ADHD and Parkinson's

I have a husband with Parkinson’s and a 20 year old son with similar executive function issues but no symptoms of Parkinson’s. Both also have extremely poor sense of smell and problems with constipation.  I keep looking for some connection that would explain both of their issues

My husband was diagnosed in 2008 with Atypical Parkinson’s/Lewy Body Dementia (both started at about the same time but the physical issues are progressing faster than the mental).  There is a study in which 48% of people with LBD had symptoms of ADHD in their youth, compared to 15% of the control and 15% of the group with Alzheimer's.  This is an issue I am interested in as the transition from my husband’s lifelong cognitive pattern, which we understood as a variant of Attention Deficit Disorder, to Atypical Parkinson's was so gradual and so much just more of the same.  Now it is further complicated because my husband's diagnosis was changed in 2012 from Lewy Body Dementia to Multiple System Atrophy, a different form of Atypical Parkinson's.

Our son has similar ADHD with particularly significant executive function issues and shows so much the same pattern as my husband.  Dr. Kenneth Bergmann originally evaluated John at Medical University of South Carolina. He looked at John’s initial neuropsych report and said “that’s not normal, that’s not even normal Parkinson’s” to have a verbal IQ 37 points higher than performance IQ. He saw that as one of several clear signs that John was on the path to Lewy Body Dementia.  But a year later our son Paul had a learning disability evaluation before he started college, and his verbal IQ tested 26 points higher than his performance IQ.  We kept saying that to Dr. Bergman  (who has since moved away to Washington) and he kept saying that it was just that John must have had mild DLB symptoms going back many years. That’s the standard answer I get from researchers on DLB. But it doesn’t fit my experience--John has always been this way, it just got worse.

I have found two genetic illnesses that involve ADHD when young and Parkinson's when older--subclinical Fragile X and Gaucher's disease carriers.  Fragile X would not link father and son and my son has been tested and does not have a high number of repeats.  My husband has been tested and does not have the most common genetic defect leading to Gaucher's, but there is research showing its link to Parkinson's and LBD.

Squash soup

2 oz cashews
1 cup cooked winter squash or pumpkin
1 cup applesauce
2 cups turkey or chicken stock
1 tblsp curry powder
1/2 teasp nutmeg
pinch of cinnamon
splash of heavy cream

Chop cashews in the blender, then add all ingredients except cream and blend.  Pour into pan and heat to just boiling.  Stir in cream and serve.

Getting creative with Photoshop

I made these images from photographs using this tutorial plus instructions from Cafepress about how to create transparent backgrounds.

They are available on T shirts and whatever at: http://www.cafepress.com/sk/pm1

A year later

I think a year ago I probably was at my maximum weight.  I don't weigh myself, in fact I usually don't even look at my weight when I am weighed at the doctor's office.  But we waited nearly half an hour at the gym before we could swim last Thursday, and I took the opportunity to weigh myself.  A doctor might not be happy with my weight--184--but I am.  My guess is that I have lost 30 pounds in the last year.  Photos are from June 2011 and November 2012.

 























A year and a half ago I decided to try taking Metformin, hoping to improve my diabetes control a little more and hoping it might help me with my pattern of post-menopausal weight gain.  I kept increasing the dose, because I felt it wasn't doing anything.  I went up to 1000 mg twice a day, and thought maybe that was helping.  Then I got something like the flu, though my flu test was negative, and lost a clothing size in a week of being mostly too sick to eat.  After that we spent all of Christmas vacation cooking, but my clothing size didn't go back up.  It was in mid January that I started following the Primal way of eating.  I think I went down another clothing size in a month, and after that I have been very very slowly losing inches (as judged by how my clothes fit).  A few weeks ago I switched my pants down another size (luckily I kept a lot--I have one more size in the attic).

I went off the Metformin last summer when I learned that my A1c was 5.8--exactly what it was before I started the Metformin.  So I don't think I am eating particularly lower carb than I was; the difference is that I very rarely eat anything made with grains or refined sugar.  I eat large meals--I am not careful how much I eat--but I have given up snacking except for a bedtime snack.  I also started supplementing with iodine and over the course of the spring and summer I worked my way up to 25 mg., which I think has given me more energy.  Having more energy makes me happy! I'm doing pretty much the same exercise--swimming twice a week, some walking and gardening.

I'm very glad to have found what works for me.

Multiple System Atrophy causes of death

Cardiopulmonary arrest	7 (33.3)
Urinary tract infection	5 (23.8)
Aspiration pneumonia	2 (9.5)
Infectious pneumonia	2 (9.5)
Acute aspiration	1 (4.8)
Wasting syndrome	3 (14.3)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117630/

"Occurrence of sudden death is a common cause of mortality in MSA and may happen in the early stages while disability remains acceptable." http://tan.sagepub.com/content/3/4/249.full.pdf+html
Citation to: Shimohata, T., Ozawa, T., Nakayama, H., Tomita, M., Shinoda, H. and Nishizawa, M. (2008) Frequency of nocturnal sudden death in patients with multiple system atrophy. J Neurol 255: 1483-1485.
Abstract:

Sudden death has been reported in patients with multiple system atrophy (MSA), although the frequency of this event has not been well delineated. We investigated the frequency and potential causes of sudden death in patients with MSA. During the 5-year observation period, 10 of 45 patients with probable MSA died. The causes of death included sudden death of unknown etiology (seven patients), aspiration pneumonia (one patient), asphyxia after vomiting (one patient), and lung cancer (one patient). The mean survival time of patients with sudden death was 63.0 ± 24.7 months (range, 39–116 months). Among seven patients who experienced sudden death, six were found to have died during sleep. Among these patients, two had been treated with tracheostomy and three with continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation (NPPV) during sleep, suggesting that these treatments do not always prevent sudden death in patients with MSA. Nocturnal sudden death should be recognized as the most common mechanism of death in patients with MSA.
 

