Thursday, January 17, 2013

Empty Out The Freezer

This smoothie is inspired by my boredom with the classic strawberry banana I usually make each morning. I opened my freezer this morning and said, "what frozen organic matter do I have that can be blended together besides strawberries and bananas". I avoided the ancient green peas and frozen scotch bonnet peppers, and stumbled upon haphazard smoothie heaven. I recognize that the average smoothie purveyor doesn't have these three frozen ingredients lying around, but it's probably worth it now. The combination of coconut and peach makes for a smooth and creamy base with a kick of ginger and the tang of apple juice.


  • 1/2 of a 6 oz package of frozen shredded coconut
  • 1 good handful of frozen peach slices, about 12
  • Less then 1 tablespoon of frozen ginger root
  • Almond milk
  • Apple juice
  1. Place all frozen ingredients in blender
  2. Cover up to 2/3 of ingredients with almond milk
  3. Fill up the remaining 1/3 with apple juice to just cover the frozen stuff
  4. Blend for a long time to ensure adequate coconut pulverization

Thursday, October 25, 2012

Monday, September 3, 2012

Immunomodulators in the treatment of infectious disease

Hysterical infectious disease doctors will whine that "we are slowly sliding into the post-antibiotic era", which very well may be true. MRSA might be turning into VRSA and super duper totally drug resistant gonorrhea is popping up all over the world including France, Japan, Hawaii, and Ohio. Rather than developing more and more super expensive antibiotics that lose efficacy after 10-15 years of irresponsible use, it is time for us to reanalyze how we manage infections.  The common gestalt is to find the right drug for the right bug. This places all of the emphasis on killing bacteria, when it is actually the body's immune response to the bacteria which causes sickness symptoms. Our immune system evolved to react to infections briskly with the innate response just to keep the pathogen temporarily at bay and then in a more controlled fashion with the adaptive immune response. Our immune system is not equipped to handle the flood of antigen released when a bolus of antibiotic causes rapid bacteriolysis. This leads to massive immune activation, much more so than is "natural". This exaggerated response includes toll-like receptor activation, leukocyte chemotaxis, cytokine release, and immune cell degranulation. Sepsis is a prime example of our failure to address the immune response in infectious disease. You can kill as many bugs as you want in the septic patient, but that isn't going to raise their BP and neutralize the inflammation in the short term.

This article: Anti-inflammatory Drugs in CAP, Journal of Internal Medicine addresses some of the emerging therapies being studied in modulating the immune response in the setting of infection, in this case the focus is on community acquired pneumonia. The first modality is the use of corticosteroids. which seems to have mixed results in the studies they review here.

The two things that really interest me are statins and macrolide antibiotics. In retrospective studies, those who come into the hospital already taking a statin and treated for CAP have better outcomes. The idea is that besides lowering LDL cholesterol, statins somehow lower the basal inflammatory state decreasing atherosclerosis and allowing for a more controlled response to infection. There are no studies yet about whether statins are useful acutely or if they should be started as treatment for infection in those without dyslipidemia.

Macrolides are starting to look like something of a wonder-drug. Probably the next "add it to the water supply" type drug after statins, vitamin D, aspirin, and SSRIs. Besides their direct effect on bacteria, macrolides are anti-secretory for the bronchi, increase mucociliary function, decrease PMN degranulation, decrease inflammatory cytokines, and decrease reactive oxygen species. This is probably why we should be giving macrolides to everyone with CAP, not just to treat mycoplasma and chlamydia pneumonia. The ceftriaxone kills the bacteria and the macrolide modulates the immune response to the infection. Maybe this is why people with viral bronchitis and URIs tend to feel better when they convince their doctor to given them a Z-pack. And here we had finally convinced a generation of doctors to militantly deny our patients antibiotics for such viral infections, the effect may have actually be much more than placebo effect.

The last modality they look at is TLR antagonists, which sound really good in theory, but apparently doesn't have very good efficacy. On a side note, and possible fodder for a future post: it looks like TLR polymorphisms play a huge role in determining who dies from infection.

In conclusion, treat the infection and treat the inflammation.

Saturday, July 28, 2012

Pop Tart Smoothie

Feeling hypoglycemic this morning? Then this concoction exploding with high fructose corn syrup and complex carbohydrates is just what you need to have an extremely short lived sugar high and subsequent day-long crash. But hey, life is all about the ups and downs, right?

