a side dish.
Throw all the ingredients together in a medium sized bowl and stir. Can keep for several days. You can serve on a bed of spinach for more vegetable power!
1.5 cups cooked lentils (3/4 c lentils cooked in 1.5 cups water)
1 fresh peach diced
1 cup purple cabbage chopped
3-4 tablespoons best quality balsamic vinegar
3 tablespoons toasted sesame oil
salt/pepper to taste
Serves two for lunch. More for a side dish.
Throw all the ingredients together in a medium sized bowl and stir. Can keep for several days. You can serve on a bed of spinach for more vegetable power!
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