Something Healthy For The Holidays: Crispy Kale!

I am grudgingly saying that I have a new favorite veggie. And it's only because it's crunchy, salty and so good for you. Crispy Kale Chips! I actually think I had been biased for all these years by an episode of "Cheers", where Woody ("Veggie-Boyd")  had to do a commercial extolling the benefits of kale. (Watch it here)

Kale is really rich in beta carotene, calcium, lutein, Vitamin K and Vitamin C.
Wishing all my American brethren a Happy Thanksgiving. Enjoy.

Recipe: Crispy Kale.

Prep Time: 10 minutes
Cooking Time: 10 minutes

Ingredients:

1 Head of Kale
1 Tablespoon Good Olive Oil
Sparing use of some nice seasoning salt. (I like stuff from The Spice and Tea Exchange)

Pre-heat your oven to 350 F, and line TWO cookie sheets with parchment paper.

Tear leaves from stems of the kae into large bite sized pieces. (they will shrink, so keep them on the larger size). I find the easiest way to do this is break the "branch" at the base of the stem, then tear the leaves from each side of the stem. Thinner stems are fine to leave intact. The thicker portion tastes a bit to gnarly.

Throw all the leaves into a large bowl, wash and pat completely dry.

Once the leaves are dry, pour the oil over, and massage it completely over every inch of the leaves. This will ensure even crispiness and maximum enjoyment.

Lay the kale leaves onto the cookie sheets, and try not to overlap, so that all the kale will crisp up.
Sprinkle your seasoning (can sub in whatever you like, but I like the simpleness of just good salt).

Bake for about 10 minutes, rotating pans halfway through.

NB. From about 8 minutes onward, watch them closely, looking for the edges to just get brown. The difference between glorious crispness, and awful burnt bitter kale is not far!

Let me know whether kale is a favorite of yours, and how else you prepare and enjoy it!

Controlling Holiday Weight Gain

It's the most wonderful time of year. American Thanksgiving, Christmas, New Year's, Hanukka, Kwanzaa; you name it, there's a reason to celebrate.
All well and good, but controlling ballooning weight gain this time of year can be awfully hard. Extra parties at work, with friends, with relatives add up quickly. Tempting treats, big dinners, excessive drinking are hundreds, if not thousands of extra calories you weren't taking in several months ago.
To make matters worse, the schedules get tighter, the weather is colder, the daylight hours are shorter, so the opportunity to burn off some of the excesses also decreases. Bad combination. Here are a few ideas to still enjoy, but control the extra pounds.

1. Have A Plan.
Absolutely critical. Know what type of party it is. Sit down meal, just appetizers, alcohol, desserts. Whatever you do, don't "bank" calories. What I mean by this, is don't starve yourself all day in preparation for eating "just a little extra" at the party. It WON'T work. Doing this generally leads to disinhibition at the event, with your brain telling you to gorge on high calories foods, because you have given it the signal all day that you are in starvation mode. Continue your usual routine through the day eating small healthy meals, and in fact, it often is worthwhile having a small snack just prior to going out.

2. Get A "Lay Of The Land".
When you arrive, don't reach for the first thing you see to eat or drink. Instead, take a minute to socialize, and look around and see what is being offered. Choose one or two things you'd like to try - I usually pick things that are special (that I can't normally get), seasonal, or just plain amazing. You don't have to "ban" any particular food - just stay in control and set a limit before you start.

3. Mix Drinks
This is an area a lot of people still have trouble with. Fluids tend not to make you feel full, and holiday drinks are calorie bombs. Egg nog, punch, hot chocolate, hot cider, can all be high in calories and fat, and only make you crave more. Alcoholic drinks are also high in empty calories and can disinhibit you from controlling the urge to shovel in high fat foods to absorb some of their effects.
Try an limit alcoholic drinks to 2-3 per party, and alternate with water or lighter drink.

One Final Note. Don't make the mistake in saying to yourself that "It's OK- I exercised today". No one can possibly exercise enough to burn off the calories you can pop in your mouth in mere minutes. It's important to  continue to exercise regularly, but don't get in the mindset that this gives you free reign to go crazy at the party tonight.

Enjoy the holiday season! Just don't let all your hard work keeping fit through the summer and autumn go to waste.

Let me know what other strategies you use to get through the holidays!

The Vitamix Blender : A Guy's Tool And A New Recipe

I recently got a new Vitamix Blender. Given that I already own a stick blender, and a decent mixer, I never would have purchased one, but, while looking through my Air Miles reward options the other day, I came upon the Vitamix. On a whim, I clicked OK, and received the new blender about a week later (really impressive shipping time, Air Miles!)

Being a guy, I was naturally sucked in by it's car-like features. "Powerful 2-Peak Horsepower Motor" that propels the blade tip "to speeds up to 240 miles per hour"! It had a "Radial cooling fan and thermal protection system". The blades are "laser-cut, stainless steel hammermill". The 64 ounce container is "BPA free Eastmann Triton Copolyester". (Not sure what that means, exactly, but it sounds so damn good.)
I swear, it sounded like I was getting a new car, so I do hand it to whoever does the marketing for these guys. And I was getting for "free"!


Anyway, I am impressed with how well it blends everything, from ice, to frozen fruit, to hard vegetables, to nuts, to whatever. I would highly endorse one, if you can get over the price. Here's something I made with Liv today, using the blender. You could easily grate the carrots and sub in applesauce if you don't have a high powered monster like this. Enjoy.




