Monday, July 28, 2014

Freakin' Fabulous Pâté

I'll admit it: even though my dietary requirements include organ meat, it was a chore to eat it...and you know what happens when that's the case. I ended up eating Atkins bars instead of liver. Partly, I've been too busy the past few weeks to eat many home-cooked meals, but mostly, there are a lot of things--even on Atkins induction--that I'd rather eat than liver.

Last Saturday, needing some wind in my sails after a few weeks of family emergencies, uncluttering my parents' house with a room temperature of 85 degrees, and being too wound up to get much sleep, I checked out a book called Freakin' Fabulous by Clinton Kelly from What Not to Wear and The Chew.

Just looking at the pictures at red lights on the drive home inspired me to stop at the store--the grocery store. I knew Kelly was a stylist, but didn't know he could cook, too. He's quite the meat eater--his good looks attest to that. That, and it sounds like he eats little or no junk food. I don't suppose the Fabulous munch on Fritos. Even though he thinks fat is bad, he's no ascetic--in fact, almost all the recipes are low-carb if you forget about the crostini. The Freakin' Fabulous Four recipes (hollandaise, roasted chicken, french omelette, and nice vinaigrette) are all fat and protein.

I set to work in the kitchen over the weekend. The little pancetta/lettuce/goat cheese rolls were one of the tastiest, easiest snacks I've made. For the first time, I roasted a tender, juicy chicken with a crispy skin. Tonight, I made the best pâté I've ever eaten, anywhere. And it was the fastest, easiest I've ever made! I did add two tablespoons of butter and skip the anchovies because I don't like them. I accidentally burned the onions because I'm not used to frying with olive oil. Even so, the burned onions smelled good, so I proceeded. It turned out beautifully. Clinton's recipe is now THE recipe for pâté in this house.

I'm planning to try the recipe for salmon mousse. Since it calls for a packet of gelatin, an ingredient some readers here have a surprisingly wide and deep knowledge of, I'll provide details on how it turns out.

Friday, July 25, 2014

It Hurts When I Eat This!

Newbies in the low-carb and paleo community often say, "the diet is great, but I still have problems eating (fill in the blank). What should I do?"

Maybe they're too young to remember a certain old joke. A man goes to see his doctor and says, "Doctor, it hurts when I do this." (Picture the patient holding his arm in odd way.) "What should I do?" The doctor says, "Stop holding your arm that way."

This old joke now represents a radical idea. If you have trouble eating something, then stop eating it. Or eat smaller amounts of it if the smaller amount doesn't give you problems and you can stop yourself at a little bit.

I have FODMAPs problems--polyols in particular. I can't eat more than a strawberry a day or a few spoonfuls of lemon juice without getting an upset stomach and acid reflux. Too much alcohol sugar gives me gas. I could try probiotics, resistant starch, fermented foods and the other latest things that purportedly heal your gut. Having taken antibiotics like candy since childhood for sinus problems and acne and taking a couple of massive courses of them to kill Staphylococcus aureus and Helicobacter pylori later on, my gut bacteria population is probably down to a few isolated tribes.

For myself, though, I don't see a point in eating more starch (carbohydrate) so that I can...eat more carbohydrate. My digestion works perfectly if I don't eat fruit or more than a little sugar alcohol or large meals. And I had some serious upper GI problems--acid reflux and an esophageal ulcer.

What if I could eat all the beans, potatoes, fruit and sugar alcohol I wanted, though? If I did, I'd probably weigh 200 pounds. I'd also have roller-coaster blood sugars and I'd start getting cavities and sore teeth again. As for large meals, I have zero need to be able to knock back a five-course dinner.

For me, taking things to "heal" my gut would be a solution looking for a problem.

Saturday, July 19, 2014

Adventures in Eldercare

This week has found me at a beautiful assisted living home, at the emergency room, and then at a shady-looking storage unit on the outskirts of Longmont to meet a stranger.

First, though, the week started with my doing some housecleaning at my parents' place. I cleaned out magazines, catalogs, junk mail, and other old papers--some 15 trash bags full. I found a vacuum cleaner, a printer, a tub of cassettes, family photos, old hunting and fishing licenses, a letter of condolence from my grandparents on the death of my brother Marvin, a letter from someone telling my parents to "kiss the baby" (me), and a bunch of unpaid bills. My parents' assistant and I organized and boxed up a lot of the stuff to get it ready for an estate sale. The room we worked in is beginning to look like a room. Yes--this was all in one room. It's the worst room, but there are several more to go.

