Monday, July 07, 2008
STOP THE PRESSES!
Local Woman Finally Normal
At a body mass index (BMI) of 23.8, Janet Elkins has achieved a weight in the "normal" range. This has only happened once before in her lifetime. How was this remarkable milestone achieved? It was made possible through the miracle of having a needle jammed into a pocket of fluid in her belly and having greenish ooze sucked out by means of a catheter, a length of tubing, and special vacuum bottles. 2.4 liters were removed, for an approximate loss of 3.6 pounds in a single day.
The procedure, which Mrs. Elkins referred to as "uncomfortable and kind of gross," is also called a paracentesis.
"Normal" BMI is healthy, right?
Recent reports indicate that those with a BMI at the lower end of the "healthy" range, or 19.1, are at lower risk of breast cancer than people who weigh more. At such a low body weight, this would place Elkins in heroin chic territory, particularly since she has lost a great deal of muscle mass due to recent hospitalizations. The way to build muscle mass is by exercising and consuming calories high in protein.
For someone who already has cancer, the normal rules do not apply. Fatigue, lack of appetite, a swollen abdomen which makes consuming more than a few bites at a time problematic all contribute to making muscle-building extremely difficult.
Doctor's Orders
The last time Elkins managed to reach a BMI in the "normal" range, it was also not through conscientious diet and exercise. It was because anxiety and narcotic pain medications (prescribed for metastatic bone pain) were causing her to vomit uncontrollably. Doctors were concerned about her weight loss then, and are concerned about it now.
When asked what Elkins should be eating, her nurse practitioner said, "I don't care. Whatever sounds good." High-quality food is preferable, but in light of uncontrolled weight loss, even high-fat foods like ice cream, steak, potato salad, and peanut butter are fine. Protein and calories are of utmost importance right now.
Smoothies have been soundly rejected by the patient, as have most sweets. "Things just don't taste right," she says. "And when eating is no fun, it becomes a horrible chore. I know I need to try to eat more, but it's hard."
Coping Techniques
Elkins has decided the best approach would be to try to eat something small at least once per hour. She has also replaced skim milk with two percent milk. Whereas most sweets and starches are not palatable to her at the moment, she finds steak to be extremely satisfying. A recent trip to Longhorn will provide grazing materials for tomorrow. Her Grandmother's bacon-suffused potato salad was recently a hit and is a possibility for further snacking.
Diet sodas and beverages will be shelved in favor of higher-calorie fare. Mr. Elkins has procured a supply of mild-flavored string cheese that the patient has found to be tasty. And peanut butter sandwiches or peanut butter crackers will be a staple at work.
"I think it's kind of good," comments Elkins, "that I started out from a point of weighing more. If I were a naturally skinny person I'd be horrifically underweight by now. Normal rules of health just don't apply to somebody in my position. I'd like to be at a point where I can exercise and eat more healthy foods, but I don't have the strength to even hoist myself up from a kneeling position, and lower calorie foods are just too bulky for my bloated belly."
"I regret being as scrawny as I am even now," she goes on. "I used to have crazy strong legs. I could do leg-presses like nobody's business."
She looks wistful for a moment, then turns away.
Labels: Brian, food, Lita, paracentesis
Thursday, November 01, 2007
Houston, We Have Risotto
The Food Network and Bravo's 'Top Chef' have created a monster.
Last night I successfully made wild mushroom and (not wild) parmesan risotto, adapting this recipe for my own needs*. It was acclaimed by all to be excellent, even without an additional protein. (I figured you don't always have to serve fish sticks with your macaroni and cheese, why should risotto be any different?) It did not turn out mushy, or goopy, or drippy, or slimy. The rice was firm, without being undercooked. The parmesan was just enough and not overpowering. The mushrooms were delicious; I used a variety. Some of the dried mushrooms were a wee bit chewy--I don't remember what they were called, but one kind was a wonky shape that just didn't reconstitute all that quickly. Oh well. I added the mushroom soakin' water to the risotto as a supplement to the chicken broth, which made the dish a little more "earthy."
Man, it took a lotta broth. The leftovers weigh about five pounds.
I would definitely make this dish again. I'd put on more comfortable shoes or sit in front of the stove on a stool or something, though. My feet started to hurt. I loved it as a main dish, but Brian, being a meat-n-potatoes guy, would probably like it as a side dish better. Either way, it is incredibly tasty. I bet it was better than Howie's risotto.
*I omitted the wine, forgot the bay leaves, and didn't have any thyme or parsley. I also don't make it a habit to have truffle oil on hand--and I think my risotto was plenty fungus-y without it.
