two (presidential) terms later

paint the town orange

2011-02-24T23:23:00.000-05:00

This weekend, Columbus will host Paint the Town Orange, a first annual benefit for the National MS Society created and organized by Jeremiah Juso and co-hosted with Basil Restaurant. For those who haven't been, Basil is one of the newest additions to the Short North. The restaurant occupies a beautiful space on High Street and serves some of the best Thai food in Columbus. The evening will combine art with advocacy, featuring a silent auction of works by local artists, as well as several fun and tasty cocktails created specifically for Paint the Town Orange. One hundred percent of proceeds from the event will go towards the National MS Society.

As many know, this event has special meaning for me for a number of reasons. I recently lost my father in October to multiple sclerosis, and the money raised at Paint the Town Orange will go directly to the Keith Kithcart Fund. The National MS Society helps fund educational and advocacy efforts, as well as basic science and clinical research. I know this personally, as a large part of my dissertation research was funded by a grant from the National MS Society. The proceeds from Sunday's benefit will go a long way towards helping those with multiple sclerosis and their families.

Everyone in Columbus is invited and encouraged to attend. Tickets are $25 in advance and can be purchased from the National MS Society on the Keith Kithcart Fund website. For those out of town, your donations are more than welcome and would help the benefit meet its fundraising goal. I'm really looking forward to enjoying a wonderful evening with friends benefiting a great cause! Hope to see you there!

in the garden, 2010 analysis

2011-02-22T11:40:00.000-05:00

As you probably noticed, I didn't post a lot of updates from the garden last year. A combination of factors led to my lack of writing. First, I was traveling 3-4 days a week during the month of September, leaving little time for my garden. The following month, I left Columbus completely for an away elective in Los Angeles, relying on my irrigation system to coast the garden into late fall. The last update I posted was shortly after a massive bug infestation of my pole beans in July. Unfortunately, even after replanting, the beans never fully recovered. Fortunately, there were also quite a few successes. The following is a list of winners and losers from 2010:

The first winner, cherry tomatoes:

If there's a variety of tomatoes that's made for container gardening, it's the cherry tomato. This plant was productive from July through late September and probably October, though I was out of town. Give this plant a large container, and it will give back several dozen tomatoes over the course of a couple months. Of note, cherry tomatoes are usually indeterminate, meaning that they produce fruit continually. This can be a good thing, but it also means you'll get a handful of tomatoes daily, rather than a large harvest like you would with determinate varieties.

Another winner, herbs:

If there's any plants for the first-time container gardener, they're herbs. Unlike tomatoes, herbs require little effort with huge rewards. Mint, basil, and thyme are especially easy to grow, but I also had good luck with tarragon, oregano, parsley, white onions, rosemary, and lavender. Pictured above is the mint, which grew faster than I could harvest it. Unfortunately, none of the herbs grew well indoors after the end of the outdoor growing season. Also, there were a couple herbs that were especially difficult, including cilantro and chives. I've had bad luck with cilantro two years in a row, and given that it's dirt cheap at the grocery store, I'll be buying my cilantro there. I'll try the chives again this year simply because I love adding the fresh herbs to mashed potatoes and omelets.

By far and away the biggest winner of 2010 was once again, the pepper:

After huge harvests in 2009, I decided to grow several varieties of peppers, including bell, jalapeno (my personal favorite), and Thai chile. I think the warm, sunny roof really makes these plants thrive, and the smaller plant size means I can grow more varieties without needing huge pots in my garden. The biggest drawback, as with 2009, was that I had so many peppers from July through October that I couldn't use all of them. By the end of the season, I got creative and made ristas from the Thai chile peppers:

After several months of drying, here's the final product (not including the tulips, of course):

I'm looking forward to using these in chili, soups, and sauces!

Finally, the losers from 2010. I already mentioned the cilantro, but there were some other, more disappointing losses. First, the beans. When they finally reached a mature height, some sort of insect devastated them from the bottom up. Even after cutting down the whole plant and starting over, they didn't have enough time left in the season to catch up. I may try beans again in the future, but not on a rooftop.

Another big disappointment were the sugar snap peas. These were actually very delicious, and I harvested quite a few peas early in the season. However, peas are extremely sensitive to heat, and as soon as May arrived the peas were done. I'm going to be growing peas from all three trellises this year in hopes of getting a larger harvest.

The biggest disappointment came from the potatoes. I planted two containers of five pounds of seed potatoes each and ended up with about two pounds of each variety. Not a very good investment. Not only are potatoes difficult to grow in containers, they're extremely labor intensive. Considering that Idaho does such a good job with their potatoes, I'll be buying from them this year.

All in all, 2010 was a mixed year. Looking back, I was probably a little too aggressive adding new plants, but that also gave me the opportunity to narrow my list for 2011. There were a few additions last year that I have high hopes for this year, especially the fruits. The dwarf lemon and orange trees had a solid winter indoors. The lemon tree has been especially productive, with more than a dozen blossoms this month. Also, I have blueberry and strawberry plants that were wintered outdoors and should have a productive year this year.

