Unnecessary Procedure
​on Terminal Patient

DEAR DR. ROACH: My mother has stage 4 cancer. She just went to a dermatologist, who performed Mohs surgery on her nose. I am BEYOND upset by this unethical behavior. The country is already deeply in debt, and Medicare is paying for this? Unconscionable! Not to mention the pain and suffering of my mother, who is now at risk of a secondary infection. I was sickened by the entire ordeal. — J.B.

ANSWER: I agree with you completely that often patients with terminal diseases receive unnecessary care. There have been studies clearly documenting this. However, the studies don’t answer why, in a particular case, a physician performed these treatments, which add only pain, anxiety and expense.

I suppose it is possible that the motivation is simple greed; however, I still have enough faith in my colleagues that I think that is a very unusual reason; I think it’s far more likely that a specialist just doesn’t see the big picture. There’s an old expression that when all you have is a hammer, the whole world looks like a nail, and I think some specialists see a problem and fix it without realizing that the problem they are fixing isn’t likely to ever cause symptoms.

For example, primary-care doctors order unnecessary tests, especially screening tests. I see mammograms ordered for women with advanced colon or ovarian cancer who are in palliative care, and this makes no sense. I have heard some physicians mention that insurance companies monitor the frequency of “quality indicators,” such as mammograms, which affect their ratings and reimbursement. That’s an example of a well-meaning system motivating wrong behavior.

I should emphasize that not all care for terminal patients is useless. If the goal is to improve quality of life or reduce suffering, then I am all for it, after a consideration of the costs (pain and inconvenience as well as dollar costs).

* * *

DEAR DR. ROACH: I have heard of yeast infections, but I don’t know what causes them. How do they affect the body, and what can be done to get rid of them? — C.R.

ANSWER: Certain yeasts, but especially the Candida species, are found on our skin, mucus membranes and GI tract. They normally live in balance with the 100 trillion or so bacteria we carry around. However, yeast can cause disease that ranges from fairly mild, like thrush of the mouth or vagina, to life-threatening, like a blood-borne, widely disseminated invasive infection. 

Candida infection of mucus membranes is usually caused by changes in our bacteria, especially after the use of antibiotics. The antibiotics kill the bacteria they are supposed to (hopefully), but they also may kill the healthy bacteria that assist us in digestion (leading to diarrhea or worse), and this allows the other bacteria and yeast to grow.

Some people with genetic faults in their immune system are predisposed to chronic candida infections. These are uncommon but can be severe, and may require treatment by specialists, such as infectious disease doctors and immunologists.

The life-threatening yeast infections generally happen in people with severe illness and with poor immune
system function.

* * *​

Dr. Roach regrets that he is unable to answer
​individual letters, but will incorporate them 
in the column whenever possible. 
Readers may email questions to ToYourGoodHealth@med.cornell.edu. 
To view and order health pamphlets, 
visit www.rbmamall.com, or write to
​Good Health, 628 Virginia Drive, Orlando, FL 32803.

© 2018 North America Synd., Inc.
All Rights Reserved

Herbed Potatoes Au Gratin

“This rich, creamy side is incredibly versatile. At Easter I add thyme and parsley, and at Christmas I use rosemary and serve it with prime rib. I like the chunky potatoes better than the traditional thinly sliced ones, plus they’re easier to prep.” — Ree Drummond

3 tablespoon unsalted butter
1 medium onion
1/2 cup heavy cream
Kosher salt
Pepper
8 ounces cream cheese
3 ounces Parmesan
1/4 cup chopped fresh flat-leaf parsley
1 tablespoon fresh thyme
3 pounds russet potatoes, sliced thin or cut
​   into chunks
Chopped fresh chives

1. Heat oven to 350 F. Butter a 3-quart shallow baking dish.

2. Melt the butter in a large skillet over medium heat. Add the onion and cook, stirring occasionally, until beginning to soften, about 5 minutes.

3. Add the milk, cream, 1 teaspoon salt and 1/2 teaspoon pepper and bring to a bare simmer. Add the cream cheese and cook, stirring, until melted, about 3 minutes; stir in 1/2 cup Parmesan. Remove from the heat and stir in the parsley and thyme.

