Tuesday, November 20, 2012

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


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!

Sunday, November 11, 2012

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!

Sunday, November 4, 2012

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

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


  • 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!

Wednesday, October 24, 2012

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.

Monday, October 22, 2012

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!

Tuesday, October 16, 2012

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!

Saturday, October 13, 2012

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.

Disneyland Aug 2010 - Main Street U.S.A.

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.