Chocolate Chip Pumpkin Bread

This one wins approval from my hallmates!  I'm posting the original recipe + the "healthified" modifications in parentheses.  The only changes I'd made in my next batch would be to up the spices, perhaps to 1.5 tablespoons of cinnamon and 1/4 tsp. of nutmeg.

 

Chocolate Chip Pumpkin Bread

1.5 cups all purpose flour (replaced all flour with white whole wheat flour)

1.25 cups whole wheat flour

1 tsp. baking powder

3/4 tsp. baking soda

1/2 tsp. salt

1 tbsp. cinnamon (would increase this to 1.5 tbsp)

1/8 tsp. nutmeg (would increase this to 1/4 tsp)

1/8 tsp. ground cloves (didn't have this)

1 cup canned pumpkin (oops - I used a whole can and it turned out fine!)

2 large eggs

1/2 cup veggie oil (1/3 cup oil and a few tablespoons of applesauce)

3/4 cup sugar (1/3 cup sugar)

handful of chocolate chips

Preheat oven to 375 F.  Grease 1 8.5" loaf pan. Sift together flour, baking powder, soda, salt, spices.  In another bowel, combine pumpkin, sugar, eggs, oil.  Add dry ingredients to pumpkin mixture and gently stir together until combined.  Fold in as chocolate chips.  Pour and scrape mixture into prepared pan and smooth top.  Bake ~40 minutes (check at 30 minutes).  Allow to cool before slicing.

The mixture is pretty thick. Next time, I may experiment with adding half a cup of yogurt to make this bread more moist (although I overbaked it at 45 minutes), but I think it's delicious as is.  Without the whole wheat flour, I doubt you'd need the yogurt.

Honey (Nut) Granola

Another super easy recipe.  Much healthier and I think just as tasty as store bought granola.  Be warned that my adjustments again "healthify" the recipe, so if you like sweeter granola, add more honey and/or brown sugar.  Also, this granola is not terribly clumpy.  To create a clumpy granola, you need to add more honey.

Honey Nut Granola

4 cups rolled oats
1 cup sliced almonds*
1 cup chopped pecans*
1 cup raw sunflower seeds*
1/3 cup canola oil --> I subbed 2 tablespoons olive oil + 1/3 cup applesauce
1 teaspoon vanilla
1 tablespoon cinnamon
1/2 cup honey" --> I used about 1/3 cup and found the granola to be plenty sweet.
*I had none of these ingredients but the nuts really take the granola up a notch.
"If you don't have honey, mix 1/2 cup brown sugar together with some hot water and add to granola.

Preheat oven to 280 F (don't go over 300 F!).  In a large bowel, combine oats, nuts, sunflower seeds.  In a separate bowel, mix oil, honey, applesauce (if using), vanilla, cinnamon.  Add to dry ingredients and mix well.  Spread onto a parchment or non-stick foil lined baking sheet.  Bake 10 minutes, stir, bake another 10 minutes.  Repeat until granola reaches your desired crunchiness.  Remove granola from baking sheet and cool.

This recipe is so versatile.  Potential variations include:
- Adding toasted pumpkin seeds and pumpkin spice for a fall granola
- Dried cranberries, apples, etc. after baking (don't bake these - you'll get a mess)
- Cashews and ground ginger.  Then, add dried crystallized ginger bits after baking.
- Chocolate chips and coconut flakes

Easy vegetable soup

I was in the mood for something filling, healthy and most importantly, had vegetables in it.  I can't even begin to go on about how poor my diet is in the hospital.  Fortunately, my mother taught me something about cooking and I threw together this easy vegetable soup.  Emphasis on the word easy - this soup is so forgiving that even folks like me can successfully make it.  The thing is, I'm not exactly bad at cooking.  It's just that I hate measuring things (1 tsp of cinnamon = okay, I think I'll just do a couple shakes); my pantry does not contain items such as spelt flour, agave nectar, nor Israeli organic sea salt (okay, I made the last one up); and I "healthify" everything such the end product never ends up tasting like what you'd purchase from Panera or Au Bon Pain (think 500 calorie butter-rich blueberry muffins that taste as such).  That's why this soup is perfect - no measurements, no special ingredients, healthy to begin with...and delicious!