Recipe: Carrot and Applesauce Cake (modified from the Vitamix Create Recipes Book)
Prep Time: 10 minutes
Cook Time: 25 minutes

Ingredients
1 cup White Whole Wheat Flour (I like King Arthur)
1 cup All Purpose Flour
1/2 cup Sugar
2 teaspoons Baking Soda
2 teaspoons Ground Cinnamon
1 teaspoon Freshly Ground Nutmeg
1/2 teaspoon salt

6 Egg Whites
2 apples, quartered ( I just left in the seeds)
2 medium carrots

Instructions

• Heat Oven to 350 F and spray Loaf Pan with cooking spray
• Whisk together flours, sugar, baking soda, nutmeg and cinnamon
• Pour egg whites, apples and carrots into Vitamix Blender.
• Crank Blender up to 10 and tamp down ingredients for about 30 seconds to liquify everything.
• Fold wet ingredients into dry.
• Pour mixture into loaf pan
• Bake for about 25 minutes until toothpick inserted into centre comes out cleanly.

We iced ours with a little icing sugar glaze, but it also tastes great on its own.

Let me know how this turns out for you!

Should Ontario Tax Junk Food?

Ontario, the province that I live, work and eat in, is considering taxing junk food. More specifically, the Ontario Medical Association (OMA), has suggested to the government, that this should come into being.
The OMA, in a press release yesterday, made the statement, with the usual eye-opening statistics.

• Almost 1 in every 3 children (31.5%) is classified as overweight/obese. This has almost doubled since the 1980's.
• Costs to Ontario's health care system due to obesity complications are in the range of 2.2-2.5 Billion dollars annually.
• Tax incentives helped reduce the number of smokers in half over the last forty years.

Their recommendations are somewhat vague and include the usual "multi-pronged" approach.

• Increasing taxes on junk food, and decreasing tax on "healthy" foods.
• Restricting marketing of junk food to kids.
• Placing graphic warning labels on pop and other non-nutritional foods. (a la cigarette cartons)
• Restricting availability of junk food at sport/recreational facilities where kids frequent.
• Legislating listing of caloric information on menu boards.
• Enlisting an educational campaign.
• Making Physical Education mandatory throughout high school.

I don't mind the concept of taxing junk food, but there are soooo many problems inherently built in. What is classified as "junk food". Who decides? What gets a "graphic label" put on their product.

Also, several of their recommendations already exist. "Healthy" food already is NOT taxed. Marketing is already restricted to kids on television. Educational campaigns already exist.

What do you think? Should we tax junk food like alcohol and tobacco?

Let me know!

Here's a great infographic on the massive amount of sugar we consume. Have a great day.

Mallet Finger: What Is It And How Do I Fix It?

A patient of mine came into the office last week complaining she couldn't straighten out her finger any more.
Two weeks ago she had been playing Volleyball and took a ball off the tip of her right ring finger. She said she could still continue playing despite the pain, but since then hadn't been able to straighten the tip of that finger any longer.



Mallet Finger: What Is It?
This very pleasant lady had suffered a tear to the extensor tendon of her ring finger. The mechanism of injury was classic. People will typically describe a direct blow to the affected finger when it is fully extended (ie straightened out). This usually will be a ball striking the tip of the finger, but occasionally happens when they run into something/someone with the finger straight out. With the tip of the finger straight, the force of the blow ends up tearing the extensor tendon off the bone, and the individual can no longer lift or straighten up the last joint of the finger.



When the tendon is torn away, it takes a little chip of bone with it, and is readily seen on plain x-rays (above).

How Do I Diagnose It?
First, my suspicion is quickly aroused with the typical history of injury. Secondly, to examine the finger, the diagnosis is usually confirmed seeing the tip of the finger hanging down (looks like a mallet, thus the nickname!)


The patient, when asked, will NOT be able to lift, or extend, the tip of the finger, confirming that the tendon is ruptured. Finally, for confirmation, I will take an x-ray to both confirm the diagnosis, and ensure that not too large a piece has broken away, and that the joint is still reasonably intact.

How Do I Fix It?
For the vast majority of patients, using a splint, HYPEREXTENDING the tip of the joint for a period of about 6 weeks allows the torn extensor tendon to reattach itself and heal.


There are commercially available splints, but I find they often don't fit snugly enough, and don't hyperextend the joint far enough. Much easier, at least for me, is to cut a piece of aluminum splint to the right length, and bend it to the degree of extension I want. Most IMPORTANTLY, I make sure that the middle joint of the finger is allowed to continue moving freeely, so that it doesn't stiffen over the period of immobilization. I also tell patients that when they are changing the tape, or cleaning the finger, to keep holding the tip of the finger in hyperextension, and NOT let it fall back down, ensuring that the torn tendon remains in contact and continues healing. I will sometimes tell them that if they let this happen, their 6 week clock has to restart again!

On rare occasions, the chip of bone is too large, or the joint is out of alignment. In these cases, I will send patients on to a plastic surgeon to discuss surgically correcting the digit. I will also, on occasion, depending on the person's occupation (ie professional piano player, etc), send them for a surgical opinion irregardless.

Final Note: I like to follow up with these individuals after 4-6 weeks and get a new xray and examine them again to ensure healing.

