My head has been around Mexican cookies for a while. I recently made some Mexican Sugar Cookies and took them to work. The recipe was created by a Mexican woman. They seemed to me like cookies someone really might find in Mexico. I didn’t like them. They were too dry and not sweet enough for my taste. Having lived in Mexico for two years, I am familiar with Mexican taste in such treats. I was pretty sure any “Mexican” cookies would have to be adjusted for an American taste for me to like them.

Debra, one of my blog followers, sent me Mexican Hot Chocolate Cookies. That recipe was almost identical to the Snickerdoodle recipe I got from Peg, a nurse I worked with in Alabama twenty-five years ago. Here is what I came up with when I kind of messed around with them all. Try them with and without the cocoa.

Here they are with cocoa as the recipe is written.

Source:

Peg the Nurse, Debra the Badtadmd.com Fan and Tad

Yield:

48

Ingredients:

2 ½ cups all purpose flour*

½  cup unsweetened cocoa powder*

2 teaspoons cream of tartar

1 teaspoon baking soda

¼ teaspoon salt

1 teaspoon anise seeds, ground**

1 pinch chipotle chile powder

½ cup butter, at room temperature

½ cup shortening

1 ½ cup brown sugar

2 large eggs

1 tablespoon vanilla

½ cup granulated sugar

2 tablespoons cinnamon

Directions:

Heat oven to 400 degrees with racks in upper and lower thirds of oven.

In a medium bowl, sift together flour cocoa powder, cream of tartar, baking soda, salt, ground anise and chile powder. Set aside.

In large bowl, using an electric mixer on medium speed, beat butter, shortening and brown sugar until light and fluffy, about 2 minutes. Scrape down sides of bowl. Add eggs and vanilla. Beat until smooth.

With mixer on low, gradually add flour mixture and beat until combined.

In a small bowl, combine granulated sugar, and cinnamon.

Using a two-tablespoon scoop, form balls of dough. Roll each in cinnamon-sugar mixture and place on parchment-line baking sheets.

Bake until cookies are set in center and begin to crack, about 10 minutes, rotating sheets half way through. (I switch the locations of the sheets on the racks and rotate them 180 degrees as well.)

Remove to wire racks to cool.

Notes:

* Non-chocolate variation: substitute 1/4 cup flour for the cocoa. Several people liked these better. Here is what they look like:

** I have a stone mortar and pestle I use to grind the seeds. You can use a blender but you will probably need to grind a larger amount.

In the emergency department, I frequently have need to aggressively get control of patients in order to get tests that might save their lives. At the same time, aggressive control carries risks so I often face tough choices of how to best control a patient for his benefit. At work one night, I had to go to CAT scan (CT) twice. It is just down the hall from the emergency department but I almost never have to go down there. It was very unusual to have to go twice in one shift. I had to go there to help control two challenging patients who both had potentially life threatening conditions.

The first guy I had to go see was in his twenties. He came in telling me he was nervous and had palpitations after taking cocaine and methamphetamines. His heart was beating fast and he was jittery but was thinking normally.

In such cases, we usually just give them something to help them relax. We watch them for a while until they are better and send them home. This guy, on the other hand, just got worse and worse. Even after being given the sedatives I ordered, he began hallucinating and his agitation increased. Over a relatively short time we gave him a ton of medicine and he finally fell asleep. Minutes later, he woke up fighting, agitated and pulled out his IV. Then he fell back asleep.

One rare complication of stimulant drug abuse is a brain hemorrhage caused by the elevated blood pressure and excess agitation. I felt I needed to scan his head to rule out a hemorrhage but he needed to sit still for a few minutes in order to perform the scan. As soon as we tried to move him to the scanner, he would wake up and thrash around again. We gave him so much medicine I was afraid he would stop breathing but whenever he was moved he became too agitated to sit still in the scanner.

Finally, at the recommendation of one of the nurses, we got a spine board and strapped him down like he was a trauma patient. We wrapped straps around his body and tape on his head and neck. We then took him to CT. Once he was given some more medicine and was left on the CT table for a few minutes, he relaxed and we were able to get a scan that showed his brain was OK.

All of this was a huge pain but, in the end, all of his tests were normal except for the cocaine and methamphetamines in his urine. Over the next several hours, he didn’t wake up so he had to be admitted to the hospital for further observation and care.

The second guy provided almost exactly the same challenge but in a very different situation. Right at the end of my shift, a young man came in after having had a seizure. He was two weeks out from having an arteriovenous malformation* (abnormal blood vessel) removed from his pons** (lower part of the brain). He had been doing well after his surgery until that night when he had a seizure. He was still unconscious when the ambulance got him to us.

