Sunday, November 29, 2009

Sunday Night Suppa'

My neighbor Irene has hosted a Sunday night dinner for our mutual friend Lelia Hamilton for many years. Both women epitomize the idea of graciousness. Lelia recently fell and fractured her hip, and she is doing very well -- mending in a metroplex rehabilitation hospital and hopefully will be home soon.

Tonight to fill the evening, I hosted the Sunday night dinner. Irene joined us along with Kristen's parents, Julie and Bill Maupin, and Tom Adams -- famed local (and even not so local) florist, caterer, and decorator.

Lelia always remarks at her China gilded parties that it is "something I just threw together for suppa'." Well, tonight I tried to emulate her idea of a good time as best as possible in her absence.

Tom started the evening with a wonderful cheese tray, fruit, glazed almonds, and dehydrated garlic (of all things!). The first dinner course was a doubled poured soup of roasted red pepper on one side and fresh corn-jalopeno soup on the other. My daughter Cathryn helped today to create the garnish of ancho chili cream and cilantro cream. The main course was served family style with grilled ribeye steak with lemon, rosemary, and olive oil; broccoli slaw; and, roasted new potatoes.

Dessert was special (my Sweetie likes these): roasted pears with caramel sauce. The recipe from Kate Zuckerman's cookbook was fabulous.

The wine worked well tonight. Irene surprised everyone with a '81 Bordeaux! Perfection. I refilled with Caymus -- not the typical drinks our house!

But whether its food or wine, the people are what make an evening meal special. And, in this case a special Sunday night suppa'.

Saturday, November 28, 2009

Thanksgiving Leftovers with a twist

Every year we are daunted by the volume of left over food from Thanksgiving dinner. This year was no exception. From a 20 pound turkey along with corn bread dressing for 19, we combined it with a 12 pound smoked ham. Plus, all the trimmings of giblet gravy and cranberry sauce.

So with the challenge of figuring out a way to convince my family and friends to eat one more turkey meal I thought I would try something new. This worked out well since we were asked to have a "leftovers" dinner with two of our closest friends, Meredith and Fred Biltz. Both are avid cooks and love to entertain. They provided wonderful cornbread dressing, ham, and Meredith's Mother's fresh mustard greens -- not something you regularly see on a table in the year 2009.

But we tried something different: I took the cornbread dressing (complete with sage, onions, garlic, and of course chopped egg) and combined it with some standard masa harina tamale dough, chicken stock and, of course, some lard. After whipping this in the stand mixer it looked great, but I added in some poultry seasoning, sage, and some salt and cracked black pepper to round out the flavors.

Next, I shredded the chicken and combined it with some left over giblet gravy. While this was all going on, I had dried corn husks soaking in hot water.

So here's the set up: I took the masa/dressing mix and spread a thin film on the corn husk. Then I laid down a small row of the turkey/gravy mix, and finished it with some few berries of cranberry sauce. I then folded over the tamale and placed it in the steamer where it cooked gently for 90 minutes.

And, you know what? They weren't have bad. We had a "Turkey and Dressing Tamale" -- the complete meal. Probably won't see it on any Mexican buffets anytime soon, but it was a cool way to eat leftovers.

Saturday, November 21, 2009

Turning off the engine...

Well, not really. But its as close as you can get in helicopter training to simulating an engine failure. Today we began autorotations.

Helicopters rely on a main rotor to supply both the airfoil and the thrust, or power, to stay aloft. Think of an airplane wing and engine combined. If you lose power, the main rotor continues to function as the "wing" to allow the chopper to glide. Now, to be honest, the glide ratio (how far you can glide compared to your altitude) is not as good as an airplane. Possibly 2:1 compared to 6:1 -- but, you need a much smaller spot to land if that's any consolation.

The key to any autorotation is to keep the main rotor turning. You see if it were to stop, you would fall like a rock. So to practice this maneuver you ascend to an altitude that will give you some time to practice before you land (say, 1400 ft AGL) and find a good open field as a target. And with my flight instructor Caleb counting down "3,2,1" I would lower collective (reduces power out of the main rotor), apply aft cyclic (pitches up the nose and causes air reversal through the blades), apply right pedal (weird thing about helicopters -- if you reduce power they want to turn to the left), and roll off throttle (reduce the engine speed to simulate an engine failure).