Have you ever suffered this injury? How was it treated? How did everything turn out?
Let me know!

Ankle Injuries: Do I Need An X-Ray?

Even if you're not a Yankees fan, you have to feel Derek Jeter's pain. Over the weekend, Jeter broke his ankle on a routine play, will miss the rest of the playoffs and may need surgery to correct the injury. Seeing such a class act and team leader go down is tough.



All of us have turned our ankle at some time as well. Be it running the bases, coming down from a rebound, sprinting down the soccer pitch, or simply stepping off the curb, we likely have rolled an ankle at some point. Ankle sprains themselves can be extremely painful, but when is the injury bad enough we may have broken something? Should you go to the ER and get an xray to be sure?

First off, sprains and breaks can both be disabling. To define a sprain, we are talking about injuring ligaments about the ankle, usually on the lateral (outside) part of the foot. This is because these ligaments are more mobile than the inside of the ankle.



Fractures are breaks of bones in the ankle and foot, again, usually on the lateral side of the foot, because the usual mechanism of injury is rolling the ankle in this direction.

So, When Should I Go Get An X-Ray?
Deciding to go the hospital after an ankle injury can sometimes be tough. If it's just a sprain, there's not a lot to be done, other than rest, elevate, and ice. If it's broken, you may need casting, an operation, who knows?
The cost, though, of blindly x-raying every ankle injury also adds up quickly, in dollars and exposure to radiation. In Ontario, x-raying every injury versus being more selective, could cost upwards of $730,000 per 100,000 patients seen. Therefore, over 20 years ago, a group of ER docs in Ottawa came up with a set of rules to decide when someone should get an x-ray, versus knowing nothing would be broken clinically. This ground breaking study, led to the Ottawa Ankle Rules, and is an extremely useful guide for the patient trying to decide when it is necessary to get assessed.

Basically, the rules are as follows.

• You should have an xray if you CAN NOT transfer weight to the injured ankle/foot TWICE, either immediately, OR in the ER.
• You should have an xray if you have TENDERNESS over the POSTERIOR (back part) of the EITHER malleolus (ankle bone).
• You should have an xray if you have TENDERNESS at the BASE of the 5th Metatarsal (baby digit), or the Navicular (bone on the instep of the foot).

That's it. If you CAN walk on the foot, no matter how sore, AND there is NO tenderness over any of the bones listed above, you can skip the x-ray. Get ice on it, keep it elevated, and give it some time.

Having said all that, of course, if things aren't settling over the next few days, get it looked at. 

These rules have been HIGHLY validated, and virtually 100% sensitive. They have gone a long way to cost savings for the health system, and have saved many unnecessary xrays.

Here's hoping Jeter is back in full form next year!

Change - The Best Motivator.

Sometimes, I get stuck in a rut. I get comfortable with my day-to-day routines; at work, at home, at the gym, whatever. I find what works and tend to stick with it. For the most part, this is a good thing. It provides consistency, quality, and predictable results. It can also start to get awfully boring. Interest and excitement can wane, and so can one's motivation to continue on. My philosophy in life has always been to work and play hard, and to always try to keep improving. This is where change is so important.



Change can be one of the great motivators in life. Being able to respond to disruptions in any aspect of life can be a good thing. At work, stepping back and looking at your environment, looking at how things get done, looking at end results and questioning whether things can be improved is important. Changing routines every now and then often freshens things up and can give new perspectives.



Change at home is a classic area of need for motivation. I am guilty for leaving tasks undone around the house, well, just, because. We often get into the routine of cooking the same things over and over. You get the drift. Shaking up the routine by finding a new recipe online, trying a new technique out for making dessert, making a more entertaining lunch for the kids (?Bento Box anyone). Just do it.




The same goes for the gym. Workout routines are good, but it's important to switch them out every few weeks. Adding 10% more weight, hitting the same muscles with a new machine, trying out a new class all can be highly motivating and improve your overall well-being.

As we get into the colder months, we all tend to lead more sheltered and, dare I say, more boring lives. In our suburb, once November hits, the only way you know actual people live on our street is by the tire tracks in the snow on their driveways. Everyone seems to drive into their "automatic garage door opened" entryway, not to be seen again until spring. This winter, change up the routine, and get outside, do something different and stay motivated!


Let me know what you do to keep from getting bored.

5 Ways To Stay Fit And Active When It Gets Cold Outside

We had our first frost this weekend and it got me thinking (sadly) about the upcoming colder weather and shorter days. I think we all find it more difficult to get motivated and stay active as the number of daylight hours start shrinking. These ideas might help out a little bit.



1. Staying Dry.
This is probably the most important factor in enjoying the colder weather. If your clothing gets wet, from sweat, rain, snow, or whatever, you will not be happy. Heat loss is accelerated if your body gets wet from evaporation and conduction, and you will be cold. Find a way to stay dry at all costs. Your outermost layers should be waterproof, including jackets, pants, and especially footwear. I try to find Gore-tex or similar material for my winter running shoes as they keep my feet both warmer and dryer.