4. Place the potatoes in the prepared baking dish and pour the milk mixture over the top. Sprinkle with the remaining 1/4 cup Parmesan and cover tightly with nonstick foil.

5. Place the baking dish on a large rimmed baking sheet and bake for 30 minutes. Uncover and bake until the potatoes are tender and the top is golden brown, 50 to 60 minutes more. Let rest for 15 minutes, then sprinkle with chives before serving, if desired. Makes 8 servings.​

​For thousands of triple-tested recipes, visit our Web site at www.goodhousekeeping.com/recipes/.
© 2018 Hearst Communications, Inc.
​All rights reserved

Asparagus Quiche

With spring in the air and asparagus readily available, here’s a great high-protein lunch dish that is sure to be a hit.


1 refrigerated unbaked 9-inch pie crust
1 1/2 cups (9 ounces) diced 97 percent fat-free ham
3 cups finely chopped fresh or thawed frozen
   cut asparagus
4 (3/4-ounce) slices reduced-fat Swiss cheese,
​   shredded
2/3 cup nonfat dry milk powder
1 cup water
2 eggs, beaten, or equivalent in egg substitute
2 teaspoons dried onion flakes
1/4 teaspoon ground nutmeg


1. Heat oven to 350 F. Place pie crust in a deep-dish 9-inch pie plate and flute edges. Layer ham and asparagus in prepared pie crust. Evenly sprinkle Swiss cheese over top. 

2. In a medium bowl, combine dry milk powder and water. Add eggs. Mix well to combine. Stir in onion flakes and nutmeg. Pour milk mixture evenly over top.

3. Bake for 50 to 55 minutes or until center tests done. Place pie plate on a wire rack and let set for 10 minutes. Cut into 8 wedges. Serves 8.

HINT: Thaw asparagus by placing in a colander and rinsing under hot water for one minute.

• Each serving equals: 230 calories, 10g fat, 15g protein, 20g carbs, 515mg sodium, 190mg calcium, 2g fiber; Diabetic Exchanges: 1 1/2 Meat, 1 Starch, 1 Vegetable, 1 Fat; Carb Choices: 1.

© 2018 King Features Synd., Inc.

Delicious Ideas For Adding
Healthy Sweet Potatoes
​To Your Daily Cooking Repertoire

(NAPS)—Sweet potatoes are trending and are all the rage—as they should be! One medium California sweet potato has only 105 calories and 0g of fat, yet this versatile veggie contains more than 80 nutrients including protein, manganese, carotene, potassium, calcium, vitamin C and more than an entire day’s worth of vitamin A. Plus, California sweet potatoes are rich with antioxidants and loaded with dietary fiber—nearly twice as much as a white potato.

Not just for Thanksgiving, thankfully, California sweet potatoes are available year-round. Chefs and home cooks are coming up with fun and creative ways (beyond Grandma’s holiday casserole) to incorporate this tasty tuber into everyday meals—winter, spring, summer and fall.

Here are some delicious ways to cook with California sweet potatoes:

•    For a quick snack, add a cooked California sweet potato (or two) to your favorite hummus recipe, garnish with a good glug of olive oil and a generous squirt of lemon. Serve with crudités and pita triangles.

•    Make a beta-carotene-rich soup by adding uniformly chopped California sweet potatoes, butternut squash, and carrots to a homemade or store-bought chicken stock. Throw in a can of white beans, a handful or two of kale and garnish with chopped flat-leaf parsley. Serve with freshly grated Parmesan.

•    What’s better than home fries for breakfast? California sweet potato home fries! Switch out white potatoes for California sweet potatoes, throw in some chopped onions, bell pepper and a sprinkle of cayenne or paprika and you’ve got sweet potatoes O’Brien to go with your bacon and eggs.

•    Mashed California sweet potatoes make a delicious accompaniment to a store-bought or homemade roasted chicken. Steam the sweet potatoes until tender, mash, and stir in warmed butter and milk. For garlic mashed, simply throw a few cloves of garlic into the steamer and mash them with the sweet potatoes.

​Brunch is always a great way to entertain family and friends. Whether it’s Easter, Mother’s Day or a regular old Sunday, why not wow your guests with a delicious spread? Coffee, mimosas, Danish, croissants, fruit salad and of course something with eggs.

