• Rick Santorum Wants to be your Ob-Gyn
• Pre-abortion Ultrasound – the medical evidence and why it’s important
• Anatomy of an unsafe abortion

But Dr Jen is not just about reproductive rights. Here are some great posts she’s written recently on common gynecologic issues -

• How common is HPV in the mouth, and can you get it from kissing?
• The low oxalate diet and vulvodynia – How a case report becomes snake oil
• Does vitamin E help breast pain?

And finally, a doc’s honest appraisal of the weight issue and women -

• What’s unhealthy about the Plus Model Magazine article on plus size bodies and why it matters
• More than two-thirds of Americans are overweight – the normalization of unhealthy

This is what I love so much about blogging – it let’s docs in the know speak directly to patients without the filter and the hype of the media. We are our own media.

You go,  Dr Jen!

After all, in most practices, getting an ultrasound before doing an abortion is pretty much routine already. Doctors who do abortions don’t want to be surprised by an unexpectedly advanced gestational age, a uterine anomaly, an erroneous diagnosis or an ectopic pregnancy. Since most Ob-Gyns have an ultrasound machine in their office, the sono is fast and easy to do. Those docs who don’t have their own sono machines will refer out. And higher volume providers may employ a radiologist or sonographer to do the sonos in their practices.

So if we’re all doing ultrasounds anyway, what’s the big deal?

This is not about abortion – It’s about the practice of medicine and the rights of patients

The big deal is that patient and physician rights are being violated by legislators with an agenda that has nothing to do with the public health and everything to do with restricting access to a legal medical procedure.

We are not talking about a doctor ordering a radiologic test. We are talking about state legislators mandating that a patient undergo a medical procedure without her consent.

It’s not only invasion of privacy, and the physician-patient contract,  it’s assault on the patient. It’s mandating that “as a component of informed consent”, a woman undergo a procedure without her consent. (Amendments that require the woman to consent for the ultrasound were voted down.)

HC 462 – The Virginia Ultrasound Law

Abortion; informed consent.  Requires that, as a component of informed consent to an abortion, to determine gestation age, every pregnant female shall undergo ultrasound imaging and be given an opportunity to view the ultrasound image of her fetus prior to the abortion. The medical professional performing the ultrasound must obtain written certification from the woman that the opportunity was offered and whether the woman availed herself of the opportunity to see the ultrasound image or hear the fetal heartbeat. A copy of the ultrasound and the written certification shall be maintained in the woman’s medical records at the facility where the abortion is to be performed. This bill incorporates HB 261.

Do you see the legal precedent being made here?

Forget for a moment that this is about abortion.

Imagine instead that there is a law requiring you to get a chest x-ray before you can be treated for pneumonia. Or mandating that as a doctor, you order an MRI and show the patient the images before treating a headache. Or forcing a male patient to undergo a rectal exam before being treated for urethritis.

We’re not talking about whether or not these are things that are happening anyway as part of the current practice of medicine. We’re talking about a law requiring them to be done as a condition of treatment. The doctor must order the test and the patient must undergo the procedure. Or the doctor is breaking the law.

This is not just about abortion. Or women’s rights. Or Planned Parenthood.

It’s about the practice of medicine and the rights of our patients. It’s about physician-patient privacy and the authority of doctors to practice medicine without the fear of breaking the law.

All physicians and patients, whether they are male or female, pro-choice or pro-life, Republican or Democrat, should be outraged. Our medical societies and our patient advocacy groups  - every single one of them, whether related to reproductive care or not – should be fighting these laws, and engaging physicians and patients everywhere to fight back. Publicly and vocally.

With the passage of Virginia HB 462, eight states now have laws mandating that a woman have an ultrasound prior to an abortion.

How soon before it’s your state? Or your specialty? Or your practice? Or your body?

What to do before you start writing –  Put down first what you want the reader to do, next the three most important things the reader needs to understand to take that action, then start to write. When you’re done, ask yourself whether if you were the reader, would you take action on the basis of what is written.

A Paradox. Writing better does not mean writing more. It takes time to write well.

On length - Short sentences and short paragraphs are easier to read than long ones. And easier to understand.

Beginnings & Endings are important - Start with that single point you want your audience to take away. Conclude with a memorable way for them to do so.

Fact vs Opinion - Never leave your reader in doubt as to what is opinion and what is fact.

Finally –  The only way some people know you is through your writing. Your writing IS you.

The book has much, much more, including tips for writing and handling email, memos and letters. It’s very concise, a quick read, and would make a great graduation gift. A nice companion to my all time favorite writing book, On Writing Well by William Zinnser.
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More great advice on writing from David Ogilvy.

We’re on deadline for a grant application, and I needed to get my letter of commitment signed, scanned and emailed to the research office ASAP. The person in my office who has the scanner was at lunch.

