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Ruminations

Ruminations 15: Lawyers 10, Science 1

Tuesday, 5 August 2008

Rumination 14

Monday, 7 July 2008

Rumination 13 - This is Science?

Saturday, 10 May 2008

Rumination 12 - Stable is Good

Wednesday, 19 March 2008

Ruminations collected

Thursday, 3 January 2008

Ruminations 10: Not So Glad Tidings

Sunday, 16 December 2007

Rumination 9. An Experiment in Diagnostics

Friday, 21 September 2007

Rumination 8: Whodathunkit!

Saturday, 4 August 2007

Rumination 7: The Path Ahead

Sunday, 24 June 2007

Rumination 6: Intermission

Saturday, 26 May 2007

Rumination 5 - The Lost Month

Monday, 14 May 2007

Ruminations 3

Thursday, 22 March 2007

Ruminations 2 - Reprieve

Friday, 9 March 2007

Rumination 1 - Reprise

Monday, 5 February 2007

Latest Entries

Pig Flip and Hopkins Hat

Tuesday, 19 August 2008 6:33 A GMT-05

 We had a great time at the pig roast on Saturday. Here is Tom inserting the skewers of shrimp and tomatoes/hearts of palm into half of a red cabbage. We took this and skewers of tomatoes and our cheese for appetizers.

 This is the pig getting its final flip. Brian cooked it in one of the best ways we have seen. The pig was butterflied open (head removed) and the body sandwiched between two grills. The grills were bolted together and the whole thing placed over the coals. The pig cooked more evenly than the spit or buried/baked ones and had gloriously crispy skin.

 

 This is Brian and Gary deciding how to carve the pig. The pig roast brought together Brian and his friends from high school. All live (or plan to live) on the Vineyard and have kept up with each other all these years. 

 Perhaps the happiest at the pig roast were the dogs who stood under the carving table to catch the drippings!

We are going to try to sell the yarn we had spun from Anne Hopkin's sheep. It is bulky weight 3 ply, not a weaving wool and not the size yarn I usually knit with. But I knit this hat (An Unoriginal Hat by The Yarn Harlot)as a demo model and am thinking that the yarn would make a nice warm vest.

Latest bi-color cabled hat

Saturday, 16 August 2008 11:02 A GMT-05

I love this bi-color cable hat! It is a variation of the Groovy Cable Tuque I'd knit earlier in hot pink.  But it draws in so much, even with going up many needle sizes. Only aggresive block saved the hat! I think I'll save this one for me, because any time it is washed, it is going to need that same blocking.

We are headed to a pig roast this afternoon. We are taking boiled shrimp, tomatoes and cheese on picks.

Jules Immortalizes Cross, The Bursar and Me

Friday, 8 August 2008 6:41 P GMT-05

Our friend Jules Worthington has his art show opening today, an annual affair hung at the Chilmark Bank. (If you know our house, the wonderful paintings of sunsets and Italy are by Jules.) We always love going and bringing an appetizer. Today we brought skewers made of two of our goudas, Tom's pickles, ham and artichoke hearts. 

 

And when we got there, we were having a grand time wandering through the two rooms filled with paintings and really admiring a unique view of Venice and an incredible one of a fisherman in a yellow rain slicker on a boat in Menemsha. And then I walked into the next room and burst into tears. There was our rooster, Cross, and hen, The Bursar, and me feeding hens. I was so overwhelmed by it all I could only cry. They were so perfect.

 

(That is me and Karen admiring it all)

 

 me and cross

If you have met our rooster Cross, you can recognize everything about him. And The Bursar (the hen on the right named after a Pterry character) is a lovely Americana blue-egg-laying hen. The paintings hang in the Chilmark bank for a while and then move to our walls!

 

Oysters in Vinegared Bean Paste (miso)

Thursday, 7 August 2008 5:46 P GMT-05

Oysters in Vinegared Bean paste -- Kaki No Sumiso-Kake

 

20-24 oysters, shucked

2-3 Tbsp Sake

8 scallions (optional garnish)

1 Tbsp mustard paste*, Japanese

2 Tbsp miso (bean paste), white

2 tsp sugar

2 Tbsp mirin

2 Tbsp rice vinegar

 

Drain oysters, discarding liquor.

 

Combine sake with 1 cup salted water and bring to boil. Add oysters and cook just long enough to plump and begin to curl, 30 – 60 seconds. Remove oysters and drain well, reserving cooking water.

 

Blanch trimmed scallions in the bioloing water for 30 seconds, cool in cold water drain well and pat dry.

 

Mix well mustard paste, miso, mirin, and vinegar and stir until smooth.

 

Divide oysters among 4 – 6 small bowls, garnish with scallions, and pour sauce over to coat oysters. Best eaten soon after preparation but it is OK to let them marinate at room temperature an hour or two – no more – before serving.

 

*1 Tbsp dried oriental mustard mixed with a little hot water to form a paste is a good alternate.

 

Ref: Ortiz & Endo: The Complete Book of Japanese Cooking (1976), modified by KTK

Japanese food spree

Thursday, 7 August 2008 3:42 P GMT-05

We had a marvelous excuse to pull out all stops and do the best we could at a Japanese style dinner last night. We had

Appetizers of two kinds of caviar on daikon slices and green beans with ginger. Pickled oysters in a miso-mustard sauce that were fantastic (recipe coming soon), pickled shitake mushrooms, ume boshi, tofu pickled and then fried, onion salad 

 And cucumbers pickled a couple of ways and daikon.