The close relationship between life-threatening breathing disorders and urine storage dysfunction in multiple system atrophy. K Deguchi, K Ikeda, R Goto, M Tsukaguchi, Y Urai… - Journal of Neurology, 2010 - Springer
Abstract:

Survival of multiple system atrophy (MSA) depends on whether a variety of sleep-related breathing problems as well as autonomic failure (AF) occur. Since the brainstem lesions that cause respiratory and autonomic dysfunction overlap with each other, these critical manifestations might get worse in parallel. If so, the detection of AF, which is comparatively easy, might be predictive of a latent life-threatening breathing disorder. In 15 patients with MSA, we performed autonomic function tests composed of postural challenges and administered a questionnaire on bladder condition, as well as polysomnography and laryngoscopy during wakefulness and under anesthesia. Polysomnographic variables such as the apnea-hypopnea index (AHI) and oxygen saturation (SpO₂) and the findings of laryngoscopy were compared with the degree of cardiac and urinary autonomic dysfunction. AHI, mean SpO₂ and the lowest SpO₂ showed significant correlations with urine storage dysfunction. In addition, patients with vocal cord abductor paralysis (VCAP) or central sleep apnea (CSA) contributing to nocturnal sudden death had more severe storage disorders than those without. On the other hand, no significant relationship between polysomnographic variables and orthostatic hypotension was observed except in the case of mean SpO₂. These results indicate that life-threatening breathing disorders have a close relationship with AF, and especially urine storage dysfunction. Therefore, longitudinal assessment of deterioration of the storage function might be useful for predicting the latent progress of VCAP and CSA.

Cognitive changes in Atypical Parkinson's

I just watched this presentation by an Australian neuropsychiatrist (about 45 minutes), and it is very helpful!

Part I: https://www.youtube.com/watch?v=b2o_lCDk0QQ&feature=relmfu

Part II: https://www.youtube.com/watch?v=FxWGipPsG4s&feature=relmfu

Part III: https://www.youtube.com/watch?v=n4XagPUf0V4&feature=relmfu

Part IV: https://www.youtube.com/watch?v=UGhfdGwGq_I&feature=relmfu

Part V: https://www.youtube.com/watch?v=TJUV9NxEhHo&feature=relmfu

She says adynamia (loss of drive and initiative) is the #1 issue.  For MSA she also talks about rigidity (loss of flexibility of thinking).   For all the atypical Parkinson’s she give a list of features:

• Reduced insight
• Mental inflexibility
• Can’t wait, narrow focus
• Reduced empathy
• Lack of appropriate concern (for example about the future progression of the disease)

That's such an accurate list of my frustrations.

Other useful lectures:
https://www.youtube.com/watch?v=qrbxb2pwPTo
https://www.youtube.com/watch?v=WPXThhpa9kM

John's medical history

I compiled this when someone asked and I am putting it here so I won't lose it.

From childhood:

• Dyslexia (difficulty learning to read and reversals)
• Difficulties with attention and memory
• Poor coordination

Early adulthood:

• Difficulty with learning languages
• Difficulty with memory and organization
• Tendency to be late, poor sense of how long things will take
• A neurological event that was never explained—pain in his chest and a band of numbness around his abdomen that lasted a few weeks
• Ongoing problems with insomnia
• Poor sense of smell
• Probably already had a 20 point gap between verbal and performance IQ—our son does

40s and 50s

• Diagnosed borderline Attention Deficit Disorder
• Managed well following a routine but didn’t deal well with change
• Snoring or sometimes a soft sound breathing in only, when sleeping on his back
• Problems with constipation
• Took antacids after every meal (this has continued, even when he went on acid blockers)
• Swallowing issues diagnosed as Schotsky’s ring and successfully treated

The two or three years before diagnosis at age 62

• Increasing slowness—set his alarm earlier and earlier to get to work on time
• Yelling and hitting out in his sleep (once he bit my hand)
• Began to make mistakes when buying airline tickets
• Tested as having a little sleep apnea, not enough to need treatment

Age 62—diagnosed by a neurologist with Parkinsonism and then by the Movement Disorder Specialist with Lewy Body Dementia (he didn’t have all the symptoms yet but that doctor thought he was on that path)

• Cogwheel rigidity, worse on his nondominant side
• Only swung one arm when walking
• Could not spell the word WORLD backwards when we met with the MDS
• He noticed he was making mistakes at work and was able to get disability retirement and Social Security Disability

First few years after diagnosis

• Head tilted forward
• Neuropsych testing showed a 30 point gap between verbal and performance IQ
• Occasional confusion
• I took over almost all bill paying and household organization—luckily he was always somewhat passive and didn’t get upset about losing control
• Test for sleep apnea a year after the first test showed less
• Blood pressure on the low side when tested in the doctor’s office
• No more heavy sweating
• Swelling of his lower legs, eventually treated with Velcro-closed elastic wraps
• Alternating diarrhea and constipation
• Surgery for benign prostate enlargement resulted in little improvement
• Passed driving evaluation by a specialist OT at the rehab hospital each year

Last couple of years (age 65-67)

• Takes him several hours to get ready and shower
• Serious swelling of his lower legs, finally treated as lymphedema with velcro-closed wraps (which someone has to put on for him)
• Occasional bowel and bladder incontinence
• Rapid shallow breathing, but he says he feels no shortness of breath
• Still able to make his own breakfast and lunch and talk politics with friends
• Increasingly noticeable that he misreads or misunderstands things
• More focused on himself, tends to say no to doing things even with our kids
• Walks with very small steps most of the time
• Diagnosis changed to MSA because he hasn’t had a steep cognitive decline (or hallucinations) as would be typical with Lewy Body Dementia

His current medications:

