My new computer is a car

After seven good years my Mini Cooper is gone, replaced by a 2012 Ford Focus.

Good things about the Mini: fun to drive, easy to find parking.
Less than good things about the Mini: premium gas, 21 actual MPG city, run-flat tires (stiff harsh ride and expensive to replace), no spare tire, rear seating a suggestion more than a reality.

Good things about the Focus: regular gas, 28 actual MPG city, computer on wheels, nice ride, more space, parks itself, american made, very competitive pricing.
Less good things about the Focus: sync interface by Microsoft.

When my wife got her Prius in 2004 I was amazed at how easily she could walk up to a locked door, open it, get in and push-button start the car without taking a key out of her pocket. Not only that but her bluetooth phone automagically paired and worked with the handsfree system. At the time there were novel features. Now I can finally do the same and much more. Go Detroit!

Recipe for pain

Start by overeating. Blend in two glasses of wine. Elevate to 6200 feet above sea level. Put on an elliptical machine for 30 minutes or until done, whichever comes first.

I now have an inkling of what Jon Krakauer was talking about in Into Thin Air.

Back to sea level tomorrow.

Kale

So this is what bolted in the garden last week. How to cook it. That was the question.

So I checked my favorite recipe sources and the consistent recommendation was Kale with Cannellini in one variation or another. But most called for lacinato kale (also called tuscan, nero, dino or variations of all). But we have red russian kale, which I learned only by googling some images. Apparently we chose it for it's less bitter taste than the more common curly Kale, at least that's what Elaine suspects. It grows earlier in the season also. But I couldn't find specific recipes for russian kale so I did what I've learned to do. Don't look at the specific ingredients, look at them as placeholders for a class of ingredients.

All the recipes for kale with beans called for sautéing veggies in a fat, then adding spice, liquid, and then beans and greens. Most sautéed a few onions, carrots and garlic in olive oil, then added cannellinis, liquid and kale. Others substituted pancetta or sausage fat for olive oil, added some celery or tomatoes to the carrot, or used other beans (navy, great northern, lima, kidney, black) or other greens (spinach, collards, chard, cabbage). The variations are clearly endless, but the overall approach was the same.

And so this is my recipe, based on what I had on hand and in our garden. One chopped carrot, onion and celery stalk sautéed in a little olive and sesame oil until softened. Then 3-4 finely chopped garlic cloves and 1/4 teaspoon of salt for another minute. I then added 3 cups of chicken stock to the mirepoix, bringing it all to a boil before adding 7 cups of washed, de-stemmed and chopped kale. I then simmered for 3 minutes and added a 1/2 can of cannellini that had been puréed with 1 cup stock and then the remaining  1/2 can of cannellini and 1 can of black beans (it was all we had). A little more salt, some pepper, a bit of chopped thyme, rosemary and sage from our garden and the juice of one lemon to add some taste. Served it with some shaved parmesan cheese and olive oil drizzled on top. Would have been better yesterday when it was raining and 58 degrees rather than sunny and 78. But it'll do. It'll definitely do.

Refusing to cry, refusing to laugh

"My dear Kepler, what would you say of the learned here, who, replete with the pertinacity of the asp, have steadfastly refused to cast a glance through the telescope?  What shall we make of this?  Shall we laugh, or shall we cry?" 

--Letter from Galileo Galilei to Johannes Kepler

Somalis in Minnesota have experienced a higher than predicted rate of measles and resultant excess of preventable deaths in the past year. A similar measles outbreak occurred in 1996-97 in Minnesota in children who were members of a religious group who eschewed immunizations. It also happened in 1977. Same place, same disease, same issue.

California and elsewhere have seen outbreaks of Pertussis (whooping cough) in recent years.

And last but not least Polio continues to win skirmishes in a war thought won 60 years ago.

I personally participated in immunization drives to combat a measles outbreak in Philadelphia in the late 1980's. I've also had the "privilege" of performing a lumbar puncture on a three month old infant with Hemophilus Influenza Type B. 

All of which leads me to struggle with how to respond to those who continue to warn of the risks of immunization. Autism! Seizures! ADHD! Asthma! Diabetes! Death! And worst of all Peanut Allergies! OMG!

Are you as non-plussed by the sensationalism, hucksterism, and general snake oil feel to the anti-immunization fringe as I am? Puh-lease save me your "What your doctor doesn't want you to know...", "We have real qualifications too...", "Just buy this..." and especially your "God doesn't want you to vaccinate...".

Yes, Immunizations are risky. We no longer use oral polio vaccine because of the risk of vaccine associated polio. We use inactivated polio instead.