 

Chawan Mushi - the savory egg custard we like so much with chicken, shrimp and ginko nuts

Chirashi Sushi - bite size bits of yellow tail, tuna, pickled mackerel, the funny pink powder but made from scratch from shrimp (Ebi Soboro), cooked shrimp, pickeled tofu, egg threads, semi-dried salmon over sushi rice

Ruminations 15: Lawyers 10, Science 1

Tuesday, 5 August 2008 10:44 A GMT-05

Rumination 15. Lawyers 10, Science 1

By

Thomas P. Vogl

August 4, 2008

 

The experiment that I proposed in Rumination 14, to get infused weekly instead of bi-weekly, (back issues are archived at http://upislandeggs.com/Ruminations.htm) was, as I predicted, turned down. The primary and overriding reason is that any deviation from an approved protocol must be reviewed and approved by the IRB (Institutional Review Board) of the hospital performing the study, the IRB of the drug company whose drug is being used, and the FDA. The excuse for this bureaucratic excess is that it is in place to protect the patients on the studies. I do not dispute that patients on studies (and otherwise) require and deserve protection. They also deserve to have the maximum possible information/data extracted from the experimental treatment in which they have volunteered to participate. Even more do they deserve, as long as the primary objective of the study is met, to have the option of modifying the treatment to explore the possibility of enhancing the benefit to the patient.  Ascertaining whether the experimental treatment is of benefit to the patient and, if it is not, discontinuing the treatment not because it is doing harm but simply because the patient has better things to do with his/her time (including exploring other potentially beneficial therapeutic options) is also a significant benefit, as is the scientific goal of ascertaining why the patient is doing well for reasons other than the experimental treatment.

 

I am a concrete example that may illustrate the problem. Of the 91 patients with solid tumors in the AZD-1152 trial, only two (me and a woman with lung cancer) exhibited no progression of disease – our diseases are stable. Patients with cancer occasionally exhibit stable disease without treatment. The standard explanation is that their immune systems are responding appropriately to the disease.  Consequently, there is a very real question whether AZD-1152 is actually effective in a few percent of the population because of the specifics of the genetics of our tumor or whether the drug is ineffective in solid tumors given the dose limitations imposed by side effects.  This is not an academic question.  If a trial drug is working, the patients should certainly stay on it. If their stability is unrelated to the drug, then it would be far better for them to try a different regimen, sooner rather than later when their natural defenses which are keeping the disease stable start to crumble.  The patients, of course, have no basis for making such a decision and their oncologists are prevented by the bureaucratic red tape from ever finding out.  In my case, the experiment I proposed was both simple and safe: Give the infusion every week instead of every other week and check the white cell count twice as often. If it starts to drop significantly, discontinue the experiment.  Since my count dropped only once, after the first infusion, and then only slightly, the risk in my case is minimal, not zero, but minimal. Other patient’s white counts have/will react differently but individual differences are not taken into account in the early trials, which, in my opinion, is one of the principal reasons so many expensive Stage III trials fail.

 

It is only since I have become personally involved that I have realized how absurd the IRB system has become since its initiation for patient protection. A large part of the problem is the amazing reliance that has developed  on the legal fiction of ‘informed consent’; the paper work for which consume the IRBs (and whose primary function is to protect the pharmaceutical industry, hospitals, and doctors from lawsuits). The reality is that the typical patient, even the very well educated and informed one, does not have either the background or the technical knowledge to perform the scientific evaluation that is required to give *informed* consent, that is, knowledgably concur that the experiment to be performed on him/her can reasonably be expected to bestow a perceived benefit that overrides the risks. Only the lawyers who wrote the rules for the IRBs can persuade themselves that giving informed consent and signing an informed consent form are in any way a comparable activities or indicative of the same mind set. The correspondence is pure fiction. The reality is that the patient is told about possible benefits and adverse effects orally and then told to take the form home and read it or, if you prefer and want to get started - a delay may jeopardize your slot in the study - just sign here.

 

In the July 18, 2008, issue of Science, page 324, is an amazing example of the absurd damage to science and scientific progress that the current IRB implementation has brought on. It is reported that a respected team of scientists at the University of Tokyo have been forced to retract a paper because “it apparently failed to obtain informed consent from tissue donors or from their IRB. Observers believe the problem stems in part from guidelines that do not sufficiently explain how to handle samples collected before Japan established informed consent procedures.”  Now I am not suggesting that IRB rules and regulations should not have teeth. However, retraction is a totally inappropriate remedy for any cause other than scientific error or fraud. As it stands, readers of the journal will know only that the paper has been retracted and will assume that it contains erroneous data or misleading conclusions, when that is not the case. This cuts the heart out of what the archival record means in science and illustrates the potential for, and the reality of, abuse of power inherent in IRBs. It punishes the scientific community, not the ‘perpetrators’.

 

On a different note, I was reliably informed that the experiment of treating weekly instead of bi-weekly had been performed in Holland (the home country of the developer of the drug) and that they found that some fraction (I have no idea what fraction) of the patients developed leucopenia on the weekly treatment, which is why they opted for the bi-weekly protocol.  That may well be true, but is that a good reason not to try it on a patient (me) who had only the mildest leucopenia in response to the first treatment and never thereafter? Particularly, since the weekly trial could be stopped at any time? Further, the weekly infusion was not on patients with stable disease. Yet further, in that the same dose was given to all patients irrespective of their weight.  Still further, since the trial has officially been terminated and only the few patients who are stable are, by courtesy, continuing to receive the drug – but of course only under the conditions imposed by the original protocol, now discontinued because it did not work. And beyond all that, that rarity, the proposed experiment is on a patient, me, who can give meaningful informed consent. The lawyers win, patients and science loses, and all asses are covered. Sic transit gloria mundi.

 

I want to state quite clearly that I do not blame any individual physicians or teaching hospitals for this state of affairs. None of them wanted this absurd system foisted upon them. However, some blame does accrue to them collectively. If they, collectively, announced that unless the system was appropriately modified they will conduct no further clinical trials, the system would be changed within months. But who will volunteer to take the responsibility for herding cats?

 

***********************************************************************************************

 

I was recently asked on what evidence I based my decision to take celecoxib (Celebrex, a COX-2 inhibitor) and the omega-3 fatty acids (fish and flax oil). Since this is a very reasonable question, I thought it appropriate to replicate my answer in these Ruminations. The COX-2 / omega-3 story is complicated since they interact in their biochemistry via the prostaglandin pathways. My choice was also based on my genetics.

