Il Panettone

The leavened cake made with a base of water, flour, butter, eggs plus the addition of dried fruits and nuts is a traditional staple in the Italian—and by extension the Italian-American—tables during the Christmas season. We have all watched our dear grandmothers and mothers bake it at home or in modern times accompany them to our favorite bakery to buy them.

What is the origin of this simple yet delicious accoutrement of festivities? There are two major legends and both arise from Milano in the Middle Ages.

The first legend says that the cooks preparing a big banquet hosted by Ludovico il Moro, the powerful duke of the city, had forgotten to take out the dessert from the oven, which ended up as pure carbon. A humble kitchen helper called Toni prepared an impromptu cake with the kitchen leftovers. The head cook was reluctant to present that novelty in the master’s table but he finally agreed, hiding behind a curtain to peek at the guests’ reaction. Everybody loved it including Ludovico who inquired who had prepared it. The cook came out of hiding, saying: “L’è ‘l pan del Toni”, i.e. il panettone.

The second one tells the passionate love that a young nobleman called Ulivo degli Atellani de Futi, a.k.a Toni, had for Algissa, the gorgeous daughter of a baker from the quarter of Contrada delle Grazie. Observing that the girl was permanently courted by many aspiring lovers that she invariably rejected, he devised a novel plan to seduce her. Camouflaging himself as a humble man, he was hired by her father to tend the wood oven in the early dawn, One day he mixed the best flour he could find with eggs, butter, honey and sultanina grapes and he clandestinely prepared the dough; then he baked it in the oven. When his boss came to check on his work, he was very impressed by it; he put it for sale in his stalls, becoming an instant success for the establishment.

When Algissa found out what he had done, she became infatuated with him. Except for the occasional gold-digger only interested in material goods, most women would appreciate that noble, original gesture inspired by his strong affection for her.

As the great playwright Jean Baptiste de Poquelin (Molière) sagely told us: “La grande ambition des femmes c’est d’inspirer l’amour.”

What do you think? Please tell us.

Don’t leave me alone.

The compulsive gambler

-“Doctor…My husband is addicted to gambling—he’s destroying us.”

Maria X. is an educated and charming middle-aged lady with a caring husband and two teenage daughters; unfortunately the successful car dealer likes to visit almost daily all the gambling options available in South Florida to try his luck. He has won big several times but his losses are even greater. Slowly he is eroding the good financial standing of the whole family and only the firm determination of his wife prevented him from mortgaging their colonial style mansion in South Dade to pay off some outstanding debts.

The basis of this addiction is that gambling stimulates the brain’s reward system like drugs and alcohol, being closely related to some personality disorders like highly competitive, restless or easily bored individuals. Sometimes it is only another behavioural manifestation of mental health disorders like depression/anxiety, bipolar disorder, obsessive-compulsive disorder, attention deficit/hyperactivity disorder or substance abuse. It used to be much more common in men but women are catching up quickly; it appears in middle age but when it does in later stages, it worsens rapidly.

As we have already discussed in our previous articles about alcohol abuse and compulsive shopping, the addicted individual needs to increase the amount he/she/sie invests in order to maintain the same level of satisfaction. Oftentimes it is an escapist attitude to cope with family or work problems that cannot be easily shared with the individual’s intimate circle. When the addicted persons try to control or stop this addiction, they feel restless and irritable with the inevitably nefarious social and professional consequences. In a consumerist society like the USA with plenty of physical and virtual opportunities to wager on almost any kind of sports or gaming tables, this addiction is fast becoming not only a personal but also a public problem.

There are some American civic personalities that are questioning the spread of state-sponsored lotteries with the purported aim of funding education; they claim that they prey on the poor and gullible without helping them.

What do you think? Please tell us.

Don’t leave me alone.

The first man that listened to women

Sigismund Schlomo Freud—born on May 6th 1856 in Pribor, Moravia and passed away on September 23rd 1939 in London, England—is one of the most respected and at the same time debated physicians in modern medicine. He was one of the earliest founders of Psychoanalysis and his pioneering work in the intricacies of the Unconscious mind still perturbs us all deeply.  He was definitely the first man that considered women as human beings with their own particular sexual desires and listened eagerly at what they said.

If you peek briefly at our screen presentation, you will see a depiction by Brouillet of a theatrical class by Jean-Martin Charcot in the Neurology clinical ward of the Pitié-Salpetrière hospital of Paris, where he had showed the power of the techniques of hypnosis to extract information from “hysterical” women that expressed neurological symptoms. Charcot dismissed the sexually-related complaints of women—“la chose genitale”—as not relevant to the therapy. But there was one Austrian physician in the public that, after spending time studying with Charcot, went back to Vienna and teamed up with Joseph Breuer to design the free association and interpretation of dreams. The recall of the early psychological traumas uncovered the origin of clinical neuroses.