Monday, a woman who runs several assisted living homes came by, interviewed Dad, and took me to a lovely place in my parents' neighborhood. It's a regular house with half a dozen residents (mostly women), clean, spacious, and easy to get around in with a large deck out back and an orchard in the back yard. Heck, I'd go live there. I'm told it's not easy to find a place for a man if he wants to bunk with someone since it's mostly women who go to nursing homes. Nevertheless, they accepted my father and I put a down payment on a room and gave them their 30-page application.

Even though I disagree with my parents about their living situation, I've respected their wishes up until now. My father doesn't want to move (he doesn't want to go to an unfamiliar place), but his living in his home puts him in danger of falling (which he's done many times) and causes a hardship for me and my mother, who have to care for him. Monday and Tuesday, I was with him for 12 hours a day since my nephew works full time and has a long commute. Wednesday morning, my nephew called at 5AM asking how to stop the bleeding from a gash in Dad's arm, which he got from his second fall of the night. I told him to apply pressure and help Dad elevate his arm over his head, thinking he'd have taken him to the emergency room if it were serious. When I got there midday, he said, "I think Grandpa should go to the doctor." He added that he overslept, hadn't done anything on the list I'd given him the night before (including giving Dad his medications), didn't clean up the mess in the bathroom, didn't do the dishes, and had to leave for work right away. He supposed he should have set his alarm.

I spent the rest of the day first at Dad's primary physician, who cleaned up his wound and gave me a list of Dad's medications. I wrestled Dad's pills away from him the night before when he said it didn't matter which pills he took--and the visiting nurse didn't fill his pill boxes and I had no idea what to put in them. The doctor recommended Dad go to a nursing home and told me to take him to the emergency room for the bump on his head.

It was a busy day at the emergency room I'd taken Mom to a few days before: a construction worker hurt his arm, a stoic young guy had, as far as I could tell, hurt his knee, a young woman came in with a neck brace and a wheelchair, another woman was having an anxiety attack, an old man lay down on the chairs, and a couple of young women with a bunch of kids were there for reasons I couldn't discern. There were several more people I didn't pay any attention to. After some hours, a doctor and an assistant came to discuss Dad's reason for being there. I later told the doctor I had plans to move Dad to assisted living, but it would take a few days. Dad's head injury and cut on his arm weren't serious, but the doctor admitted him as an inpatient for an infection Dad had been treated for at home--god bless him.

At 6PM, after a day without a proper meal, the elephant took over. The elephant is the part of your brain that just wants to be warm, dry, fed, comfortable and happy. I got the nurse at the front desk to keep an eye on Dad, walked out in front of a moving car, drove to McDonald's, and ordered two burgers that the counter clerk suggested. I ate one, asked for a coffee and a bag for the other burger, left the coffee there, went home and changed into warmer clothes because it was cold and rainy, came back, grabbed the coffee and ate the other burger. Then I went to my mother's hospital room.

I think it was that day that my mother had dialysis. Despite treatment, her kidney function went downhill from the time she was admitted. As a result, she was so confused and incoherent that the doctor asked my permission to do dialysis to prevent permanent complications from the toxins in her body. I knew dialysis was a painful thing to go through, but said yes since I thought it might help her. After two rounds, she has improved so much that she's back to her old self and the hospital is making sure she's going to be ready for discharge.

The main concern was safety--her ability to get around. Friday night last week, Mom called me because her wheelchair was stalled. A burner on the stove was on and she couldn't get to it to shut it off. I came over, got her into her other wheelchair, and saw that she couldn't get through the room with the papers, cassettes, printer, vacuum cleaner, and other treasures. That's when I started cleaning it up.

This morning, a wheelchair repairman quoted me $125 to come out and diagnose the problem. Repairs would cost parts plus $85 per hour in labor. This, for a chair that's been through several repairs and that Mom complains hurts her back. I called a number on Craigslist for a chair that looked promising: never used, fairly small, and with a foot rest that wouldn't require Mom to lift her legs over a divider to transfer to a bed or chair. Great price, too. The guy sounded like a Frenchman, couldn't tell me the address of the place to meet him, but said it was at a storage place on Whatever Road in Longmont. I couldn't find any Whatever Road in Longmont on Google maps. He named a different storage place on another street at the end of the road. I was to call him from there.

Resources being limited, I bit. I drove north to oil well country to the outskirts of Longmont, past an abandoned factory to the storage place at the end of the road past some guys parked in the street. It was them. I followed them to another storage unit on Weaver Road (way-a-ver, with my brain supplying the T). The unit was neat and clean, the chair was just as described, and the guy let me use his phone to find a credit union branch nearby, since I wouldn't need someone with a truck to haul it--it would come apart and fit in my car. Nevertheless, I had to drive all the way to north Denver to make a withdrawal and come back. Even though the guy seemed pleasant enough, I drove back thinking, "I'm taking a wad of cash by myself to meet a stranger from Craigslist at a storage unit." Even so, I wasn't really worried: the guy didn't give me the creeps, and I'm easily creeped out by people.