Let me begin with the science by providing a bibliography of some of the more relevant papers. I have copies of most of them if anyone is interested enough to read them. Otherwise, the titles will suffice to suggest the basis of my decision:

A. Bundschere et al., Antiproliferative and proapoptotic effects of rapamycin and celecoxib in malignant melanoma lines. Oncology Reports 19: 547 - 553 (2008)

C. Lee et al., Expression of cyclooxygenase-2 and peroxisome  proliferator-activated receptor gamma during malignant melanoma progression. J. Cutaneous Path. (2008) doi:10.1111/j.1600-0560.2007.00939.x

S. K. Lee.
et al., Vitamic C suppresses proliferation of the human melanoma cell SK-MEL-2 through inhibition of COX-2 expression and the modulation of insulin-like growth factor II (IGF-II) production. Cell. Physiol. 216: 180 - 188 (2008)

 Kast, R.E., Melanoma inhibition by cyclooxygenase inhibitors: role of interleukin-6 suppression, a putative mechanism of action, and clinical implications. Med. Oncol. 24: 1-6 (2007)

K. Muller-Decker et al., The cyclooxygenase-2 mediated prostaglandin  signaling is causally related to epithelial carcinogenesis. Mol. Carcinog. 46: 705-710 (2007)

 J-C Marshall et al., The effects of a cyclooxygenase-2 (COX-2) expression and inhibition on human uveal melanoma cell proliferation and macrophage nitric oxide production. J. Carcinog.
6: 17 doi:10.1186/1477-3163-6-17 (2007)

J. C. Marshall et al., The use of a cyclooxygenase inhibitor (Nepafenac) in an ocular and metastatic animal model of uveal melanoma. Carcinogenesis 28: 2053 - 2058 (2007)

F.J. Lejeune et al., Complete and long-lasting regression of disseminated multiple skin melanoma metastases under treatment with cyclooxygenase inhibitor. Melanoma Res. 16: 263-265 (2006)

K. S. Wilson, Cyclooxygenase-2 inhibition and regression of metastatic melanoma. Melanoma Res. 18(?): 465-466 (2006)

K. S. Wilson, et al., Clinical activity of Celecoxib in metastatic melanoma. Cancer Invest. 24: 740 -746 (2006)

S. Xia et al., Melanoma growth is reduced in fat-1 transgenic mice: Impact of omega-6/omega-3 essential fatty acids. PNAS 103: 12499-12504 (2006)

 Y. Denkins et al., Role of w-3 polyunsaturated fatty acids on cyclooxygenase-2 metabolism in brain-metastatic melanoma. J. Lipid Res. 46: 1278 - 1284 (2005)

C. Denkert et al., Expression of cyclooxygenase-2 in human malignant melanoma. Cancer Res. 61: 303 - 308 (2001)


The COX-2/ Omega-3 story is particularly relevant in my particular case for two reasons that, until I thought about it, I had previously always thought were unrelated.

I have had a life-long affliction from hereditary polymorphic light eruptions (PMLE). My mother had a mild case, I have a severe case, and one of my daughters has an intermediate case.  In the past, if I spent 15 minutes in the sun, three days later I would break out in typical PMLEs.  Several very competent dermatologists have tried to help over the years, including a course of PUVA (psoralen & UV light), but nothing helped. Until I started taking omega-3 supplements. With the usual dose, the PMLEs decreased significantly in severity and on the double dose I am now taking they have disappeared completely.

I also have hereditary colonic polyps (not polyposis).  Both my parents died of colon cancer. I had my first polyp removed at age 40 and few harvested every couple of years since, until I started taking 200 mg/day of Celebrex about 7 years ago. Since then, not a single polyp in three scopings.  If 200 mg/day will completely suppress the colonic precancerous lesions, might my melanoma also have similar pathways, given my genotype? 400 mg/day is the clinically accepted maximum dose so why not see if that will help, given that I have no cardiovascular risk factors. (The Celebrex also does a great job keeping my lumbago/sciatica under control.)

That is why I concluded that it would be prudent to increase my intake of both omega-3 fatty acids and COX-2 inhibitor. Neither can do me significant harm. Given my genetics, I think that they are likely to do me some good by reducing tumerogenesis.  That is why I proposed the experiment to Dr. Shapiro to increase the frequency of AZD-1152 for one cycle to see if it makes a difference. It may well be, given that AZD-1152 at the accepted tolerable dose has not been a success in over 90% of solid tumor patients, that my stability derives from the omega-3 / Celebrex in collaboration with my immune system and not the AZD-1152.  It would be nice to find out, but given the rules under which the IRBs and FDA have chosen/been forced to operate, it will not happen. So, I really have no meaningful choice but to stay on the current regimen and travel to Boston every other week for two days for infusion, even though that effort may have no bearing on my well being and it would be so easy to find out whether or not it does.  Alas, we will probably never know.

 

There is a glimmer of light at the end of the tunnel. Current commentary by scientists and clinicians express the growing realization that anti-cancer monotherapy block-buster drugs are illusive if not illusions. Whether this will cause the pharmaceutical companies to explore and collaborate on novel multi-drug therapies or abandon the development of anti-cancer drugs remains to be seen.

Sock Blank and Biscuits

Monday, 4 August 2008 4:00 P GMT-05

I'm trying the Knit Picks sock blanks .  These are a double-stranded, knitted length of fabric, like a short white scarf made from superwash yarn.  The idea is to dye them and then knit straight from the now-dyed blank.

I squirted dye in a busy pattern - probably too busy, but I won't really know until it is a pair of socks.  The turkeys who normally pace the deck were not happy to be ousted for a sock blank. They are just off camera looking worried.

The blank is now washed and is drying.

Today I think I also nailed down the drop biscuit recipe.

The recipe makes 12 nice size biscuits.