We did our initial assessments and treatments in record time and the nurses headed off with him to CT. They soon called saying he was thrashing around. I had sent them with instructions to give him a sedative if he seized again or wouldn’t sit still. They had followed my instructions but he hadn’t responded to the medicine. I gave orders for more medicine. That didn’t work either. They were unable to scan him, as he wouldn’t lie still.

I hurried down to CT with another nurse and more medicine. I was finally able sedate him adequately to get him to sit still just long enough for the scan. It showed he had bled into his brain at the surgical site.

It was very challenging to get him to sit still. But it was a big bummer to see the hemorrhage. It had caused the seizure and the agitation, and was also probably going to lead to his death.

So, in the first case, the patient brought his problems upon himself by taking too many stimulant drugs. His CT was normal and he would probably be fine. The second guy had the really bad luck of bleeding after brain surgery. His CT was positive and he was certainly going to have a bad result. It shows why it is so important to be able to get control of such patients to get their studies so any needed care can be provided in a timely fashion.

* http://en.wikipedia.org/wiki/Arteriovenous_malformation

* http://en.wikipedia.org/wiki/Pons

My patient was an elderly man who tripped and hit his head in a minor fall. It was only a big deal because he was taking the blood thinner, Coumadin, to keep his artificial heart valve from clotting off. People on this medicine can bleed into their brains and die after minor trauma that would normally cause no serious injury at all.

As feared, within minutes, his minor fall turned into a deadly hemorrhage around his brain. Though we did everything we could to reverse the effects of the Coumadin and save his life, it was clear that he was in big trouble. I enlisted help from the appropriate specialists then made arrangements for him to be admitted to the hospital.

When I went into the family room to tell waiting family members the bad news, who was sitting there but a friend of mine from church? The patient was his father.

Delivering bad news to family is always a bit dicey. When you throw in a personal connection, it makes it more difficult but more interesting and potentially more rewarding too. Our interactions in the family room were warm and satisfying. My friend understood his father was going to die and thanked me for my efforts in his behalf. I took him to be with his father.

The patient went on to die the next day so his whole huge family started heading into town for the funeral. My wife, as president of the women’s’ organization at church, contacted the family to offer assistance. Besides arranging for rolls and dessert for 200 people for the family dinner at the church, we also offered our house to help them put up members of their immediate family. The wife, her two daughters, two sons-in-law and three grandkids stayed in our three spare bedrooms until the funeral was over and they headed back to Las Vegas.

Who would have guessed, as I headed into the trauma room that night, that it would lead to having my house full of family members mourning the loss of my patient?

Basically the same base as Tad’s Oatmeal Chocolate Chip Cookies but loaded with what I call “floaties.” Chocolate chips, toffee chips, oatmeal, dried cherries. Rather than roll, refrigerate and cut, I just scooped them with a 2 tablespoon scooper. Because they are so loaded, they are a challenge to stir and scoop but you can do it!

Recipe By:

allrecipes.com

 Ingredients:

3 cups all-purpose flour

2 teaspoons baking soda

2 cups unsalted butter, softened

1 ½ cup brown sugar

1 ½  cup white sugar

2 large eggs

1 tablespoon vanilla extract

3 cups rolled oats

2 cups dried cherries

2 cups miniature semisweet chocolate chips

16 ounces toffee baking bits

 Directions:

1. Heat oven to 350 degrees.

2. Grease cookie sheets or line them with parchment paper.

3. Sift together the flour and baking soda. Set aside.

4. In a large bowl, cream together butter and sugars until smooth.

5. Beat in the egg and vanilla.

6. Gradually stir in flour mixture.

7. Mix in oats, cherries, chocolate chips and toffee bits until evenly distributed.

8. Divide the dough in to 3 portions and form them into logs, about 2 inches in diameter. Wrap in waxed paper and refrigerate or freeze until firm.

9. Slice dough logs into 3/4 inch thick slices. Place the cookies 2 inches apart on prepared cookie sheets.

10. Bake 8 to 10 minutes. Allow cookies to cool on baking sheet for 5 minutes before removing to a wire rack to cool completely.

Generally speaking, the smaller the item, the harder it is for me to sew. I was able to plan ahead so this was not that hard. I got it right on just the second try. It hangs around her neck and is just big enough for the phone to sit in snuggly yet be easily accessible. Very handy for Health Center Managers who don’t always have pockets and don’t like to carry a purse!

Here it is around her neck, with name badge attached.

Here you can see it with the phone showing.

When not at work, the badge comes off for civilian use.

Again, with the phone showing.

To celebrate the First Anniversary my blog, I have decided to have a competition.