Easy Vegetable Soup

Ingredients
- carrots
- potatoes
- cabbage
- squash
- spinach
- other vegetables (see below for suggestions)
- chicken stock, or if you're cheap like me, chicken bouillon

Feel free to mix and match vegetables, but I will say that I think the potatoes are key (sorry carb haters).  They help thicken the soup.  Tomatoes add a nice tang and I think fresh peas would also be delicious.  I love cabbage but they impart a strong flavor.  Essentially, you want to add veggies that take longest to cook (potatoes, carrots) first and wait until later to add the faster cookies ones (tomatoes, squash, spinach).

Dice carrots and potatoes.  Add to enough boiling water so that's there's ~1-2 inches covering them.  After ~2-3 minutes, add chopped cabbage.  When cabbage is almost soft (this takes about 5-7 minutes at med heat), add sliced squash.  When all ingredients are soft, add a few tablespoons of chicken bouillon to taste.  Then add chopped spinach until wilted and mix well.  serve with some bread.  But not the bread that I make.

Bread: 1 Human: 0

I got it in my head a few weeks ago that I had to make fresh bread. All that carby deliciousness - well, I just had to be a part of it.  No matter that I had never made real bread, with yeast, before. I was on a mission.

I hiked over to the grocery store and bought two packets of active yeast and woke up very early in the morning in anticipation.  My hopes were high.  Presenting the result:

 Yeah, that worked wonderfully.  I knew I was in trouble when the bread barely rose at all.

Fortunately, this turned out better:  Recipe to come in another post.

Half way finished???

I officially reached the half way mark of third year.  I can't believe it; third year is flying by way too quickly and at this rate, I'll still be clueless by the end of the year.  I took the neuro shelf and am pretty exhausted.  There were lots of questions about peds neuro and what the heck do I know about that, given that I'd never seen a kid the entire time while on neuro?  I hope that I passed the shelf!

This weekend, I definitely need to think, recharge, and prepare mentally for medicine.  I really want to get the most out of this medicine rotation and do well in it.

Cool (or perhaps not so cool but certainly memorable) things in neurology:
1.  Watching everyone's response to an acute stroke.  It's no joke and has been the closest thing to ER (meaning the TV show, with all the doctors/nurses running alongside a patient's gurney, mowing down everything and everyone in the way) that I've witnessed so.  The urgency of the situation is palpable.  Time is of the essence since there's a 3 hour window from symptom onset to give IV TPA and 6 hours to give IA (intra-arterial) TPA.  Sometimes we get transfers from outside hospitals and can only shake our heads: they scanned the patient, saw an ischemic bleed, yet didn't give TPA - are you kidding?  Now the patient is out of the time window!

2. TB meningitis.  So very rare in the U.S yet we had a patient in the Neuro ICU with what we are almost entirely sure had this.  The patient had the classic pattern of cerebral damage.  Unfortunately, she declined rapidly and passed away.

3. Serotonin syndrome.  Also no joke!  The patient's temp rose to 105, hypertension, tremor, and some serious clonus.  He was taking linezolid and demerol, the combination of which we think triggered the serotonin syndrome.  Did you know that linezolid, in addition to being an antibiotic, is an MAO inhibitor?

HSV meningitis

Classic characteristics:
1. Temporal lobe involvement
2. PLEDs (periodic lateralized epileptiform discharges) on EEG
3. CSF : normal to slightly low glucose, mononuclear pleocytosis with lymphocyte predominance, elevated protein, can have elevated RBC

Parkinson's Disease and Atypical Antipsychotics

We saw a pt today who looked like he had classic Parkinson's Disease - masked facies, cogwheel rigidity, trouble swallowing, stooped posture, trouble initiating movements, and a resting, pill-rolling tremor.  Turns out, he had Parkinsonism, likely from the risperidone he had been taking for many years for his bipolar disease.  So what do you do about pts with bipolar/psychosis/schizophrenia (too much dopamine) who have Parkinson's features (too little dopamine)? 