 KTK Drop Biscuits

5 oz bread flour (1cup)

5 oz cake flour (1 cup)

2 tsp baking powder

½ tsp baking soda

1 tsp sugar

¼ tsp salt

1 cup buttermilk, cold

4 oz unsalted butter, melted, room temp.

 

Preheat oven to 450F. Combine all the dry ingredients in a large bowl and mix or whisk well.

 

When oven is ready, add buttermilk and melted butter to dry ingredients and mix gently until just combined. If necessary, add a little flour until the dough pulls away from the sides of the bowl.

 

Using two spoons, drop onto parchment paper lined sheet and bake until biscuits are golden, 12 – 15 minutes.

 

Makes about 12 biscuits.

 

Problems growing herbs

Saturday, 2 August 2008 11:19 A GMT-05

I was wondering why my little herb container looked so beaten down and rather sad - even though it has gotten lots of sun and water. Then I found out why.

That herb pot is full of oregano, thyme, chives, tarragon and turkey. And the little pot next to it is full of epazote and turkey.

Hmmmm.  It was bad enough when they decided to eat the seeds off the wild flowers earlier this week.

Peach Fuzz and Spumoni Skater

Friday, 25 July 2008 3:10 P GMT-05

I made a peach fuzz hat with removable stem and leaf for Leslie. She doesn't need a chemo hat, but may indeed need a convertable peach.

And a Spumoni Skater Dude hat for Ellen (though I wouldn't be surprised if it ends up on Ben.)

It is hot here and we had just over 3" on rain over the last two days - which was badly needed.

The Ag Society is contracting with an Amish company to come build a barn at the Fair Grounds - tentatively in early September. Details are still very unconfirmed, but we've been asked to oversee the feeding and housing of the crew. I'm making lists of people who can help. If you want to volunteer a guest bedroom or meals or transport, please let me know. We will need all the help we can find - if the pictures I've seen of barn raisings are anything to go by. More details as I find them out! 

Green hat

Monday, 21 July 2008 8:15 A GMT-05

Just as Tom gets ready to mail off the lilac hat, I get the green one done. This one may be a bit too big. I might try it again with a smaller needle. This is the Nottingham hat pattern by Melissa Mall.

I have given up trying to find a nice head mannequin on eBay. I'm always outbid. I wanted something studier than styrofoam, but the glass ones seem too fragile, the professional ones too expensive, and the cosmetology ones (for student hairdressers who have chopped off all the hair) are perfect - but I get outbid. So a stainless steel bowl will do for now.

 We will be going to Maynard Silva 's (also look here ) memorial in early August. Maynard was a local legend, a bluesman who mentored many. But Tom knew him pretty well from meeting him going to and from cancer treatments. It is a pot luck at the Ag Hall and we will take a ham and biscuits.

Another Pi Topper hat

Friday, 18 July 2008 2:03 P GMT-05

This is the third time I've knit the Pi Topper hat . It turns out better each time.  

It is HOT here today. We are going to a cocktail party later this afternoon and I'm trying to figure out what to wear and what to knit. 

Web Stuff I Like: Dr. Horrible

Thursday, 17 July 2008 2:59 P GMT-05

 I love the new web video from Joss Whedon, Dr. Horrible's Sing-Along Blog .  This project is for fans of Firefly and The Guild (and the Big Bang Theory [love the actor, Simon Helberg ,  who plays Moist in Doc Horrible, ]).  It is a 3-part web video (parts one and two are out now, part 3 due in 2 days.) If you watch them right now, they are free. Or you can buy the series off of Itunes and sometime on a DVD. It will be pulled from the web by the end of the month, I think.

So, quick, go see them! 

Fuzzies

Sunday, 13 July 2008 12:04 P GMT-05

I knit a couple of very quick fuzzy hats, each just took a few hours while doing other things. Both are knit with one strand of worsted (Rowan Calmer for the green, Knit Picks Shine for the blue) and a strand of Fizz.

The pattern is adapted from the "No-Hair Day Chemo Cap " from Head Huggers. The original pattern just uses the Fizz yarn, but I find that hard to knit with by itself.

Category: Knitting

Purple Grooves Hat done

Friday, 11 July 2008 2:57 P GMT-05

I knit the Groovy Cable Tuque for Ellen. I don't think I quite followed the instructions on how to decrease at the top, but it came out OK anyhow.

As you can see, it is bright here today, but not too hot. No cheesemaking for a while because the cow I get milk from is drying up. But the dairy has bought two Jerseys so I ought to have milk again in two weeks or so.

In WoW news, I now have three level 70 hunters (I know.) But this way I've one to sacrifice for the new class when the expansion pack Wrath of the Lich King comes out.  In the meantime, I'm playing against type and have both a rogue and a palladin started.

Farm to Folk Blog

Wednesday, 9 July 2008 4:55 P GMT-05
Susie at the Farm to Folk blog has written a very nice article on our hens. Susie came out for a hen-visit a couple of weeks ago and said she wanted to write out raising chickens.  Thanks for all the lovely compliments!

Sweetbreads and Corn

Tuesday, 8 July 2008 5:28 A GMT-05

Sweetbreads And Corn  - Crepes de Ris de Veau au Mais

 

 1 1/2  lb         sweetbreads, veal               

----  For the sauce: ----

4          tbsp     butter                             

                        seasoned flour for dredging       

4          tbsp     vinegar, cider                    

1 1/2   cup      heavy cream  

         pinch  saffron threads (optional)                   

3          tbsp     chives, fresh                     

2          tbsp     butter                            

1          cup      corn, cut from 3 ears   

----  For the crepes (optional):----         

  3/4     cup      + 1 tbsp flour                    

  1/4     tsp       salt                              

  1                    egg, beaten lightly               

  1        cup      + 1 tbsp milk                     

  2 1/2 tbsp     butter, melted                    

                 

Prepare the sweetbreads: Soak the sweetbreads in acidulated (lemon juice or vinegar) water or buttermilk/kefir/yoghurt for several hours or overnight. Rinse. In boiling water, blanch the sweetbreads for 5 minutes, drain, and refresh in ice water. Peel off the membrane, trim the sweetbreads, and divide into the naturally occurring lumps. Dry well on paper towels.