Write to me or post to the blog a fun idea of something that someone might make out of trauma straps. Any idea will be accepted, practical or fantastic.

On April 1st, 2013, a winner will be selected and will receive a Tad Bag.

I am really excited to see what you come up with! Hopefully you will be excited to get your bag!

We were at RAFT and came across a small bag, constructed to serve as a little backpack with drawstring straps. It was sold, originally, full of golf balls. I used the webbing to make a tad bag of basically the same design.

Here it is on one of our badtadmd.com super models.

Another view of the bag on the same amazing model.

My wife had a few minutes down time so she went online to find some weird cookie recipes for us to try. When she presented me with this one, my first response was negative. I have not liked any of the chocolate with bacon I have eaten. Why would bacon make cookies good?

I was pleasantly surprised with how tasty these are. The tastes meld well together and they are not very bacony for how much bacon and bacon fat they have in them. They have a good texture. The pinch of chipotle is just right. This is a good cookie.

Only bake as many as you want to eat today because I have never made a cookie that went over-the-hill so fast. You will not want to eat them the next day!

Here, unflattened, you can see the peanuts, chocolate chips and, if you look closely, little bits of bacon.

Here it is flattened.

Nice looking cookie!

Source:

Internet search

Yield:

24

Ingredients:

1 ¼ cups all-purpose flour

¼ teaspoon baking soda

¼ teaspoon baking powder

1/8 teaspoon ground cinnamon

Pinch of chipotle or ancho chile powder

¼ teaspoon kosher salt

5 strips bacon (1/3 pound)

4 tablespoons unsalted butter, at room temperature

½ cup creamy peanut butter

½ cup granulated sugar

½ cup packed light brown sugar

1 large egg

1 teaspoon vanilla extract

½ cup roughly chopped honey- roasted peanuts

1/3 cup bittersweet or semisweet chocolate chips

Instructions:

Heat oven to 350 degrees F.

Line 2 baking sheets with parchment paper.

Combine flour, baking soda, baking powder, cinnamon, chile powder and salt in a large bowl. Set aside.

Cook bacon in a large skillet over medium heat until crisp, about 4 to 6 minutes per side.* Transfer to a paper towel-lined plate. Reserve 2 tablespoons of the drippings and set aside to cool. Crumble the bacon, discarding any chewy bits.

Beat the butter and reserved bacon drippings in a large bowl with a mixer on medium-high speed until smooth, about 1 minute.

Beat in the peanut butter until combined, about 1 minute.

Beat in the sugars until creamy, about 4 minutes.

Add egg and vanilla. Beat until light and fluffy, about 2 more minutes.

Reduce the mixer speed to low. Add flour mixture in 2 additions. Mix just until combined, scraping down the bowl as needed.

Stir in peanuts and all but 2 tablespoons each of the chocolate chips and bacon.**

Form the dough into 12 balls and arrange 2 inches apart on the prepared baking sheets. Flatten with your fingers.*** (The cookies will not spread in the oven.) Press the reserved bacon and chocolate chips into tops.

Bake until golden, 12 to 14 minutes. Let the cookies cool 2 minutes on the baking sheets, then transfer to a rack to cool completely. Store in an airtight container for up to 3 days.

Notes:

* Years ago, while helping cook at our church girls’ camp, I learned from Alex to bake bacon. Here is how to do it:

Heat the oven to 400 degrees.

Line a jelly roll pan with a sheet of baking parchment with the edges hanging over the pan.

Place bacon evenly on parchment.

Bake about ten minutes. Remove the pan from the oven and flip the strips of bacon.

Put back in the oven. Watch it closely and take it out when it is cooked the way you like it, usually about ten more minutes for me. I like my bacon cooked until it is not rubbery but is still chewy like meat. I think bacon cooked until                    crumbly tastes terrible. For these cookies, I cooked the bacon perfectly then cut it into very small pieced with a French chef knife. Delicious.

Best part: throw the paper away and put the pan back in the cupboard.

** I skipped this step and put all of the bacon and chips in the dough.

*** Rather than press with fingers, I used my buttered-and-sugared glass method: Butter the bottom of a glass then dip into sugar. Flatten the dough ball with bottom of glass until desired thickness. Redip the glass before pressing each next cookie.

I frequently tell people they should stop smoking. To me it is kind of a ridiculous thing to do. Everyone in our society knows it is stupid to smoke. When I ask people why they smoke, among the most common responses are “I’m stupid” or “I’m trying to quit.”

Needless to say, when I invite them to join the 85% of adults in California who don’t smoke, I feel it is a waste of time. They know they shouldn’t smoke. Most of them wish they didn’t smoke. If they were going to quit, they would. What good would it do for an emergency physician to tell them to stop?

