Ginger Ale for the Ailments

Growing up, when I was sick my dad made me drink Gatorade—he was convinced that Gatorade is the nectar of the gods with the perfect balance of carbohydrates and electrolytes to cure any ailment.  Most other parents immediately went for, and still go straight to the ginger ale.  Ginger ale is pretty much the only drink in the hospital wards as well.  Every medical student has probably overdosed on diet Shasta more than once.  Even though it is ubiquitous, does ginger actually calm the stomach?

Interestingly, when looking for studies of the effects of ginger on nausea and vomiting, many focus heavily on nausea and vomiting in pregnancy.  A review article in Obstetrics and Gynecology in 2005 analyzed four small randomized control trials that showed effectiveness of ginger for reducing nausea and vomiting over placebo [1]. Ginger has also been shown to reduce postoperative nausea and vomiting, although is not as effective in chemotherapy related nausea and vomiting [2,3]. 

I’ve been working in the OB/GYN emergency room for the past three weeks.  I’ve taken care of a fair amount of women with significant nausea and vomiting in their early pregnancy.  Usually we give them pretty strong anti-nausea drugs and fluids to help them to feel better.   Even though ginger probably doesn’t help for women who have severe enough nausea and vomiting to cause dehydration, it is good to know that ginger can probably help for women with more mild symptoms.   The best part about ginger is that is very safe to take in pregnancy, so there is no harm in trying it, and most importantly, it is delicious.

To drown out memories of late night Shasta on call in medical school, I made my own ginger ale.  It is based on a very pungent ginger syrup that can be added to club soda, or if you are feeling not nauseous (or pregnant) could use it as a base for a coctail with dark rum or whiskey.  Very refreshing!

Ginger ale

2 tbsp fresh ginger grated

1.5 tsp powdered ginger

1 cup sugar

1 cup water

Club soda

Ice (optional)

Lime wedge (optional)

Over medium high heat, bring all ingredients to a boil and allow to cook until syrup is reduced to half and begins to darken.   Allow to cool, add about ¼ cup syrup to 1 cup of chilled club soda.  Add ice and a squeeze of lime juice. 

1. Borrelli  F, Capasso  R, Aviello  G, Pittler  MH, Izzo  AA.  Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea and vomiting.  Obstet Gynecol.  2005;105:849–56.

2. Chaiyakunapruk  N, Kitikannakorn  N, Nathisuwan  S, Leeprakobboon  K, Leelasettagool  C.  The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis.  Am J Obstet Gynecol.  2006;194:95–9.

3. White, B.  Ginger: an Overview.  American Family Physician. 2007 June 1; 75(11): 1689-1691

COOKIES!

Not much to say this week.  Still working, still surviving.  The highlight of my week was some delicious, crunchy, sweet, chocolaty, nutty, tangy cookies I stockpiled with unusual ingredients such as malt balls, malt powder, graham flour and pretzels.  I brought them to work to seduce the nurses to correct all of my poorly placed orders.  Seemingly it worked. 

Elizabeth’s slightly unusual but unusually good cookies

½ lb malt balls (such as Whopper’s)

1 to 1 ½ cup sourdough pretzel pieces

¾ cup butter (a stick and a half)
½ cup peanut butter

¾ cup brown sugar

½ cup granulated sugar

2 eggs

1 tsp vanilla

¼ cup malt powder

3/4 cup graham flour (or whole wheat flour)

½ cup oats

1 tsp baking soda

½ tsp salt

1 cup all purpose flour

Preheat oven to 350.  In food processor, pulse pretzels and malt balls until bite sized.  Alternatively, place in large ziplock bag and pound with rolling pin until bite sized.  In medium bowl, combine malt, graham flour, oats, baking soda, salt and flour.  Cream butter, peanut butter, and sugars until fluffy with mixer.  Add eggs and vanilla, stir to combine.  Stir in flour until well combined, then add pretzels and malt balls.  Using tablespoons, drop onto ungreased cookie sheets and bake until barely brown (8-9 minutes).  Cookies burn on bottom quickly so take em out fast!

Cool and enjoy.  

Suturing dinner—herbed ricotta chicken roulades

Still alive!  I’m a week and a half into it all.  Seems like a lot longer.  I feel like I know a whole lot more than I did just a week ago and that each day gets a bit more manageable.  Even so, as more straightforward patients seem easier, I am given more responsibility with more complicated patients.  I’m learning how to rule out ectopic pregnancies, diagnose all kinds of infections, and how to do endometrial biopsies.  I have become the queen of speculum exams; I even found somebody’s cervix in the dark as the exam room had no light besides the overhead lamp.

Along with responsibilities in the hospital on the job, we are required, thankfully, to perfect our surgical skills outside of the operating room.   We have a test in September on our knot tying and suturing (a fancy word for sewing).  Even though I grew up sewing, I definitely did not do so on a curved needle.  When you suture in the operating room, you hold the needle with a tool called a needle driver, which pushes the needle through the tissue.  I can do it, but I’m awfully slow.