 

Make the sauce: Soak the saffron threads in the cream. Reserve.

 

In a skillet heat the butter over moderately high heat until the foam begins to subside. Dredge the sweetbread in flour seasoned with salt and white pepper, shaking off the excess, and saute them in the butter, turning them until they are golden on the outside and firm to the touch (4-8 minutes). Reserve.

 

In a skillet heat the corn in the butter over moderately low heat, stirring, for a few minutes until it is barely cooked, and season it with salt and pepper.

 

Pour off excess fat from the skillet, add the vinegar, and deglaze the skillet, scraping up the brown bits. Add the cream, reduce the liquid by half, and add sweetbreads and heat through. Add the chives and serve with the corn.

 

This dish is best when served on a crepe or pancake. A crepe recipe is given below. Sourdough pancakes (q.v.) are our preferred accompaniment. Rice or baked potato are good alternatives, in which case reduce the cream by ¼ instead of ½.

 

Serves 4.

 

Make the crepes: In a bowl combine the flour and the salt, make a well in the center, and add the egg, the milk, and 1 1/2 Tbsp of the butter. Stir the flour gradually into the wet ingredients until the batter is combined and let the batter stand, covered with plastic wrap, for 1 hour. Heat a 5 inch crepe pan over moderate heat until it is hot but not smoking and brush it with a little of the remaining 1 Tbsp butter. Stir the batter well, fill a 1/4-cup measure with it, and pour the batter into the pan. Tilt and rotate the pan quickly so that the batter covers the bottom and cook the crepe until the underside is browned lightly. (The crepe should be thick.) Turn the crepe, cook it until the underside is browned lightly, and transfer it to a rack. Make crepes with the remaining batter in the same manner, brushing the pan lightly with the remaining melted butter as necessary. Keep 4 of the crepes warm, covered with a damp dish towel, in a preheated 200 F. oven, reserving the remaining crepes for another use. (The crepes may be stacked, separated by layers of wax paper, and frozen, wrapped in plastic wrap.)

Category: Hungry?

Rumination 14

Monday, 7 July 2008 2:27 P GMT-05

Rumination 14: Still Crazy Stable After All These Years.

By

Thomas P. Vogl

July 4, 2008

 

I had my scheduled re-scans on Tuesday. I had predicted that I was stable or possibly slightly regressed. To the bemusement of my docs I was right on the button.  By the standard we are using, the PET scan, my “prevascular and hepatic tumor burden had decreased. There has been an increase in the size and avidity of the right cervical lymph node and upper abdominal lymph node. The right sacral lesion is unchanged.”  None the less, according to the CT with contrast “There is a mild increase in upper abdominal and periportal lymphadenopathy. There are innumerable hepatic metastases … Increased conspicuity to subcentimeter pulmonary nodules and stable hylar adenopathy.”

 

Translation: Although there are a lot of tiny metastases in my liver, they are less actively growing that at the last scan. My blood tests of liver status are within the normal range. The tumors in the lymph nodes are growing very slowly.  To this I can add that I am feeling fit as a fiddle, my body strength continues to be normal (I can toss 50 lb feed bags around much as I could 20 years ago); none the less and even without disease, age takes its toll: I tire a little more easily and getting up off the floor is not as easy as it was a decade or two ago.

 

I had a long chat with Dr. Shapiro (who is in charge of the phase I clinical trials for solid tumors and who I think is terrific) and we agreed that it makes no sense to switch from what we are currently doing and which is keeping me stable to some other protocol which may, or may not, be better.  New drugs and new results on melanoma patients are appearing weekly if not daily. The longer I stay stable the more likely it is that a effective novel therapy will be available when my melanoma starts to progress. 

 

It may be my optimism rather than biomedical reality, but the large number of stable lesions in my liver suggest to me that when I do start to progress my liver will fail rapidly. When that happens, faster is better (I hate itching).

 

AstraZenica, the drug company that produces the AZD-1152 which I am taking, has discontinued its clinical trial of the drug on solid tumors (and is focusing on the drug for leukemia because they are having success at the much higher doses that are safe only for leukemia patients who have deranged white blood cells anyhow).  A total of 91 patients with a variety of solid tumors have participated in the trial – I was number 91. Of these 91, two patients have achieved stability – a woman with lung cancer and I. We are both getting the same dose although she weighs only 55% as much as I do. {The wonders of questionable clinical trial designs!} What no one knows is whether it is the drug that is the cause of the stability or something else, e.g., we have more active immune systems, we are taking some other drug that is having a beneficial effect, something in our life styles or environment, or …

 

There are two fundamental precepts of experimental design:

 

  1. Experiments must be designed so that no matter what the outcome, useful information results.
  2. Experiments must be designed so that the amount of information obtained is maximized.

 

Both are violated in many, if not most, clinical trials. The primary purpose of any study should not be compromised; however, the associated opportunity to collect ancillary data – not necessarily in all patients, probably not statistically significant data, but, none the less, data potentially capable of providing useful clues that may improve efficacy, save time and future trial costs, and provide hints on patient selection – should never be ignored, but usually are.

 

When I see Dr. Shapiro next week, I am going to propose a simple n-of-1 experiment, that is an experiment in which I become my own control. Assuming I remain stable at my next scan early in September, that during the next two month cycle we do the infusion every week instead of every two weeks and see whether this produces any change in the results, e.g., more regression than the slight avidity decrease we just saw and, possibly no progression elsewhere.  I would agree to not change any of the other drugs I am taking for the course of the experiment. This would at least give a clue as to the contribution that AZD-1152 is making to the stability and provide some data to better inform the decision of whether to continue on this drug or try something else.