• Sinemet (Carbidopa 25 mg/Levidopa 100 mg) 2 tablets 4 times a day
• Aricept (Donepezil)10 mg once a day
• Wellbutrin (Bupropion) 300 mg. once a day.
• Proscar (Finasteride) 5 mg. one once a day for benign prostate enlargement
• Flomax (Tamsulosin) .4 mg. once a day for benign prostate enlargement.
• Clonazepam .5 mg at bedtime for sleep and REM sleep disorder
• Mirtazapine ½ of mg. before bed for sleep (he used to take Clonidine but was taken off it because it lowers blood pressure
• Omeprazole 40 mg once a day for acid reflux
• Amitiza (Lubiprostone) 24 mcg once daily for constipation
• Famciclovir 500 mg once a day for herpes prevention

Supplements and OTC:

• MCT oil 1 tbsp a day and Coconut oil 1 ½ teasp a day
• Vitamin D 2000 IU once a day (plus 2000 in vitamin for a total of 4000)
• Life Extension 2 per day multivitamin
• Jarro-Dophilus EPS probiotic one a day and Ultra-Zime digestive enzyme supplement 2/day
• D-Mannose, 500 mg once a day (to prevent UTIs)
• 3 mg melatonin one a day
• Tums (Calcium carbonate) 500 mg. antacid about 12 a day as needed
• Miralax 1/2 dose once a day
• Metamucil one tblsp a day

Change in diagnosis!



We went for our regular appointment at the Movement Disorder Specialist at Medical University of South Carolina, and she changed John's diagnosis to a different kind of Atypical Parkinson's--Multiple Systems Atrophy (instead of Lewy Body Dementia).  Her main argument was that he has not had a steep cognitive decline.  I have thought he did have fluctuating cognition, one of the two essential symptoms of Lewy Body Dementia, because sometimes he can have a sophisticated conversation (about politics) and sometimes he is confused.  But that is hard to define.

I'm shaken up by the new diagnosis for two reasons. One is that it makes me feel alone--I no longer fit in several of the communities that have been helpful to me. MSA is a much rarer disease. The other is what would we have done differently if we had had the correct diagnosis earlier? I don't think John would have had two surgeries for benign prostate enlargement, which gave little benefit. I took over more things because I expected more rapid progression to dementia, though I think my doing so has made his life more pleasant.

The new diagnosis does make sense. The key symptoms are rigidity, slowness, and problems with the autonomic nervous system such as postural hypotension, urinary retention, constipation, and both kinds of incontinence.  Consider a list of red flags for MSA:

• Early instability--John has only started falling several times a month recently, but he has had balance problems from early on
• Rapid progression--not so much so, but if defined as in a wheelchair in 10 years (the Parkinson's disease definition) that is likely to fit
• Abnormal postures--he has something called disproportionate antecollis where his head is way forward
• Bulbar dysfunction--various voice issues, which he doesn't have except a little hoarseness
• Respiratory dysfunction--snoring and another noise breathing in while sleeping, but these were issues for many years.  He often falls into a shallow rapid breathing pattern, though he reports no shortness of breath
• REM Sleep Behavior Disorder--this was an early symptom
• Emotional incontinence--not an issue

I had read about Multiple Systems Atrophy but had never considered that it fit John, because some diagnostic criteria specifically exclude anyone with dementia.  Cognitive issues were a key symptom when he was first diagnosed because he was having difficulty with his job, but those have gotten worse only slowly.  I found an article that says 11-32% of patients with MSA show significant cognitive impairment.

The relationship between the diseases is odd--most of these symptoms are seen in both diseases, the difference is which are predominant.  Yet they show different kinds cell damage on autopsy.  One article states: "Although the molecular mechanisms of misfolding, aggregation, and fibrillation of α-synuclein might partly overlap among the α-synucleinopathies, disease-specific cascades that are determined by genetic and environmental factors are likely to discriminate these." That is, Lewy Body and MSA may start with the same process that is damaging the brain, but the brain can fight that damage in several different ways, which define the different diseases.

Both diseases have treatment only for symptoms, no way to modify the course of the disease.  Because of the change in diagnoses the doctor did increase John's Sinemet dose, in hopes of reducing his stiffness and balance issues.  There doesn't seem to be anything more we can do about the constipation and incontinence issues.  Life expectacy is similar for the two diseases, perhaps with fewer people with MSA living more than 10 years from diagnosis.  With MSA, the body is likely to go before the brain goes completely, which is a good thing. 

(The image is a road sign from Alaska sent to me by a friend)

Homemade Grainy Mustard

I've been very frustrated reading instructions for making mustard on the internet.  Some call for cooking it, others say never heat mustard.  Some say it gets stronger with sitting, others that it mellows.  I'm currently guessing that it gets stronger when you grind it until you add vinegar, then mellows, at least so long as it is at room temperature.  So here is my first try, rather randomly put together from various recipies I read.  My goal was a mustard with a lot of mustard flavor but not a lot of hotness.  I didn't measure anything, so amounts are approximate.

1 cup yellow mustard seeds
1/4 cup brown mustard seeds
pure cold water to cover by an inch
1 tblsp sea salt
1/4 cup cider vinegar
2 tblsp whey from yogurt or kefir

Extras:
2 teasp tumeric
2 teasp mustard powder
2 tbsp cider vinegar
1 tbsp honey
ground pepper

Soak the mustard seeds in water 12-24 hours.  If there is significant water not absorbed, strain out seeds and reserve the water.  A funky smell is ok.  Put all ingredients in a blender and puree to the texture you like.   You may need to add more water to get the blender to work, but the mustard will thicken after it is made.  Pour in jars and leave at room temperature for several days to mellow before refrigerating.  This nearly filled two pint jars.

