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By Paul Goldfinger, MD  (This article has been updated from our 2011 post)

Sal commented regarding our article about hamburgers.  He said, “Be careful mentioning that your burger was medium rare… isn’t it now against the law to serve a burger in NJ that’s not well done?  No pink at all from what I know.”

Sal makes an important point. I could not find an actual health department regulation for restaurants about this, so if any readers know more, please comment below. I have checked the USDA recommendations (US Dept. of Agriculture. See link below)  They monitor meat processing plants routinely.

When you buy hamburger from the store, leave it in the original packaging and keep in the refrigerator at less than 40 degrees F.  for no more than 1-2 days before cooking.  Below 40 degrees will keep the bacteria from multiplying.     If the meet is frozen, thaw it in the refrigerator; never at room temperature. Do not leave the meat out at room temperature for more than 2 hours. But the best practice is never to leave it out of the fridge. Bring a cooler to the grocery store for the trip home.

Get a good food thermometer to check the burger while cooking it.

Here is a USDA link on this subject:

www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/meat-preparation/ground-beef-and-food-safety/CT_Index

HAMBURGER MEAT (160°F)

Hamburgers from fast food restaurants are OK because they are cooked safely to 160°F. In other restaurants, ALWAYS order your child’s hamburgers well done. Also, older people, pregnant women, or people with a serious illness should order hamburgers well done.

At home, cook burgers to 160°F and keep cooking for at least  15 seconds. Looking  at the interior color not a good way to know if hamburgers are cooked enough. Check the temperature with a good quality food thermometer.

The concern is about E. Coli or other worrisome bacteria such as Salmonella—- These are dangerous organisms that may grow on the surface of meat and which can be stirred into the mix when meat is ground.   It is recommended that you do not grind meat at home.

The pathogens may survive within the burger even if the burger is in the fridge.  You kill the bacteria when you cook the meat to 160 degrees.  When you use a thermometer, insert it into the interior center of the  burger.

I saw a video of the famous chef  Daniel Boulud making a hamburger. He grilled it on a cast iron pan, stove top, for 3 minutes on each side. He then proudly cut a piece off and exclaimed success. It was rare. But, of course, he is confident of where his meat is coming from and what the condition of his kitchen is.

To tell the truth, when I ordered my burger medium rare at Ivan and Andy’s, I didn’t worry about it because it was a fine restaurant where I suspect they cut and grind their own meat. But, when I am in a diner or most other restaurants, I always ask for it to be medium. Sometimes the restaurant will refuse to serve it rare or medium rare.  Some people will not order a burger in a restaurant.

On occasion, the health risks surrounding food are especially high, and so we must change our habits. About 15 years ago I stopped eating something that I loved: raw clams and oysters. One of my colleagues, an infectious disease specialist, had just returned from a medical meeting in New Orleans. He said that he did not eat any raw shellfish down there because of the substantial risk of hepatitis. If he could turn his back on those New Orleans oysters, then it was time for me to bite the bullet.

But as for hamburgers, I think the risk varies with circumstances. My official advice is to always order or cook your burgers well done. But if Daniel Boulud were making my burger, I probably would still ask for it medium rare, which is the most delicious end point.

There is an adage: “Physician—heal thyself.” But doctors are imperfect, and if we do order our burgers medium rare, we probably shouldn’t admit it on Blogfinger.

 

DUKE ELLINGTON AND HIS ORCHESTRA like to stop at Dixie Roadside Diners:

 

Lah de dah, tis Autumn.

“Marvin, should we head south or stick around for Thanksgiving?” ©      Sue Gioulis cartoon for Blogfinger.

“..then the birds got together to chirp about the weather…..lah de dah, ’tis autumn.”

*This lyric is from the 1941 song “Tis’ Autumn” by Henry Nemo. Nat King Cole had the first recording of this composition. The Stacey Kent version can be found in our post below.  Here is Stan Getz:

STAN GETZ  “Tis’ Autumn.”

Asbury Avenue.  Ocean Grove. September 23, 2017.    Paul Goldfinger© #1 in a series.  Click to enlarge.

STACEY KENT   from her album “The Boy Next Door.”

Cleo

Hurricane Cleo hits Miami Beach in August 1964, demolishing the lobby of the Deauville  Hotel. Paul Goldfinger award winning photograph. ©

 

GLORIA ESTEFAN AND THE MIAMI SOUND MACHINE:  “Anything For You.”

 

Beach babies. Ocean Grove,New Jersey. 2015. “Girls in their Summer Clothes”© Paul Goldfinger photograph.

 

FIRST CLASS:  “Beach Baby”   By a British band in 1974.

 

 

Purchases today from the Asbury Sunset Farmers Market. 9/23/17. Blogfinger photo in Ocean Grove. 

By Eileen and Paul Goldfinger, editors @Blogfinger.net

Despite the autumn date, the farmers at the Sunset Saturday morning market had a lot of merchandise. I knew exactly what to get.  If Eileen had been there she would have studied everything and bought 2-3 times as much.