 

The only likely side effect, if any, of this change may be leucopenia (a decrease in white blood cells).  Biweekly blood tests will catch this and we can discontinue the weekly infusion if need be. Since I have not had any problem with leucopenia on the current regime, and since when used for leukemia patients who are administered over six times my dose no serious side effects are observed (leucopenia is irrelevant in leukemia since it is malignancy of the white blood cells) it is more than reasonable to expect no other potential problems.  [Why did they anglicize leucopenia by using a c rather than a k, but left leukemia alone?]

 

Does this mean that it will happen?  Given the nature and attitudes of IRBs (Institutional Review Boards) as currently constituted (and complaints and discussion of their shortcomings populate the literature) and drug company lawyers, I estimate the probability of this simple experiment actually going forward at less than 20%.

 

Stay tuned.

 

Bunch of Grapes Fire

Saturday, 5 July 2008 5:12 A GMT-05

Most of you who have visited us will remember the Bunch of Grapes bookstore in Vineyard Haven - maybe the best little independent bookstore in the country. It was badly damaged when the cafe next door burned down yesterday. (Follow the link for the story in the Vineyard Gazette and this one for the video of the fire from our local Plum TV. And traffic and businesses were disrupted all day on one of the island's busiest days.

 

Black Hen Substitute

Friday, 4 July 2008 5:54 A GMT-05

Tom is back from Boston and is still stable or close to it. That is wonderful news and he will continue his once-every-two week treatments and get a scan again in 2 months.

We start on a very busy couple of days with picnics, cookouts, clam bakes, and a beach wedding to attend. Plus the usual Friday cheesemaking and Saturday baking.

The droopy hen perked up, much to my surprise and as far as I can tell, not due to my nursing. Day before yesterday she was pretty obviously dying and yesterday she may have turned a corner and started eating rice and hard boiled egg. But she is still inside because she is very weak and thin and a secondary infection or virus to whatever the primary thing is she is recovering from, could still do her in. Popo (named after the volcano Popocatepetl in Mexico that I used to see out my dorm window in Puebla) is learning to be a house chicken. She spent a lot of yesterday either perched on my black wool slippers

 

or on the edge of the trash can near my desk. Then in the late afternoon, she found she could scramble from the trash can edge, to my arm and then up my shoulder.

(That is me playing WoW. My poor guild got to hear all about Popo.) I couldn't figure out why she was so clingy to my slippers and shoulder and Tom pointed out that the black slippers and black shirt may remind her of her foster mom, the black silkie hen. Makes as much sense as anything. This morning she is back on the slippers because she isn't strong enough to jump up to the trash can edge and doesn't want to be picked up and helped up.

Droopy Chick

Tuesday, 1 July 2008 10:09 A GMT-05

Tom is off to Boston for his scan, and if he is still stable, the infusion. So I'm stuck trying to take pictures of the top of my head and latest cabled hat.

I'd hoped this one could be bi-colored, but the pattern just didn't work well with that.  I'm torn between knitting this again in a wool/silk/merino blend and trying something new. Still deciding.

Yesterday I had a D&C to try to figure out if a menopause issue was serious. It had to be done off island and getting anywhere this time of year is difficult. But the Steamship Authority got me on the boat I had to be on and let us get back on a earlier boat in the afternoon. They really do try very hard to accomodate medical stuff. Falmouth Hosptial was pretty nice and they had far less trouble than I feared with getting the IV in. Still not real clear what my issue is, but it isn't cancer (which was a tiny but real possibility so a look needed to be taken.)

Keeping me company this week is a turkey strutting his stuff

and a Dorking chick who seems under the weather. I can't see anything wrong, but she is not as active as she ought to be, is walking a little funny, and eating - but not eating lots. Feels thin. Loose smelly poops.  I've brought her in and will keep an eye on her today.  Could be she got squished by a big chicken, or there is a digestion problem. I think her temperature is fine.  Less likely is an internal parasite since everyone else seems fine.  Don't see any external parasits or problems. This is the usual problem with trying to figure out what is wrong with a droopy chick.

On a Stick

Sunday, 22 June 2008 4:57 P GMT-05

We are headed out this evening to eat with friends and are bringing the appetizers. And they will be on a stick. It has been so long since we skewered anything!

We skewered asparagus, mortadella,Tom's garlic pickles, grilled scallops, olives, our Romano, grilled eggplant and salami.

The latest hat is done and packed up with two others to go to Ellen.

Even though I'd rather knit cables, I'm taking a cable-break and have started on a stripey one in sort of a Taos colorway.

Today was much calmer than yesterday. The story in the papers about the Chilmark police who shot a tame turkey tom who was, reportedly attacking some delivery people and the subsequent arrest of the person who had raised the turkey who apparently assaulted the officers is much with us.

We go very very far out of our way not to be friends with our roosters - not enemies either of course, but we play the game by the rooster's rules. Don't tease them, don't look them in the eye, don't wear red around them, don't pick them up unless absolutely necessary, don't give them an opportunity to jump up at you, and don't let them think of you as a hen, another rooster or a threat. If a rooster starts to get unhappy that I've picked up his favorite hen, put the hen down and walk away.  If a visitor is wearing red, they don't get to go see the chickens unless they take the red off or hide it (which has made for some comical moments but roosters see the color red and to them it looks like a red comb that signals aggression if it another rooster or sexual availability if it is a hen - and neither is good if you are a people.) Figures are iffy, but I think 60% or so of roosters go mean. They are protecting their flock, but a 10 pound rooster headed for you at chest level with 3 inch needle sharp spurs is dangerous. And once a rooster becomes aggressive, we have not seen anyway to reverse the process. We have too many visitors to allow a rooster to even become pushy, much less aggressive. And some of the tricks that work some of the time are the ones above.  And that is dealing with an animal whose genes have been tweaked towards docility by domestication for the past couple of thousand years. 

But a turkey tom - and it is now mating season - who sees a person as a threat is yet another level of problem. Look at the tom who is wooing turkey hens on our deck.

He barely has to bend his head to drink out of the bird bath. 40 pounds? 5 foot wing span or better?  I wouldn't want him coming after me. Who knows about the details of the Chilmark thing, but my bottom line is that you treat domestic and non-domestic bulls of all species with lots of respect and distance.