Notes:

• I bought my mustard seeds from Penzeys.
• My food processor would not grind the seeds even after almost 24 hours of soaking--they just whirled around.
• I filled one jar with the plain mixture and then blended in added half the amount given of extras to make a second jar.
• A purist would say either use vinegar or whey, not both.  But I added whey from kefir because that seemed to me extra insurance that my mustard wouldn't go bad--I gave good bacteria a head start.
• I added vinegar at the beginning of grinding the seeds because I didn't want a hot mustard.  For a hotter mustard, grind the seeds with water and let sit 10 minutes to an hour before adding whey (or vinegar, but vinegar will reduce the hotness more).  The whey will start a process of lactofermentation that will build up an effect similar to vinegar over several days.  (Traditional pickles are fermented, not made with vinegar).
• One of the frustrating things about making mustard is that you can't really taste for seasonings--it isn't going to taste good until it has sat for at least a couple of hours.

Simple sweet potato souffle

I invented this just to use up some leftover egg whites, but it was such a success I want to record the recipe for future use.  I didn't take a photo and six of us ate it all.  It isn't a true souffle that poufs, but it has a pleasant light texture and no added sugar.

2 medium sweet potatoes, cooked and peeled
2 tblsp butter
1/4 cup heavy cream
salt
5 egg whites
pinch of cream of tartar
1/4 cup chopped pecans

Oil a souffle dish or 8x8 pan and preheat oven to 400.  Process cooked sweet potatoes, butter and cream in a food processor until very smooth (a stick blender would probably also work).  Add salt to taste.  Beat egg whites with cream of tartar until stiff.  Mix a third of beaten egg whites into the sweet potato mixture, then fold the sweet potatoes gently into the egg whites until completely combined.  Pour into pan, smooth the top, and sprinkle with pecans.  Bake at 400 for 20-40 minutes, depending on thickness.

shun hatred

I'm frustrated by the conversation I see about the Colorado shooting--it seems to me to miss the deeper point.

My preference would be strict gun control--at least as strict as the licensing and registration system for cars as well as a ban on automatic and semi-automatic weapons.  But I live in the south and gun control here is a divisive issue.  It is also a technological fix--we can't make people less violent so let's limit their access to weapons.

Could we agree instead on working towards a society where hate and violence are shunned, not glorified?  I am sure some people will immediately think that shunning haters only adds to the isolation that is part of the story of most mass murderers.  Certainly not all isolated people turn to guns.  I would argue that violent TV, movies, and comic books populate the imaginations of those who do.  I'm not a big believer in censorship, but could we please censor violence as much as we do sex?

More important, I wish these violent events would inspire us to forswear hatred. Conservatives and liberals both fall into demonizing their opponents.  It seems to me that hatred is becoming more and more socially acceptable,  and that is taking us in the wrong direction.  What if hatred and excessive violence became as socially unacceptable as racism?  That isn't perfect--racism is certainly still a problem--but even a veneer of broad-based social disapproval makes it harder to take pride in hatred.

What if we took loving our enemies more seriously?

dawn effect and fasted exercise

I have always eaten something before exercising, even 5:30 am masters swimming.  I have a cast iron stomach--the only time it ever bothers me is if I catch the stomach flu.  When I first started training for triathlons, I ate a little carbohydrate and protein before morning training, something like an orange and a couple of pieces of cheese.  Even after I went low carb, I was prone to feel out of energy and irritable if I went too long without eating (though my blood glucose was not problematically low).

I also had read that for some people with type 2 diabetes, morning high blood glucose (the dawn effect) would just go higher and higher until the person ate something to stimulate the body to produce insulin.  The liver would release glucose, but the body wouldn't be able to use it until it got that insulin.  I never tested that myself; it matched all my assumptions about eating before exercise.  And when I was training for racing, the approach I took worked well for me, as it fit into my fueling strategy for racing.

Now that I am following the primal way of eating, I have been paying attention to the arguments for not snacking and realizing that I'm not hungry.  I am less and less prone to that running out of fuel feeling.  So I decided I would do a test and see if my blood glucose went high if I exercised without eating first.  My test was swim practice-- 1 1/2 hours of swimming starting at 5:30 am.  I tested after my warmup and an hour or so in after some hard swimming.  I first tested the way I had been doing it, and then five days later I tested without eating first:

July 5
5:00  120 waking
5:25  115 before exercise, just after eating melon
6:05    93 after 1/2 hour of warmup
6:45  105 after swimming hard
7:30  125 1/2 hour after finishing workout
8:30  137 just finished slowly drinking my breakfast smoothie
9:40  119 to see if it came down

July 10
5:15  116 waking
5:50  100 after 1/2 hour warmup, no food
6:30  106 after swimming hard
7:40  120 after showering and driving home
8:20  130 after slowly drinking my breakfast smoothie

So there certainly doesn't seem to be any harm in fasting exercise for me.  I felt a little less energy, and a little strange when the food hit me afterwards.  But my body will adapt.

Making kefir

I decided to try kefir instead of yogurt because it has more different probiotics and I didn't want to keep buying starter.  Kefir is also more convenient because it cultures at room temperature, using lumps of probiotics and yeast that are called grains.  I bought a kefir kit, but I found the strainer that came in the kit has too small holes, it is too hard to get the finished kefir through the strainer.

As with yogurt, I have been making my kefir with fresh raw milk from a source that I trust, without heating the milk first.  With my raw milk from Jersey cows, the kefir sets up as firm as yogurt, and once the culture is going well a quart takes about 8 hours in this warm summer weather (my kitchen is in the high 70s or even 80).  Raw goat milk makes a much thinner kefir with whey forming on top, instead of on the bottom as with cows milk, and takes longer.  I use it in a breakfast smoothie so it doesn't matter how thick it is, but it is harder to tell when it is done.

My kefir grains seem to do fine spending most of the week in the refrigerator in some milk, though the instructions recommend keeping them at room temperature making more kefir all the time.  After I left them in the refrigerator for almost three weeks when I was away, I restarted them by rinsing them and putting them in about a cup of fresh low-temperature-pasturized milk on the counter, changing the milk every 24 hours for a couple of days before going back to my usual quart of raw milk.