Along with practicing in our surgical skills lab, I brought home some suture from the hospital to practice at home.  What better way to practice sewing flesh than on dinner?  Sewing meat simulates the operating environment a lot more accurately than the dry toys that we practice on.  Besides, when you make a lovely roulade, it keeps everything together really nicely—much better than interrupted knots. 

So for dinner tonight I made herbed ricotta and tomato stuffed chicken breast roulades with a yummy zucchini orzo on the side.  The only problem was that the suture was flesh colored and thus was difficult to find in the chicken.  I might have swallowed a knot.  If you don’t have suture and a needle driver you could use regular needle and thread, or just use toothpicks or kitchen string to tie it up.  If you are like me and trying to get better at sewing, this is a delicious way to improve.

 Herbed Ricotta and Tomato Chicken Roulades

3 large boneless skinless chicken breasts

½ cup all purpose flour

15 oz reduced fat ricotta

½ tsp fresh rosemary

2 tbsp fresh parsley

2-3 tbsp fresh basil

3 cloves garlic

½ shallot

¼ cup parmesan cheese grated

2 tomatoes thinly sliced

1 tbsp butter

2 tbsp olive oil

~1 cup white wine

2 tbsp balsamic vinegar

Cut chicken breasts in half horizontally and pound down until about 1/8-1/4 inch thick.  Dredge in salted and pepper flour.  Chop herbs, shallot and garlic finely, mix in with ricotta.   Add parmesan, salt, pepper and a splash of olive oil to ricotta mixture.  With each breast, spread a thin layer of cheese and a few slices of tomato.  Roll up widthwise and sew or tie up.  Preheat large skillet or dutch over over medium high heat.  Add olive oil and butter and sear chicken breasts for 3-4 minutes.  Add white wine to cover breasts about half way up, cover and reduce heat to medium low.  Cook until chicken cooked through, about 15 minutes.  Remove chicken from pan, add another tsp or so of salt to the sauce, add balsamic vinegar.  Turn heat up to medium high and cook sauce until reduced by about 50%.  Strain and serve with chicken.

Lemony Zucchini Orzo

½ lb orzo pasta

1 medium sized zucchini, grated

2 cloves garlic finely diced

1 medium shallot finely diced

Juice of one lemon

Splash of white wine

Salt and pepper

¼ cup grated parmesan cheese

Cook orzo in salted water according to instructions.  Over medium high heat in about 2 tbsp olive oil, sauté garlic, shallot and zucchini until zucchini cooked through about 5 minutes.  Turn heat off, add orzo, white wine, lemon juice, pepper and cheese.  Stir to combine and serve. 

Soft in the middle--Molten Chocolate Cakes

In my last year of medical school, we were required to do a month in the Emergency Room.  I would get frustrated sometimes when I wasn’t as thorough as I should have been in my physical exam or I didn’t consider every possible diagnosis.  One awesome attending that I worked with, an oddball of sorts who would wear camouflage hunting shirts underneath his white coat and would blast Train songs in the workroom, always reassured me: “You’re not supposed to know everything.  If you did, you wouldn’t have to go to medical school, and then do residency.  You’re like a muffin in the oven.  You just haven’t cooked yet.  You’re soft on the inside.”

If I’m soft on the inside this is how I feel:

After four days of residency, I definitely need more time in the oven.  This month I’m working in the Women’s Emergency Room, which is mostly gynecology and first trimester obstetrics.  It’s definitely a “learning on the job” kind of place.  Fortunately the second year resident I’m working with knows a lot and is helping me a ton and the nurses are very forgiving.   It’s amazing how much nicer people are to you when you can sign orders and write prescriptions.  (It’s also amazing that I can write prescriptions.)

So, all in all, work is scary at times and frustrating at times, but residency is awesome.  I finally get to do what I want to do and my patients consider me their doctor.  And, I also get days off, like today, to bake yummy lava cakes.   Sometimes it’s good to be soft in the middle, as long as you stop and reflect on it and get yourself cookin’.

Molten Chocolate Cakes

From Bon Appetit January 2001

5 ounces bittersweet (not unsweetened) or semisweet chocolate, chopped

10 tablespoons unsalted butter

3 large eggs

3 large egg yolks

1 1/2 cups powdered sugar

1/2 cup all purpose flour

Vanilla ice cream

Fresh rasberries

For cakes:  
Preheat oven to 450°F. Butter six 3/4-cup soufflé dishes or custard cups. Stir chocolate and butter in heavy medium saucepan over low heat until melted. Cool slightly. Whisk eggs and egg yolks in large bowl to blend. Whisk in sugar, then chocolate mixture and flour. Pour batter into dishes, dividing equally. (Can be made 1 day ahead. Cover; chill.)

Bake cakes until sides are set but center remains soft and runny, about 11 minutes or up to 14 minutes for batter that was refrigerated. Run small knife around cakes to loosen. Immediately turn cakes out onto plates.  Serve with ice cream and rasberries.