2. Layering.
No matter what the activity is, I follow the same rules for layering in the winter.

•  Base layer - Wicking layer including tights and long sleeved shirt. I tend to prefer Under Armor's Cold Gear, but anything similar does a great job wicking sweat away, and providing a bit of warmth.
•  Thermal layer - A thicker layer goes on next and holds in body heat. Find something that isn't too bulky and allows free movement, but still keeps you toasty. Stuff with Thinsulate, or similar type material is best.
•  Wind/Waterproof Outer Layer - Keeping both wind and wet from touching your body is critical to enjoying the outdoors. As mentioned in point #1, Gore-tex or similar material does the best job at this. If you're going to be out at night, make sure you have reflective material incorporated as well.

3. Find More Light!

The shorter winter daylight hours can be a real downer. It can sometimes be enough to cause mild depression, or Seasonal Affective Disorder, which certainly decreases motivation. Take advantage of bright sunny days, and find a way to get sun exposure when you're at work. Get outside at coffee breaks, recess, lunchtime, whatever. Get the lights on at home, and open up the blinds to let as much natural light in as possible. Going to work in the dark, and coming home in the dark isn't much fun.

4. Take Advantage of Fall's Bounty

We often get in the mindset that summer is the time for the best food, but I actually like fall's offerings better.

This is an opportunity to get wonderful, healthy fruits and vegetables like corn, pumpkins, squash, apples, yams. Here are some amazing links to using some of these great ingredients, and here, and here.

5. Go Inside. 

I've finally admitted to myself that there are some days that even I can't go outside and get my run in. Finding a good gym, or some good quality home equipment makes up for it. 

When checking out gyms, make sure their hours work for you. Do you need a 24 hour gym? Are they excessively busy when you want to go? Look at the quality of the machines. Do they keep it well maintained? If you like the looks of the gym, ask for a short trial membership before you commit.

If you're going to the effort of buying home equipment, get the best quality you can afford. If you buy it from late night TV, or purchase without trying it out first, you have only yourself to blame.

Well, again, I want to hear from you. What else do you do to get through the colder months?

Let me know!

Rant: Stealing From Community Gardens Is Pretty Low.

There's a small town named Owen Sound, about 3 hours north of where I live. Usually, news about things going on there don't really make it down here, but this news item caught my eye. A community garden, behind a church, no less, was robbed of its prized vegetables last week. Some of the items included a 200 pound pumpkin, some squash and watermelon. To add insult to injury, the garden has been managed by the Canadian Mental Health Association. The garden has been used as a tool to help people with mental health disorders gain independence, self-confidence, and employable skills. They have been tending it since 2008 and watching this year's crop grow since May.



To move a 200 pound pumpkin is not a spur of the moment prank, and must have been planned well in advance. To do this to anyone is pretty low, let alone to a community project. If you happen to see someone trying to pawn off a giant pumpkin, or a load of pumpkin pies Crime Stoppers is 1-800-222-8477, and the local Owen Sound Police is 519-376-1234.




Let me know what you think should happen to the people who did this.

Time To Get Your Flu Shot Again!

Every year around this time, our family medicine clinic really starts to get busy. School is back in session, the weather starts getting cooler, the leaves start changing, and the season's flu vaccine becomes available.
Older patients wait with baited breath, like it's Christmas time, constantly phoning to see whether the serum is in yet.

We hold flu vaccine clinics for several weeks every fall, and the line ups prior to the doors opening are like that of a rock concert, or Boxing Day sale. That's great, although I wish we could get more kids in, as they tend to be most at risk and most likely to spread the flu.



What is the Flu Anyway?
When we take about the "flu", we're using the short version of influenza, a highly contagious virus. In North America, the bug causes a respiratory illness, generally peaking in fall and winter. There are 2 main strains, Influenza A and Influenza B, with the "A" strain generally being more contagious and severe. Symptoms typically are sudden in onset and include headache, fever, sore throat, cough, runny noses and itchy eyes. Often muscles are very achy, especially in the low back. The course will typically last a week to 10 days and can really knock you off your feet. Generally speaking, we distinguish influenza from the common cold by the rapid onset, the severity with which it hits you, and body aches. The common cold is usually milder. Formal diagnosis must be made by taking a nasopharyngeal (back of your nostrils into your throat) swab.



How do we Treat the Flu?
Treatment for the flu is generally symptomatic and supportive, as the symptoms, although significant, are self limiting. Lots of fluids,Tylenol or Ibuprofen for aches and fever are really all that are necessary.

There are also antiviral medications like Tamiflu  or Relenza that have been shown to shorten the course of the flu by 1-2 days if started immediately. This may be of benefit if work is time critical or an important event is imminent.

Prevention 
Not getting sick is always the best option if possible. Keeping hands as clean as possible, coughing into your sleeve, and avoiding contact will sick people are always good choices. Getting the Flu Vaccine is the best method of staying healthy this winter.

Every year, a prediction of the prevailing influenza strains is made and 3 vaccines are incorporated into the annual influenza vaccine. This is because the influenza virus is constantly mutating and new strains become prevalent. The vaccine always contains 2 strains of the Influenza A and 1 strain of Influenza B. This year's strains are:

• A/California/7/2009 H1N1
• A/Victoria/361/2011 H3N2
• B/Wisconsin/1/2010

Who Should Get Vaccinated?

In Ontario, we vaccinate everyone from 6 months of age onward. Highest risk groups should be given priority, which include the elderly (>65), those with chronic medical conditions (diabetes, heart disease. . .), those in long term facilities, pregnant women, and those coming in contact with high risk individuals (ie, health care workers, community workers like teachers, etc.)