If you are thinking of getting into making kefir, make sure that you have a source of milk that is organic and not ultra-pasturized.  And make sure you want to use kefir regularly; it isn't something you can make now and then when inspiration hits, the grains need to be used most weeks.

Yellow squash and sausage casserole

1-2 lb yellow squash, sliced very thin
1 lb breakfast sausage
1 onion
2 eggs
8 oz sour cream
6-8 oz grated cheddar cheese

Preheat over to 350 and grease two 8x8 or one 9x13 pans. Salt the yellow squash and put it in a collander to drain. Saute the sausage until done, breaking it up.  Remove from pan and saute the onion (my sausage was very low fat so I used olive oil) until golden.  Beat the eggs in a bowl and beat in the sour cream.  Mix in cooked sausage, cooked onions, 1/2 the cheese, and sliced raw squash.  Distribute into pan(s), press down well, and top with remaining cheese.  Bake for 30 minutes or until bubbling a little around the edges.  Run under the broiler to brown if needed.

Low Carb Fish Pie

2 lbs. flounder or other thin fish
grated rind of one lemon
juice of 1/2 lemon
1 large shallot, diced small
1 tblsp olive oil
8 oz. creme fraiche or sour cream
2 egg yolks
1 tblsp chopped fresh parsley
salt and pepper to taste
2 tblsp grated parmesan
1 medium spaghetti squash
2-4 tblsp grated cheddar

Preheat oven to 400.  Grease a pan, maybe 9x12, and lay out the raw fish in an even layer.  Sprinkle fish with half the lemon peel and all the lemon juice.  Cook the shallots in olive oil until they begin to brown.  Remove from heat and add creme fraiche and then egg yolks (and 1-2  tblsp potato starch if you want a thicker sauce).  Stir in parsley, the other half the lemon peel, salt and pepper, and parmesan.  Shred cooked spaghetti squash into a bowl and mix with the sauce.  Layer squash mixture over the fish.  Sprinkle with grated cheddar.  Cook at 400 for 30-40 minutes, or until it begins to bubble.

no sugar added chocolate cheesecake

1-2 teasp butter
2 tblsp almond or other nut flour
6 oz bittersweet chocolate (70% cocoa or more)
1 oz (1/4 of a 4 oz stick) butter
3 8 oz blocks cream cheese, room temperature
4 whole eggs
1 egg yolk
a little salt
1/4 cup heavy cream
1/2 cup cherry juice concentrate (found at many health food stores)

Preheat oven to 325.  Grease a springform pan with butter and sprinkle bottom with almond flour.  Wrap outside with aluminum foil.  Melt 1 oz. butter with chocolate over very low heat.  Set aside to cool a little.  Beat cream cheese and add eggs and yolk and salt.  Beat in one at a time heavy cream, cherry juice concentrate, and melted chocolate mixture.  If you prefer a somewhat lighter cheesecake beat an extra minute or two.  Pour into prepared springform pan and place in a larger pan.  Pour hot tap water (not boiling water) into the larger pan about 1/3 to 1/2 way up the side of the springform pan.  Bake at 325 for about an hour, or until mostly puffed or beginning to pull away from the sides of the pan. Cool in over with door ajar for 30 minutes or so. Cool fully before serving but it is softer and creamier if you make it the afternoon you are going to serve it and don't refrigerate it before serving.  Remove sides of the pan and serve from the pan bottom.

Duck with Rhubarb in the Persian Style

4 duck legs
1 onion
1 large shallot
1 tsp coriander
1 tsp cumin
½ tsp cinnamon
1 tblsp grated fresh ginger
¼ tsp nutmeg
1 1/2 cup chicken stock
1/2 cup port or apple cider
1 Tbsp tomato paste
3 large stalks rhubarb – cut into 1 inch pieces with stringy bits removed if the skins are very thick
1/2 cup golden raisins
salt and pepper as needed
1 Tblsp potato starch mixed with a little cold water
¼ cup minced mint and parsley

In a deep saucepan or dutch oven brown the duck legs then remove from the pan. Cook the onion and shallots in the rendered duck fat.  Add the coriander and cumin and saute a little longer.  Add cinnamon, ginger and nutmeg, stock, port, tomato paste and the duck legs.  Bring to a boil on top of stove. Cover with a tight fitting lid and place in a 300 degree oven and cook for 1/2 hour. Add the rhubarb and raisins and cook for an hour more, or until meat is very tender.  Strain out the solids and boil the sauce until reduced by half.  Remove some of the fat with a fat separator or skim it, then taste the sauce and add salt and pepper if needed.  Return the solids to the pan and add the potato starch slurry.  Remove from the heat and stir in the mint/parsley mixture. Serve over pureed celery root. 

Credit for the recipe we worked from: http://getting-stitched-on-the-farm.blogspot.com/2011/05/mahboubeh-persian-tulips-and-lamb-and.html

Fluoride in drinking water

I am trying not to become a health nut, but the more you know the more there is to avoid.  I am a believer in the benefits of fluoridation of water for teeth, but now that I am taking Iodine I do think it would help to limit my exposure to fluoride to help the iodine get to where it is needed (fluorine is chemically similar enough to block the receptors).  So I wondered about getting spring water.  I just did some research, and Poland Springs water has about .1 mg/liter fluoride.  My local city water shows .53 mg/liter in the latest test results.  I found a 2011 news story saying the government is lowering recommended fluoride levels to .7 mg/liter.  So not a high priority--my city water is on the low side.  I do use a filter pitcher because I dislike the clorine taste, but filter pitchers do not remove fluoride.

