Tomato Cucumber Soup

The cold weather has rolled in to stay for the season and with that brings the excitement of my kitchen back to life. Since I live in a tiny, airconditionless apartment the summer is not prime cooking time for me. My most recent in depth home cooked meal was none other than my favorite soup: Tomato Cucumber. Its full of veggies, spices, and love :) I used to call it "Hot, wannabe gazpacho" because of the types of veggies used, namely the cucumber flavor that comes through, but over time it has evolved and therefore the name needed to evolve as well.

P.S. I used to make this recipe by pre-chopping all the veggies in a food processor, but I recently obtained an immersion blender which significantly lessens the work and improves the texture of the soup - if you don't have one of these and you like to make soup, please please please consider buying one. It is my new favorite kitchen toy and I'm constantly looking for excuses to use it!

Tomato Cucumber Soup
Ingredients (makes 4-6+ servings):
1.5 tbls Butter
1/2 medium sized Yellow Onion
3 cloves of Garlic
1/2 tsp of Thyme
3 tbls Flour
~3 cups Chicken Stock (can substitute with 3 cups water + 3 bullion cubes)
3 stalks of Celery
16 oz can Diced Tomatoes in Sauce
8 oz can Tomato Sauce
1 medium-large Cucumber
1/2 tsp Crushed Red Pepper Flakes
Pinch or two of Sugar
2 tbls Parsley
2 heavy handed tbls Basil
Salt and Pepper
~1/4 cup Heavy Cream

*Note: for easier prep, pre-chop all veggies. They only need to be roughly chopped if you have an immersion blender or plan to blend the soup at the end. Otherwise, finely chop in a food processor and reduce cooking time in steps 3 on by approximately half.

1. In a medium pot on medium heat, drizzle a bit of oil (approx 2 tbls) and add 1 tbls butter. Once butter is mostly melted add roughly chopped onion and sprinkle a little bit of salt and pepper over the onion to add flavor and draw out the juices. Cook until onion softens and starts to become translucent.

2. Add garlic (roughly chopped) and thyme and allow to cook for approximately 3-5 minutes. Your pot should become fragrant. Add flour to form a roux by constantly mixing flour into the oil &butter so that it is absorbed. Once roux begins to turn a light golden color, add chicken stock slowly while stirring or whisking continuously. If you do not stir continuously and pour in stock slowly you will get a lumpy texture - do not cheat here!

3. Add red pepper flakes, and roughly chopped celery. Increase heat slightly to allow to come to a simmer and then lower. You will want the soup to continue simmering for the rest of the cooking process. Allow celery to simmer in soup for approximately 8-10 minutes on medium-low heat.

4. Add diced tomatoes, tomato sauce, and chopped cucumber. Allow to simmer for an additional 5-8 minutes.

5. (My favorite part) Get out your immersion blender and blend veggies (I use lowest setting... my immersion blender is powerful). If you don't have one, you can also transfer the soup in batches into a food processor or blender and then return it to the pot for the final cooking/addition of spices.

6. Add pinch of sugar, parsley and basil. Feel free to add a little more basil - this is a flavor that should be prominent at the end. Taste test for salt and pepper and add more if desired. (The saltiness of your rough product will depend on what type of broth/bullion cubes you use and how much you pre-salt your onions at the beginning). Allow to simmer an additional 5-10 minutes so the flavors can marry a bit more. Add the heavy cream - I say approximately 1/4 cup but I just drizzle in a bit to very slightly lighten the color and thicken the soup. You can even omit the cream all together. This is art not science, you can simmer or continue to cook on low heat for longer if you wish - it may even make the flavor profile richer... I just tend to be impatient at this point.

7. Serve with garnishing of your desire, I like to add some shredded cheddar. If you are not a soup-is-an-entree person, this goes very nicely with grilled cheese or, my personal choice, BLTs.

*Recipe disclaimer: I don't measure my spices at home! These are estimates to guide you based on quantity approximation. Always taste your food as you go and remember you can always add a spice but once its in you can't take it out.

Time for some PA Advocacy!

If you are a frequent flyer to my blog, you already know I'm a Physician Assistant. Given the recent passing of national PA Week (October 6-12, 2013), lets take a moment to spread the word about PAs!