In the puritan social atmosphere of early 20th century Vienna, Freud was considered a dangerous, rebel practitioner and he struggled to make a living. Even today he still has many ardent detractors that view him as nothing more than a clinical impostor that has been unfairly idealized by the public. Frederick Crews writes in his book “The making of an illusion” that we must strip Freud of his perennial image as “a lone explorer possessing courageous perseverance, deductive brilliance, tragic insight, and healing power.”  He even claimed that Freud had plagiarized the data of Pierre Janet, a French psychologist, in his articles, which is refuted by the fact that Freud gave due credit to his colleague in his early writings about the origin of neuroses.

Keenly trying to disparage him Crews writes about Freud’s experimentation with cocaine, a new drug then, his Victorian views of women and even his purported affair with his sister-in-law. He questions his whining about being a “lone outcast” dismissed because he was a Jew, considering that 20 % of the student body in his medical school class were Jewish, even though only 10% of the city population professed that faith. As a member of the Italian-American community, I understand how Freud wanted to assimilate while at the same time  keeping a resilient sense of “not belonging.”

What really flustered me when I was reading this book is that the author claimed that Freud had little contact with patients and that he fabricated his clinical data. In the Library of Congress, we can see Freud’s 1886-1889 patient record book where it shows that he treated almost 500 of them regularly. There is no way that Freud could have learnt so much about women and their ideation without going through the slogging task of actually listening to them. I know. I have been there. In a humble physician’s office like Freud’s inner sanctum.

What really prodded me to write about women’s emotional frustration in my novel “Madame D.C.” and in my 2nd manuscript, is that, after stoically listening to them in my office for years, something has percolated through my brain. In our male-dominated society, that caring predisposition to really listen to them can make you a lot of enemies.

What do you think? Please tell us.

Don’t leave me alone.





Crying alone in the bathroom

-“Doctor…At nights I hide in the bathroom—so my children can’t hear me cry.”

Veronica X. is a nice, attractive, intelligent and hard-working mother of two small children who has had to shoulder the entire burden of her household all alone as her husband is serving a two years-sentence for a minor offense. Her family cannot help her economically and only her mother is pitching in. Oftentimes feeling overwhelmed by all her responsibilities, she puts her kids to bed, finishes her household duties and then locks herself in the bathroom to well up at ease. It is an almost daily ritual that she needs to go through in order to decompress her strained psyche and get some needed sleep.

When she was telling me that anecdote in my office, I immediately felt the surge into my conscience of a stampede of sweet-sour childhood memories. In 1965 my father Mario—God bless his soul—was arbitrarily jailed for a few months to force him to pay an outstanding debt—a barbaric maneuver. My dear mother Gladys became extremely depressive and our grandmother Yolanda took us in her large suburban home so she could rest and recover. My brother and I were only 10 and 11 years old at the time but we knew that something was sorely amiss, especially when we heard her crying in the loo late at night. Those memories were painfully seared in our subconscious.

Modern women, who are employed full-time in demanding jobs, usually have to return home to complete the family tasks with little or no help from their live-in partners; to make maters worse they might not have the support offered by the female friendship. They decided to stoically hide their deep feelings of angst from impressionable children and from some relatives that might not completely share her opinions. In our digital age where most of the rooms in a house are invaded by a pinging or noisy device, they have to retrench to the bathroom as the improvised refuge for a safe, solitary exteriorization.

As sons and spouses of these most devoted women there is something we can do. We can wait until they get out of their hiding place and hug them tenderly in silence. We can tell them how much we appreciate their work and what a difference it makes in our lives. We can give them a lot of affection and moral support. And yes, we can offer to share more of the burden of homemaking with her. Chose the way you want to help (I love to cook for example) but do not ignore her suffering and extend her a hand. She’s waiting.

What do you think? Please tell us.

Don’t leave me alone.

Clinical challenges in Transitioning

There is a dearth of clinical knowledge and expertise in the slowly yet surely evolving field of Transgender Medicine as only lately most practicing physicians have honestly  acknowledged that they know little or next to nothing about Transitioning for these patients. But many enthusiastic and honest professionals are starting to study the clinical challenges posed by these patients and trying some specific, practical steps.

Considering that Transgender people are usually receiving treatment with exogenous hormones that alter their metabolism, the established treatment protocols might not be entirely appropriate and they must be adjusted. Moreover since the hormonal schedules are often changed in composition and dosage, the treatment of chronic ailments must be adjusted accordingly.