This breakfast strata made with tasty, wholesome
sweet potatoes can be a great way to punch up a brunch buffet.

This breakfast strata will more than satisfy:

California Breakfast Strata with Sweet Potatoes, Chiles and Goat Cheese
Serves 10 to 12

Ingredients:

1 tablespoon cooking oil
1 pound orange-fleshed sweet potatoes, cut into
    3/4-inch dice (about 31/4 cups)
12 ounces loose breakfast sausage or breakfast
    sausage patties
One 7-ounce can chopped green chiles
Nonstick cooking spray
10 ounces crusty Italian or French bread, with
    crusts cut or torn into 3/4-inch pieces
    (about 10 cups)
4 ounces chèvre (spreadable goat cheese),
    crumbled (about 1 cup)
3 tablespoons chopped fresh sage
8 large eggs
2 cups milk
3/4 teaspoon salt
1/2 teaspoon pepper

Instructions:

In a large skillet over medium heat, warm the oil. Add the sweet potatoes and cook, stirring occasionally, for 5 minutes. Add the sausage and cook, breaking it up and stirring occasionally, until the sweet potatoes are lightly browned and tender and the sausage is cooked through, about 8 minutes. Stir in the chiles and set the skillet aside.

Coat a 21/2- to 3-quart casserole dish with cooking spray. Arrange 1/3 of the bread in the dish. Top with 1/3 of the sweet potato mixture, 1/3 of the cheese and 1/3 of the sage. Repeat 2 times. Set aside.

In a large bowl, whisk the eggs, milk, salt and pepper. Pour the egg mixture over the casserole and set aside for 20 minutes, pressing on the bread occasionally to help it absorb the liquid.

Meanwhile, preheat the oven to 350° F.

Cover the casserole with foil and bake for 50 minutes. Remove the foil and continue baking until the top is browned and the center is set, about 10 minutes. Let stand 10 minutes before cutting and serving.

​For more information about California sweet potatoes and for delicious recipes, visit
www.casweetpotatoes.com.

Leftovers and Food Safety

The first step in having safe leftovers is to cook the food safely. To be sure you are cooking food to the proper temperature, use a food thermometer. 

Bacteria grow rapidly, and to unsafe levels, if food is kept in what is called the “temperature danger zone.” (40°F to 140°F)  Be sure your leftovers are kept safe by following these steps:

• Refrigerate leftovers within 2 hours of cooking or holding it hot.

• Throw away all cooked food that has been at room temperature for more than 2 hours.

• Cool foods rapidly. To do this, large quantities of food should be cut in smaller pieces first or divided into shallow containers that will aid in cooling.

• Cover leftovers well before refrigerating. This helps keep odors and bacteria out and moisture in.

• Store leftovers in the refrigerator for up to 4 days or freeze for up to 4 months. Although leftovers are safe indefinitely when frozen, quality will deteriorate when stored longer.


For a chart on storage times, visit: http://www.foodsafety.gov/keep/charts/storagetimes.html


If you are unsure about food storage or have other home and family-related questions, contact our ISU Extension and Outreach “AnswerLine.” Did you know you will actually talk to a person?! Yes, this is rare these days! You can speak directly with a Home Economist by calling the toll-free ISU AnswerLine number in Iowa!  

AnswerLine is staffed Monday-Friday from 9 am-noon and 1-4 pm. To reach AnswerLine, call: 


1-800-262-3804 (in Iowa)

1-800-854-1678 (in Minnesota)

​1-800-735-2942 (Relay Iowa phone linkage for deaf and hard-of-hearing individuals)


You can also visit AnswerLine’s website at:
www.extension.iastate.edu/families/answerline

• “To make sure I’m drinking water throughout the day, I use a permanent marker to designate levels on my large reusable water cup. I labeled them 10 a.m., noon, 2 p.m. and 4 p.m. That’s for a big one that sits on my desk at work. I have another for at home. This way I am not trying to play catch up later in the day.” --
A.L. in Oklahoma

• Three ways to save money on water-heater bills: 1) Set your temperature gauge to a lower setting. 2) Install a timer so that it’s not heating water when you aren’t there to use it. 3) Add an insulating cover to keep heat from escaping.