  • 12 oz of your favorite fake milk product (I used rice milk)
  • 1 frozen banana
  • 8 frozen strawberries
  • 2 Pop Tarts, strawberry with frosting and sprinkles!
  • 4 ice cubes
8 easy steps:
  1. Put ingredients into blender
  2. Put lid onto blender
  3. Push button to blend for a while until it's smooth
  4. Turn off blender
  5. Take off blender lid
  6. Pour into a cup that you'd like to drink from
  7. Insert a flexi-straw
  8. Sip smoothie through flexi-straw into mouth and swallow

Saturday, July 21, 2012

Antiretroviral flavors

I just finished one month of of doing infectious disease consults at Jackson and one of my consults last week was antiretroviral (HIV) medication recommendations for a patient with a PJG (feeding) tube. In most of these cases medications are crushed, mixed with some water and pushed through the PJG. ARVs are pretty fancy high-tech pills that cannot be crushed without decreasing the efficacy of the medication or inactivating it completely. So it was my esteemed pleasure to look up what ARVs can be crushed and which come in liquid form. I found a pretty straightforward article with all the info I needed. I couldn't help but chuckle at all the exotic flavors of liquid HIV medication formulations. I'd thought liquid HIV medications would be a pretty utilitarian market, but how wrong I was. Without further ado, I give you your flavor options:

  • Abacavir (ZIAGEN): Strawberry-Banana
  • Emtricitabine (EMTRIVA): Cotton candy
  • Lamivudine (EPIVIR): Strawberry-Banana
  • Stavudine (ZERIT): Fruit
  • Zidovudine (RETROVIR): Strawberry
  • Fosamprenavir (LEXIVA): Grape, bubble gum, or peppermint
  • Tirpanavir (APTIVUS): Butternut or butter-toffee
  • Ritonavir (NORVIR): Peppermint or caramel
This is complicated by the fact that most people are on at least 3 HIV medications, adding up to some really funky flavor combo possibilities. Imagine mixing your "butter-toffee" syrup with the "cotton candy". Luckily our patient had two medications that were strawberry-banana and one that was unflavored, so there was no flavor clash issues. Did you ever think there would be a connection between SMOOTHIES and INFECTIOUS DISEASE? It happened so quickly

On a similar topic of pharmaceutical ridiculousness, take this quiz and decide if it's a drug name or a pokemon name: Drug or Pokemon
Even 3 years deep into medical school and formerly a pokemon follower, this was pretty difficult. I mostly know only generic drug names and the brand names are the weird ones. I am also only familiar with the first 150 pokemon. 

Saturday, July 14, 2012

The Classixx: Strawberry and Banana

Smoothie enthusiasts are not a snobbish bunch. Sure we love the latest and greatest smoothies, using the most cutting edge ingredients and blending methods, but we all appreciate the classics just as well. This is my interpretation of the classic SBBS (strawberry banana smoothie). In this case, it's the Classixx remix. Enjoy these silky smooth disco tunes by LA DJs, The Classixx, while you get your blend on.


  • 1 frozen banana
  • 1/2 cup of frozen strawberries
  • 3/4 cup almond/soy milk
  • 3/4 cup apple juice
  • 5-10 ice cubes
  1. Pull all that crap into the blender
  2. Press blend
  3. Add sweetener to taste if you want type 2 diabetes you fat-ass

The Peanut Butter and Jelly Sandwich Smoothie

This creation was inspired by the classic PBJ with a glass of milk. I love a PBJ on toasted wheat bread, but it's kind of annoying to deal with. First of all, toasted bread has a way of spewing crumbs all over the place, and I rarely clean my kitchen, so these crumbs tend to stick around for a while and get stuck to my feet when I walk around barefoot. Second, I hate spreading shit with a knife, it's such a pain. And also, what do I do once I've spread the peanut butter? I have to clean the damn knife off on something so I don't contaminate the jelly with all the crudded up peanut butter detritus. So I said, let me just throw all this junk into a blender, besides, chewing is overrated.

  • 1/2 cup grape nuts or other hearty cereal, I bet granola would be good. This is our "bread"
  • Soy milk or almond milk
  • 1 frozen banana - peel it you idiot
  • 1/2 cup frozen blueberries - or any frozen fruit you like. This is the "jelly"
  • 1 heaping spoonful of peanut butter - a little goes a long way in a smoothie
  • Agave nectar, honey, or other sweetener, to taste.
  • 5-10 cubes of ice
  1. Put grape nuts in blender
  2. Add fake-milk-product until the grape nuts are fully submerged then pour until the liquid is 1-2 cm above the cereal. Learn your damn metrics
  3. Add the banana, peanut butter, berries, and ice
  4. BLEND BLEND BLEND - Some grittiness should remain, especially if you're using grape nuts, that stuff is like rocks, so it adds a nice crunch as you slurp down the smoothie.
  5. Sweeten to taste - honestly I can't remember if I added any extra sweetener when I made this. But if so I use splenda or agave.