TurboScan to the rescue! Print on letterhead, sign the letter, snap 3 quick pics of it with my iPhone4, let it process and then email the PDF to myself.  Less than 3 minutes.  Done.

TurboScan is not a free app, but as far as I’m concerned, it’s worth more than the $1.99 I paid for it.  (And no, I was not paid to write this post. I just love technology. And my iPhone, of course.)

Breadcrumbs in a cake? I’d never head of such a thing. But I had a few leftover baguette crusts in my freezer, and the memory of an amazing cake I’d made a few years back from this wonderful little vintage cookbook, Favorite Tortes and Cake Recipes by Rose Oller Harbaugh and Mary Adams.

If the authors were suggesting I use breadcrumbs in my torte, who was I to question? Besides, it was long past time to see what other gifts the book might have in store for me, other than the charming illustrations and typeface, which are a true delight.

I’m happy to report that Ms Harbaugh and Adams came through for me again, this time with a recipe for Rococo Torte with Mocha Frosting. A touch of cinnamon in the batter enhances the chocolate flavor of the not-too-sweet sponge-like cake that is filled and iced with just the right amount of mocha frosting.

What exactly is a Torte?

Ms Harbaugh and Adams tell us that tortes are “the cakes of European cooks”.  They are made light with eggs instead of leavening, with ground nuts, cracker or bread crumbs used in place of or in addition to a markedly small amount of flour. They can be filled with fruit pulp or whipped jellies, and extracts are used to flavor their whipped frostings.

Tortes are a favorite Passover dessert, since eggs rather than baking powder or soda create the leavening, and little to no flour is used. This rococo torte could be modified for Passover by substituting ground nuts for the flour and using ground matzo meal instead of breadcrumbs. (Alternatively, you can use ground nuts to substitute for both the flour and breadcrumbs.)

Why my torte is not quite Rococo

A bit of internet exploration yields evidence that the Rococo Torte recipe in my cookbook may hail from Hungary, where it is called  Rokokka Torta, and is made with a hazelnut filling and whipped mocha frosting. (Click the link to see a truly gorgeous torte!)

As I looked at the traditional Hungarian Rokokka Torta, I realized that I had used the wrong mocha frosting on my torte! The authors had actually suggested mocha whipped cream frosting, which is just what the Hungarian recipe uses. And indeed, there the right frosting was, on the same page of the cookbook as the frosting I had mistakenly made.

So it seems that my little torte is actually “not quite rococo”. But it’s simplicity makes it much less fancy than the traditional Hungarian torte, and it really is a delicious and lovely little cake.

NOT QUITE ROCOCO TORTE

• 5 eggs, separated and allowed to come to room temp before using
• 5 tbsp sugar
• 2 tbsp homemade bread crumbs (recipe below)
• 3 tbsp flour (cake flour if you have it)
• 2 squares bittersweet chocolate, grated or processed fine in the food processor
• 1/2 tsp cinnamon
• shaved chocolate for topping

Preheat oven to 325 degrees fahrenheit. Butter and flour 2-8 inch cake pans. (I also lined the bottom with waxed paper.)

Beat egg whites till stiff. Set aside. Beat egg yolks till lemon-colored. Add sugar and beat well. Add bread crumbs and sifted flour and beat thoroughly. Beat in grated chocolate and cinammon. Fold in stiffly beaten egg whites. Divide between two 8-inch cake pans and bake for 25-30 mins till done. Fill and cover with Mocha Frosting or Mocha Whipped Frosting (recipes below) Shave some bittersweet chocolate on top.

The cakes did not immediately drop out of the pan for me, even after running a spatula around the sides, so I slipped the spatula an inch or so under one side and then used my hands to remove the cake, which was light and yet remarkably sturdy. (Alternatively, you could use two 8 inch spring form pans.) Here’s what the bottom looked like after I removed the waxed paper -

and what it looked like filled and frosted -

MOCHA FROSTING

Although at first it seemed like it was not enough, this recipe makes exactly the right amount of frosting for this cake. I substituted Kahlua for the mocha extract.

• 1/3 cup sweet butter
• 1 1/2 cups confectioners sugar
• 1 tbsp cocoa
• 1/2 tsp mocha extract (I used Kahlua)
• 1 tbsp strong coffee (I dissolved a tsp of instant espresso into a tbsp of hot water)
• Sift sugar and cocoa

Cream butter thoroughly in electric mixer. Add sifted sugar and cocoa. Add mocha extract. Add coffee a drop at a time until spreading consistency (I used the entire tbsp of coffee).

MOCHA WHIPPED CREAM FROSTING

• 2 tbsp confectioner’s sugar
• 2 tbsp cocoa
• 2 tsp cinnamon
• 1/2 pint whipping cream
• 1 tsp mocha extract

Sift sugar, cocoa and cinnamon. Whip cream. Fold in sifter dry ingredients. Add mocha extract and whip till spreading consistency.