As the winter relaxes its grip on central Ohio, I'm looking forward to getting back out in the garden again soon. Since I'll be starting July in a new city, I'm going to focus my garden on spring varities, including peas, spinach, lettuces, asparagus, and Brussels sprouts. I'll have more updates in the next couple weeks, but until then, happy gardening!

do-it-yourself chicken stock

2011-02-19T13:01:00.002-05:00

There are a few things that are better homemade: chocolate chip cookies, fresh baked bread, and yes, chicken stock. Anyone who has made a stew, soup, or sauce has probably required chicken stock, which can found in stores in boxes and cans. I, for one, will resort to commercial chicken stock in a pinch, but after my first batch of homemade chicken stock, I'll never look back.

I adapted the following recipe from a wise woman who once told me I should always use homemade chicken stock:

Chicken Stock

5-6 pounds bone-in chicken thighs
2 large yellow onions, unpeeled and quartered
4 carrots, unpeeled and halved
3 stalks celery with leaves, cut into thirds
3 parsnips, unpeeled and cut in half
15 sprigs fresh parsley
10 sprigs fresh thyme
15 sprigs fresh dill
1 head garlic, unpeeled and cut in half crosswise
2 tablespoons kosher salt
2 teaspoons whole black peppercorns

I start my chicken stock with thighs for a couple reasons. First, thighs are usually the cheapest chicken parts available in the grocery store, and second, you can store them pretty easily in your freezer. I usually buy the thighs when they're on sale and keep them in the freezer until I'm ready to make chicken stock. You could also use a whole chicken or any other parts you have on hand. Just make sure you include the bones because that will add a lot to the flavor.

Add to a large stock pot your chicken, onions, carrots, celery, and parsnips. The pot will start to get really full at this point.

To really pump up the flavor, add in lots of herbs. If you can't find the fresh stuff, dried will work, but your stock won't taste nearly as good.

Add to the herbs and vegetables an entire head of garlic, peppercorns, and salt.

Top of the raw ingredients with water and heat to a boil. Simmer on the stove for several hours, ideally four or more. The longer you cook it the more flavor you'll get. Before:

And after:

If you're so inclined, after an hour or so, take out some of the chicken thighs for chicken soup. Cooking them more than an hour will make the meat tough. After you've taken off the meat, throw the bones back into the stock and cook for the remaining three hours.

When you're satisfied with the flavor of your chicken stock, remove from the heat, strain, and allow to cool. I put the whole stock pot in the fridge to allow the fats to solidify, which makes it easier to make a lean stock. After removing the fat, I separate the stock into containers and freeze for future use. I always leave one in the fridge for impromptu cooking experiments.

For chicken soup, reheat the stock with two cups each of carrots, peas, and celery, a quarter cup each of fresh dill and parsley, and the chicken you removed after an hour of cooking. Salt and pepper to taste. Enjoy!

the consequence of being nice

2011-02-18T11:28:00.002-05:00

It would seem bad things really do happen to good people.

Those in the medical field have often heard that the friendliest and nicest patients end up with the worst diagnoses. My first experience with this "Murphy's Law" of medical management was a year ago on the hematology service. A very pleasant, elderly woman, the proud grandmother of several sons, daughters, grandsons, and granddaughters, came in with the complaint of painless jaundice. It's well known that painless jaundice portends a poor prognosis, and sure enough we diagnosed this woman with metastatic pancreatic cancer. With most of her family in the room, it was one of the most painful conversations I have had with a patient.

Meanwhile, the worst patients, whose rank include the alcoholics, drug dealers, child abusers, etc, often leave the hospital unscathed. It's true that most drunk drivers survive the accidents they cause, while their victims often end up on life support. Even violent crime offenders with the worst comorbities and the poorest followup seem to accept hepatitis C and heart disease in stride, often living full, although unhealthy, lives.

So it came as no surprise this week when another very nice woman ended up with a difficult diagnosis. Without giving away too much personal health information, this woman made her way to my ER after nearly seven decades without carrying a single chronic medical condition, a minor miracle in the patient population with which I work. She presented with mild discomfort, but would eventually leave the hospital after having been diagnosed with a massive tumor in her abdomen. It goes without saying, she was an incredibly pleasant patient, and I felt worse with every painful new piece of information I had to share with her. She was immediately put in touch with an oncologist and scheduled for surgery.

It's likely many of these observations are based on selection bias, the idea that certain individuals are preferentially selected due to outside, and usually subconscious, factors. We remember the patients we like, and we tend to dwell on those difficult conversations we have with patients with whom we were previously laughing. This is not to say that we enjoy handing out bad diagnoses to bad patients, because even the most difficult patients are treated with the same respect and professionalism as any other. But when we develop that special connection with a patient, it seems unfair that they should receive the worst prognoses.

If there's a silver lining I can glean from the last two years, it's that those patients with the the most generous personalities and the most loving hearts are rewarded with an extensive support system of family and friends. In the face of a devastating diagnosis, when doctors are left with few therapeutic options, having the support of those around you is the best for which anyone can hope.

home stretch

2011-02-09T11:56:00.002-05:00

It's been painfully long since my last update, but let me give you a quick peek at what's been going on in my life:

I wrapped up my last residency interview in January. In total, I interviewed at 14 different programs in nine states. My final rank list is due on February 23rd.
This month I'm on emergency medicine, which, for me, is a completely different way of practicing medicine. I'm also working a lot more evenings than usual.
February is the first of my last three months at Ohio State. My last day in the hospital as a medical student is April 29th, and the College's hooding ceremony is June 2nd.