Definition: 
A PA (Physician Assistant) is a member of a medical care team supervised by a physician. Depending on what part of the country you are in, and what medical setting we are discussing, this medical team can include multiple physicians, PAs, nurses, medical assistants, or it can be a two person team consisting of just the physician and the PA.

The details of physician supervision varies by state, but overall the term generally means that physicians oversea and delegate the activities the PA performs and assumes some level of responsibility for the medical care provided by a PA. The physician need not always be in the same vicinity as the PA nor does the physician always dictate each and every medical decision a PA makes. PA's are an extension of physicians. We are educated in the same model as physicians and we are licensed by the state in which we practice to provide competent medical care. We must graduate from an accredited PA program and pass a national board examination in order to become licensed.

What I do:
I work for a major medical center in the department of hospital medicine (we take care of all the patients admitted to the hospital under general medicine, as opposed to a specialty such as neurology, surgery, cardiology). A day in my life begins with reviewing lab work, test results, vital signs, rounding on 12-16 patients with or without the physician present, make a medical plan with the physician and carrying out that medical plan whether it be ordering tests, prescribing medications, or calling specialty consultants. The physician may physically be on the floor with me for as little as 2 hours, or as many as 8-10 hours a day depending on their practicing style. When they are present, we work together coordinating patient care, tests, consults, and social needs with the social work team. When the physician is not present, I not only continue to carry out the plan discussed with the physician, but handle any issues that may come up in the meantime. However, I am never completely on my own and can always reach the physician on call by phone, pager, or text if needed.


For links to more information: Click here!

Waking in Autumn

The air is different now. It's smell has changed and the lens of your eye captures a more burnt quality in the color of the leaves and grass. Its a subtle change, something you may not notice in the middle of your day, but something you surely feel as you struggle a little bit more to wake in the morning with your alarm clock. It seems the sun has decided to push "snooze." What's ten more minutes? As you come into your body from that dream state, your skin is first to realize the morning crispness. Yes, ten more minutes, please. Anything to postpone sticking your toes out into the world from their snuggly abode under your sheets and blankets.

F is also for Food

I seem to be starting a theme here for Fall -- first fantasy football, now food, perhaps I'll dedicate a whole month to "F" related posts in honor of Fall (then again perhaps I won't since this alliteration was mostly coincidental).

Anyway, the point of this post is to discuss food. Rather, its to discuss diet. I've written a post or two in the past about improving healthy lifestyle through diet and exercise, and since its something that is constantly on my mind you should expect to see this topic come up every now and then. Today I read an article entitled the Anti Inflammatory Diet from JAAPA (The Journal of the American Academy of Physician Assistants). I have an inflammatory condition so articles like this always intrigue me on a personal level to begin with so of course I read it.

The article touched on concepts we already know: whole grains are better for you than refined grains, excessive sugary and deep fried foods are bad for you, eat more fruits and vegetables. What was different was the extensive number of statistics the article posed with regards to the differences in inflammation within the body of individuals who eat "western diets" (low fiber, high refined grains, sugars, fried foods, red-processed meats) vs. those who eat a "prudent diet" (high fiber, fruits, veggies, fish, whole grains, legumes, etc). The article referenced several studies that showed significant results that should be quite meaningful to any medical practitioner.

Overall, the conclusions were that inflammatory markers (signs of inflammation in the body) were increased in those who consumed the "western diet". This not only meant that these individuals were more at risk for conditions such as cardiac disease from the high fat intake, or diabetes from the high sugar intake, but that they were more at risk for their bodies to be under a chronic state of inflammation, which wears and tears on your tissues over time. Unsurprisingly on the contrary, those with a "prudent diet" had decreased inflammatory markers = less inflammation, less damage, overall healthier and at lower risk for future health conditions. Yay for fruits and veggies!  

F is for Fall Fantasy Football

Fall used to be a simpler time for me - it would bring a simple sadness that winter was coming and my summer clothes would be doomed to darkness in the dresser for the next 9 months. The only bright light during this dim time would be Thanksgiving and the joys of the holiday season. But never fear, fantasy football is here.

This is my third season and I've graduated to participating in two leagues. Two leagues, I had hoped, would equal twice the fun. No. I was wrong. Two leagues = twice the disappointment, anxiety, and bitterness on each and every Sunday and Monday for the 4 months of this terrible and wonderful time of year. Let me explain:

The season starts with the giddy joy of being accepted back to the leagues (as a woman this is quite a feat). The excitement continues with the prospect of the draft - who will make the team? Will it be Drew Brees? Or will I finally believe Howie when he says I over-value quarterbacks and attempt to hoard receivers and runners? And what about my team name? Oh the pain of seeking a brilliant team name that strikes fears into the hearts of others in my league! In actuality, I really just hope my team name gets at least a chuckle for being mildly clever.