25 years later

Yesterday was our 25th wedding anniversary (which I forgot until today), and as I thought about that time I was curious to see how much I had changed.  So I scanned a wedding photo and found one from a recent photo shoot with a very similar smile, though a slightly different angle.  I used photoshop to adjust sizes, brightness, and contrast and blurr the more recent one to make them more similar.

I'm not sure what I conclude.  In some ways I am amazed by how little I have changed.  In other ways I think I look frighteningly young in the wedding photo (particularly considering that I was 31).  How much do people usually change?

the doubting Thomas story

Susie's sermon today at Peace Congregational Church was about the story that is called Doubting Thomas, because she only got half way through the reading when she preached on it the week after Easter.  What she had to say grew partly out of a story I had told her, and it moved me very deeply.

She started by saying that Doubting Thomas should really be called Brave Thomas, and with a quote from Kahlil Gilbran: "Doubt is a pain too lonely to know that faith is his twin brother."  She pointed out that Thomas was very brave not to run away or make excuses when Jesus appeared again and invited him to touch Jesus's wounds. 

Then she moved from the story to how she imagined the scene.  She imagined that Jesus reached out and took Thomas's hand, and placed it on his wounds, first each hand and then in his side.   And then Jesus lifted Thomas's chin to see his eyes and invited him to believe.

The story I had told her was about a therapist who literally touched my wound when I asked for that.  I had forgotten the detail that I reached out and placed his hand on my arm. 

raw milk yogurt

I buy from a pre-order farm market, Clemson Area Food Exchange.  For a while I bought goat milk yogurt there, but learning about a primal diet I kept reading about the advantages of raw milk (and the goat milk yogurt is pasturized).  CAFE offers raw milk from Jersey cows, which some people think has a healthier kind of protein than the more common milk from Holsteins.  I felt a bit intimidated by the raw milk both because there is so much written about the risks and because I remember not liking it as a child, so I decided to make yogurt to use in my smoothies.

After some research, I decided that I wanted to keep the advantages of the raw milk and not heat the milk to 180 degrees, as most recipes call for.  I'm currently using purchased yogurt starter.  If you use raw milk you shouldn't just start your yogurt from the last batch, as other bacteria can increase.  I didn't want to go to the trouble of making separate batches in pasturized milk to use as starter, and the purchased starter has the advantage of a wider range of live cultures than even good supermarket yogurt. 

So here's the system I have worked out.  To my surprise, it makes a nice firm yogurt even though it is low fat and from raw milk, both of which tend to make yogurt set less well.  I thought about buying a yogurt maker but I keep reading reviews that they run too hot or too cold so I decided that the cooler method would work as well.

Raw milk yogurt

Sterilize glass canning jars in boiling water (I make two quarts).  I pour off most of the cream from my half gallon of raw milk to use for other purposes.  Fill your jars (leaving at least an inch headspace) with milk and place in the pan of warm water left over from sterilizing the jars.  Let sit, stirring occasionally, until it reaches 115 degrees.  Stir in yogurt starter.  Cover loosely (I use the plastic storage lids sold for canning jars). I wrap the jars in a towel inside a cooler with a hot water bottle of hot tap water and a couple of insulated travel mugs of boiling water and let it sit on the counter for 8 to 10 hours.  Refrigerate. 

going primal and boosting my thyroid

I'm now about three month into following a primal way of eating, learning mostly from Marks Daily Apple.  I was already eating low carb, so the big change is that I have given up all grains, legumes and sugar (things I previously at in small amounts) and am trying to avoid all vegetable oils except olive and coconut oils.

My thyroid is fine according to my doctor, but my TSH has been creeping up and two of my sisters are on thyroid replacement.  I realized I was cold all the time and decided to  try supplements to help my thyroid.  For many years I took no vitamins or minerals at all, figuring I ate a very healthy diet.  I'm not entirely comfortable with the "you need these vitamins to clear the toxins from your body" line of argument, but I did see a difference from supplementing vitamin D on days when I wasn't in the sun, so I will try the whole package.

It made sense to me that I might be deficient in iodine because for years I almost never added salt to my food and I eat a lot of seafood only a few weeks a year.  So I am supplementing with iodine and the necessary companion supplements.  I currently take:

• 2 drops Lugols 2% (increasing my iodine very slowly)
• 2 Brazil nuts for selenium
• 1000 mg. vitamin C in ascorbate form
• 200 mg. Magnesium in Bis-Glycinate form
• 100 mg. Riboflavin
• 500 mg. Niacin (as inositol hexanicotinate)
• 5000 IU vitamin D3
• Ashwagandha (reduces the effect of stress on my blood glucose)
• 1/2 teasp celtic or himalayan natural salt

and am adding

• 1100 mcg. vitamin K2
• milk thistle

I'm particularly curious whether my LDL cholesterol will go down--apparently high cholesterol can result from low thyroid.  Last year I tried garlic and oat bran, and neither helped.  My HDL and Triglycerides are excellent so I don't take any medication.  But my LDL did go up when I briefly took Zoloft, which is known to reduce one of the thyroid hormones.

It was late last fall before I got to a dose of Metformin that I thought did anything for me, and my weight gain stopped at that point.  So I can't say one thing made the difference, but I am down two and a half pants sizes since the beginning of December, without limiting how much I eat.
I am beginning to realize that I do have more energy and feel better.  And it is lovely not to be hungry.