• Game changer: “When dunking a sandwich cookie (e.g. Oreos), jab a fork into the filling. Then you can dunk the whole thing or part of it without getting your fingers all milky — or your milk all ‘fingery.’” — A.J. in Florida

• When you microwave leftovers on a flat plate, be sure to spread them out for even heating. The classic ring of food is best — leaving the center of the plate empty. Slice already-cooked potatoes, and cover with a moistened paper towel.

• Need to light a pillar candle inside a hurricane glass? Use a stick of spaghetti! The pasta stick lights easily, and it’s long enough to give you the reach you need. It burns evenly, too.

• “If you like to save money by buying large packs of meat — say, ground beef or chicken tenderloins — here’s a great tip for storing them: Fill quart-size freezer bags, making sure to get out as much air as possible. Then stack flat on top of a pizza box in the freezer.” — T.L. in Missouri

Send your tips to 
Now Here’s a Tip,
628 Virginia Drive,
Orlando, FL 32803.

​© 2018 King Features Synd., Inc.

How To Keep Home Fires
​From Burning

A few simple steps can help seniors stay safe at home.

(NAPS)—More than 350,000 fires occur each year and often in the homes of seniors. In fact, older adults are consistently more threatened with death or injury by fire than any other age group—but you can keep your home safe by following these safety tips.

Heating Safety

•    Keep anything that can burn at least three feet away from heating equipment.

•    Don’t use your stove for heating.

•    Don’t dry clothes on a space heater.

•    Have your heating system inspected by a qualified service professional at least once a year.

•    Make sure all fuel-burning heating equipment is vented to the outside.

•    Keep intake and output vents clean and clear of debris and dust.

Space Heaters

•    Inspect heaters for cracked or broken plugs or loose connections before each use. If anything is frayed, worn or damaged, don’t use the heater.

•    Place space heaters on level, flat surfaces and out of high-traffic areas and doorways.

•    Plug portable space heaters directly into an outlet; don’t use an extension cord.

•    Keep space heaters at least three feet away from anything flammable.

•    Never leave a space heater unattended. Turn it off when you leave the room or go to sleep.

Fireplaces and Wood Stoves

•    Have your chimney or wood stove inspected annually by a certified chimney specialist.

•    Use a fireplace screen to stop sparks from flying into the room.

•    Never leave an open flame unattended.

Cooking

•    Unattended cooking is the leading cause of home fires. If you have to leave, even for a short time, turn off the stove. 

•    Wear short, close- fitting or tightly rolled sleeves when cooking. 

•    Keep the stove top and oven clean and free of grease and oil.

•    Keep all flammable material away from heating elements. 

•    Keep towels and pot holders away from hot surfaces. 

•    Turn pot handles in.

Smoke and Carbon Monoxide Alarms

•    Place alarms inside each bedroom, outside each sleeping area and on every level of your home. 

•    Don’t put alarms near windows or ducts where
drafts might interfere with their effectiveness. 

•    Never paint smoke alarms. 

•    Test them at least once a month and change the batteries at least once a year.

•    Keep smoke alarms at least 10 feet away from
cooking appliances to minimize false alarms.

•    People who have difficulty hearing can get alarms that make low-pitched sounds or vibrations.

Electrical Safety

•    Call an electrician if you see a discolored wall plate, smell burning, or hear a crackling or buzzing sound from wall switches or receptacles. 

•    Never plug two extension cords into each other.

•    Make sure all appliances are plugged directly into
a receptacle. 

•    Don’t run extension cords through walls or doorways. 

•    Don’t cover cords. 

•    Avoid nailing or stapling cords.

•    Don’t substitute extension cords for permanent wiring.

•    Have a licensed electrician install an arc fault circuit interrupter (AFCI) circuit breaker or receptacle. AFCIs can prevent 50 percent of home fires.

•    Make sure all appliances have been approved by a nationally approved testing laboratory.

•    Have your home inspected by a licensed electrician every 10 years to determine if you have the proper electrical equipment.

Learn More

For further facts and tips on safety, from the experts at Electrical Safety Foundation International, the premier nonprofit organization dedicated exclusively to promoting electrical safety at home and in the workplace, visit www.esfi.org.

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