Then draft day arrives. With many windows open on my screen, I jump back and forth frazzled trying to look up the players I'm not as familiar with between picks. After all, before fantasy entered my life I only ever paid attention to the Giants - there are a lot of players in the NFL to learn about! The end of the draft brings some relief, but also the onset of nerves. Did I make the right picks? Is my team solid? Week one will tell.

A loss and a win. Okay, I can deal with that, its only week 1.

Week 2: a loss and a win. Alright, being 1:1 in both leagues is not bad... its still early.

Week 3: a loss and a loss. Ughhh. My defense is falling apart in one league... my receivers in the other are getting double covered on every play. My stars are falling to "Questionable" for next week. The players left on free agency are limited. I fear a trade. What to do? What to do? It's still early...

Week 4: Here we are. What started out as a hopeful Sunday in the lead after the 1:00pm games has turned into a nightmare and I'm looking at another 0-2 weekend. How can this happen? My teams were solid...

My options seem to be dwindling and despite the appearances of solidarity on a "stacked" team, my players still can't keep it all together to get me a win. What looks like a solid lead turns into a 30 point deficit just because Tony Gonzalez has a breakout 38-point achievement that never should have happened while my defense dwindles into negative points for the 2nd or 3rd week in a row.

I know this is all of a lot of jargon and for those of you who don't participate in fantasy football, this is probably a nonsense post. I just can't help but reflect how my fall has changed from a time of mourning the seasonal equinox to anticipation over how my 17 players from 10+ different teams will play in their weekend match-ups. I now worry over predictions and averages and rivalries. In some ways, my fall is a lot more exciting, especially when my team wins. Its also brought me closer to a sport I grew up with but did not fully appreciate before. However, it also brings with it the emotional roller coaster of a lifetime. Oh fantasy. 

The light at the end of the tunnel

Six weeks post-wedding and here we are! This will be my last wedding related post. I couldn't leave you all hanging at the 2 months-to-go mark so here is a synopsis of the craziness that happened at the end.

{Since this is the last "getting married" post, I just want to remind anyone who is reading who needs some helpful links and vendor recs to see the Wedding Links page under the "More.." tab.}

Where we left off ...
     Engagement photos: We had wanted to do these in April. Then we wanted to do them in May. Then we scheduled them for mid-June. With everything we had going on at the time, we sprung for the extra $200 to have the photographer come to us in NY from his home base outside Philly - which was well worth it. This was one thing I had initially thought I was not going to do at the beginning of my engagement, but boy am I glad I did. Not only do we now have tons of professionally done pictures of the two of us (as opposed to only having a handful of photos taken with smartphones on tipsy nights in poorly lit bars, clubs, or restaurants), but we also got to know our photographer and have a lighthearted "date" of sorts with each other to ease some stress.

     Flowers: Last we chatted flowers were not done at the two month mark. Thankfully all it took was a skype date with a smaller mom & pop florist shop and a bit of chemistry to check this off the list. I showed her a few pictures of flower arrangements I liked based on my likes and dislikes I sorted out from the first shop we almost contracted with.

     Transportation: I ended up feeling frazzled enough that I ended up putting this in the hands of my then-fiance. He contacted my brother who knew of bus companies in the area from his fraternity events-coordinator days and he called up a few limo companies found via google. We calculated the best way to limit the number of vehicles we needed by deciding to transport the bridal party around in shifts using one limo, and likewise scheduling shifts with one school bus for transporting our guests between the hotel and reception venue.

     Favors: We knew we wanted something that was not going to be thrown out when people got home the next day. We didn't want a personalized trinket or "souvenir" to send our guests home with. So my mom suggested we give away Hope's Cookies, a local mini-chain in the Villanova area that baked and packaged the cookies in pairs for us. All we had to do was pick them up. It was perfect.

     Seating Plan: This was tricky. We only had approximately 2 weeks to sit down and do this and its really the type of chore that you just have to buckle down and get it done.