The use of Testosterone in the female to male transitioning schedule could worsen a previously existing endometrial neoplasia. The use of estrogens in the male to female transitioning schedule can stimulate the appearance of blood clots. The use of hormones can affect chronic neurological diseases like Epilepsy. Some studies have suggested that there is negative interaction of Estrogen with antiepileptic drugs but its extent has not been established. The control of seizures becomes more difficult as new hormones are added.Transgender people have a higher rate of HIV infections and use retro-viral medication, which can interact with the hormones in still unforeseen ways.

Sadly one of the commonest reactions of clinicians who encounter treatment difficulties in their Transgender patients is that they must immediately stop the use of hormones until further notice. The subconscious in their minds still resists the idea that Transgender people are different and they need their hormonal treatments to become fully identified with their gender of choice. The only way to surpass this obstacle is to maintain good communications between the clinicians and the experts managing the hormonal treatments. Trans patients occasionally complain that some drugs are promoting a faster metabolic degradation of the hormones in their livers, for which they cannot benefit from their full metabolic effects in their Transitioning protocols. Instead of just dismissing those complaints, physicians should find solutions.

What do you think? Please tell us.

Don’t leave me alone.

Happy “Day of the Physician”

Dear medical colleagues of our great American continent:

Yesterday, December 3rd, we celebrated the “Day of the physician” in the Americas in honor of all the dedicated and hard-working professionals tending to the health care needs of people from Alaska in the extreme North to Ushuaia in the extreme South.

The “Panamerican Health Organization”, or “Organizacion Panamericana de la Salud” in Spanish, designated this day in honor of Carlos Juan Finlay Barres, a Cuban physician and researcher who had discovered in 1881 that the Yellow Fever was transmitted through an insect vector like Aedes aegypti; he was born on December 3, 1833 in Puerto Principe, Cuba, and studied Medicine at Jefferson Medical College in Philadelphia.

Dr. Finlay, dubbed as “the mosquito doctor” by his detractors, had a hard time to prove his hypothesis but he finally collected enough clinical data to submit to the “Yellow Fever panel” headed by Dr. Walter Reed that finally accepted his findings in 1901. That medical breakthrough prodded the Panama Canal authorities to set up the proper sanitary conditions in the workers’ camps in order to finish the humonguous project. In 1902 Dr. Finlay headed the precursor office of the present day PHO.  Dr. Remo Bergoglio, an Argentine physician acting on behalf of the “Sociedad Medica de Cordoba”, submitted a proposal to celebrate this day on the floor of the PHO congress in Dallas in 1953.

To my dear colleagues of the Americas, thank you for your devoted daily work. Cheers!

A mes collègues de l’Amérique, felicitations pour votre travail dévouée de tous les jours. Salut!

A mis queridos colegas de las Americas, gracias por su trabajo abnegado de todos los días. Salud!

The fat girl

-“Doctor…People stare at me all the time in the street—because I’m fat.”

Rhonda X. is a charming young woman that just happens to be overweight. She has all the right attributes to become the enchanting partner of any man, yet she is still stubbornly single, as she cannot meet a match of her liking. She attributes it to her excess weight and the social stigma attached to it. As someone who has lately battled with obesity her plight sounds very familiar.

In modern nations there is a rise of the obesity’s indexes due to many socio-economic factors that influence the diet, usually saturated with sugar and fat. Even though there are laws that prohibit the discrimination against obese people, in fact there is widespread reluctance to employ and house them. Even the airlines have joined the fray by charging extra to customers that cannot fit snugly into their ever-shrinking seat planes—a cynical diversion.

In ultra-conscious about physical appearance-France, a young obese woman called Gabrielle Deydier became a celebrity after she published a book called “On Ne Naît Pas Grosse” where she narrated her daily vicissitudes. In a country where most people pride themselves in their good image, the rising rate of obesity is a taboo subject in the mass media and in the private sphere. Following the trend of all EU nations, the French youth is eating less healthy dishes in favour of the processed preparations and commercial junk food.

A report published by the Inserm, the French equivalent of the National Institute of Health, showed that almost 16% of the population was obese in 2016 compared to 12% in 2008. In the USA, the CDC found that 36% of the population had a body mass index (BMI) of 30 or higher in a 2014 report. The worrying social trend has prompted the American media to deal with the reality of millions of Americans and to foster reasonable ways to remedy it. There is a good discussion of the dietary value of foods and the need to limit the intake of noxious material and unhealthy additives in our foodstuff. This public discussion is just beginning in France, where they are still in denial.

What do you think? Please tell us.

Don’t leave me alone.