I've been getting a lot of questions about where I want to go for residency. Truth be told, I interviewed at a lot of great programs, and most of them would give me an excellent clinical training. There were a handful of places that didn't have the right fit, and so I won't be ranking those programs. For the rest, my final rank list will be based on program strengths, lifestyle, cost of living, and most importantly, opportunities for the future. Of course, there's a lot of plain old gut feeling that goes into the final residency program ranking, and once the final list is made, I'm probably only going to share it with a handful of people. Through it all, I've had an amazing time catching up with old friends across the country, and choosing only one city to spend the next several years will truly be a difficult decision.

summer pests, and the waiting game

2010-07-20T10:09:00.001-05:00

I haven't updated for a few weeks, and since that time a lot has happened in the garden. First, let me tell you that all the lettuce is now gone. I tried keeping it for as long as I could, even moving around pots to keep it in the shade, but in the end the summer heat was too much for the tender greens. I ended up cutting it all out and replacing it with hardier tomatoes and peppers. In fact, you could even say the new plants have thrived in the hot weather, which frequently gets over 100 degrees on my black tar roof.

In other news, I had a nasty infestation of beetles that completely destroyed my peas and beans. At first, I had a suspicion something was eating my leaves. The plants had the characteristic mottled pattern typical of insects. I was able to stave off the plague for a few weeks with some insecticide, but after a crazy couple weeks on surgery, I went out to the garden to find the beans and peas completely destroyed.

Rather than try to save what was obviously already lost, I uprooted the whole plants and started over. Beans and peas are cool weather plants, so they should do just as well in the fall as they did in the spring. I already have little sprouts, and this time I'll be on the lookout for pests.

Finally, the tomatoes and peppers I planted in the spring are starting to mature. I've been harvesting cherry tomatoes for several weeks now, and a lot more are on the way.

I've also picked a few jalapenos. As you can see below, I'm going to have a bumper crop of peppers this year. With the beans out of the picture, the jalapeno plant has taken over and basically become a pepper tree. I can count several dozen peppers on this one plant alone, and that's not even including the bells and chilies I have growing elsewhere in the garden.

All in all, it's been a successful year so far. At this point, it's all about waiting for the vegetables to ripen. I have plenty of other plants, including the mint and herbs, to keep me busy cooking while I wait to make salsas and sauces later this summer.

Happy gardening!

seven down, one to go

2010-07-06T20:15:00.004-05:00

I always mark the anniversary of another year passing by updating the description of my blog. Slowly, at times painfully so, it's gone from first- and second-year MD/PhD student to now eighth-year MD/PhD student. The eighth is significant for a number of reasons, but most notably as my last in the higher education system.

I'm not going to dwell too much on the soon-to-be defunct title of my blog (after all, I've already been a student through one two-term president, and I don't see a second term in the current president's future). Instead, I'll focus on what will surely be one of the best years of my life. The fourth year of medical school is a magical time when the schedule is mine to shape as I choose, and the last real break of my adult life until retirement. Built into the four months of required courses and four months of electives are four beautiful months of vacation. It feels a lot like my last year of college, when I didn't have to schedule 7:30 chemistry labs anymore, and I took on a new appreciation for phys ed classes.

I hope to be spending my last year of school banking hours towards mastering my profession (don't forget the 10,000-Hour Rule), and doing a little traveling in between. If the cards fall in my favor, I'll be spending the fall in SoCal, wintering in blustery Chicago, and sunning myself next spring on the shores of the Mediterranean.

If it all sounds too amazing to be true, it probably is. I still have a month of sub-internship to survive and a nasty little series of licensing exams before I'm on my way towards fourth year bliss. But after seven long years, it feels closer than ever.

spring harvest

2010-06-07T19:47:00.000-05:00

Summer is still two weeks away, but I've already harvested lots of fresh produce from the garden.

I previously mentioned the lettuce, which is still growing well. The two early "bolters," spinach and black seeded lettuce, have already gone to seed. I'll soon be replacing them with tomatoes, peppers, and herbs. The other greens, including the kale, Swiss chard, and romaine still have a few more days left in them. Cold weather plants bolt when temperatures start to rise and the days get longer. They turn from producing luscious, green foliage to tall, ugly flower stalks. The leaves aren't worth much at this point, and the plants are essentially wastes of space.

In exciting news, I've also started to harvest from other plants in my garden. The beans are really starting to ramp up, which means green beans for dinner in the near future. The strawberries are also starting to turn, but I'm not really expecting a lot out of them as it's their first season. Finally, I've harvested quite a few sugar snap peas. Unfortunately, those will be the last of the peas until fall as they've already started to turn from the warm weather.