The legwork, housework and paperwork has been a full-time job this week, but things are falling into place: Dad will have a place to go where he'll be taken care of, Mom has a new wheelchair at a great price, and the house will be ready to sell if we keep after the cleanup. I'm still doing Atkins, and so have little desire to snack--and great thing given how much I've had to do without time to stop for little meals every few hours.

Sunday, July 13, 2014

Want Something? The Universe Doesn't Care

Wouldn't it be great to think, picture and believe your way to a wonderful life? Being a science geek, it's easy to forget how popular that belief is, even among educated people. Call it The Secret, the law of attraction, positive thinking, or affirmations. I call it wishing for a no-effort solution; Richard Rumelt describes it aptly in Good Strategy, Bad Strategy:

But I do know that believing that rays come out of your head and change the physical world, and that by thinking only of success you can become a success, are forms of psychosis and cannot be recommended as approaches to management or strategy....Nevertheless, the doctrine that one can impose one's visions and desires on the world by the force of thought alone retains a powerful appeal to many people. 

This hit home lately because my mother is in the hospital and I have to take time off from work to be with my father since my nephew works afternoons and nights. My parents have an assistant and she's done a yeoman's work, but she has other clients besides them. I'm trying to get Dad into a nursing home, but given his needs, it's not easy to find a place. Since my parents' Medicaid application hasn't gone through yet, we're "Medicaid pending," meaning somebody has to pay full freight (around $3,000 per month) until the application is approved. Once it's approved, you get reimbursed.

No amount of positive thinking will make this go away. The buck stops here with me because it has to--there's no one else's lap to dump it in. Wishful thinking won't get Dad into a nursing home and the law of attraction hasn't turned up many people who want to deal with this.

Fantasize all you want, the universe doesn't care. Is someone supposed to jump at the chance to take on your responsibilities for bathing and cooking for Grandma just because you'd rather be backpacking in Thailand?

Affirmations aren't substitutes for difficult decisions. My parents could have taken action to make this easier for me: signing the application for Medicaid months ago when it looked like Dad might need to go to a nursing home, moving to a smaller place near my home (they'd have had more resources to deal with this), getting rid of things instead of accumulating more and fantasizing about needing rototillers and a garage full of power tools at the age of 80. The things could have been organized instead of thrown into piles. I used to have nightmares about dealing with all my parents' stuff. For whatever reason, a LC diet makes me sleep like the dead. I rarely have dreams anymore--a blessing.

To take such action, though, you have to answer unpleasant questions: what if neither of us could drive anymore? What if we can't take care of ourselves? What if somebody else has to deal with this? 

Wednesday, July 9, 2014

A Bumpy Ride off the Bed

Summertime keeps finding me in trouble: a bike wreck, carrageenan poisoning, a badly stubbed toe, and mineral deficiency. Now it seems to be my mom's turn.

Saturday, I took her to the emergency room because she was having so much pain in her lower back. Since she's disabled, they called a paramedic to help her on to the stretcher, and she remarked how much she liked big, strong men like him. Hey, she's eighty-four, not ninety-four. Since she'd just had several x-rays of her back a few days before that showed nothing was broken, the doctor gave her some pain medication and sent her home.

The pain medication made her woozy. This morning, she lost her balance and fell into her wheelchair while getting out of bed. Dad wouldn't call 911 (he has dementia, and even in better days, he wasn't one to overwhelm you with help). Luckily, mom called 911 herself.

Having called for help some 30 times in the past three months, my parents are personae non gratae with the fire department. The captain himself called me and my brother to say they couldn't keep doing this.

This message and another from my sister-in-law were waiting for me when I got to work. I arranged for someone else to take over for me and went to my parents' house. Their case manager called and said she'd look for a Medicaid-pending nursing care facility for my father if I could get some verification that the application was in the system. After 35 minutes on hold, an employee with the State of Colorado agreed to expedite the paperwork to go through in 72 hours.

The nurse from the emergency center called and I asked her if they could change Mom's pain medication. She became dizzy taking cyclobenzoate, but felt good on valium the last time she was there. She had the same reaction I did when I had valium: she was in pain, but she didn't care. The nurse got the prescription changed.