It is so nice to have those visible results because by conventional wisdom it is a strange way of eating.  My usual day goes something like this:

• Breakfast: smoothie with one cup yogurt made from raw milk, 1 tblsp MCT oil, 2 local eggs (raw yolks, whites cooked in coconut oil), 1 banana, 1 kale leaf, and ice cubes
• Lunch: salad with meat and cheese on it or leftovers
• Dinner: meat and vegetables
• Bedtime snack: currently local strawberries with cream or custard

restaurants and chocolate mousse

I have eaten low carb for about 7 years.  Cheesecake or chocolate mousse was usually a safe dessert to order.  But now I am eating Primal, no grains or sugar.  I haven't reduced my carbs much more; I am eating more fruit.  We took Aunt Florence out for her birthday tonight, and I suggested John and I share a chocolate mousse.  It was very sweet, and with a thin cake layer at the bottom, so I decided after a few bites that it wasn't worth eating.  So I came home and made myself something I would enjoy more.  I didn't have any eggs to spare, so I invented my own take on chocolate pannacotta.  I melted 1/4 of an 85% chocolate bar in a little butter, sprinkled a little unflavored gelatin over it, and set it aside to cool.  I put maybe 3/4 of a cup of heavy cream in the blender and blended it until whipped, then added the chocolate mixture and blended some more.  By this point it was too firm to blend well, but I just scraped it out of the blender and mixed it together.  It was a bit austere so I added maybe a tablespoon of tart cherry juice concentrate, which was perfect.  Delicious!  And I put half of it in the refrigerator for tomorrow.

Spaghetti Squash and Chard Gratin

1 large cooked spaghetti squash
1 bunch swiss chard
grated rind of 1 lemon
salt, pepper, seasonings to taste
1 cup sour cream
sliced or grated cheese (I used swiss)

Cut the chard into small pieces and shred the spaghetti squash.  Mix squash, chard, lemon rind, seasonings, and sour cream. Top with cheese and bake at 400 for 25 minutes.

Many variations are obviously possible, but I'm recording the recipe because it had never occurred to me to make a gratin with spaghetti squash, much less to add chard.

No Added Sugar Banana Cheesecake

2 packages (8 oz) regular cream cheese at room temperature
3/4 cup sour cream
3 large or extra large eggs
3 ripe bananas
juice of 1 small lemon
1 teasp vanilla
1 tblsp rum

Butter springform pan (and sprinkle with some almond flour if you have it) and preheat oven to 315 F.  Beat cream cheese at low speed until smooth then add sour cream and beat until smooth.  Add eggs one at a time and beat until smooth.  Mash bananas with lemon juice and add to cheese mixture.  Add vanilla and rum and beat until smooth (beat more for a lighter cheesecake, less for a denser one).  Pour into pan.  I put my pan inside a larger springform pan to moderate the heat a little without bothering with a boiling water bath.  Bake for 1 hour or until no longer jiggly in the middle.  If you cool it and then refrigerate it a few hours it will cut more neatly than if you can't resist cutting a piece while it is still warm.

I like this the way it is, but if you like desserts sweeter you can add the sweetener of your choice.

Resentment

John has slipped significantly, and I realize I have been repressing my reactions.  For me, a lot of frustration and resentment comes up before I ever get to grief.  And I worry that if I complain now I will look back when things get worse and wish I had appreciated how things are now.

For the last six months or so he has been having occasional bowel incontinence, maybe once a week at totally unpredictable times.  He wears disposable underwear when he is particularly worried about it, but he doesn't like to wear them when he is fully dressed with jeans and belt because then he has to undo his belt to urinate instead of just opening his fly.  He did agree to wear boxer briefs (once I cut one layer of the fly for easier access) so the mess would be more contained.  Occasionally the problem is very minor and he doesn't need my help, but often he needs help with his clothes and with cleaning himself.

He finally got the help he needed for his swelled legs, and before he got any really problematic infections.  And the therapist understood that he wouldn't be able to put on compression socks and recommended velcro-closed wraps.  But that means he depends on me to be home to rewrap his legs after he showers.  For the first time I am grateful he only showers twice a week.  Today he said he would be ready for me to wrap his legs at 1 pm.  Instead it was 3:15.

He can still talk to someone and appear just fine.  But I asked him if he wanted to cancel an appointment Monday afternoon--he has an appointment in Charleston Tuesday morning so I will drive us down sometime Monday afternoon/evening.  He said yes and commented that he can't look ahead that way and see the relationship of things.  He is barely hanging in there with a Google calendar to be able to keep track of his schedule at all.  He went to the doctor alone for a urinary tract infection and wanted to get a new prescription for another medication he takes occasionally.  I reminded him to take the bottle so that he could get the same thing but he forgot.  When I picked up the prescription at the pharmacy it wasn't what he wanted (too few days).  He said he would call and straighten it out but when I asked him about it several days later he said he hadn't had time.

He doesn't like to ask me for help, so I get indirect questions when he is hoping I will do something, which just makes me feel that he is expecting me to do whatever extra it is.  Yesterday he asked about recipes to use a lot of frozen blueberries that were accidentally left out.

He drools and his nose drips a good bit.  He tries to carry a napkin, but then he leaves those around the kitchen.  Sigh.

Borscht Stew

Borscht Stew

2 lbs beef chuck
oil of your choice for browning
1 large onion, chopped
1 clove garlic, minced
1 teasp smoked paprika
1 cup water or beef stock or enough to mostly cover the meat
2 bay leaves
1 can tomatoes (optional)
1/4 cup sherry vinegar
3 medium-large beets, cooked, peeled, and chopped
10 baby carrots, cut in half
1/4 green or red cabbage, chopped finely
4 leaves swiss chard, cut up
1 teasp ground cumin
1/2 teasp mace
Greek yogurt as garnish

Brown meat in oil and set aside.  I browned my meat whole then cut it into small pieces when it had cooled, which meant more juice to supplement the stock.  Cook onions in oil until softened and browned.  Add garlic, smoked paprika, stock, bay leaves, the reserved meat, and tomatoes with their juice if you are using them.  Press down the meat in the pan and make sure you have enough liquid to nearly cover it.  Cook, covered, barely simmering for 1 1/2 to 2 hours--until meat is tender.  Add cut up cooked beets, carrots, cabbage, cumin, and mace, and cook, covered, stirring occasionally, until vegetables are tender.  Add chard,  and cook briefly until the chard is wilted.  Serve with a dollop of greek yogurt.