In other exciting news, I planted a blueberry plant a couple weeks ago. I also planted the rest of the tomatoes and peppers that were waiting inside for warmer temperatures. Now that the tomatoes and peppers are starting to bloom, I changed my fertilizer to one rich in phosphorous and potassium, which will improve flower and fruit production. I recently had to teach myself about plant fertilizers because I had heard certain chemicals are better for certain types of growth. For instance, every fertilizer has a three digit number, usually something like 12-12-12. This represents the percentage of nitrogen, phosphorous, and potassium, respectively. A higher nitrogen content favors leaf production, a higher phosphorous favors more fruit, and a higher potassium favors more flowers. Ideally, I would treat each plant individually, based on what I'm trying to get them to produce. However, since I'm simply adding fertilizer to the irrigation system, I'm generalizing my plants based on what I think is most important (which right now is tomatoes and peppers). I switched from a 24-8-16 to a 18-18-21.

As you can see, the garden is coming along quite nicely. We've had a wet spring in Columbus, which is perfect for container gardens because if you've put enough holes in the bottom of the containers, you can never over water your plants. Happy gardening!

uninvited guest

2010-06-05T09:49:00.002-05:00

I have lots of updates from the garden, but this one had to be discussed first.

Over the last several weeks, I noticed some of my larger plants had signs of damage. At first, it looked like bugs might be nibbling off the ends of my bean leaves. Then I found a large piece of Swiss chard chewed off at the base. Finally, last week I found an entire pea plant chopped off about six inches off the ground.

So who was the culprit? I finally got a picture of the suspect last week:

Can you spot him? No? Well how about a closer look:

Despite the damage the little rodent is doing, he looks pretty cute in this picture. I haven't resorted to rat poison yet, but if he keeps having lunch in my garden, I'm going to cap the pipe he's using to get up to the roof.

We're getting rain this morning in Columbus, which is great for the tomatoes and peppers. Unfortunately, I won't have more pictures from the garden when the weather is a bit drier. Until then, happy gardening, and have a great weekend!

rainy weather makes great greens

2010-05-22T12:17:00.000-05:00

We've gotten quite a bit of rain here in central Ohio over the last several days. While I've missed most of it while I spend the month in the OR (one tiny advantage of scheduling your surgery rotation during the spring), my garden certainly has enjoyed all the recent moisture. Most of my plants are what you would consider "cool weather" varieties, so the mild, cloudy days have been a boon to my greens and vegetables.

First, I have to say the Great Potato Experiment is going better than expected. I was unsure where this project was going when I started buying rebar by the foot at Lowe's, but I've been pleasantly surprised. Still no potatoes yet, but they're now well on their way, and the red potatoes are even starting to bloom. I've been told that as soon as you start seeing flowers, you can expect that little potatoes are growing down below. I'll probably start investigating in the next couple weeks.

I've also seem some great progress with my beans and peas. I was a little worried at first, because peas are more of a cool weather plant, but beans like the hot weather of July and August. As it turns out, the weather has been great for both, and they're well on their way along the trellises. This weekend, the first of the tiny pea pods started to appear! Peas grow quickly, so I'm expecting some harvests soon.

Speaking of harvests, as I already mentioned the greens have thrived in this weather. I harvested about five heads of lettuce and some radishes last weekend, and this weekend I took out several more to make way for my tomatoes and peppers.

I made asian lettuce wraps with one of the heads of lettuce, but I was a little unsure what to do with the kale. A quick search on Food Network led me to this recipe from Ina Garten: Ribolitta!

Now that temperatures overnight are finally over 45, I planted the tomatoes and peppers in my kitchen that have been patiently been waiting to be placed outside. I also set my tomato cages, after a painful lesson last year that tomatoes grow too big too quickly to place cages later in the season. I can't even imagine how big my garden will be after these cages our filled out.

The rest of this weekend, I'll be busy finalizing some manuscripts and celebrating a friend's birthday, but I plan to make a trip tomorrow to Home Depot for a couple more pots. I made the difficult (read: easy) decision to add a couple more varieties of mint, including chocolate mint and peppermint. I'm excited to play with different combinations of mint and fruit for some fun summer mojitos!

Hope everyone has a great weekend, and as always, happy gardening!

in the garden - rooftop salad bar

2010-05-10T21:33:00.002-05:00

Mother's Day weekend is typically the time when gardeners get out in their yards and finally start planting. The last frost date has passed, and the days are warm enough to support growth. In my case, the rooftop garden is already off to a great start.

As I mentioned in my last post, my computer died recently so I wasn't able to update for a few weeks. Since that time, the greens I planted back in April, including the red sail lettuce, butter lettuce, romaine lettuce, kale, and Swiss chard, have really taken off:

I also started my potatoes, which required some creative engineering. Potatoes are traditionally planted deep in troughs, and as the sprouts grow, dirt is mounded over the plants until the trough essentially becomes a 12" hill. The potatoes grow along the entire length of roots, so longer roots make more potatoes. Container gardeners can take advantage of this little quirk of nature. First, I sprouted my potatoes indoors. After a couple weeks, I planted the spuds in two large plastic containers. As the potatoes grow, I'll pile straw on top until the straw is 2-3 feet above the container. Of course, this means I need a frame to fill with straw, which I modified from two sheets of concrete rebar:

Even though I picked up the idea from trusted sources, I'm still worried at the end of summer I'll end up with two four foot stacks of straw and no potatoes. The next few weeks should be very interesting!