Then its just a matter of keeping 70 knots airspeed which is the best speed to give you the best distance, watch the main rotor RPM so that it stays around 100% (not to fast or to slow), and keep the field in sight. When you get close to your spot (since its just practice), pull in collective, set your pitch attitude, add back throttle, and climb to your altitude and do it all over again.

Its an essential skill in learning to fly a helicopter, and I have to tell you, a lot of fun. I'll keep you posted.

2009 Fall Psoriasis Symposium LIVE BLOG

Friday, November 20, 2009

Psoriasis in Eur-Asia

Today we hosted about 40 physicians from Europe, Asia, and Australia on the Baylor University Medical Center campus in the second part of the 2009 Psoriasis Forum sponsored by International Psoriasis Council. The event is coordinated by Dr. Alan Menter of Texas Dermatology in Dallas, Texas.

This two day event began with an introduction of the concept of psoriasis being a systemic disease - concentrating on metabolic syndrome (heart disease, liver disease, etc), joint disease, and the basics of systemic drug treatment. This afternoon I gave a review on "Biologic Drug Treatment in Psoriasis" followed by Dr. Caitrina Ryan from Dublin, Ireland who spoke on ustekinumab and other research drugs focusing on the IL-12/IL-23 pathway.

Tomorrow we invite patients to tell the story of the impact of the disease on their life. These emotional narratives really bring home the message of how devastating psoriasis can be on quality of life. Modern pharmaceutical therapy will allow most patients to enjoy life, many for the first time. One particular patient will tell the story of being kicked out of a public swimming pool at the age of eleven. He was thought to have something contagious and dangerous for those around him. We've come along way in taking away the stigma of the disease, particularly now that patients can access effective treatments.

Tuesday, November 17, 2009

Molecules of Omaha

I'm off this evening to Omaha, Nebraska to speak on behalf of Centocor as they educate physicians on their new medication Stelara. Stelara is a human monoclonal antibody that binds to two specific cytokines (IL-12, IL-23) to prevent lymphocyte activation and therefore inflammation in psoriasis.

The science behind the new medicines to hit the market these disease is remarkable. When I finished medical school in 1989 most of the pharmaceuticals released were considered toxic products -- that is, they worked primarily by chemically interfering with a biochemical process. Most were "shot gun" type drugs that had minimal specificity for organs or cell types. The result usually meant that in addition to monitoring a patient for improvement or in particular enhancement of a given blood marker (such as cholesterol), you had to also generally and carefully monitor organ function.

Enter the molecular age: today's drugs, if you can even call them that, rely not so much on chemistry, but on manipulating normal human constituents (antibodies, hormones, enzymes) and often perform the task as molecular engineered components of the body. Take Stelara, or ustekinumab as its known in the research world. This drug is a monoclonal antibody that binds to two different small chemicals found in the body in infinitesimally small concentrations (read picograms) and prevents them from binding to cell surface receptors. By blocking this marriage if you will, it prevents these cells from producing bad products that cause psoriasis. Only a small amount of this "drug" creates changes in the micro environment around individual cells that results in better health. No more "toxic" products to think about.

To be completely fair in disclosure, these new medications bring a host of new potential problems. From immunosuppression and the possibility of increased infections and malignancies, to rare bizarre neurological disorders, the jury is still out on the long term safety compared to commonplace medicines like penicillin. Nevertheless, for the first time, many patients are able to lead normal, productive, and satisfying lives with minimal interference of disease and minimal side effects of treatment.

Sunday, November 15, 2009

Smoke on the Bradley Smoker

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Grill first on the Hasty Bake

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Prep the ribs and charcoal

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Duane's Dual Grill Smoked Ribs

Cooking ribs is certainly an art form. Sure, if you are lucky enough like someone I know who owns a $14,000 Southern Pride, slow smoking ribs over hickory or mesquite for 8 hours is easy. And, they are great. Kristen and I were fortunate enough during a spring break SCUBA trip to Balmorhea State Park to stay at the Laird Ranch - a small B&B on the edge of dessert and town. Yes, I said SCUBA, and yes, it is just at the Northern tip of Big Bend National Park. Here the water bubbles from the earth into a large pond (read: pool) that contains fish and 30 feet of the clearest water in the world. This was Will's first official open water dive and it was perfect.