Homemade bread crumbs

Allow frozen bread to come to room temp. Slice into 1 inch slices and lay out on a baking sheet. Heat in a 250 degree oven till dry but not brown – about 15 minutes – turning halfway through so they dry evenly. Cool, then process in food processor till finely ground. Store in a tightly capped jar in the freezer till use.

By now, you’ve heard that Susan G Komen For the Cure, which at first announced that it would withdraw its funding to Planned Parenthood for breast cancer screening programs, now appears to (but may not actually) have reversed that decision after an enormous public outcry.

Komen is not new to controversy.  Many have criticized their “pink-washing” campaign, which has promoted some very unhealthy products and brands in return for donations (Pink buckets of fried chicken? Really?…) But with this latest political move, they’ve gone too far for many of their supporters, some of whom say they will stop supporting Komen. Planned Parenthood, in the meantime, has raised record dollars since Komen’s initial announcement, topped off by a $250,000 matching grant from Michael Bloomberg.

I could go on and on about the controversy, but that’s not the point of this post, which is simply to answer the question I found myself asking – what should Komen’s former supporters do now? How can they channel their efforts to fight breast cancer if they are not going to give to Komen?

One option, of course, is to give to Planned Parenthood, The other option is to donate to one of the other charities on the front lines in the battle against breast cancer. Komen, after all, is not the only game in town.

Here are a few other places where your dollars will be put to good use fighting breast cancer. All of the following groups get high ratings from the American Institute of Philanthroy and/or Charity Navigator-

• The Breast Cancer Research Foundation (BCRF). The only breast cancer charity with an A+ from AIP.
• Breast Cancer Fund - Advocates for elimination of environmental & other preventable causes of breast cancer.
• National Breast Cancer Coalition Fund (NBCC) – “Our mission is to end breast cancer by January 1, 2020″
• The National Breast Cancer Foundation (NBCF) – Funds breast cancer research and free mammograms for women who could otherwise not afford them.
• BreastCancer.org - A nonprofit organization dedicated to providing the most reliable, complete, and up-to-date information about breast cancer.
• Cancer Research Institute - Funds fellowships & grants for cancer research
• Memorial Sloan Kettering Cancer Center - Funds Cancer research and patient care
• Dana Farber Cancer Institute - Advancing cancer research & patient care.
• The Rose - Houston area charity providing screening  & access to treatment regardless of ability to pay.
• Breast Cancer Connections – San Francisco-based organization providing “free programs and services for those touched by breast cancer and the people who care about them”.
• Living Beyond Breast Cancer – Specialized programs and services for the newly diagnosed, young women, women with advanced breast cancer, women at high risk for developing the disease, and African-American and Latina women.
• Young Survivor Coalition - For younger women with breast cancer.

And if you’re not already donating to the fight against breast cancer? Well, maybe it’s time to start.

So much can go wrong - not having a reservation and spending a half hour wandering Restaurant Row with the tourists looking for a table (I’ve done that more times than I can count); finding out your dinner reservation has put you into a pre-theater mill where you’re herded like cattle at the slaughter (ditto); or rushing anxiously through an otherwise delicious dinner and then running like crazy to make curtain time (I call it doing the Times Square Bob and Weave).

Then there’s choosing a bad play (not often but it happens); choosing a great play that one of your company hates and everyone else loves (that play with the goat); finding out the lead is replaced by the understudy  (that Laura Linney play that wasn’t); and let’s not get into the lines at the ladies room, shall we?

Well, last night we pulled it off. Dinner at Maze and tix to Other Desert Cities. Perfect combo. (Not to mention great friends…)

MAZE

The only table available at Maze was at 5:30, and while I felt a bit like I was heading out for an early bird special, the timing was just right. So right that it’s going to be my new dinner start time for pre-theater. We had a wonderfully leisurely meal and great conversation unencumbered by worries about making curtain time. And had time for an absolutely perfect Margarita at the bar before sitting down to a fabulous meal.

The bread – best I’ve ever had at a restaurant, hands down. A lightly salted cross between a focaccia and a baguette is the best way to describe it. It felt very light on the tummy and we went through two little buckets – mostly because we needed it to sop up all the great sauces we had.

Two of us ordered the scallops appetizer – perfectly cooked with little bits of cauliflower and capers. (Sautéed sea scallops golden raisin purée, cauliflower beignets, crispy capers $18)

The single short rib ravioli appetizer had a surprisingly generous and delicious meat filling.