In other news, have you forgotten about my beans and peas? Both have gotten off to a strong start, but the peas needed a little help grabbing the trellis. With a little modification, the peas should be climbing up soon.

This week should bring more mild but wet weather, which is perfect for my greens. As soon as overnight temps are reliably 45 degrees or greater, I'll plant the peppers and tomatoes, which have patiently been waiting on my kitchen counter.

Until then, happy gardening!

Who says gardening isn't dirty?

out of order

2010-04-21T21:18:00.000-05:00

You may be wondering why I haven't posted in a while (but most likely, you haven't). As luck may have it, my laptop took an unfortunate spill last week while I was in Toronto. The screen has a nasty crack down the middle, which makes it hard to work on anything larger than a Post-It note. While I have every intention of replacing it with a brand new Apple MacBook Pro, that will have to wait until I return from Costa Rica May 1st.

Until then, you'll have to bide your time reading something else, knowing I have lots of stories to share, including a few about my garden.

you may or may not like it

2010-04-13T19:09:00.000-05:00

As an avid cilantro fan, I've never objected to adding the herb to soups, salsas, even omelettes. Apparently, there's a small, but very vocal, group out there that despises the herb, including the late Julia Child. If you find yourself agreeing more with Child, there may be good reason you think cilantro, and its relative coriander, tastes like soap:

The authoritative Oxford Companion to Food notes that the word “coriander” is said to derive from the Greek word for bedbug, that cilantro aroma “has been compared with the smell of bug-infested bedclothes” and that “Europeans often have difficulty in overcoming their initial aversion to this smell.”

... Modern cilantrophobes tend to describe the offending flavor as soapy rather than buggy. I don’t hate cilantro, but it does sometimes remind me of hand lotion. Each of these associations turns out to make good chemical sense.

Flavor chemists have found that cilantro aroma is created by a half-dozen or so substances, and most of these are modified fragments of fat molecules called aldehydes. The same or similar aldehydes are also found in soaps and lotions and the bug family of insects.

like a fine wine

2010-04-13T18:48:00.000-05:00

Soon, doctors may be as hard to find, and as difficult to afford, as a bottle of 2000 Château Pétrus.

The demand for physicians is expected to increase exponentially over the next 10-20 years as millions of new Americans will require health care. The combination of the recent health care legislation and an aging population will place new strains on an already stressed medical education system. Currently, around 18,000 medical students are matriculated each year, but that number will need to double in 15 years to meet growing demands:

At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.

That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.

The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.

The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020.

Unfortunately, training another 45,000 physicians takes time. This time includes not only the four years required for medical school, but also the additional three to four years for a primary care residency. With work hour restrictions limiting time with patients, that additional training could easily take four to five years.

When considering an educational process that has an inherent lag time of 7+ years, is it already too late to avoid a widespread physician shortage? If we're going to truly address this growing problem, we need to provide the incentives that will lead more medical students to enter primary care specialties.

south of the border

2010-04-12T15:08:00.001-05:00

Taco trucks have been a staple of the Columbus dining scene for several years now, but my distinguishing palate for fine Mexican food has yet to lead me to one of these parking lot restaurateurs. Maybe I should take this as an opportunity to finally give them a try:

Taco Truck Tour 2010

white house garden grows

2010-04-02T05:25:00.002-05:00

You likely remember last year when Michelle Obama dug up part of the South Lawn at the White House to plant her own "recession garden." She not only started a national conversation on healthy eating, but also grew more than 1000 pounds of fruits and vegetables for White House guests and local food pantries.

This year, the White House garden will be even larger:

First lady Michelle Obama welcomed spring to the White House Wednesday by replanting her popular vegetable garden with the help of local elementary school students.

The newly planted garden is 400 square feet larger than last year and will contain four new vegetables: bok choy, cauliflower, artichokes, and mustard greens.

Joining Mrs. Obama were Agriculture Secretary Tom Vilsack, Health and Human Services Secretary Kathleen Sebelius ,and several White House chefs.

in the garden - more from the produce aisle

2010-04-01T14:21:00.008-05:00

As I promised in my last post, I planted more than veggies and greens last weekend. I also built three trellises for pole beans and sugar snap peas, varieties that I have been assured will be heavy producers later this spring. Below are the trellises with their pots of beans and peas.As the weeks pass by, I expect these trellises to be covered with eight feet of produce. Just like the greens, beans and peas are early producers that don't like the heat of a rooftop garden, so when they begin to fade in late May, I'll replace the vines with tomato plants and use the trellises for support.In other news, I also added several fruits to the garden this year. Below are my strawberries, which will produce a large crop in June and then be done for the year. Again, I'll replace these with summer vegetables, including peppers, when their productivity has waned. There are varieties of strawberries available that produce all year long, but the quantity and quality of those plants isn't as great, so I opted for the larger, better crop all at once in June.I also added citrus to my garden this year. Yes, citrus! While I'm not expecting a lot of production this year, I'm hoping to get some good growth this summer. I ordered the dwarf trees from Four Winds Growers. They graft real citrus trees with dwarf roots to produce a miniature tree that produces full-sized fruit. They might not look impressive now, but by this winter they'll be in full bloom and ready for harvest the following fall.Here's the lemon tree:And an orange tree:Finally, as I mentioned in my first post, I started an experiment this week growing outdoor bulbs indoors. I think sprouting plants are one of the most exciting things to watch, so I placed the gladiola bulbs in a clear glass jar and set the bulbs in rocks.I was a little worried adding bulbs to rocks with water would lead to a big moldy mess, but within a couple days, I have sprouts!I can't wait to watch these bulbs develop over the summer. By August, they should be almost five feet tall!That's all for now. Coming up this weekend: potatoes!