     The Extras: The last week before the wedding there were, of course, a million little extras that needed to get done. At first I was not going to take that entire week off from work, but boy am I glad that I did! I needed the time to finish all the miscellaneous details and feel secure that we did all we could to make it "perfect".

     The Big Day: Surprisingly, the entire occasion went off without a hitch on the day of - except for my own nerves of course. All the details were perfect, the flowers were perfect, the DJ was perfect. We had an amazing time and really enjoyed our celebration. If you are planning your wedding in the greater Philadelphia area please see the wedding links page (under the "Extras" tab) for our vendor suggestions - we LOVED each and every one of them.

     The Honeymoon! YAY! The best part of everything! We booked in June for the end of August. We wanted somewhere non-traditional after our bold original plan of going to Italy fell through. I knew it needed adventure and relaxation to appease both of our interests so we chose Belize! It was absolutely fantastic and we would go again in a heartbeat. Beach, ocean, snorkeling, Mayan ruins exploration, swimming with sharks, zip-lining, fantastic food, we couldn't have asked for more!

What's in a vitamin? (Vitamin B12)

Last summer I started this little segment about vitamins, so here's a lighthearted post about our next special vitamin. How do we really know what vitamins are actually worth the buzz? That's what I'm attempting to discover. We've already discussed the benefits of vitamin D and C, next up: B12.

Vitamin B12

B12, aka cyanocobalamin, is fairly well known as an energy booster and has been on trend for the past several years. Given is ubiquitously known name, lets just jump in and affirm that yes - B12 boosts your energy! This is mostly due to the fact that people with a B12 deficiency suffer from weakness and fatigue as a side effect. So when you replace what you've lost, you feel better! But what else can this little bugger do for you?

B12 is a vitamin only obtained via diet, whether it be fortified foods, OTC or prescription supplements, or naturally occurring in foods. Without it not only will you feel your metabolism slow (two of its by products are active in metabolism.. metabolism = energy), but you can also develop anemia and neurological deficits including abnormal sensations, such as pins and needles, and memory loss, which can contribute to a sense of weakness and fatigue. Deficiency can also lead to constipation, depression, weight loss, and loss of appetite. There are a few factors that put a person at risk for developing a B12 deficiency.

1 - being vegan or vegetarian. B12 is naturally found in the meat, fish, shellfish, chicken, and dairy... therefore if you are not eating any of those foods you put yourself at risk for developing a B12 deficiency, among other things. If you practice vegetarianism, be sure to see a nutritionist to make sure you are getting enough of the vitamins and minerals you might be missing out on. Side note: B12 can also be found in fortified cereals.

2 - being elderly. As you grow older, you GI system gets tired and doesn't absorb the nutrients in the foods you eat as well as it did when you were younger. In fact, many times older people may be misdiagnosed with early dementia if their chief complaint is only memory loss and therefore the practitioner doesn't think to check for B12 deficiency. NY Times wrote an article on Vitamin B12 with this scenario as their back story.

3 - having a gastrointestinal disorder. B12 is absorbed in the small intestine. If you have a GI disorder, such as Crohn's Disease, Celiac's, or another condition that affects the small intestine, it can lead to malabsorbtion of many things, including B12.

4 - having had GI surgery or bariatric surgery. If you are missing some of your pieces, then its fair to guess that your body is going to miss out on whatever it is those pieces do for you. You lose your gallbladder, you can no longer secrete the enzymes needed to break down fatty foods, therefore you can no longer eat those fatty foods you love or else they'll be coming straight out the other end the same way they came in... gross (sorry for the visual, it was the first example that came to mind and I was too lazy slash entertained to change it to something more benign like losing your uterus means no babies). Likewise, if you are missing part of your GI tract, you can bet you're gonna miss out on absorbing some or many of the nutrients your body needs.

So how does this affect you and what can you do about it? For most of the young American population, you probably aren't B12 deficient. If you are tired, its probably because you stayed up too late watching TV or going out with you friends or taking care of your kids all day. However, you should eat a well balanced diet including an appropriate amount of meats, fish and dairy, and you should still get an annual physical in which your doc does routine blood work to check for anemia and vitamin deficiencies. And if you are still worried you might be deficient - a little OTC B12 never hurt nobody (at least not that I can find in the literature...)

Another fun fact: along with folate and vitamin B6, B12 also contributes indirectly to overall cardiovascular health.

Where this information came from: 

Vitamin B12 Fact Sheet, NIH