After my brother and sister-in-law arrived, we discussed what to do in the meantime. I asked if their son would like to live with Mom and Dad. My nephew's roommate had Tourette's Syndrome and diabetes that sounded like it was wildly out of control. He threw all his own mail on the floor and put fresh eggs in with the old ones so that you broke an egg, you never knew if you'd get ingredients for an omelette or a stink bomb. While Dad has some dementia and Mom gets confused sometimes, they're not lunatics. My nephew also had to get around on the bus in a far-flung suburb; at my parents' house, he could use their car. So he and his dog moved into my parents' house today--something I've wanted to happen for a long time. He's strong enough to physically help my parents and he can be there most of the time. My sister-in-law and I moved boxes and boxes of clutter out of my old room, I charged the battery on the car, showed my nephew how to air up the tires and loaned him my jumper cables just in case the battery doesn't hold the charge.

My parents' caregiver will come over evenings to help put my father to bed since my nephew works afternoons and evenings.

Mom is in a lot of pain--she has a swollen black eye and bruises on her torso. She wanted to stay at the hospital. It's painful for her to chew anything and she probably can't cook for awhile. I got her some broccoli cheese soup, chicken salad and Atkins dinners and Atkins bars (which the store kept next to the tampons). It wasn't easy finding pre-made, low-carb food.

My father should go to a nursing home even though he doesn't want to since my mother can't take care of him and the fire department can't keep picking him up every few days. Anyone who thinks that putting someone in a nursing home is cruel and people should be cared for at home can come on over and help with this mess: helping him dress, bathe, use the bathroom, stop him from wandering outside and letting the dogs into the street, and keeping the door and windows closed to avoid $400 heating bills in the winter. To spend more than a few hours a day with my parents, I'd have to quit my job, sell my house and move in with them. (If I quit a good job, where do I get money for my old age?) Getting to their house from my job takes 90 minutes through rush-hour traffic. They don't live close to downtown, the Denver Tech Center or anywhere else I could get a good job--they're out in the suburban boonies without even a bus stop or a light rail station nearby. My efforts some years ago to get them to move closer to my house and job--a move that would have netted them $100,000 in cash, a far lower cost of living, a house with less maintenance, ability to get around without driving, and proximity to two hospitals and a gazillion doctors--met with a stone wall. They wanted to stay in their house, end of sentence, end of paragraph.

So I do the best I can with an employer who needs my services and parents who need my help, and I'm grateful to my brother, sister-in-law, nephew, and my parents' caregiver, neighbor and fire department for their help. I don't hear anybody in the middle of this situation or others like it insisting that people should never go to a nursing home.

Tuesday, July 8, 2014

A Bumpy Ride on Atkins

It's been three and a half weeks since I first started Atkins induction. I had to stop for several days because of magnesium and potassium deficiencies (I unfortunately started the day before oral surgery, where I had a shot of epinephrine, which can also cause low potassium, and couldn't eat very much in the days following).

I lost a few pounds right away, then another few when I restarted. Then I gained it all back due to, ahem, female hormones. That's never happened to me before. I didn't change the way I was eating: no chocolate indulgences or anything saltier than what I'd been eating, and a keto-stick showed large ketones. But I'm back to losing about 0.6 pounds a day. I started at 130; this morning I was 127 and had moderate to large ketones.

My energy level is beyond what it was before I started. Sunday, for the first time in far too long, I took my dog for a long hike in the mountains, where she loves to swim in the creek. (She's doing her own version of Atkins: no more carrots or nuts, just meat, eggs, pork rinds and bones.) I felt great after yoga yesterday, even though our substitute instructor gave us a harder-than-usual workout. There was no need to stop at the wine bar for sustenance afterward.

My mouth feels like it's completely healed; the site my surgeon took the tissue from feels just like the other side and the graft site feels normal. As you might expect, there's zero plaque even though I've only flossed once since the surgery. Likewise, I haven't had a nosebleed since I started Atkins. This still might be partly from the unusual humidity (we had another downpour last night). We'll see if it continues.

My sense of well-being that Dr. Atkins said was so important is back. My only complaint is that I'm tired of eating so much meat--and I love meat. My only real-food respite is eggs since I can't eat cheese (as I've rediscovered--it gives me acne) and haven't been able to even look at a piece of fish. For variety, since vegetables are limited, I made some low-carb brownies with rice protein powder from the book 500 Low-Carb Recipes. I'm still eating Atkins bars and shared a delicious Lily chocolate bar with my mother. It's low carb (no added sugar), we both loved it, and it didn't spur me to eat more chocolate when it was gone. (Thanks for the tip, Tyrannocaster!)