The sweetbreads appetizer was a bit of a disappointment. When I eat sweetbreads, I’m looking for that soft inner texture. These pieces were more like crackling sweetbreads. Delicious, just not what one would hope for.  A better description in the menu would have been helpful. (Oven baked beetroots caramelized sweet breads, celeriac mousseline, mache salad $18)

The Bronzino was truly amazing. Trust me, we sopped up every bit of that beurre rouge. (Filet of branzino spinach and artichoke fricassée, beurre rouge, crispy phyllo $26)

But the star of the evening? The little pot of fingerling potatoes in a shallot cream sauce that were served with the Trout Market special. (Whole roasted Idaho brook trout Sheldon Farm fingerling potatoes, orange and fennel salad $29) There were more than needed for one person, which meant we all got to share them. OMG. The potatoes were perfectly cooked and the sauce – well, we were all practically licking the pot to get every bit. I asked how they were made and got this much – shallots, garlic, chicken broth and I assume butter and cream and parsley. If anyone reading this has the Maze cookbook, let me know if the recipe is in there. (I tweeted Ramsay to see if he would share it – I’ll let you know if he responds.)

We all shared dessert – delicious. (Chocolate pudding stout ice cream, pretzel, peanut butter powder $9.00)

No one overate or over-drank, both of which can be disasterous before a play. Susan and I shared the Bronzino, MR TBTAM only had appetizers, Boyd shared his potatoes (OMG again…) and we all tasted one another’s dishes and shared the dessert.  It was a completely satisfying meal. The bill for 4 of us, including 2 beers and 1 glass of wine, but not the drinks at the bar, was $200.

Maze also has a pre-fixe theater menu during the week for $35. I consider that a real bargain.

Our early reservations meant we had time to enjoy a leisurely walk to the  Booth Theater on 45th St to see Other Desert Cities.

OTHER DESERT CITIES

What a cast.

I’ve loved Rachel Griffiths since Muriel’s Wedding, and she was fabulous as Brooke, a 30-something writer who arrives at her parent’s Palm Springs home to announce she’s publishing a memoir that revisits their shared tragedy and threatens to upend her parent’s carefully reconstructed life.  Stockard Channing it a tour de force as a Jewish-Texan Right-wing Mama Grizzly modeled on Nancy Reagan, and Stacy Keatch her completely sympathetic Papa bear counterpart. Judith Light is transformed as a recovering alcoholic aunt. (Why have I not seen her in a play before? I’ve been missing some amazing stage acting!) And I was thrilled to find Justin Kirk playing Brooke’s younger brother Trip – while there was much of Andy Botwin in Trip, it’s a character I happen to love, and Kirk plays the part beautifully. (His final outburst actually drew applause during the play.)

We found ourselves a bit confused as to the chronology of the play – which war were they talking about – Iraq or Vietnam? What year was it? How old is everyone supposed to be?  But that just gave us fodder for a spirited conversation at intermission, which was the first one in as long as I can remember that did not include a visit to the ladies room.

Hanging around talking afterwards, a nearby burst of applause made us realize we were near the stage door, from which the cast was emerging.

I got a few pics and had a brief conversation with Judith Light, who, after signing autographs and taking pics strolled off with her companion and merged into the crowd on 45th street.

It’s what I so love about New York. The Gods walk among us.

The pill they’ve recalled is called Lo-Ovral or its generic Norgestrel 0.3 mg/Ethinyl Estradiol 0.03mg. I’ve posted a list of the affected lots below. The first thing you need to do is check your pill pack against the list to see if you are taking a recalled pill.

If you’re not taking a recalled pack, take a deep breath and relax. Then share this post on Facebook or wherever you share, so that your friends who may be taking a recalled pill learn about it as soon as possible.

What should you do if you are taking a recalled pack?

Talk to your doctor about what you should do if you are taking a recalled pack. Here’s what I’ll be telling my affected patients.  (Disclaimer – What follows is advice I will be giving my patients.  What your doctor may want you to do could differ. )

• First of all, don’t panic.  If you’re not spotting or bleeding out of schedule,  you’re probably still protected against pregnancy. But make no assumptions – Presume you are unprotected and follow the steps below.

• Head immediately to the pharmacy for a new pack of pills.

• If you’ve been sexually active since your last period, do a pregnancy test. If it’s negative (and it most likely will be negative), start your new pack immediately and use condoms for the next two weeks. Your next period should come at the end of your new pack of pills. If it does not, do another pregnancy test. If you don’t want to wait till then to be sure you’re not pregnant, you can do a second pregnancy test two to three weeks after the first.

• If you’ve had sex in the past 5 days, discuss with your doc if you should consider taking emergency contraception.

• If you haven’t been sexually active, no harm has been done. Get a new pack and start it right away. Use condoms if you have sex in the next two weeks.

• If you’re pregnant, contact your doctor. What you decide is up to you, but know that accidental exposure to normal doses of birth control pills in early pregnancy should not impact the pregnancy outcome.