John thought this was missing something, but he doesn't like things with any strong flavor so I was very cautious with the spices.

Nut cookies

This is a primal recipe--no grains, relatively low carb.  I started from this recipe for chocolate chip cookies--http://www.marksdailyapple.com/primal-holiday-desserts/#ixzz1lNNNbckJ--but I didn't bother with the chocolate chips and didn't miss them.

8 pitted prunes
1 1/2 cup walnuts
1/2 cup pecans
1 tsp baking soda
1/8 teaspoon salt
2 tablespoons coconut oil
1 egg
1/4 cup sunflower seeds

Preheat oven to 350 degrees Fahrenheit.
Grind prunes, walnuts and pecans in a food processor until very finely chopped. Add baking soda and salt and pulse a few more times.

Melt the coconut oil. With the food processor running, drizzle it into the batter with the egg and vanilla. Add sunflower seeds and process until somewhat chopped.  Stir in chocolate chips or raisins if desired.

The dough will form a wet ball.  Make small balls and flatten on a cookie sheet lined with parchment paper.  Bake 15 minutes, or until nicely browned.

year end garden reflections

I turned my garden last week and got sugar snap peas planted yesterday.  I left kale plants I put in during the fall.  I was daunted about eating the kale for a long time, as my husband doesn't like greens, but I've been putting a leaf into my morning smoothie for natural vitamins.  The whispy little plants are fennel plants from the farmers exchange.

 I also have swiss chard that I planted last spring, which has come back nicely this winter after nearly disappearing in the heat of summer.

I pulled out the last few parsnips that I planted last spring.  We ate some in late summer and some were woody, but the ones I roasted tonight were tasty.  I planted them early spring and they developed very slowly.  I won't plant them as a spring crop again, but I might try them as a fall crop

So what were the successes of the garden?  I had good lettuce last early spring but I didn't succeed in getting it started this fall.  The sugar snap peas last spring were wonderful and more than we could eat.  I bought a few brocolli plants which did well, but one plant doesn't yield very much broccoli.

For the second year in a row, Japanese eggplant (bought as plants at Lowes) yielded reliably all summer.  I got some cucumbers from the couple of plants I bought, though not as many as last year.  I planted fewer tomato plants and they did better, but I still am caught on the dilemma of wanting to let them get really ripe on the vine but instead they start to go bad.

So this year I want to plant beans again, and I will stick with eggplant, cucumber, and tomatoes as summer crops.  I planted broccoli rape, pak choy, and lettuce as early spring crops.  I did plant some broccoli rape last year, but it kept flowering before I could harvest it.  I should probably try it as a fall crop.  

Reduced Carb Lemon Mousse Cake

Cake: (based loosely on Foolproof Sponge Cake in The New Best Recipe)

3/4 cup whole wheat flour (I used King Arthur's white whole wheat)
1 teasp baking powder
1/4 teasp salt
3 tblsp butter
7 eggs
1/2 cup sugar
1/2 cup almond meal or almond flour
grated peel of one lemon

Preheat oven to 350 and thoroughly butter or spray a bundt pan.  Sift together flour, wheat gluten, baking powder and salt.  Melt the butter and set aside to cool.  Separate 3 eggs.  Beat the 3 egg whites, adding 1/4 cup sugar when they are frothy, until they form soft peaks.  Beat the egg yolks and remaining eggs in a separate bowl until light-colored and thick.  Beat in the almond meal and grated lemon peel.  Fold in the beaten egg whites.  Sift the dry ingredients over the egg mixture and fold in gently.  Pour the melted butter along the side of the bowl and fold in gently.  Immediately pour the batter into the prepared bundt pan.  Cook for 45 minutes or until the top springs back when touched.  Cooking time would be more like 25 minutes if you bake it in two layer pans.  Cool in the pan at least 10 minutes, then invert onto a rack and cool completely.

Lemon curd: from The New Best Recipe
2 eggs and 1 egg yolk
1/4 cup sugar
1/3 cup lemon juice
2 tblsp butter, cold or room temperature
2 tblsp heavy cream
a pinch of salt

Whisk the eggs until uniform in a non-reactive pan, then whisk in the sugar.  Heat the lemon juice until hot but not boiling (I do this in the microwave in the glass measuring cup) and pour slowly into the eggs, whisking all the time.  Put the pan on medium low heat and cook, stirring constantly with a wooden spoon, until it thickens.  Stir in the butter quickly to stop the cooking, then stir in the cream and salt.  Cool to room temperature.

Lemon Mousse:
1/2 teasp unflavored gelatin
1 recipe (above) of lemon curd
1 cup heavy cream, cold

Put the gelatin in a small bowl with 1 tblsp cold water.  Wait a few minutes until it no longer looks white.  Put the bowl into a pan of hot water and warm until the gelatin dissolves completely.  Set aside to cool.  Whip the cream.  Stir the gelatin into the room temperature lemon curd.  Fold the lemon curd into the whipped cream.  Chill for at least a couple of hours before assembling the cake, overnight would probably be better.

Assembly:
If you made the cake in a bundt pan, slice the cake horizontally into the number of layers you want.  If you want a surprise filling, cut it into two layers and partially hollow out the cut sides of the two layers with a grapefruit knife to make a channel for the filling.  Fill with the lemon mousse.  I use a bundt pan because I think it is attractive enough with no icing, but you could dust the finished cake with powdered sugar or add a lemon glaze.  I spread filling over the top because I had so much left over.  If you make the cake in layer pans, you can slice each layer in half horizontally, spread lemon curd between each layer to make a four layer cake, and then frost with the frosting of your choice.

Adjustments:
If you aren't interested in reducing carbohydrates you can double the amounts of sugar, leave out the almond meal, and use 1 1/4 cups of white flour instead of the whole wheat flour, wheat gluten, and almond meal.