warning: junk food may be addicting

2010-03-29T08:18:00.002-05:00

Researchers at the Scripps Research Institute in Jupiter, FL have found that foods high in fat and low in nutritional value may become addicting. In fact, the researchers suggest there may be a biological explanation for food addiction. The results of their studies were published online this week in Nature Neuroscience.Researchers were investigating compulsive eating habits of obese rats compared to those of lean rats. They started by giving rats unlimited access to bacon, sausage, pound cake, candy bars, and other fatty foods. The rats quickly became obese, and even after researchers shocked the feet of rats when they overate, the rats continued their compulsive eating behavior. When the unhealthy food was eventually withdrawn, the rats went on a two week hunger strike, refusing to eat any healthy food.For anyone that's been to Taco Bell or enjoyed a Big Gulp at 7-Eleven, this doesn't come as much of a surprise. We know certain foods can become addicting, but this study takes our observations a step further. Researchers found changes in the brains of obese mice that were very similar to those of people suffering drug addiction. The researchers found reduced levels of dopamine receptor in obese mice, which mirrors what scientists have found in the brains of drug addicts. Dopamine is a potent neurotransmitter, elevated in the brain during periods of pleasure. By having lower levels of the receptor, obese rats, like drug addicts, need more of the pleasure-producing sensations in order to feel satisfied. In other words, giving up junk food for some people may be just as difficult as giving up heroin for a drug addict.I think this study is important because it may lead to new therapeutic strategies for obesity. Many of the same treatment principles in addiction medicine could be applied to certain obese patients, including targeting the dopamine receptor. Interestingly, the changes found in the brains of obese rats were induced only after they were fed an unhealthy diet. The rats weren't genetically susceptible to obesity, but rather developed an addiction following a learned behavior. This would suggest that many of the factors that determine obesity are learned during childhood, not from the womb.

in the garden - spring has sprung

2010-03-28T20:00:00.009-05:00

We're barely a week into spring and my garden is already off to a running start. The weather in Columbus was unseasonably warm last week, before a cold snap Thursday reminded us that we still live in the Midwest. Even though the weather was a bit of a set back, that didn't stop me from planting several cold weather varieties of vegetables over the weekend.But before I get ahead of myself, remember those white onions from a couple weeks back?Things have certainly come a long way. The seedlings should be ready to go by the statistical last frost date next month. The other indoor herbs are still going strong and will be ready when the weather warms up a bit.As I alluded to earlier, my larger garden outside is starting to take shape. I took advantage of the warm weather earlier in the week to till the soil and tidy up my pots. One advantage of container gardening is that tilling is as easy as turning over the soil with a garden shovel. No fancy equipment required here!After setting my pots, I decided on several spring vegetables that were already available in local nurseries. Another advantage to container gardening is that the soil temperature quickly rises to match the air temperature. This is not true of traditional gardens, where the soil temperature often lags several degrees behind. After a lengthy elimination process (I have limited resources, after all), I settled on winter kale, red sails lettuce, and butter lettuce. I also directly sowed romaine, black-seeded Simpson lettuce, and Mesclun greens. You may also pick out a few cold-hardy pansies among the new vegetables.One of the great things about spring veggies is that they reach their peak early in the season. I'll be harvesting most of these greens by the end of May, which will be just in time to start planting tomatoes and peppers in their place. I recently picked up a book called Bountiful Container, which in my opinion is the definitive source for information on container gardening. In it they describe a process called succession gardening, in which spring greens are replaced by summer vegetables and eventually fall plants, all growing in the same container over the course of a single growing season. Talk about efficiency!I have more updates to share from this weekend, but unfortunately I have a dozen other things on my list for this evening. So until then, happy gardening!

in the garden, 2010 edition

2010-03-05T16:49:00.006-05:00

I know what you're thinking, an "in the garden" update already? It's only March 5th, and there's still snow on the ground in Columbus. Spring is at least two weeks away.While it may seem early, it's the perfect time to get things started indoors. Most seedlings can be started 2-6 weeks before the last frost, which incidentally for Columbus is April 26th. One of the best reasons for starting early is that many nurseries have sales starting in late winter.This week, I took advantage of Oakland Nursery's spring sale to pick up some seeds, bulbs, and plants for the 2010 season. If you haven't been to Oakland Nursery and live in the Columbus area, I highly recommend stopping by. They have one of the best selections in town, and the sales people are very knowledgeable. At this point, you should know I am NOT a paid spokesman for Oakland Nursery.Below you can see some of the seeds I picked out. I typically prefer starting with live plants (simply because it's easier), but none of the varieties below are available as plants and I wanted to get an early start with the seedlings. I most excited about the beans. I decided on a vine variety this year that should grow up a trellis, making for easy harvest.I also picked up some summer bulbs. Both varieties are some of my favorite summer flowers, and the gladiolus was actually my class flower in high school. This year, I'm going to try growing the bulbs indoors. I've heard most can be grown on rocks in a large vase, so I'm going to give it a try with the gladiolus first, and if that's successful try the callas.As I mentioned before, I also picked up some live plants. For these, I actually went to Whole Foods, which has an amazing selection of herbs (and by the way, they're on sale). Even if you don't plan on starting a garden this summer, you should definitely think about picking up a couple herbs for your windowsill.Below, you can see the basil and rosemary. On the right, I started some chive and green onion seedlings.Of course, I'll keep you updated as I start moving my garden outdoors. Happy gardening!