Overall, the benefits are large, and the risks are very low, so I strongly encourage everyone to get their flu shot again this year!

Let me know - Have you gotten your shot yet? 

SHOCKING NEWS: Sugary Beverages Cause Weight Gain In Children.

The New England Journal of Medicine is one the medical journals I hold in highest esteem. They publish some of the most ground breaking medical studies in the world, and it would be an honour to have a study accepted there. Often, their research helps guide best practises of physicians, and the work is always carefully reviewed and only published if it provides new knowledge.




You can thus understand my mild surprise in seeing that most of this week's journal was dedicated to research on whether sugar containing beverages contributes to weight gain in children. (full article here)
Seems fairly obvious, no?

In fact, there are two additional articles on the theme, as well as the highlight editorial, and a case study on the subject as well. Michael Bloomberg must be jumping for joy.




To briefly summarize this study though, 699 Dutch children (ages 4-11) were randomly and blindly given either an 8 ounce (250 ml) can of sugar-containing, or sugar-free drink. This would be the equivalent of about 104 extra calories per day for the sugar drink. Otherwise the groups were similar in all respects. Over the 18 months of the study, the group drinking the one can of sugar per day gained 1.01 kg (2.2 lbs) more than the sugar-free group, which was significant. Please do take note that this effect was due to only 104 extra calories per day, and the average U.S. child drinks more than 3 times this amount per day.

All kidding aside, this study does emphasize the need to avoid excess calories in not only our children's diets, but our own as well. Can we control this ourselves, or do soda bans, like those recently put in place in NYC, need to set in place for us?



Let me know what you think!

This Could Be The Best Way To Avoid Winter Weight Gain!

The American College of Sports Medicine recommends exercising 30 minutes at least 5 times per week. I ask my patients to do this at a Borg Scale level of exertion of 13-14. This correlates with moderate intensity, and I simplify it further by saying you should be working hard enough to get your heart rate up, but still be able to complete a full sentence without having to stop to catch your breath. Of course this should be the minimal amount to be considered exercise, and if you can I certainly encourage higher intensity!

In the summer months, this tends to be a lot easier, as most of us get outside to at least walk, garden, bike, swim or whatever. In Canada, our late fall and winter months start to get nastier, and the daylight hours get awfully short. For many North Americans, this tends to be a pretty good reason to avoid continuing good exercise habits set in the summer.

In my opinion, one of the best ways to maintain your activity level is to track it! Perhaps the simplest way of doing this is using a pedometer. These can be purchased almost anywhere, and the simplest versions do a reasonable job of monitoring the number of steps you take in a day. I recommend aiming for 10,000 steps over the course of a day, which translates into about 5 miles, or 8 kilometres.



Fitbit, a tech company based out of San Francisco, has just released an updated monitor of their tiny activity tracker. Not only does it measure your daily activity level, including stairs, it also monitors your sleep! Of course, this data can all be uploaded and shared with friends, if that's your thing.

There are several apps for your phone that do a similar thing and don't need a separate device. One of my favourites is the Nike+ Running app. The link goes to iTunes, but is also available on Android as well. The app is free and is nice in that your runs/walks are mapped out and paces are given. (It will even cheer you on!)



By having a simple way to monitor your activity, you can hold yourself accountable, and stay fit, even as the seasons change.

Do you use an activity tracker?
Do you have a favourite app or device for doing it?
Let me know!

Korean Rice Poppers

I'll admit I'm awfully late on this trend, but I got a big kick out of seeing the rice poppers "exploding" out of the Broghies machine this morning.



Our local grocery store was kicking them out this morning, and the explosions certainly drew my attention.
I had read about them previously in the Toronto Star, but London, being the backwater town it is, only recently got a machine in house. The entertainment value is worth the cost itself, but these little treats are actually pretty tasty on their own, let alone slathered in honey, Nutella, fruit, yogurt, or even Speculoos Spread!

If you're as unfamiliar with Korean Rice Poppers, aka Broghies, "poppas" or the like, they are essentially fresh made rice cakes. The ones being made this morning were simply corn masala, salt, heat and a lot of air pressure, but taste fabulous. They have a nice airy crunch and can serve as a perfect base for almost anything - sweet or savoury.

On their own, they are a very low calorie snack, being about 20 calories each, with no fat.



Although I'm Korean by ancestry, I had no knowledge of these things. The history, so it goes, is that Korean street vendors would sell them, making them out of rice, heat and wicked air pressure. They've been fairly big in Korea since the 1980's and have been spreading across North America over the last several years.

Have you tried these things before?
Do you like them on their own?
What is your favorite topping?

Let me know if you've seen one of these machines in the wild!
Here's some live action. (great explosion at :30s)
http://www.youtube.com/watch?v=utyDUEZUk80&feature=player_embedded#!

Recipe: Low Fat Pumpkin Bread Pudding

The beginning of fall weather in Southwestern Ontario is always my favourite time of year. It's still beautiful out, but not quite as hot as the sweltering humid summer was. The nights are just starting to get a little crisp, and the mornings are perfect for fast paced running.

This type of weather gets me thinking about harvest foods and stuff to warm the belly a little. I pulled out an old recipe for pumpkin bread pudding, and continue to modify it, keeping treat-like, but still really, really tasty. Let me know what you think!

Low Fat Pumpkin Bread Pudding.