And finally, the shitake log who we have been nursing since December finally decided the humidity was high enough and is in glorious flush. Thank you Olivia and Anna!

 

The Third Blog of the Day

Saturday, 21 June 2008 5:43 P GMT-05

I know, it is very rare of me to blog three times in one day. But the day got odd after the last blog.

My throat is still sore from screaming. I heard the chickens making a horrible noise and dashed out to find a dog attacking them. They were in their coop, but the dog was throwing himself against the fence and dashing between the coops to try to kill each flock. I screamed and screamed and the dog charged me - but stopped, and then ran, and I chased the dog, screaming for it owner. (The chickens are fine, just tramautized.)

The dog ran to the old cemetery behind the coops, me screaming the whole time, and finally a voice came from the cemetary half-heartedly calling the dog.  I came awfully close to completely losing my temper at the woman who had let her dog out of her car and not noticed when it went after the chickens. She claimed she was too upset by the "bad anniversary" as she tended a grave and refused to give me her name. I told her I was calling the cops and got her license plate number. She finally got the dog and put it back in her car and continued to pick small weeds around a grave site.  (Someone who came by later thinks she identifies the woman as a person dealing with a lot of sorrow and tragedy.)  But I do not see how that absolves her of the responsibility of controlling her dog. It may excuse her for the things she said to me, but not neglecting the gods damn dog. It looked like a cross between a black husky and a corgi. The  fence we had put between us and the cemetery was useless since the dog just jumped it. And through all this the hens and roosters are making more noise than you can imagine and she just ignored it all. I am so mad. I wish the ACOs could issue tickets to people to ignore the West Tisbury leash laws. My only consolation is before the go attacked the chickens, it tore up the compost pit. Where Tom had rectnly dumped the contents of the fly traps. So one can only hope the dog was covered in nice, smelly maggots when she finally got it back in an overheated car. Idiots.

And we had called the cops, but that turned out to be right at the time a helicopter was going into the water off the island.  (Last I heard every one survived.) Our truly wonderful Animal Control Officer showed up later (her car had died)  (the woman and the dog had left, but she, or at least her car, had come back) and the ACO was going to go to the cemetary to speak to the dog owner. I can protect the chickens against hawks and racoons, dogs are different. Idiots don't know or don't care that a scared chicken can fly straight up and hit a beam and break its neck. The dog may not have laid a tooth on the chicken, but it is just as dead. We certainly expect egg laying to be off for a while. Idiots. 

Other wierd stuff happened (rumors of cheese making scandals) but I'm too mad still to blog about them.

Peachy Scallops

Saturday, 21 June 2008 11:36 A GMT-05
Peachy Scallops
 
1 lb scallops, large, sea
2-3 peaches*, ripe
4-6 plums*, ripe
2 Tbsp butter
 
Cut each fruit (peeling optional) into 8 wedges.
Melt butter in a frying pan and allow to brown slightly.
Add fruit and cook until soft.
Add scallops and cook until just barely done - slightly underdone is better than overdone. About 2-3 minutes on each side for huge scallops (8/lb) and half that for smaller scallops.
Serve over rice or sourdough pancakes.
*Note: Other ripe fruit in season (pears, pitted cherries, apricots, etc. also work well.
*************************************************************
 
Sourdough pancakes
 
  2/3 cup bead flour *                       
  1/3 cup cake flour *
                        
  1 cup whole wheat flour                 
  2 Tbsp Sugar                             
  2 cup buttermilk; body temperature
  1 cup sourdough starter                 
  2 eggs                              
  1/4 cup Butter; melted
  3/4 tsp. Salt                              
  1 tsp. baking soda   
                    
Make the sponge: Combine flours, sugar, and buttermilk and mix well. Add sourdough starter and blend thoroughly. Cover with plastic wrap and let rest at room temperature overnight. (Less time will result in a less 'sour' pancake.)
 
When the griddle is ready (400 F), beat/whisk the eggs, melted butter, and baking soda together until light. Blend this mixture into the sponge and start making pancakes immediately on a buttered griddle.
 
*1 cup 'all-purpose' flour may be substituted for the bread & cake flour.
 
Note: The time to make these is when you take a cup of started out of the crock to feed the starter. Instead of throwing the extra cup of starter away. make these pancakes instead.
(Pancake recipe courtesy of King Arthur Flour Cookbook)

Category: Hungry?

Emerge and Merge

Saturday, 21 June 2008 5:17 A GMT-05

The experiment yesterday was to combine the baby flock with one of the grown ones. The chicks and their foster mom were a little dubious about going through the door between the coops.

But after a while they took the plunge. The big chickens mostly ignored them. They were far more interested in exploring the coop they had not been in in 4 months. And eating the chick's food. Chicks ought to eat their starter food for another couple of months, but since the flocks are merged, will certainly be eating regular layer pellets.

Layer pellets have too much calcium in them for chicks, and chick food not enough for grown hens. However, even though the flocks are merged, they still go into their respective coops at night and I can shut the adjoining door and refill the chick's feeder with starter pellets. That way they can at least have a good breakfast of their appropriate food.

I spent a couple of hours out with them, sitting on the bench we have in the run, listening to podcasts from Slate (I particularly like the Political Gabfest and Culture Gabfest and Spoiler Specials [info on how to listen/subscribe under the Slate link above]) and knitting a hat for Ellen.  I'm working on Mod Cables and it is my new favorite cable pattern. I can't wait to try the pattern in bi-color. 

 

This is knit in a worsted weight cotton, for summer, but it really wants an alpaca/silk/merino Andean Silk blend from Knit Picks (in cinnamon and chocolate.) 