in case you missed it

2010-02-03T11:46:00.003-05:00

Yesterday, the British journal The Lancet retracted a 1998 paper linking vaccines with autism. In the sports world, this is the equivalent of Pete Rose apologizing for betting on baseball.Following the original publication, numerous flaws in the study were revealed, and subsequent larger, better designed studies refuted the results of the 1998 publication. But despite mounting evidence against such a link, numerous organizations and celebrities continue to gain press in the media, much to the chagrin of physicians. (You can watch Jenny McCarthy's claim to "cure" her son's autism here.)If you're interested in the subject, I recommend reading Dr. Paul Offit's "Autism's False Profits." He points out that this debate has run its course, and rather than continue to spend millions of dollars every year running down a dead end, we should reinvest that money is actually understanding the factors that influence autism.

doctor's corner: my prescription for a healthy life

2010-02-02T21:59:00.003-05:00

Keeping up with medical literature can be a lot like trying to drink water from a fire hydrant. It seems like every day another group promises "the next big thing" in preventative health care. Deciphering those studies can be difficult, especially after they trickle through the main stream media.So what's a layperson to do? How can you tell what advice to take and what can be ignored?Let me try to help. Below are ten recommendations which, when followed, will improve your general health and may even add a few years to your life. I tried to avoid writing a list of commandments, but rather focused on positive changes you can make to improve your health. Disclaimer: The following are not necessarily the ten most important things you can do, just easy tips to improve your health. Also, I'm not including references here, but if anyone wants to see the original study, just leave a comment.And now, in no particular order, my Prescription for a Healthy Life:1) Lose weight.Despite what you may have heard about diets (Atkins, South Beach, etc), anyone can lose weight as long as they keep this simple rule in mind: Input < Output = Weight Loss. One could theoretically lose weight eating Big Macs all day as long as they burned enough calories. Obesity increases the risk for diabetes, heart disease, stroke, cancer, and arthritis, to name a few. Sadly, this year obesity will pass tobacco use as the number one cause of preventable death in developed countries.And speaking of tobacco...2) Don't smoke.I don't need to spend much time here. Smoking, even second hand smoke, can cause lung cancer, and lung cancer is not a pleasant way to die. Most are found late in disease, when treatments are largely ineffective. The majority of patients die within six months of diagnosis.3) Take 1000 U of vitamin D daily.Doctors are better understanding the benefits of vitamin D every year. Studies have found most people are deficient of vitamin D, which is synthesized in the skin by sunlight. Adding vitamin D may increase your energy, help prevent osteoporosis, even prevent autoimmune diseases like diabetes and multiple sclerosis.4) Drink more pomegranate juice.The labels on the bottles of Pom are correct - pomegranate juice has the highest concentration of antioxidants of any other juice. Antioxidants help break down the free radicals that are the natural result of breathing oxygen (sorry, you can't do anything about that - yet). For added nutritional benefit, buy whole pomegranates and make the juice yourself at home.5) Wash your hands. Often.The vast majority of infectious diseases are spread by your hands. While you may not think about it, your hands come in contact with your mouth and nose often, and those are the easiest orifices for bacteria and viruses to enter your body. Wash your hands, and you may stave off that cold going around the office.6) Try zinc.Despite the lawsuit against Airborne, zinc has been shown in clinical trials to shorten the duration of viral colds. Though the mechanism is unclear, it probably strengthens the epithelial cells that line your respiratory tract. Zinc is available in a number of preparations, including nasal sprays, cough drops, and supplements.7) Embrace the fish.Over the last 20 years, doctors have understood that the cholesterol we have floating around in our arteries deposits and eventually clogs the small vessels in the heart and brain. Unfortunately, it seems this process starts early in life, before the symptoms of cardiovascular disease appear. The omega-3 fatty acids, which are found in certain types of fish, seem to slow this process, and a recent large study confirmed that adding omega-3 fatty acids prevented heart attacks and strokes. A word of warning, if you decide to add a supplement, you may experience the unfortunate side effect of "fish burp."8) Moisturize.This recommendation is probably the most debatable. While some studies have shown drinking eight glasses of water a day improves skin quality and renal function, others have shown no such benefit. However, when weighing the pros and cons, great skin and kidneys on the one hand, pale yellow urine on the other, I don't see the problem with making the recommendation. Of course, you can overdue it, so as with anything else in life, keep it in moderation.9) Wear sunscreen to the beach.This one is particularly difficult, even for me. While the short term benefits of sun exposure are readily apparent, the long term complications of a lifetime of suntans are well documented. Sun exposure causes premature aging, wrinkles, sun spots, and of course, cancer. In an age when everything is fake, go with the spray tan if you can.10) Visit your doctor.Nothing can replace the yearly physical with your family physician. The old cliche, "an ounce of prevention is worth a pound of cure" couldn't be more true, especially in today's economic climate. A statin once a day for the rest of your life is tens of thousands of dollars cheaper than your first open heart surgery, and even an expensive gym membership is cheaper than a lifetime of sequelae secondary to obesity. The important thing to remember is that early detection is really the best way to prevent disease, so go to your doctor, and do it often!