Prep Time: 10 minutes (+ bread soaking time)
Cooking Time: 45 minutes

Ingredients

1 cup Pumpkin Puree
3/4 cup brown sugar
1/4 cup pure Canadian Maple Syrup
2 cups milk (skim is fine)
2 egg whites, beaten
1/2 tsp freshly ground nutmeg
1/4 tsp cloves
2 tsp cinnamon
1 tsp vanilla

1 loaf Day old French Baguette
3/4 cup plump California Raisins

Preheat oven to 350 F. Grease an 11x17 baking dish.
Cut the loaf into 1 inch slices, and then cube as equally as possible. (I like keeping the crust!)
Put bread into a large bowl and pour milk over, mix and let bread soak for about an hour.

Combine brown sugar, pumpkin, egg whites, vanilla and spices. Mix well, then add to bread/milk along with raisins. Mix all ingredients together, and spread evenly in baking dish.

Bake for 40-45 minutes until top just gets crusty.



Enjoy!

Let me know how you like it!

Is This The Best Chicago Mix Popcorn Ever?

Sometimes fate is a funny thing. I was lucky enough to visit Chicago, for the first time, with my 9 year old daughter this summer. We did the usual touristy things like visiting the Aquarium, seeing Navy Pier, Millenium Park, and of course, trying Garrett's Chicago Mix Popcorn.

If you're not familiar, Chicago Mix is a blend of sweet caramel corn and savoury cheese corn. I'm usually a strictly sweets lover, so when I first heard what the combination was, I was pretty wary. But, walking into Garrett's and smelling the freshly popped corn, I was willing to try a sample.

Experiencing the Chicago Mix is probably like what Mr. Reese first experienced when he put together  chocolate and peanut butter - a match made in heaven. Somehow the sweet and savoury create a synergy that each on its own doesn't quite reach. That bag of warm, freshly popped Chicago Mix was one of the best things we have ever had! Sadly, in Canada, the difficulty in getting Garrett's, although remotely possible, is extremely expensive, circuitous, and certainly not fresh when it arrives.

Here's where fate comes in. . .

This week, on a random trip to our local Costco, way off in the back corner, amongst pallets of bottled water and toilet paper I literally walked into a small display of Cretors Chicago Mix Popcorn!



G.H. Cretor?
Admittedly, I'd never heard of Cretor's before, so I hesitantly turned the bag over, not believing anything could come close to Garrett's. The bag and label certainly was enticing, evoking old time marketing. Cretor's also had the mandatory backstory, actually laying claim to inventing the popcorn machine in 1885. They also make their own caramel in old school copper kettles and melt their own  cheddar cheese (no artificial powder!) for the cheese corn. Finally they had all the right buzz words - Gluten free, Kosher (although I'm not Jewish), and "all natural".

How's It Taste?
With little cajoling from the kids, I threw a bag into the cart, and as soon as we got home, broke into it - for scientific research only. My initial impression was certainly positive. The kernels were all fully popped and extremely large mushroom style. In fact,  I couldn't find any unpopped kernels at the bottom of the bag.

Being a sweets guy, I tried the caramel corn on its own first. Impressive. It had a nice fresh crunch to the outside, then almost melted beneath that coating my mouth with buttery sweetness. For a bagged product, this was pretty good.

I hesitantly threw a cheese corn piece into my mouth. I looked at my hands first - NO orange powder residue! Nice. The cheese corn was just salty enough, and again nice and fresh. No sogginess to be found.

Finally I popped a combination of several of each, the way that Mr Garrett and Mr Cretor intended. The blend of sweet and savoury was just right, and evoked memories of that fresh stuff in Chicago. Of course it wasn't warm from being just popped, but came awfully close. I think I've found a new go-to snack; until I can find another excuse to visit Chicago!

Full Disclosure- I was not paid by anyone to review either product (sadly) and purchased all product on my own. (although if anyone wants to send me more Chicago Mix, I'd be happy to eat it up!)

So, which side are you on - Garrett's or Cretor's? Let me know!

Quick Hit For Asthmatics: A New Add on Drug?

In a new article published this week in the New England Journal of Medicine, (full article here), adding the long acting anticholinergic drug, tiotropium, or Respimat, to poorly controlled asthmatics current treatment, significantly improved their symptoms.

People with asthma can have a tough go with simple daily activities, with triggers ranging from smoke, to pets, to pollens, to household dust. They can have trouble in the cold, with exercise, and anyone who has felt their breathing feel tight on occasion can sympathize with the sensation of this disease.



Respimat is a soft mist inhaler taken twice daily, and in this study of asthmatics between the ages of  18-75, their breathing was significantly improved.

Now, these individuals had severe asthma, that was poorly controlled, despite already using long acting steroid inhalers in addition to long acting beta agonists. They were also allowed to continue using short acting rescue medications if needed.

Results showed significant improvements in FEV1 (forced expiration volume in 1sec), or how strongly they could exhaled their air out, as well as preventing severe flare ups of their disease.

Side effects of the medications were similar to the placebo group.


Bottom Line: This is an interesting addition to the regimen of asthma medications, when control is difficult despite usual therapy.

Whooping Cough: Making A Comeback?

With kids going back to school, and in close quarters with their mates, it might be worthwhile revisiting a bug making a bit of a comeback.