From the Paterson Italian baker I chose the Sicilian twist.  This bread was $4.00 and well worth it.  The crunchy crust was bejeweled with baked sesame seeds. It is guaranteed that about 10% of them will wind up between your teeth; but who cares?  The interior is soft and chewy.  Never use a knife on this.  Do like the Sicilians and rip off a hunk and then dip it into extra virgin olive oil.

There is a dealer there who has wonderful olive oil from his family’s farm in Calabria, which is the toe of the Italy boot. Some of his oils are flavored with garlic, but Eileen prefers the plain. Sometimes his girlfriend takes my money, and that is a bonus.  I’ve always found the name “extra-virgin” to be  provocative. It has a technical definition, but I prefer to use my imagination.

On the right is a stromboli made by the Paterson baker. It has mozzarella cheese and fried eggplant inside. On the outside is pastry dough. You put it into the oven to melt the cheese, and it is delicious. He also bakes them with sausage and a few other ingredients. I like to imagine myself with Sicilians sitting around in a vineyard, sipping Chianti while muching on stromboli. But my hopes were dashed when I read this in Wikipedia:

“Stromboli was invented in the United States in the 1950s.  It was named after the Italian film  Stromboli.   A stromboli is somewhat similar to a calzone.”

And, as you can see, the Jersey tomatoes still exist, and the prices are starting to drop.  This is a great time to buy in quantity to make sauces, soups, stews—–and for canning.

LUCIANO PAVAROTTI WITH THE THEATER ORCHESTRA OF BOLOGNA:  “‘A vucchella.”

Arrhythmogenic right ventricular dysplasia.

By Paul Goldfinger, MD, FACC

The front page of today’s Asbury Park Press is about the sudden cardiac death (SCD)  of a 16 year old male high school varsity lacrosse player from Howell Township.  The event occurred during a game being held at Rutgers.

The autopsy revealed the presence of a rare genetic  heart muscle disorder called arrhythmogenic right ventricular dysplasia  (ARVD)

The pathology of this condition  (see drawing above)  consists of a weakening of the walls of the main pumping chamber on the right side of the heart  (right ventricle) causing that chamber to dilate (enlarge).   The muscle of the right ventricular wall deteriorates and becomes replaced by fatty tissue.  Dangerous cardiac rhythm disturbances can occur and result in SCD.

But we also want to talk about  how we are screening our high school and college athletes for cardiac risk before allowing them to participate in strenuous sports.

ARVD is one of a number of congenital disorders that can cause SCD.  The most common one, albeit rare, is also a familial condition called hypertrophic cardiomyopathy.

The National Institutes of Health (NIH) says, “The sudden death rate among high school athletes is 1:100,000–200,000;  among marathon runners 1:50, 000;  and among recreational joggers 1:15, 000.   Thus, exercise-triggered sudden cardiac death is a rare event.”

Not everyone with  ARVD  will experience a sudden death,  but those who do often have  a history of preceding symptoms.   Such symptoms may include fainting, dizziness and/or palpitations.  Medical personnel who perform evaluations of athletes must be alert to such  warning indicators of risk.  The physical examinations of those with ARVD are often unrevealing. But certain tests may suggest a cardiac problem such as an electrocardiogram (ECG). And a cardiac ultrasound  (echocardiogram) is often diagnostic.

In addition, the victim may have no relatives who are known to have this familial disorder.

All students at high schools and colleges undergo  a screening history and physical examination before being allowed to participate in a strenuous sport such as lacrosse. But such an evaluation may fail to find something worrisome in many cases of ARVD with subsequent SCD.  Or a clue may be missed—for example if the examiner doesn’t ask about symptoms such as palpitations.

But beyond the history and physical,  there is controversy as to what else should be done routinely  to screen these athletes.

Of course, if a student has symptoms such a palpitations or fainting; or a worrisome family history; or something of concern on the physical exam, then a referral must be made to a cardiologist, at which point more testing should be done which may include electrocardiography (ECG), echocardiography (ultrasound,) MRI of the heart,  heart muscle biopsy, angiography, stress testing, or genetic analysis.

But  is there anything else that should be done by way of routine risk assessment in all athletes besides the history and physical exam?  In my opinion, an ECG is a must.  Some experts believe that an echocardiogram should also be done routinely on athletes.

The problem is that those hidden conditions, such as ARVD,  which may cause sudden death are extremely rare as is the incidence of SCD  in apparently healthy young athletes.  And the yield of checking thousands of athletes with ECG’s and ECHO tests is extremely low and very expensive.   And even with such testing, certain diagnoses can be missed,  so in the US, most screening does not include more than the history and physical exam.

But in Europe they do routine ECG’s and find it to be very useful in locating some high risk individuals.  I don’t know if any programs use routine echocardiograms.