doctor's corner: pharyngitis

2009-10-07T13:03:00.004-05:00

I've had a lot of friends with sore throats recently and have answered a lot of questions about cause, and most importantly, treatment. So, in light of the upcoming cold and flu season, I thought it was timely to address the most common diagnosis at the doctor's office: pharyngitis.Sore throats are the bane of employers, accounting for more sick days than any other complaint. Pharyngitis is actually a very broad diagnosis that can be due to a number of causes, the vast majority viral. While everyone has probably had a case of strep throat as a child, caused by the bacteria Streptococcus pyogenes, most adults suffer an infection with one of the many viruses that can produce cold-like symptoms. This list includes the ubiquitous rhinovirus, as well as the adenovirus, influenza virus, cytomegalovirus, and Epstein-Barr virus, the causative agent of mononucleosis.The good news is that viral infections are typically self-limited. Infections rarely last beyond two weeks, and symptoms, once they appear, usually resolve themselves within 3-7 days. Unfortunately, there's not a lot physicians can do to hasten the recovery process. Treatment is usually supportive and includes the triad of family medicine: rest, fluids, and if necessary, pain medications. Ibuprofen or acetaminophen are staples; interestingly, aspirin may actually increase viral shedding and make the patient more infectious. Other treatments include gargling with salt water and vitamin C, D, E, or zinc. While supplements are widely available and commonly used, the data about them is mixed. However, as long as they're taken safely and within reason, there is little chance they'll prolong symptoms.In the case of influenza, antiviral medications are often used. It's important to note they're most effective within the first 48 hours of symptoms, so prompt treatment is required. There are rapid tests available for the seasonal influenza, and up to 70% of the time, H1N1 can be detected, as well. Again, the key is early treatment. There is no evidence treatment after 48 hours has any effect on the duration or severity of disease.One last note, which is more of a pet peeve than anything else: antibiotics, unless proven otherwise, have no role in treating pharyngitis. In cases of strep throat or other causes of bacterial pharyngitis, antibiotics need to be administered to clear the infection, however remember the vast majority of cases involve viral infection and do not respond to antibiotics. In my experience, most antibiotics are prescribed to alleviate patients' concerns and not to actually treat the disease.That's all for this edition of doctor's corner. If you happen to be unlucky enough to get a sore throat this cold season, take care of yourself first. But also keep this fact in mind: viruses are most contagious immediately after the onset of symptoms. So, help everyone else out, and take a few days off to get some rest after you realize you're getting sick.P.S. If you're a hypochondriac like me, there are a total of 229 causes of pharyngitis, but they're not nearly as common as viral infection. Check out the list here.

professionalism in the 21st century

2009-09-30T07:47:00.003-05:00

When I started medical school, the most notable advice I received in regards to professionalism was simple: Don't go to the bars in your white coat.Seemed pretty obvious at the time. In my opinion, the white coat, especially the short white coat, is one of the more cumbersome and unfashionable pieces of clothing in my closet. Why would anyone wear his or her white coat to the bar?Now, with social networking sites and Google, it seems more important what medical students do without their white coats. Increasingly, deans and residency directors, even patients, are Googling medical students and residents, and what they're finding isn't necessarily professional. Most recently, the Journal of the American Medical Association reported (registration required) that up to 60% of medical schools had identified cases in which medical students posted inappropriate information online. This information ranged from pictures of students intoxicated to details about patient encounters in which key identifying details were revealed. In at least one instance, a medical student was inappropriately requesting the online friendship of his or her patients. Of the more serious cases, at least seven resulted in medical students being asked to leave the program.It's really an interesting article and one that should prompt medical students to re-evaluate what they post online. It may be as simple as restricting privacy settings on sites like Facebook, but could be as serious as losing one's credibility as a doctor.Med Students Put Unprofessional Info Online

rising in the ranks

2009-09-29T21:28:00.003-05:00

Rereading my previous post about Med III, I can see how some people were concerned about my well-being. However, after finishing my third week on an inpatient service, I can report things are going much better. Since my last visit, I've taken a new approach. Thanks to some comments from others, I've started using Med III as an opportunity to learn, however selfish that may sound. While it is true medical students are part of the health care team, it is more important that we learn as much as possible, if for no other reason than to be better doctors ourselves when it's our turn to make the decisions. Also, it seems the more I learn, the better medical student I become and the more helpful I can be to my residents. I guess I had some growing pains to overcome, but I'm glad things are improving!