Thursday, July 3, 2014

Troubleshooting Low Energy, Low Mood & Other Problems on Atkins Induction

Do Calories Matter on Atkins?
As the saying goes, just because you're not counting calories doesn't mean that calories don't count. Dr. Atkins wrote in Dr. Atkins' Diet Revolution that you'll lose weight faster on fewer calories, but you won't necessarily have a sense of well-being. Most readers knows what he means: low mood and flagging energy.

Lack of Energy, Low Mood
This was how I felt Sunday afternoon and Monday. Part of my low mood was from having to fill out an application for Medicaid for both my parents, mostly so that my father can go live in a nursing home. It's too hard for my mother to take care of him and I can't be with them enough to help day-to-day.

I was thinking about my parents during yoga that evening and fighting tears. I didn't have a physical sense of well-being, either. The climb from the train station up to the street took more energy than it should have; so did the yoga class. I went back to the book for advice and read a chapter called "Why One Dieter in Ten Gets Stuck Temporarily."

Troubleshooting
The chapter offers many reasons why dieters can get stuck. Last month's diet pills (amphetamines) and diuretics? Never took them. Very strong tranquilizers and sex hormones? Never needed them. Thyroid deficiency? I've never had an abnormal thyroid test. Easily corrected problems that discourage dieters? "You may not be eating enough...or luxuriously enough." That sounded right. In the past, I've always felt better when I snacked, which I hadn't been doing since Atkins induction killed my desire to do so. Too few calories can make you tired and depressed. And I tend to lose my appetite when I'm sad or upset. Sunday, I had a late breakfast, dinner and no lunch. Monday, I didn't snack, but ate three meals that just made me not-hungry.

I read the rest of the chapter to make sure I wasn't missing anything.

"Salt deprivation and potassium deprivation are common and cause discomfort." Don't I know it. "Constipation is sometimes a problem." Not for me. "Rarely, low blood sugar symptoms continue." When my blood sugar gets low, you don't want to get between me and a snack. But since starting Atkins induction, my urge to snack has been extinguished. This diet is the only thing that has ever done this except for stress and illness (your blood sugar goes up a little when you're sick). If anything, my blood sugar is probably the most normal it's ever been.

"A tablespoon of potato salad can slow you down." Haven't had any--no chocolates, either. "Keep a written record of everything you eat--and count those grams." I haven't kept a written record, but I know I've followed the diet closely but not perfectly. I had too much cream in my coffee in social situations where the coffee needed something to make it tolerable. I've had a couple of half-glasses of red wine. I had some cheese that wasn't very hard or aged. I made some salad dressing with avocado that might not have been induction-kosher. That's it.

"It's possible to slow yourself down by eating too much salad." I don't think I'm that metabolically challenged. "Use Ketostix to check your progress." Yesterday, I turned one as purple as a pomegranate, meaning "large ketones." That means green salad and my niggling indulgences in wine, cream, avocado and squishy cheese weren't causing my problems. "Your attitude towards your own body makes a difference." I look at low-carb as a lifelong way of eating.

Solutions!
Since it looked like my problem was down to too little food, the next day and today I ate usual induction meals plus snacks, including the dreaded Atkins peanut butter chocolate bar, which I liked. Eating more lifted my spirits and made me more energetic. Atkins bars have added vitamins, which might have helped, too.  They were about the only thing that I could eat in the convenience store in the building where I work, since I don't care for canned tuna. I need to eat past the not-hungry stage to fullness to avoid low energy and mood. (I don't stuff myself since it gives me a stomach ache.) I'm still sad to see my parents declining, but I'm not overwrought with sadness anymore.

Good Vitamins, Bad Vitamins
Taking lesser quality magnesium over the weekend probably didn't help me. Regular readers know I suffered from mineral deficiencies at the beginning of the diet because I unfortunately started it right before oral surgery. Magnesium and potassium in particular need to be supplemented when starting a LC diet. Without enough magnesium, you won't absorb potassium, vitamin D, or calcium, involuntary muscles like the heart and digestive muscles won't work properly, and the hundreds of bodily functions that require magnesium will be off. The magnesium I keep at work and home are different--and the lesser quality pills at home might have accounted for some of my malaise. The first ingredient is magnesium oxide, which isn't absorbed as well as substances that end in -ate. When I got to work on Monday, I started taking the good stuff again. Even though a dose has less magnesium, the pills feel like they work better.

Conclusion
The difference between low-carb and very low-carb is like the difference between fall and winter. They're often lumped together, but they're different. Hunger, cravings, supplement needs and food choices change going from around 50-70g of carb per day to less than 20. Just as if you were going someplace where it was winter, you'd need to be better prepared than if it were fall.