Last night I successfully made wild mushroom and (not wild) parmesan risotto, adapting this recipe for my own needs*. It was acclaimed by all to be excellent, even without an additional protein. (I figured you don't always have to serve fish sticks with your macaroni and cheese, why should risotto be any different?) It did not turn out mushy, or goopy, or drippy, or slimy. The rice was firm, without being undercooked. The parmesan was just enough and not overpowering. The mushrooms were delicious; I used a variety. Some of the dried mushrooms were a wee bit chewy--I don't remember what they were called, but one kind was a wonky shape that just didn't reconstitute all that quickly. Oh well. I added the mushroom soakin' water to the risotto as a supplement to the chicken broth, which made the dish a little more "earthy."
Man, it took a lotta broth. The leftovers weigh about five pounds.
I would definitely make this dish again. I'd put on more comfortable shoes or sit in front of the stove on a stool or something, though. My feet started to hurt. I loved it as a main dish, but Brian, being a meat-n-potatoes guy, would probably like it as a side dish better. Either way, it is incredibly tasty. I bet it was better than Howie's risotto.
*I omitted the wine, forgot the bay leaves, and didn't have any thyme or parsley. I also don't make it a habit to have truffle oil on hand--and I think my risotto was plenty fungus-y without it.
Sunday, February 05, 2006
Lesson Learned on 6A: be a squeaky wheel
The attending physician on floor 6A was usually preceeded by one of his interns, who would come to ask questions, take vitals, poke and prod, and ask me to breathe so he could listen with a stethescope. Then the full-fledged doctor would show up, with a group of two or more of his interns (I called them "doctorlets"), and repeat the process, which never elicited any new or exciting information. The typical questions were always: "How's your pain?" and "Any shortness of breath?" or "How are your bowels?" or "Much of an appetite?"
They would provide medication based on my answers, which gradually resulted in my taking, in addition to the patch I already had, an increased dosage on the patch, pills for pain (a narcotic and ibuprofen), pills for muscle spasms, muscle relaxing pills, pills for promoting bowel movements, pills for softening stools, pills for stomach health, pills for sleeping, pills for depressions, pills for anxiety, a powder mixed with liquid for--well, they were never able to really clarify what the Nutri-phos is for (I think it might be something like pedialyte)--either an injection of a very powerful opiate or liquid morphine taken orally when I was to be moved, and an incredibly painful shot for preventing blood clots that felt like a bee sting and which I decided might have consisted of concentrated bee venom. After having been immobile for several weeks and on various narcotic products, my digestive system was seriously backed up, which was leading to the abdominal pain and spleen/gallbladder symptoms. So they decided to step up the cleansing of the alimentary canal and also prescribed things intended to flush the colon from every conceivable direction. Yes. You know what I'm talking about. Mercifully by this time I had a private room.
Naturally, I came to dread visits by the attending and his little doctorlets. They were torturing me. Every time they came to visit, I found myself getting nauseous and vomit-y. When my dad and Susan came into town, they took over talking to the doctors when they could (the timing of their visits meant that sometimes they'd miss him and his posse on rounds), and would even leave the room to talk about topics that seemed to turn me green.
I was not in a good way.
When I got moved to my private room, I might have looked forward to getting more individual attention and care from the nursing staff. I now know that this does not necessarily happen.
One of the things the doctors told me is that I needed to drink as much as I could. Take in fluids at all times. Any fluids. Juice, water, milk, anything. I didn't seem to be getting any water, although they did have me on an iv. Also, food is important to get the bowels moving. I needed to keep my digestion working, but I didn't seem to be getting any food, either.
I was actually getting kind of hungry, which at that point meant that I was starving, since my appetite had generally been quite poor, but my breakfast never arrived. I assumed this had something to do with having been moved. Maybe my breakfast got delivered to the other room? By lunchtime I figured things would be straightened out, but again was kept waiting. They had been quite prompt with the food delivery; are they just slower on this hallway, or something? The doctors came, asking about my appetite, and they went. I complained I hadn't gotten any food, and they said they'd make sure the order was there to get anything I wanted.
A few hours later I was ready to chew my arm off.
I called the nurse.
"Um, am I supposed to get a lunch? I've been waiting and I'm really hungry."
"Oh, your orders say no food or water due to a test."
"What test?" I had been told no food or water for the untrasound, but that had been done at six o'clock the previous day.
She flipped through the chart, and found it. "Ultrasound," she said. "You need to not have food or water before the test."
When I pointed out that the test had already occurred--"Or is this another one?" I asked sarcastically--she looked a little bit disconcerted and went to go check.
A little bit later, somebody from food service showed up with a tray. Hospital food is not exciting, nor is it particularly appetizing, but I felt myself beginning to drool. Food, glorious food!
I beheld my tray. It consisted of clear broth, apple juice, and a plate of air.
I laughed hysterically. Clear liquid diet! This is just great...so I hit the nurse call light again and told the person who answered that my plate of air really wasn't the lunch I had been hoping for. "Have you been eating?" They wanted to know. "Usually when you're not eating they start you on clear liquids then..."
