Monthly Archives: March 2014

Citrus Salmon Caesar Salad

citrus caesar salad

I have a freezer full of Alaskan salmon and I eat it at least twice a week. It is low in mercury, high in omega 3, and sustainable. This dinner entrée is satisfying, easy to make for a week night or for a special meal with friends. If entertaining you may want to splurge and make toasted sour dough bread croutons with butter and garlic. If your friends enjoy a low carb lifestyle then they won’t miss the bread.

Short cuts and fast food
Instead of this salmon preparation you could substitute my orange braised salmon recipe or use any leftover fish or chicken. Serve with a side of steamed broccoli and fresh fruit.

I have made this salad with rotisserie chicken and bagged lettuce that I purchased on the way home from the office after a busy day. This is a fast food that can be on the table in minutes. There’s no reason to stop for take out.

Citrus Salmon Caesar Salad

  • Servings: 2-4
  • Time: 40 minutes
  • Difficulty: easy
  • Print

Ingredients:
• 1 8 oz Pacific salmon filet
• 1 head romaine lettuce
• 1 tsp salt divided
• 1 tsp ground black pepper
• ½ c water or white wine
• 2 lemons, 1 sliced, 1 juiced
• 1 garlic clove
• 1-2 anchovy or 1 tsp anchovy paste
• 1 tsp brown mustard
• 1 organic, fresh egg – (Raw eggs may contain salmonella so infants and immune compromised individuals should not eat raw egg. I only use farm fresh eggs from a farmer I know. Substitute bottled Caesar salad dressing if avoiding eggs.)
• ½ cup extra virgin olive oil
• 2 oz shaved parmesan cheese, divided
Directions
1. Rinse and slice romaine lettuce, spin or pat dry, set aside.
2. Lightly salt and pepper the salmon with skin side down.
3. Place lemon slices in skillet with white wine or water and simmer for 3 minutes.
4. Place salmon over lemon slices and cover. Braise 10-15 minutes until salmon is no longer lucent, it should be uniformly pink, don’t over cook.
5. Prepare salad dressing (if using bottled dressing skip to salad assembly). You can also substitute 1 cup of mayonnaise for the olive oil and raw egg in this recipe. Whirl egg, garlic, olive oil, mustard, salt and pepper in food processor until frothy, add juice of one lemon and continue to process until combined. Add 1 oz of parmesan and combine in short bursts leaving pieces of cheese intact.
6. Assemble salad by combining salad dressing with romaine in a bowl to coat and toss. You will have leftover salad dressing. Reduce your calories by reducing the amount of dressing you use. Flake the cooked salmon into large bite sized pieces and arrange over salad and serve. Shave parmesan cheese over salmon

Notes:
Traditional Caesar salad uses bread croutons but I skip them in this low carb salad.
Serving size is 4 oz of salmon, 2 cups of lettuce, ¼ cup of dressing, 1 oz of cheese
550 kcal Carb: 7.5 gm, Protein: 36 gm, Fat: 43 gm (includes good monounsaturated, omega 3 fatty acids and some saturated fat)
Weight Watchers pp – 13 points

Diet Advice

You can lower the weight watcher points and calories by using less dressing or substituting a squeeze of lemon and a tablespoon of olive oil for the dressing. If I order salad in a restaurant when I am not in control of the dressing then I ask for the dressing on the side. I will often dip my fork in the dressing with each bite instead of drowning the food in calories.

Take what you need and savor every bite.

Yes: Contraceptive Care IS Preventive Care

Birth control counseling is between me and my patient. I would thank the government and the boss to stay out of my exam room. Women have fought long and hard for access to contraception. This is 2014 and there’s still a threat to contraception. Take a stand ladies. I’m wondering if the Hobby Lobby has any women executives who were able to climb the corporate ladder without the ability to plan pregnancy. Pregnancy is still the most dangerous health risk that young women face and birth control is preventative medicine.

acogpresident

Dr. Jeanne Conry speaks at the #NotMyBossBusiness rally on the Supreme Court steps on March 25, 2014. Dr. Jeanne Conry speaks at the #NotMyBossBusiness rally on the Supreme Court steps on March 25.

I had the unique opportunity to stand on the Supreme Court steps this morning and share my experience as an ob-gyn, and the experiences of my patients back home in California, as the Court hears arguments in the Hobby Lobby case. My patients are among the millions of women who need and deserve contraceptive coverage.