The other night, I went into a patient room and introduced myself to a middle-aged man who said, “I know you. You were my doctor last year and you told me to stop smoking. I haven’t had a cigarette since then and I really appreciate you encouraging me to stop.”

Wow! I was really set back by that. Now I can use that as encouragement to continue to jab people about their smoking. Good luck to me as I try to keep up my efforts and good luck to all smokers as they try to quit.

Globus 1

A man in his mid thirties claimed he repeatedly had food stick in his esophagus. It started ten years earlier when he took a big handful of vitamins at one time and he couldn’t get them to go down. He had to force them out by sticking his fingers down his throat, causing him to forcibly vomit. He had experienced many such episodes since then and said it could happen with eating something as simple as a poorly chewed almond.

People with abnormal narrowing of the esophagus may have problems like this. However, this guy had been told his esophagus was normal on a recent x-ray swallowing study.

After hearing this history, I felt pretty sure he did not have a physical problem. As I watched him, this impression was reinforced. He appeared nervous, uptight, and very weird. He gave in-depth, detailed descriptions of all his symptoms. When I was talking, he would stare off into space with an anxious look on his face, holding his hand on his chest. Lost in his own thoughts and concerns, he would then interrupt me to add some new detail of his condition. He would get up mid-sentence, whether his or mine, go to the sink, stick his fingers down his throat causing himself to bring up a small amount of saliva which he would point at and say, “See!”

He paid such little attention to my explanations that, had it not been so fascinating, I would have been annoyed. Finely, I had to be blunt. “We are sending you home now. I just need to know if you want me to refer you to a doctor here or if you are going to see your doctor in the city where you live.” I had to ask him several times before he gave an answer rather than just repeating things he had already said or going to the sink and pushing fingers down his throat.

Globus 2

A middle-aged man came in by ambulance after almost choking to death on his saliva while driving. He said he was saved only after he managed to get a Hall’s cough drop in his mouth. The menthol vapors allegedly opened his chronically congested nasal passages so he could better breathe through his nose, saving him from certain death.

He had a long history of ankylosing spondylitis* which caused fusion of his entire spine so he was not able to bend or rotate his trunk or neck. He also had a long history of unexplained weight loss.

For a year, he had trouble breathing out of his nose. He also had recurrent choking on thick saliva. Unfortunately, no doctor had been able to explain this or offer any beneficial treatment.

My immediate impression was the guy was crazy. He looked distracted when I was talking. Looking down, he plugged one nostril with a thumb, took a little sniff to see if it were open and then repeated the same with the other side of his nose. This he repeated several times during our interview.

I’ve been saved many times in emergency medicine by stopping to ask if my impressions are wrong or if I might be missing something. My impression was that this was all in his head but I forced myself to re-examine my perceptions in this situation. The patient was very skinny. His stiff spine and abnormally stooped posture gave him a creepy appearance and caused him to move in a strange way. Could he also have something that might cause him to choke to death?

I excused myself and went to the computer to look closer at his medical record. I confirmed the history he gave me. A recent CT scan showed normal airway anatomy and a swallowing study showed no abnormality. He also had an unremarkable evaluation by an ENT specialist. This supported my impression he was suffering from a mental and not a physical problem. The only other thing I needed to know was if he could swallow or not.

I got a cup of water and took it to him. He said he was unable to swallow because his saliva was too thick. I told him to drink anyway.

He hesitatingly took the cup and pressed it to his lips. A slight amount of water entered his mouth.

“Good. Drink some more.”

This time he actually took a small sip.

“Drink it all.”

And he did. With no problem.

I tried to help him see that his perceptions were not logical and had no basis in anatomy or medicine.  I did this in a gentle and understanding but straightforward way. He would accept no reassurance nor reconsider his impressions that he was at risk of dying from nasal congestion and choking on thick saliva. He was truly afraid if he went home he would die. As he begged to stay, the poor man painted such a miserable picture, I was unable to kick him out.

For the rest of the night, he slept on a gurney in the hallway. A couple of times, he got up to tell me “it” was happening. He would demonstrate “it” by sticking out his long, snaky tongue covered with saliva he had collected in his mouth. I would get him another drink of water and he would go back to his bed.

In the morning, he left with plans to drink water, take Hall’s as needed and follow up with his doctors.

Take a look at http://en.wikipedia.org/wiki/Globus_pharyngis which points out that people get this sort of thing and it is all in their brain. A broader Google search was also interesting to me.

* http://en.wikipedia.org/wiki/Ankylosing_spondylitis