Yes, Immunizations are not perfectly effective. But perfection is the enemy of the good, and immunizations are much more than good enough, measuring higher even than chocolate or Cliff Lee on the goodness scale.

Immunizations are not a choice between disease and no disease; they are a choice between less vaccine preventable disease and complications (with all the costs that come with vaccination) and more vaccine preventable disease and complications (and all the costs that come with no vaccines.) If you wish to save money, vaccinate. If you wish to reduce overall morbidity and mortality, vaccinate. These choices are not imaginary; they are written in the history of those who've made them before us, and those who forget the past...

Lastly, immunization is a social act. The risks of vaccination are borne by those who vaccinate, while the benefits of immunity are received not only by the vaccinated but also by those who aren't, whether they ask for it or not. The least the un-immunized could do is gracefully and thankfully accept that saner, braver folk are not only willing to tolerate their fear but also work to ensure that it doesn't kill the rest of us. But history also tells me that this expectation is too great. Sigh.

Sometimes my patients ask me "Do I have to take this medicine for the rest of my life?" or, in another version "Should I get this immunization?", and my answer to both remains the same. Yes, until we know  better, or until something better comes along. Knowing better or identifying something better is often hard, except in the case of immunizations. That one is easy. For most of us anyway. So long as we wear head protection.

We love you Bruiser

Bruiser died today. Suddenly if not unexpectedly. He's been on medications for his heart for years, and could barely make it around the park without getting short of breath, but he still wagged his tail and pranced for joy until the last, like all good dogs do.

He was 11 years and one month old today. Here's a picture of him with his siblings. You can tell why he was called Bruiser. He's the one with the blue collar.

Like all Scotties he thought he was bigger. Here he's playing (and winning) at Frisbee with his cousin Scout.

But this is how I'll remember him - tail wagging and wanting to play.

Good dog.

Good dog.

Travel and Karma

I'm waiting for my flight back to PHL from SeaTac after a week in Seattle-Vancouver-Olympia and feel compelled to share the benefits of a week of good karma.

As I learned during a forced layover in Rouen several years ago the travel gods kneecap your best laid plans for a reason. In this instance last minute changes resulted in my 'discovering' the Chucknaut Drive in northwest Washington, the Skagit Valley Tulip Festival, Mallard Ice Cream in Bellingham, the Sunset Inn in Vancouver's Davie Village, Milestones Restaurant in Kitsilano, the Cedarbrook Lodge, and the best meal of the trip - homemade (literally!) pasta with asparagus, fennel, and red onions by none other than Chef Daniel Lipson (husband of noneother than Penn's own Michelle Seelig) who moonlights daytimes as a Physician Assistant at Group Health Puget Sound. If there were ever an argument for slow travel, this trip was it. Get off the interstate peeps!

I was in Vancouver for the Society of Teachers of Family Medicine. As is true of all good meetings I learned more than I thought possible and benefitted repeatedly from serendipity.

For example I would never have planned 20 minutes in a private informal discussion with Jerome Kassirer, emeritus editor of the New England Journal of Medicine, but that's what happened when he chanced upon me in an out of the way spot we both discovered while waiting for his talk. Was he hoping to nap too? And what a talk! His slides aren't up yet but here's a podcast of his thoughts on industry-medicine relationships. Standing ovation from a full house. At 4:30 in the afternoon! Be still my heart.

The mantra of business travelers is free (fast) wifi and breakfast, but Cedarbrook Lodge (right at SeaTac!) provides the fast free wifi, breakfast of charcuterie, hard boiled eggs, outstanding coffee, oatmeal, juices, bagel, croissant, cheese, yogurt, artisinal bread, in the room you see here. The view out the floor to ceiling windows is even better. Great rates through online booking sites. If you have an early flight out of SeaTac you *can't* stay anyplace else. Did I mention the free all you can eat malted chocolate balls in three different flavors (mint, chocolate, and butterscotch)? Inconceivable!

I met some great new folk, caught up with old friends (Congratulations Mike R.), and remain impressed that our specialty is attracting some enthusiastic and energetic young talent like our own Mario DeMarco who talked about experiential learning in residency properwise. The man haz powerpoint skillz.

And who could ask for more than a dropped ball in the 11th to seal a passable if not winning road trip for the Phillies?

Glad to be coming home. The gate agent is calling...

I have more than enough. Do you? Here's how to tell.

Kurt Vonnegut first got my attention as a freshman in college. I ran across this when he passed away a few years ago and thought I had lost it. Fortunately a friend's request got me looking again and reminded me how Yossarian and Billy Pilgrim are related.