Olanzapine (Zyprexa), risperidone (Risperdal), and aripriprazole (Geodon), all atypical antipsychotics, worsen motor function.  Clozapine (Clozaril) is an acceptable alternative due fewer extrapyramidal side effects, but since it requires vigilant monitoring for agranulocytosis, the drug of choice is quietapine (Seroquel).

Publishing in EMR

Resident #1: Did you see that NEJM editorial that Annie (senior resident) published?

Resident #2: Yeah, she's a publishing machine.  Did you see the article she wrote for JAMA last year?

Resident #1: I heard about it...she did it on bedrest.

Resident #3 (overhearing): Ha, the only articles I've authored are in [name of electronic medical record system.]

Stuffed!

Good food makes everything better!  I'm currently enjoying mushroom ravioli with squash and sage sauce, spinach salad with blue cheese, cranberries, Granny Smith apples, and candied walnuts, and cannoli.  The delivery person forgot the cannoli and came back within 10 minutes with twice the cannoli I had ordered.  Great for my palate, not so much for my arteries!

Sigh...

Totally can't bring myself to study...what happened to motivation? :(

Mr. G

Mr. G arrived on the Neuro ICU early Thursday morning.  A man who had barely crossed the threshold into middle age, he suffered from relapsed refractory leukemia.  The cancer had left him with few functioning blood cells, causing him to develop an intracranial hemorrhage.  The resident loaded him up with bag after bag of FFP and platelets, to no avail - his INR, at 1.7, would not budge.  Finally, she pulled the "big gun" and ordered Profile 9, a specialized blood product used as a last resort in coagulopathies.  The resident jokingly pointed out that with one click of a mouse, she had spent her entire year's salary on this patient.  (Profile 9 is apparently extraordinarily expensive.)  But the cancer had put its foot down, and his INR went up to 1.8.  The bleeding, however, was only one of his many problems.  Overnight, he had spiked fevers as high as 105 and no amount of antipyretics, chilling blankets, and even cold saline would touch his fever.

Mr. G's room was located directly across from the Neuro ICU resident "nook," where we sat to type notes,  examine images, and check lab results.  Even from 20 feet away, I could see that he was miserable.  Shivering and delirious, he managed to nod when we asked if he was nauseous.  His wife visited daily, and I learned that he had a young school-age daughter.  Over the next few days, I watched him slip further away and become less and less responsive.  Eventually, he was transferred to the oncology floor, where he died the next day.  In my short two weeks in the Neuro ICU, I would see 3 others on the floor pass away, but none that were as excruciating to witness as Mr. G.  I hope his family finds peace.

Neuro and the Stanford 25

It's been over a month since I've written and I feel that so much has happened since then. I see so many things in the hospital, and as I've written about in my last post, sometimes it is just easier not to think about them. Of course, the unconscious thinking doesn't, or rather, can't stop.

In any case, I'm currently on my neurology rotation, and it's been among my favorite so far. I finished two tough weeks in the Neuro ICU, spending long hours seeing very, very sick patients, most with such poor prognoses. I love neurology. I love how diagnostic it is, how doing a thorough neurologic exam correlates with the pathology. These neurologists are some of the best observers and diagnosticians that I've seen. I love how academic the field is, how we spend hours discussing patients and case reports and latest treatments based on clinical trials and pathology and pathways. At the same time, it intimidates me a bit. What I don't love is how little we have to offer these patients. Stroke - okay, let's watch it and make sure your BP doesn't dip too low. In the meantime, you're weak on your L side, encephalopathic, and probably just lost half of your ability to function.

At the beginning of third year, my top choice specialty was oncology. A field within internal medicine is still at the top of my list, and if I couldn't go into IM, I'd probably pick neuro. Neurology and oncology. Two extremely academic specialties. Two with very high morbidity and often, mortality. Tell me why I'm attracted to fields where the patients are sick, sick, sick and often die?

Other thing is that I really need to work on my physical exam. I can do the motions yet, but I certainly haven't any where near mastered the ability to elegantly palpate a spleen, access a thyroid, listen for heart murmurs. I like this site that I found from Stanford's Abraham Verghese, a physician-humanist who wrote The Tennis Partner. It's 25 "must know" physical exam techniques to master, called the Stanford 25. Yeah - go Stanford! It's here at: http://stanford25.wordpress.com