In our city, there was a small spike of whooping cough (pertussis) over the summer, with half of them coming from unvaccinated kids. Other reported increases have been occurring within the province, within Canada, and within the U.S.

What Is Whooping Cough?
Whooping Cough, or Pertussis, is a highly infectious bacteria. First described in the year 1679, Bordetella pertussis translates as "violent cough". The Chinese coined the phrase "the cough of 100 days" because of its chronic nature.

The classic inspiratory whoop following a paroxysmal cough in children is not always present, especially in teens and adults and may contribute to some missed diagnoses. Other typical features include a cough lasting more than 2 weeks, sudden onset coughing spells, sometimes associated with vomiting. Fever is often NOT present or low.

How Do You Catch It?
The actual bug is a gram negative coocobacillus that is slow growing and highly virulent, meaning that those people who are exposed and unvaccinated are very likely to contract the disease. Attack rates range from 90-100 percent when NOT vaccinated. Transmission is by exposure to respiratory droplets from infected individuals.

Before vaccines were given against Pertussis in the 1940's, upwards of 200,000 cases of pertussis were reported annually in the United States. Epidemics spiked every 3-4 years without respect to seasons.
Infection rates decreased 150 fold after introducing vaccines, and spikes continue to occur when vaccination rates decline. (Britain saw a huge spike several years ago when there was unwarranted concern with respect to links to autism.)

Classic Presentation
The classic presentation is in 3 stages; Catarrhal stage, Paroxysmal stage, and Convalescent stage.
In the Catarrhal stage, lasting 1-2 weeks, the individual feels rundown with mild cough, perhaps low grade fever and runny nose. (Like a common cold.)

The Paroxysmal stage can last 2-4 weeks and is when people get more concerned. The cough is defined as sudden, repetitive coughing with up to 10-30 coughs per spasm. A whoop may or may not follow, and is more common in kids than older individuals. Posttussive vomiting is not uncommon, and fever may or not accompany this phase.

The Convalescent, or recovery stage, can last months and the cough should decline, but may continue to wax and wane.



Diagnosis and Treatment
Diagnosis is often clinical, but definitive diagnosis is by having a nasopharyngeal swab done. The time to diagnosis is several days, and treatment should probably get started prior to final diagnosis. First line treatment is straight forward and effective, so see your physician sooner than later.

Finally, immunization for both kids and ongoing boosters for adults should be the critical preventive method.
Immunity against pertussis wanes, and in Ontario, we have added the acellular pertussis vaccine to our tetanus booster given every 10 years.

Epidemics in schools should prompt review of your kids boosters, as well as your own.
I strongly advocate following our immunization program.

Let me know what you think.
Have you had any local outbreaks where you are?

Guiding Stars: Useful Nutritional Tool?

After a short test run last year at a few stores in Toronto, Loblaws, (Canada's largest grocery chain) has rolled out the "Guiding Stars" nutritional rating system at it's Ontario branches.

Guiding Stars is a program that scores food based on it's nutrient content using a scientific algorithm (here) that grades food on a credit/debit system.  Food score more stars for containing vitamins, minerals, fibre, whole grains and omega-3 fats. They lose stars for containing saturated fat, trans fat, added sodium, or added sugars.

A given food can obtain a maximum of 3 stars (best). The worst score is zero stars.


Guiding Stars has been present in the U.S. since 2006, but only recently began in Canada last year. For Canadians, the guidelines differ slightly than Americans, as the algorithm must align with Health Canada and the Canadian Food Inspection Agency.  For the most part, foods are very similarly rated, with one interesting exception. Canada has decided NOT to use cholesterol as a nutrient to avoid in its rating system, whereas the U.S. has. This was based on a Canadian paper published in 1990, where a scientific committee did NOT set an upper limit for cholesterol, and has not updated things since! (This needs to get updated NOW!)

The Essentials
Foods are broken into 4 categories.

1. General Foods and Beverages
2. Meats/Poultry/Nuts/Dairy/Seafood
3. Fats/Oils
4. Infants/Toddler Foods

Foods are then broken down into standardized 100kcal portions so that they can be equally compared side by side. Percent Daily Value is then calculated based on a 2000 kcal diet.

A score is then assigned by giving credits for nutrients to encourage and subtracting points for having nutrients to avoid present. The number of stars is then displayed for easy consideration.

The program is not intended to tell you what to purchase, but rather "guide" you to more nutritious choices.

Loblaws has taken this campaign one step further by offering dieticians in several locations to review the system and help consumers with their choices.

Is It A Good System?

Overall, I think the Guiding Stars algorithm is sound. A bit simplistic, but certainly something to point people in the right direction. More importantly, as an independent agent, I give them more credit than other systems like Health Check, where criteria are not nearly as stringent, and much more biased. and can be bought.

What do you think?

Do you use this, or other rating systems at the grocery store to influence your buying?

Did I Rupture My Achilles Tendon?

I had an interesting case hobble into the clinic yesterday. An 87 year old man tells me he awoke one morning with some pain in his left foot. He swears up and down that he didn't injure it in any way, but he now can't walk on it normally. Sure enough, as I watch him come down the hall, he's moving, but only with the assistance of heavily leaning on his cane. I know this guy and he usually can move better than this.