Yes, yes. I know all that. But I wasn't on a restricted diet. It was only for that one test, could I please have something normal, instead of something imaginary? He went to go ask the nurse if it was ok. I think she was embarrassed, because they agreed to get anything I wanted. My toasted bagel with cream cheese and container of chocolate milk were delicious.
This was not the only time different shifts of the nursing staff had some confusion about changes in my orders; I learned that as a patient, I was going to have to keep on top of things and let them know. My dad and Susan also helped keep a running list of questions to ask the doctors, which helped immensely. It's also good to know that you can question anything, and you do have the right to refuse the bee-sting shots if you just can't stand them any more, or the plate of air if you want something tastier.
To be continued...
They would provide medication based on my answers, which gradually resulted in my taking, in addition to the patch I already had, an increased dosage on the patch, pills for pain (a narcotic and ibuprofen), pills for muscle spasms, muscle relaxing pills, pills for promoting bowel movements, pills for softening stools, pills for stomach health, pills for sleeping, pills for depressions, pills for anxiety, a powder mixed with liquid for--well, they were never able to really clarify what the Nutri-phos is for (I think it might be something like pedialyte)--either an injection of a very powerful opiate or liquid morphine taken orally when I was to be moved, and an incredibly painful shot for preventing blood clots that felt like a bee sting and which I decided might have consisted of concentrated bee venom. After having been immobile for several weeks and on various narcotic products, my digestive system was seriously backed up, which was leading to the abdominal pain and spleen/gallbladder symptoms. So they decided to step up the cleansing of the alimentary canal and also prescribed things intended to flush the colon from every conceivable direction. Yes. You know what I'm talking about. Mercifully by this time I had a private room.
Naturally, I came to dread visits by the attending and his little doctorlets. They were torturing me. Every time they came to visit, I found myself getting nauseous and vomit-y. When my dad and Susan came into town, they took over talking to the doctors when they could (the timing of their visits meant that sometimes they'd miss him and his posse on rounds), and would even leave the room to talk about topics that seemed to turn me green.
I was not in a good way.
When I got moved to my private room, I might have looked forward to getting more individual attention and care from the nursing staff. I now know that this does not necessarily happen.
One of the things the doctors told me is that I needed to drink as much as I could. Take in fluids at all times. Any fluids. Juice, water, milk, anything. I didn't seem to be getting any water, although they did have me on an iv. Also, food is important to get the bowels moving. I needed to keep my digestion working, but I didn't seem to be getting any food, either.
I was actually getting kind of hungry, which at that point meant that I was starving, since my appetite had generally been quite poor, but my breakfast never arrived. I assumed this had something to do with having been moved. Maybe my breakfast got delivered to the other room? By lunchtime I figured things would be straightened out, but again was kept waiting. They had been quite prompt with the food delivery; are they just slower on this hallway, or something? The doctors came, asking about my appetite, and they went. I complained I hadn't gotten any food, and they said they'd make sure the order was there to get anything I wanted.
A few hours later I was ready to chew my arm off.
I called the nurse.
"Um, am I supposed to get a lunch? I've been waiting and I'm really hungry."
"Oh, your orders say no food or water due to a test."
"What test?" I had been told no food or water for the untrasound, but that had been done at six o'clock the previous day.
She flipped through the chart, and found it. "Ultrasound," she said. "You need to not have food or water before the test."
When I pointed out that the test had already occurred--"Or is this another one?" I asked sarcastically--she looked a little bit disconcerted and went to go check.
A little bit later, somebody from food service showed up with a tray. Hospital food is not exciting, nor is it particularly appetizing, but I felt myself beginning to drool. Food, glorious food!
I beheld my tray. It consisted of clear broth, apple juice, and a plate of air.
I laughed hysterically. Clear liquid diet! This is just great...so I hit the nurse call light again and told the person who answered that my plate of air really wasn't the lunch I had been hoping for. "Have you been eating?" They wanted to know. "Usually when you're not eating they start you on clear liquids then..."
Yes, yes. I know all that. But I wasn't on a restricted diet. It was only for that one test, could I please have something normal, instead of something imaginary? He went to go ask the nurse if it was ok. I think she was embarrassed, because they agreed to get anything I wanted. My toasted bagel with cream cheese and container of chocolate milk were delicious.
This was not the only time different shifts of the nursing staff had some confusion about changes in my orders; I learned that as a patient, I was going to have to keep on top of things and let them know. My dad and Susan also helped keep a running list of questions to ask the doctors, which helped immensely. It's also good to know that you can question anything, and you do have the right to refuse the bee-sting shots if you just can't stand them any more, or the plate of air if you want something tastier.
To be continued...
Labels: anxiety, Dad, doctorlets, food, hospital, morphine, nausea, spasms, Susan G. Komen