If I had my way, and money were no object, all these screening exams would be conducted by cardiologists, but the reality is that general practitioners and even physician extenders such as nurse practitioners are usually given the job; however, they might overlook something.

I would definitely do an ECG regardless of cost on each student being screened.  And the ECG must be read by a cardiologist.    No official public health organization has suggested a routine echocardiogram.

But even for rare conditions, if you could make the diagnosis of, for example, arrhythmogenic RV dysplasia, you could offer the patient an opportunity for counseling and therapy, even though ARVD is not curable.  Some such patients have even received a heart transplant.

To put this in perspective, SCD in young athletes is a rare event among the many hundreds of thousands of students who participate in strenuous sports, and when such an event occurs, it always appears in the news, so the concerns get amplified.

But that doesn’t mean we shouldn’t aggressively try and identify those who are at risk, even if such screening  is not 100% successful.

Parents could get some peace of mind by having an ECG and echocardiogram done, even if they have to pay for it themselves. And, don’t forget that close relatives of SCD  victims should get screened themselves.

 

 

pot roast

Eileen’s holiday pot roast. Photograph and recipe by Eileen Goldfinger, Food Editor@Blogfinger.net .  ©

Prepare 1-2 days before serving
Preheat oven 350 degrees

5-6 pound brisket
freshly ground black pepper
paprika
5 tablespoons vegetable oil
4 cooking onions, diced
4 carrots, peeled, cut in ¼” rings
4 stalks celery with leaves, ¼” slices
1 package (8-10 oz) fresh crimini or white mushrooms, thinly sliced
5 small cans of whole white potatoes (drained of the liquid)
5 cloves garlic, minced
2 8 oz jars beef gravy
1 cup red wine
1 box low sodium beef or chicken broth
½ cup marinara sauce

Rub paprika and black pepper on both sides of the brisket (approximately 2 tablespoons of paprika & 1 tablespoon black pepper.)
Heat a large oven proof pan (with cover) on the stove. When pan is hot place brisket in pan and sear until meat turns brown. Turn meat over and sear on the other side. Remove brisket from pan and set aside.

Add oil to the pan and heat medium low. Add onions, carrots, and celery. Sauté on medium low heat for 15 minutes. Next add garlic, 1 jar beef gravy, red wine, box of broth, and marinara sauce. Stir the liquids with the vegetables and add the seared brisket to the pan. Place the cover on the pan and put it in the oven for 3 hours. Half way through the cooking time, turn the meat over and continue cooking with lid on pot.

After the 3 hours remove the pan from the oven and allow it to cool. Place meat and gravy in a closed container and store in the refrigerator until the morning of the day you plan to serve the meat. Remove congealed fat and take brisket out of container (scrap gravy off the meat). Slice the brisket in ¼” slices on the diagonal, against the grain of the meat. It is very important that you slice against the grain or the meat will be tough and stringy.

Preheat oven 250 degrees.

Place the meat in the original pot. Add the gravy, all the potatoes, mushrooms, and 1 jar beef gravy. Place cover on the pot and place in the oven for 2 hours. I serve the brisket right from the pot it was cooked in. Serves 8

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A taste of Jewish history:  It’s now 5777 by the Hebrew calendar, and Rosh Hashanah is upon us. The Jewish New Year is a serious religious event, but, like so many of our holidays, food is a big deal, especially traditional recipes. There are a lot of moving parts, but if Eileen leaves out anything she hears about it.

We eat apples dipped in honey for a sweet new year. Pomegranates have a similar purpose. (Although the Chinese like this too.)  We have round  (goodness without end) egg breads (challah)–often with raisins.  Some of our foods are so good that they show up at multiple holidays.  For example there’s chicken soup with matzoh balls and/or noodles. Then there is sweet Kosher wine and, the piéce de résistance—pot roast.
Of course Jews were scattered all over the world for thousands of years, so there are variations in the foods.  If you are in the north east, brisket is usually used, but if you head to other parts of the country, the pot roast is made with different cuts of meat.

Many Jews that one might meet in New Jersey and New York are from families that escaped from eastern Europe during waves of immigration during  the late 1800’s to early 1900’s.  So they brought pot roast with them.  On the other hand the Sephardic Jews in Deal might have couscous, leeks, pumpkin and fish with the head still attached.

My family, like most others, wanted to be Americanized as soon as possible. And that included customs, dress and language. But the foods were never forgotten. They spoke Yiddish at home because of the grand parents, but they always spoke English elsewhere.

Here is Mandy Patinkin who made an album of songs sung in Yiddish, and in this song he celebrates America–not the old world, but the new…..

By Paul Goldfinger, Editor @Blogfinger

Montmartre, Paris

Montmartre, Paris (A large hill on the right bank) By Paul Goldfinger ©

Montmartre, Paris (A large hill on the Right Bank) By Paul Goldfinger © Reposted from 2015.

GERRY MULLIGAN  “Home when shadows fall”