After some gentle examination, his left calf is certainly a bit swollen, and there appears to be a gap in his Achilles tendon. I ask him to get up onto his tiptoes, and he has no strength to do so. A few other physical tests confirm my thoughts, and a diagnostic ultrasound confirms a complete rupture of the tendon!

How Does The Achilles Tendon Get Torn?
This example is certainly the exception to the rule.  The Achilles tendon is the connection between the calf muscles (gastrocnemius and soleus), and the heel bone (calcaneus). It helps the foot push off the ground when running or jumping. When it is torn, therefore, people can't get up on their tip-toes with any strength.



The classic history is a middle aged person playing a sport where quick movements or explosive jumping is involved like sprinting, basketball, tennis or squash. The person will often feel like they've been hit or shot in the back of the leg, and often either blame their playing partner for hitting them or look for the object that "hit" them. The event is usually sudden and therefore very memorable. The examination is also usually fairly straightforward with an obvious gap in the tendon, and no passive motion of the foot when testing the calf. The diagnosis is usually then confirmed by diagnostic ultrasound.

One other uncommon, but not unheard of cause is from taking quinolone antibiotics, of which Cipro is best known.

How Do You Fix It?
Generally speaking, there are TWO options - surgical or non-surgical.

Surgical management essentially sews back the two ends repairing the connection. The risks include bleeding, infection and a small risk of re-rupture in the range of 4-5%.

Non-surgical management involves wearing a boot cast with the foot slightly plantarflexed (toes pointing down) for 6-8 weeks. This allows the torn ends to come into contact with each other and heal while immobilized. Benefits are that one avoids surgery, but the risk of re-rupturing the tendon is significantly higher, in the range of 10-15%.

One should never generalize, but "generally speaking", I recommend surgery for younger athletes, and those who are going to go back to explosive type sports. For older athletes (ie over 40), I try to guide them towards non-surgical management, as the outcome is still quite good (ie 85-90%), and only go to surgery if this route fails.

Have you every torn your Achilles?
How was it managed?
Let me know!

Does Bribing Your Kids Help Get Better Grades?

One of my favourite "pop" economists is Steven Levitt. He is a professor of economics at the University of Chicago Booth School of Business, but is probably better known for his book, Freakonomics.

Recently, he posted a blog and podcast discussing his field research into bribing kids to try harder on tests at school. Financial incentives are nothing new, but a working paper he published in September, 2011, revealed some interesting results.

The Summary.
A total of 6,500 students in the Chicago area were involved. The students, prior to a standardized low stake test, were offered a reward (either financial, or non-financial, like a trophy or toy), just prior to taking the test. The reward would be given out immediately following the test, if improvement was shown from previous baseline testing. The control group was told nothing. In an added twist, a "loss condition" group was actually handed the reward (ie. cash or trophy)  before writing the test and had it sit on their desk while they wrote. It was taken away from them if they did not improve their mark, versus the reward group receiving their reward upon completion and improvement.

The experiment also was conducted with a delay arm, giving the reward out 1 month after testing versus no  reward. Finally, the results were analysed based on age of student, arbitrarily divided into younger children (grades 2-4) and older kids (grade 5-8).

Results were interesting. For younger children, non-financial rewards were just as effective as cash. However, in the older group, cash was king, with no benefit seen for trinkets and trophies, or even lower dollar amounts ($10 vs $20).

Most interesting though, was the "loss" group had the most significant impact. Students who were given cash prior to testing with the potential to having it taken away saw the biggest improvement.

Conclusions for Real Life.
This is pretty intriguing. Levitt's study seems to show that getting the most bang for your buck is to actually give your child a reward for doing their best on a test (ie. getting an "A" or whatever goal you designate), but adding the caveat that if they don't achieve it, the reward gets taken away.

I don't think I could be that cold-hearted, but it makes me rethink offering a little something for working a little harder.

Well, this should open up a can of worms.
What do you think?
Do you offer any rewards for tests at school? How about sport?
Does this research make you want to change your tactics?
Let me know!

Do Nike Volts Make You Faster?

Pop Quiz Time. Who was the official shoe sponsor for the London 2012 Olympics?
Answer: Adidas. You'd be forgiven, given the exposure on the track if you'd guessed Nike.



Despite Nike not putting up the sponsorship dollars to become an "Official" Partner of the Olympics, the company has again managed to be the most prominent company of the Games. In almost every race on the track, at almost every medal ceremony, and every jump on the field,  neon yellow feet could be seen.

In a brilliant marketing move, every Nike athlete was kitted out in the same coloured shoe. Whether they were wearing the Flyknit, the Zoom, the Superfly, or any other Nike shoe, the colour was an eye-catching "Volt" - a fusion of neon yellow and lime green which jumped in contrast against the reddish-brown track.



Adidas paid 80 million pounds ($125 million CDN dollars) for the honour of being the official athletic sponsor, and the marketing department must be kicking themselves. Nike spent zero dollars, other than coming up with a simple, but brilliant idea of unifying their look for the Games.


So, does the Volt make you faster?

As in previous posts (Shoe Advice), it's more about the right shoe for your foot type. If the colour makes you feel faster, maybe. Otherwise, get what feels best for you, and don't worry about the flash.

Let's see what happens in Rio 2016, when the shoe is on the other foot and Nike becomes the official sponsor and Adidas is sitting on the sidelines. Let the marketing games begin!


What do you think?
How much does marketing hype influence you in athletic purchases?
Let me know.