I have treated thousands of women in my career and have seen firsthand how birth control and contraceptive counseling have helped them. For some, it helped to avoid an unintended pregnancy. For others, it helped to delay pregnancy until the time was right. For others, it has helped other medical conditions. But they all had one thing in common: Their family planning decisions were personal and their boss was not in the exam room. That is the way it…

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Orange Braised Alaskan Salmon

orange braised salmon

Orange Braised Alaskan Salmon

  • Servings: 2-4
  • Time: 30mins
  • Difficulty: easy
  • Print

Ingredients:
•1 pound Alaskan salmon filet, substitute any pacific salmon
•2 oranges, 1 sliced in 1/4 inch slices and one juiced
•1/2 teaspoon sea salt
•1 tablespoon chopped fresh dill or 1 teaspoon dried dill
•1 tablespoon lemon zest
•1/2 teaspoon freshly ground black pepper
•1 teaspoon paprika
•1 tablespoon olive oil
•1/4 cup dry white wine
•1/4 cup water

Directions
In a small bowl, toss together salt through paprika to make a rub. Rinse salmon filets and remove any pin bones. Rub sea salt rub into the fleshy side of the salmon and allow to rest 10 minutes. Heat olive and lightly sear salmon, skin side up in the oil. Turn salmon skin side down. Add orange slices, juice of one orange, 1/4 cup of water and white wine and cover. Braise for 7-10 minutes depending on the thickness of the filet, until no longer lucent. Do not over cook.

Savor every bite

I leave you with pictures of the wilds of Alaska where this salmon was taken. For your own sailing adventure in Southeast Alaska visit www.soundsailing.com Captain Blain Anderson will take you on the trip of a lifetime.

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We had to yield our salmon to this big guy.
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WHO sugar guidelines

No one should be surprised by the compelling evidence that links increased sugar consumption with the sky rocketing obesity epidemic in the U.S. and in the World.

Check out the discussion here and savor every bite.

WHO | WHO opens public consultation on draft sugars guideline.

Is your doctor judging you or just putting the pieces of your story together?

puzzle

Am I judgmental?
I had an unusual encounter in my office with a new patient. After introducing myself I asked how I could help her and then I asked her to tell her story. Her problem was complex and there were key pieces of the puzzle missing so I asked her my usual probing gyno questions. What have you tried? When was your last period? Could you be pregnant? What do you use for birth control? Do you use condoms to protect you from STDs? Do you have sex with men or women? Is there pain and at what level and duration, odor, discharge, fever, chills, nausea, vomiting, and etc, etc?????

Take a deep breathe and give me the facts ma’am.
Doctors call this information the HPI or history of the present
illness. What made the patient seek help today? I call it the patient’s story.
I do not call it the Inquisition!

Was it something I asked?
I feel bad about this particular visit because the patient left dissatisfied and frustrated. I could sense her anger during the first five minutes of the discussion so I asked her how I could better help her and she said, “You are judging me.” Wait, what just happened? I was blind sided by her comments so I spent days trying to unravel, actually obsessing, about this interaction. Her situation was complicated so I needed as many pieces of the puzzle as possible to help her. Unfortunately my probing questions felt judgmental to her even though I truly was not judging her.

Believe me; I know when I’m asking judgmental questions.
Just ask my sons about the Inquisitions they endured when I found out they were jumping into the river off of railroad bridges or doing any of the many idiotic things that boys do! Those conversations were full of judgments.

Doctors are just human.
We do occasionally judge our patients as much as we try not to, but usually not over the things patients think we are judging. For example; when you contract an STD or experience an unintended pregnancy, I empathize with you but I don’t judge you. If you no show, no call for your appointment, then I judge your irresponsible behavior or your defective smart phone calendar. If you’ve had multiple sexual partners I don’t judge. If you yell at my staff because you failed to plan and now need an emergency prescription refill, then I judge your lack of planning ability. (Every prescription tells you how many refills you have left so you have many opportunities to call for a refill before you take the last pill in your pack. So don’t shoot the messenger!)