But, back to the ribs. There is very little in the way of food or for that fact anything in Balmorhea. Only one restaurant and a small gas station with a few packages of sandwich meat. The Laird's must have liked us, because although we were only able to stay with them one night, they offered to cook dinner for us the next. They sent two slabs of baby back ribs along with wine, potato salad, and cold slaw for us to enjoy at the park. Unbelievable people that not only shared their kindness and generosity but also awesome ribs. As a distributor for Southern Pride I'm sure he wanted to sell me one. If you haven't seen one of these beauties before, they are a backyard chef's dream. Measuring about 6 feet x 8 feet x 4 feet they aren't small. They have a rotisserie along with heat generated from an attached propane burner. The key though is the smoke box: where propane jets slowly burn whatever wood you desire to flavor your meat. In general, they allow you to "set it and forget it."

Creating slow smoked ribs in the backyard is more of a problem. Home smokers are challenged usually be the lack of consistency of temperature that's necessary for great meat. In addition, the caramelized sugar on the exterior of of ribs is hard to get with a home smoker. My brother in law Duane Sparkman, a CPA in Stephenville, Texas, is a phenomenal backyard chef. Having finally talked me into a Hasty Bake Grill a year ago, I am eternally grateful for him leading me down the rationalization path of spending $700 on a charcoal grill. But this has been probably the most used item in our yard ever since. Our poor Weber grill has spider webs and and a full tank of propane.

Duane's ribs allow for something similar to those Laird Ranch Southern Pride gems but are capable of being produced in three hours or so. These delicious ribs are due to the fact they are cooked in two parts: first, grilled on the Hasty Bake over charcoal, then smoked in an electric smoker for several hours. This two part approach has become my favorite way to cook spare ribs.

I've attached some photos to demonstrate the technique, but basically season your ribs with whatever rub you like (here I used William's BBQ seasoning, one of my favorites. Duane likes to use Don's Cajun Seasoning from a small company near Lafayette, Louisiana). Place them on the Hasty Bake over an open charcoal fire for about an hour. Then place them in an electric smoker set to around 200 degrees (we both use the Bradley Smoker) for about two hours . The result: great ribs that look and taste like you were at a BBQ cook off (well, we'll dream.). Let me know what you think.

Helicopter Skill Building

Caleb took this photo after we landed 4154C in Garland. Yes, I'm a little sweaty across the brow. A slight wind challenged my hover into the landing spot and especially the set down. I have to admit, this little machine (a Robinson R44) is quite a ride. We spent the afternoon doing some special maneuvers that were new to me.

We first practiced steep approaches into Mesquite Regional Airport. This is basically a normal approach, but instead of the usual 300 ft above grown level turn to final, you might be 600 ft. You just have to make sure you keep coming down at the same time you bleed off your airspeed. Once we landed, we made several high performance take offs -- ascend to desired altitude mostly vertical then slowly gain airspeed to 40k before you pull in more power. Not too difficult.

The final part of the day was practicing recovery from vertical ring state. Simply put, you have to be careful if you descend a helicopter into its own downwash: going down fast without moving much forward. To practice we go over an open field (I guess in case we have to land!), ascend to 2000 ft AGL, slow down to zero into a hover, then begin a rapid descent. Once we are over 600 feet per minute, even if you add power, you still go down! To recover, you just lower power and go forward on the cyclic to fly out of it. Not too bad at that altitude, but I wouldn't want to have to really recover from it on an approach. Prevention is the better part of valor.

Anyway, Caleb is a great instructor and the folks at Sky Helicopters couldn't be a better place for an old dog to learn new tricks.

New Texas Dermatology Videocast

Today I uploaded our first videocast using and Camtasia. Dr. Richard Warren, one of our visiting professors from the UK, did an excellent job giving the impromptu presentation. Linda Timmerman was a great editor as well. Its a little technical for most folks, but Richard's insight into methotrexate pharmacogenetics is really novel. Check it out: its entitled Pharmacogenetics of Methotrexate.

Saturday, November 14, 2009

Caramel Sauce

My family is easy to please: dessert tonight was caramel with Jona Gold apples. Nice to dip as a Fall after dinner treat. Sugar + Water + invert sugar + heat then cream and some vanilla and salt. Hopefully we will have enough left over for tomorrow!


Publishing a blog is something I never thought I would do. In fact, as our world has moved from print media and the days of the college newspaper being crafted on wax covered film, to today's life of Twitter and 140 characters, you would think that I would find ways to compress any message I might feel compelled to publish. But, that's not the case! I wanted a place to share ideas, content, links and photos with my friends. This seemed the right place for it. Thanks for clicking this blog and I look forward to any feedback you have.