Yesterday we had a fabulous and interesting meal of local scallops (recipe coming soon.) Local scallops are very very good but these were better than usual. It turns out that most scallps are caught by boats that go out for a week or ten days and it is a toss-up about whether a scallop wa caught on day one or dayseven or ten.  However there are day boats that go scalloping off Nantucket. And if for some reason they don't want to take their catch to New Bedford, they bring it to our friend Louie at Net Result . He then trucks them to New Bedford, but first he keeps the best for his store, and that is what we had last night. And they were the best scallops ever. Tom invented a grand summer recipe for them which I'll post as soon as he writes it down!

Cable needle hunt

Wednesday, 11 June 2008 2:17 P GMT-05

I am enjoying knitting cables, especially bi-color cables, but I keep losing my cable needles. After knitting the cable twist, I put the little cable needle down, and it often vanishes.  I've probably lost 5 in the last two weeks. Some are gone for good, somewhere out in the yard when I was grazing chickens and knitting. Others have probably worked themselves down into the framework of my recliner.  (Yes, I've tried cabling without using the needle and it isn't for me.) What works best is something that attaches me to the cable needle.

 Third best is to use a ponytail band wrapped around a finger with the cable needle stuck under. But that is a bit awkward to knit with and sooner or later my circulation protests. Second best is to use the cuff I knit out of homespun that usually holds my roving when I'm drop spinning. Except at this time of year with the temperature in the 90s, the cuff makes my wrist very hot and sweaty. 

My current favorite solution is a found object - the band from my Ipod case.  Ifrogz.com makes silicone Ipod cases and some of them have bands to go around the case and a hole for the headphone jack. The video ipod case band is the perfect size to fit loose around my wrist, hold the needle firmly and even glow in the dark.

So far my favorite cable needles are the ones from Britanny Birch . They have a nice waist to hold the stiches - which I like better than the seagull shaped metal ones or the 3/4 horseshoe shaped ones or the ones with ridges. I mostly use the middle size - I wonder if I can just buy that size instead of the set of small/medium/large. 

latest hat, this one for Ellen

Tuesday, 10 June 2008 5:31 P GMT-05

Mostly finished on the ferry today. 

New View

Monday, 9 June 2008 6:21 A GMT-05

Our neighbor cut down the Russian olive thicket that covered one of his properties. The view is back to what it was when we moved in  - though an awful lot of bird habitat and sound barrier was lost. No idea what he plans to do next. I suggested a wildflower meadow (even with a gazebo and some parking) since the neighbor is in the wedding business and Vineyard brides are crazy about wildflowers for weddings. No response on that one.  Here is the view, with a turkey looking on and over.  If nothing is done to pull up the roots the Russian olive grove will be back in three years or so.

Aside from having a killer heat wave (95F yesterday which is unusual for us this early) our spectacular sunsets have started - which we can now see better.

Here is yesterday's sunset - three photos taken just a minute apart to show how fast the sky changes.

Random Bits and Not Really a Rooster

Wednesday, 4 June 2008 1:47 P GMT-05

Tom is in Boston and had a dreadful time getting there this morning.  It took the bus 2 1/2 hours taking the back roads to avoid traffic. He isn't sure whether there was a wreck, or this is just the start of summer madness. He barely was on time for his appointment - this is important because all the appointments tomorrow depend on when he gets started today. At least he will be flying back tomorrow afternoon.

Yesterday I heard a crow - as in crowing - and not from our roosters or the neighboring rooster, but from one of our hens. It is fairly common, at least enough that there are various versions of the folk saying about "a whistling woman and a crowing hen". Apparently it comes from a hormone imbalance, which I find interesting since chickens have gender issues. For example, when a fertilized egg is layed, it isn't decided yet whether the chick that hatches is male or female. The brooding temperature decides that, at least in part, and a warmer clutch yields more roosters, cooler more hens. So, if you have two hens brooding the same clutch, the eggs will stay warmer. If for no other reason that the two hens usually don't take the food/poop breaks at the same time so the eggs don't cool down as they normally would with one broody hen. From what I've read, some crowing hens are still laying eggs, but I don't think ours is. Her crow is more of a croak, but it certainly isn't one of the noises a hen makes!

An interesting bit of trivia is that there is a nation wide mealworm shortage. (I feed mealworms to the zebra and java finches in the sunroom. And the chickens when they need a super special treat. I used a trail of mealworms to teach the baby chicks to climb up and down the ramp in their coop.) Anyhow, I don't know details but apparently one or more of the big mealworm suppliers had a failed crop and that has effected the whole country. Fortunately I found out about it right before I fed off the last of my mealies and I'm now nuturing them. They aren't hard to raise on a small scale at least.

And the last bit of randomness is that I really like singer/songwriter/ukulele player Julia Nunes.  Look at her vids on Youtube. Expecially Build Me Up, Buttercup and It's Raining Men   and her  own song Into the Sunshine .

Better Frizzled Sumatran Chick and Silkie Pictures

Monday, 2 June 2008 7:15 P GMT-05

 There is a better photo of the frizzled Sumatran chick.

And here is a better one of the foster mom. She is a black Silkie - a Chinese breed with black skin and black bones. The feathers are very downy and can be a variety of colors. Silkies tend to make good moms and this one is superb! 

First Steps, Bi-Colored Binary Cables

Monday, 2 June 2008 10:53 A GMT-05

The chicks took their first steps out of the coop onto the grass last week, carefully supervised by me and the mama hen.

 This is the, I suspect, little rooster braving the door sill while the rest watch dubiously. But soon all were out grazing in the few square feet I'd fenced off for them.

The frizzled Sumatran is frizzling nicely (better pic coming soon) though without a head-frizzle, his/her body looks way to big for the head. 

 

And I finished the Binary Cable cap by Firefairy at Different Dummer Designs.  This pattern is free to download from Ravelry. (This link may not work since you have to register with Ravelry.) I really like this hat - each cable is different and represents counting in binary from 1 to 16.  I knit it in cotton worsted and will knit it again in wool. It is a bit small and has no stretch. But this is my first attempt at bi-colored cables and I think I've found a new knitting love! The best of cabling and stranded! Tom thinks it looks like a wonderful forest tangle.