It is my privilege to hear your story
My son, the newest Dr. Delaplain, once wrote, “Every patient has a story and it’s a physician’s job to hear it.” We don’t know your story until you tell it to us. I genuinely want to help but I need the facts. You can’t offend, gross out or shock a gynecologist. In 27 years of medicine, I have heard everything, so trust me with your secrets. My exam room is a sacred and safe place. My lips are sealed. Tell me everything even if you are scared, embarrassed, have regrets, think its trivial, or think I’m judging you.

The next time you go to the doctor take the time to write down a few notes.
When did the problem start? What is the intensity and duration? What makes it better or worse? What have you tried? Have you had it before and what helped? Bring your old records if possible.

Help me find the missing pieces; tell me your story and don’t leave out the good or the bad parts.

Be well

Roma Saltimbocca di Pollo

meal ready
Please enjoy the recipe photo shoot that resulted in a cold, stressful, enjoyable meal. I’ve included a few photos taken in Rome. We rented an apartment in the Ancient quarter of Rome where I shopped for fresh produce daily and recreated a Cooking Light recipe with the ingredients that I found at the neighborhood market and the farmers market at Campo de Fiori.

Believe me photographing food is not for sissies. The glass of vino was definitely a reward. The lighting in my kitchen isn’t good enough to take photos in natural light so I set the camera on a tripod in the dining room. This necessitates running back and forth from the kitchen to the dining room. And no it wasn’t a long way but try cooking a meal tonight, while you prep the food in your kitchen, then take it into the dining room to be photographed. (The thought of anyone moving raw chicken from room to room probably has my salmonella obsessed sister shuttering about now.) Apparently you are never to photograph food with a flash but I did it anyway ‘cuz, I’m a rebel like that. Anyway, the photos are fair and the meal was lukewarm but my man and I gladly ate it after the aerobic photo sprints. Cheers. Savor every bite.

Roma Lemon Saltimbocca di Pollo
Adapted from Cooking Light Magazine with embellishments and
inspiration from Rome
Preparing saltimbocca

cooking phase

Ingredients:
4 boneless, skinless organic 1/2 chicken breasts (about 4 ounces each)
If the breast are thicker than 1 inch then filet them in half through the flat center.
1 teaspoon black pepper
8 thin slices prosciutto
8 sage leaves, more for garnish
3/4 cup flour
2 tablespoons butter, divided
1 1/2 tablespoon olive oil
2 lemons divided
Lemon juice from 1 lemon, 2 tablespoons
1/2 cup dry white wine
1/2 cup low-sodium chicken broth
1 tablespoon of capers
Lemon wedges
Makes 8 servings.
1 serving 7 WW points plus, 334 kcal
Fat 18 gm
Carb 3 gm
Protein 30

Instructions
Prepare the chicken and cut into thinner pieces if needed. Pepper the chicken but skip the salt. Prosciutto is salty enough. Place 2 large fresh sage leaves over each breast and wrap with 1 slice prosciutto. Dredge each breast in wheat flour. Heat olive oil and 1/2 the butter in a skillet until hot (not smoking). Cook chicken and ½ thinly sliced lemon for 7 minutes on each side over medium heat until juices run clear. Squeeze 1 lemon over the chicken pieces and the pan. Remove the chicken to a plate. Add wine and de-glaze the pan, scraping the brown bits. Add 1/2 cup broth and simmer 3-4 minutes until slightly thickened. Add remaining butter and capers. Drizzle chicken with the sauce, fresh lemon slices a sprig of fresh sage or basil.
chicken on platter

Notes:
Traditional chicken saltimbocca uses scallopini (pounded flat) chicken breast. Who has time for that? Seriously? You can skip the lemon and capers but why would you do that? You could substitute veal but please don’t.

Serving ideas: Serve over wilted fresh spinach, faux zucchini noodles or asparagus. No need for heavy pasta with this hearty dish. Garnish with lemon slices. Enjoy with a 5 oz glass of white wine.

Complete meal as shown including a glass of wine, total 611 kcal or 12 WW points

Faux Zucchini Pasta Pomodoro
Sauté 1 cup of cherry tomatoes in 1 tablespoon of extra virgin olive oil with 1 clove of chopped garlic. When tomatoes burst add 2 cups of faux zucchini noodles and a hand full of fresh basil leaves. Cook until crisp tender. 127 kcal, 9 gm carb, 9 gm fat.

Wine suggestion:
A crisp Pinot Grigio or Sauvignon Blanc.
white wine glass

Savor every bite

The roof top apartment overlooking Vatican City where this recipe was born.

vatican city

Rome street, tracey

piazza navona

Roma windows

ostia antiqua

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Do I really need a mammogram?

Do I really need a mammogram?

I hear this question every week. My quick answer to any question that starts with, “Do I really need to do this test?” is “Only if you want to know the answer”. I’m not trying to be trite or sarcastic. My philosophy is to only order tests when the results will make a difference in my patient’s health or well being. My job is to help my patients navigate the healthcare system. You always have choices and responsibilities when it comes to accepting a physician’s advice.

The usefulness of mammograms has been the focus of recent research.

For an in depth review, see these articles.
Screening Mammography: Making an Informed Decision
Tom G. Bartol, NP
February 27, 2014 WWW.Medscape.com

Quantifying the Benefits and Harms of Screening Mammography
Welch HG, Passow HJ
JAMA Intern Med. 2014 Mar 1;174(3):448-54. doi: 10.1001/jamainternmed.2013.13635.

The benefit of mammograms in reducing breast cancer deaths is in question. There is compelling evidence that the number of deaths from breast cancer has been reduced very little in the last few decades, despite a marked increase in diagnosed breast cancers. The implication is that we are finding more cancers with the improvement in and availability of screening tests, i.e. mammograms, ultrasounds, and magnetic resonance imaging (MRI) but we aren’t reducing deaths from breast cancer.

In Screening Mammography: Making an Informed Decision, Tom Bartol, NP makes the case for patient education concerning mammograms. I agree that patients should be given more data about their choices before the provider orders a mammogram. You would probably be surprised if your doctor asked you if you would like to have a mammogram since 40% of patients are not given a choice and 54% of patients never have their choices explained.

The mammogram is a very good screening tool to detect early breast cancers. Patients and physicians believe that having a mammogram will reduce the patient’s risk of dying from breast cancer, and they do reduce deaths. However, all of us are probably overestimating that benefit. Breast cancer accounts for 40,000 deaths per year or 1% of all deaths. Those are very small numbers so it is easy to see that if a mammogram only saves 16-49 lives per 1000 women that statistically the mammogram is not a cost effective test.

 

Am I saying that mammograms are unnecessary? Absolutely not and I hope you are asking yourself “but what if I am one of those women who’s life is saved by a mammogram?”. The answer of course is that the test was extremely cost effective for you.

Population studies don’t take into account the benefits of any one test to the individual. The benefits of a mammogram increase with the age of the patient being studied. I know that we will be seeing more and more of these types of reports on the cost effectiveness of medical testing as we try to curb escalating healthcare costs in this country. You should expect to hear your physician talking about necessary and unnecessary testing more often as we venture farther into cost effective, evidence based medicine. (That’s a discussion for another day.)

Have a seat at my kitchen table and let’s chat about your choices.

As always my advice is general and every woman should make decisions with the assistance of her personal physician who knows her history and physical exam findings.

Lesson #1
A mammogram does not replace the physical exam! Get an exam and do a breast self exam.

Lesson #2
If you have a lump that you or your physician can feel then you need a diagnostic mammogram and/or breast ultrasound and the statistics for screening mammograms no longer apply. Twenty percent of breast cancers that you can feel are not seen on screening mammograms.

Lesson #3
Do not panic if you are called back for additional views. You have a 50% chance of having a false positive result in your lifetime that will necessitate additional views. Of those having additional views, about 10% will result in a biopsy. Only a few of those women will actually have cancer.

Lesson #4
If you are notified that you have a dense breast on mammogram don’t be scared into paying cash for unnecessary additional testing. The younger you are, the more dense your breast will be. Make an appointment with your doctor to discuss the results first and if you haven’t had a recent breast exam then HAVE A PHYSICAL EXAMINATION OF THE BREAST. See Lesson # 1. Your doctor can interpret the results in light of your exam, family history, age, and your personal risk factors. The radiologist doesn’t know you when she dictates your mammogram report.

Lesson # 5
You have a choice but you are also responsible for your choice. Ask questions. Consider your options and ask yourself, “What if I’m one of the 40,000 women who will die from breast cancer because I didn’t have a mammogram?”. You are the only one who can answer that question. Always remember Lesson# 1 and Lesson # 2 and don’t make your decisions in a vacuum with too little information.

Follow me if you would like to see more kitchen table chats.

Be well